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ID PMID Title PublicationDate abstract
10606358 Mortality in rheumatoid arthritis: have we made an impact in 4 decades? 1999 Dec OBJECTIVE: To evaluate trends in survival among patients with rheumatoid arthritis (RA) over the past 4 decades. METHODS: Three population based prevalence cohorts of all Rochester, Minnesota, residents age > or =35 years with RA (1987 American College of Rheumatology criteria) on January 1, 1965, January 1, 1975, and January 1, 1985; and an incidence cohort of all new cases of RA occurring in the same population between January 1, 1955 and January 1, 1985, were followed longitudinally through their entire medical records (including all inpatient and outpatient care by any provider) until death or migration from the county. Mortality was described using the Kaplan-Meier method and the influence of age, sex, rheumatoid factor (RF) positivity, and comorbidity (using the Charlson Comorbidity Index) on mortality was analyzed using Cox proportional hazards models. RESULTS: Mortality was statistically significantly worse than expected for each of the cohorts (overall p<0.0001). A trend toward increased mortality in the 1975 and 1985 prevalence cohorts compared to the 1965 prevalence cohort was present, even after adjusting for significant predictors of mortality (age, RF positivity, and comorbidity). Survival for the general population of Rochester residents of similar age and sex improved in 1975 compared to 1965, and in 1985 compared to 1975. CONCLUSION: The excess mortality associated with RA has not changed in 4 decades. Moreover, people with RA have not enjoyed the same improvements in survival experienced by their non-RA peers. More attention should be paid to mortality as an outcome measure in RA.
10343534 Mortality in rheumatoid arthritis patients with disease onset in the 1980s. 1999 Jan OBJECTIVE: Several previous studies have shown increased mortality in rheumatoid arthritis (RA) patients. This study investigated if this was true also for patients with disease onset in the 1980s. PATIENTS AND METHODS: The study group comprised 183 patients (67 men and 116 women) with definite RA participating in an ongoing prospective study. Mean age at onset of disease was 51 years, and mean duration of joint symptoms at inclusion was 11 months. The patients were included between 1985-89. Seventy five per cent of the patients were rheumatoid factor (RF) positive, 85% carried the shared epitope, and 90% became erosive. By 1 September 1997 the number and causes of death, obtained from the death certificates, were recorded. Standardised mortality ratio (SMR) was calculated, comparing the observed number of deaths in the cohort with the expected number of deaths in the general population in the same area, age and sex matched. The predictive values of demographics, genotype, RF status, and clinical data at baseline were estimated using the Cox proportional hazards regression model. RESULTS: Eighteen patients (11 men and 7 women) had died compared with 20 expected deaths. SMR with 95% confidence intervals was 87 (53, 136). There was no significant increase in the number of deaths at any time during follow up for either sex. RA was not the main cause of death in any of the cases. By reading the patient charts two cases were found where RA or its treatment could have contributed to death. No RA related variable contributed significantly to an increased risk of death. CONCLUSION: There was no increased mortality during the first 8-13 years of disease in this group of patients who developed RA in the 1980s.
11155797 Bone mineral density and biochemical markers of bone metabolism in late onset rheumatoid a 2000 In the present prospective study, bone metabolism was examined in 51 patients at the time of diagnosis and 6-7 months later: 29 patients had definitive diagnosis of late onset rheumatoid arthritis (LORA) and 22 patients had polymyalgia rheumatica (PMR). At the time of diagnosis, the patients had not received any medication; during the 6-7 months of follow-up they were treated with corticosteroids and nonsteroidal-antirheumatic drugs (NSAIDs). Serum levels of osteocalcin, alkaline phosphatase and ostase, as markers for bone formation, were tested. Bone density was examined by dual x-ray absorption (DEXA) of the lumbar spine and the left ward triangle. At the time of diagnosis, no signs of bone alterations were seen. After 6-7 months, abnormal values of the serum parameters and bone mineral density were found in 16/51 patients (31%): 10/29 patients with LORA and 6/22 with PMR. Thus, our findings suggest that an alteration of bone metabolism could be observed in a minority of patients during the first few months of glucocorticoid medication, but in the majority of patients an osteoprotective effect seems to be worth discussing. The results suggest from a prophylactic and therapeutic point of view that an additional disease-modifying antirheumatic medication should be considered in the early stages of therapy to reduce the osteoporotic risk of a longterm corticoid therapy.
10357114 N-acetyl-beta-D-glucosaminidase urinary excretion as an early indicator of kidney damage i 1999 The purpose of the study was to determine the effect of initiation of gold therapy on glomerular and tubular integrity. Urine albumin was used as a marker of glomerular damage. N-acetyl-beta-D-glucosaminidase (NAG) urinary excretion served as an indicator of proximal tubular damage. This study was an adjunct to a clinical trial that investigated the safety and the efficacy of Depo-Medrone during the induction phase of gold therapy. The NAG activities and albumin levels in the urine of 36 patients with active rheumatoid arthritis treated with sodium aurothiomalate weekly up to a total of 1 g were investigated. NAG was assayed in 565 early morning urine samples of these patients at weekly intervals for 24 weeks. The mean NAG level rose from 50.2 nmol/mg of creatinine on entry to peak NAG excretion of 120.4 nmol/mg of creatinine at week 4 and then fell to 56.3 nmol/mg of creatinine at week 24. Urinary albumin was assayed in 252 early morning urine samples at monthly intervals during gold treatment. Values greater than 20 mg/l were observed in 7.5% of urine samples. Microalbuminuria was present in 9% of patients at baseline. Two patients who were withdrawn because of proteinuria and macroalbuminuria had normoalbuminuria on entry. We conclude that raised levels of NAG associated with tubular damage are more frequent than glomerular damage on entry to, and during, treatment with gold salts.
9692845 Quantitation of the oligosaccharides of human serum IgG from patients with rheumatoid arth 1998 Apr 15 Several different chromatographic methods and a lectin-based assay have been compared for the quantitation of oligosaccharides released from immunoglobulin G (IgG). The analysis of a series of IgG samples purified from the serum of rheumatoid arthritis patients was carried out by these methods to evaluate the percentage of the glycoforms having 0, 1 or 2 galactose residues (G0, G1 and G2) in order to (a) identify the method that can be most widely used for quantitation, (b) accurately define the range of G0 values found in patients with rheumatoid arthritis, and (c) make available a series of characterised standards for distribution to clinical chemistry laboratories. The chromatographic methods involved: release of oligosaccharides by glycoamidase A after protease digestion followed by HPLC analysis of aminopyridine derivatives on reverse phase and normal phase columns; hydrazinolysis treatment with exoglycosidases (G0 mix) and Biogel P4 chromatography of 2-aminobenzamide (2-AB) derivatives; hydrazinolysis and weak anion exchange or normal phase HPLC of 2-AB derivatives; release of oligosaccharides by PNGase F and either Biogel P4 chromatography of 2-AB derivatives or HPAEC-PAD analysis of native oligosaccharides. The G0 values given by these methods compared favourably with each other and a dot blot assay of denatured IgG interaction with Ricinus communis agglutinin and Bandeiraea simplicifolialectin II. The HPLC and HPAEC methods give additional information that may be important in less routine assays.
10478225 Follicular bronchiolitis: thin-section CT and histologic findings. 1999 Sep PURPOSE: To evaluate the thin-section computed tomographic (CT) findings of follicular bronchiolitis and compare them with the histologic findings. MATERIALS AND METHODS: Thin-section CT scans obtained in 12 patients (age range, 24-77 years; mean age, 47 years) with follicular bronchiolitis proved at open lung biopsy were reviewed by two observers. Underlying conditions included rheumatoid arthritis (n = 8), mixed collagen vascular disorders (n = 2), autoimmune disorder (n = 1), and acquired immunodeficiency syndrome (n = 1). All patients had thin-section CT scans (1.0-1.5-mm collimation, 11 patients; 3.0-mm collimation, one patient; high-spatial-frequency reconstruction algorithm) obtained at 10-mm intervals through the chest. RESULTS: The main CT findings included bilateral centrilobular (n = 12) and peribronchial (n = 5) nodules. All 12 patients had nodules smaller than 3 mm in diameter; six patients also had nodules 3-12 mm in diameter. Areas of ground-glass opacity were present in nine (75%) patients. Histologically, all patients had lymphoid hyperplasia along the bronchioles; eight had peribronchiolar lymphocytic infiltration. CONCLUSION: The cardinal CT feature of follicular bronchiolitis consists of small centrilobular nodules variably associated with peribronchial nodules and areas of ground-glass opacity.
10528792 Genetics of rheumatoid arthritis (RA): two separate regions in the major histocompatibilit 1999 Sep 1 We analyzed HLA-DR antigens and microsatellite Bat2 alleles in 97 adult caucasian patients with classical seropositive rheumatoid arthritis (RA) and 95 normal healthy controls. The results demonstrate that the prevalence of microsatellite Bat2 138 allele was significantly higher in RA-susceptibility DRB1 QKRAA/QRRAA epitope-negative patients as compared with normal controls. Analysis of the data suggested that Bat2 138 allele has primary association with RA-susceptibility in QKRAA/QRRAA epitope-negative patients. The Bat2 138 allele thus provides an additional risk in RA-susceptibility. In addition, microsatellite Bat2 138 allele showed a highly significant positive association with microsatellite D6S273 138 allele, which has similar (identical) association with RA development in DRB1 QKRAA/QRRAA epitope-negative patients. The present data demonstrate that DRB1 QKRAA/QRRAA epitope and microsatellite Bat2 138/D6S273 138 alleles more completely define the risk for development of RA. The results in the present study therefore suggest that two regions in MHC, class II (DRB1) and class III (Bat2 and D6S273 in HSP70-Bat2 region), contribute to susceptibility to RA.
9852752 [A case with rheumatoid arthritis complicated with ANCA-associated vasculitis]. 1998 Oct A 50-year-old woman with rheumatoid arthritis (RA) developed constitutive symptoms such as fever and weight loss, mononeuritis multiplex and rapidly progressive glomerulonephritis (RPGN). The renal biopsy revealed crescentic glomerulonephritis (CrGN) with few immune deposits such as IgG and C 3 and necrotizing vasculitis, which led to the pathological diagnosis of microscopic polyangiitis (MPA). Moreover the high serum level of anti-myeloperoxidase (MPO) antibody, one of the anti-neutrophil cytoplasmic antibody (ANCA), suggested that she had ANCA-associated vasculitis. The renal prognosis of the ANCA-associated vasculitis is said to be poor unless patients were treated in the early phase of the disease. As we started to treat the patient when her serum creatinine level (sCr) was 1.7 mg/dl and creatinine clearance (CCr) was 27 ml/min, her renal function returned to the almost normal level (sCr = 0.6, CCr = 91). It is well known that patients with RA may develop various kinds of extraarticular manifestations which are usually related to immune-complex mediated vasculitis, what we call malignant RA. We emphasize that ANCA-associated vasculitis is another important complication of RA. When we see a RA patient with constitutional symptom, abnormal urinary sediments and other clinical signs of vasculitis such as mononeuritis multiplex, ANCA-associated vasculitis should be considered. Since the early diagnosis and treatment of ANCA-associated vasculitis is a key to prevent renal failure, it is encouraged to measure the serum ANCA titer for not only the diagnosis of such patients but the evaluation of their clinical course.
9272301 Antibodies to streptococcal cell wall in psoriatic arthritis and cutaneous psoriasis. 1997 Jul OBJECTIVE: To evaluate the possible role of streptococcal cell wall antigens in the development of psoriatic arthritis. METHODS: IgM, IgA and IgG class serum antibodies against peptidoglycan-polysaccharide (PG-PS) and peptidoglycan (PG), both from group A streptococcus, were measured in patients with psoriatic arthritis (PA), non-arthritic psoriasis (NAP), rheumatoid arthritis (RA) and in healthy controls, using ELISA. RESULTS: Both groups of psoriatic patients had elevated IgA levels specific to streptococcal PG-PS. No association with the severity of the skin disease or with the different subsets of PA was detected. Higher concentrations of IgG against the two streptococcal preparations was observed in PA than in RA. Analysis of antibody levels in patients with recent onset arthritis showed lower concentrations of IgM antibodies against streptococcal as well as control antigens in early than in late PA, whereas an overall increase of specific IgA and IgG antibodies was observed in early RA. CONCLUSION: The results suggest chronic mucosal stimulation of lymphocytes by long-lived streptococcal antigens in patients with psoriasis, without any difference observed between PA and NAP. The differences between recent onset versus established PA and RA could reflect a distinct immunopathology in the two arthritides.
11225469 [Body complaints and neuroticism in pediatric patients with rheumatism]. 2001 Jan BACKGROUND: Pain and aches are part of subjective experience. Caring for chronically ill children and adolescents not only objective results but also the children s subjective perception of their illness should be taken into consideration. We have tried to record the extent of subjective suffering of a group of pediatric rheumatic patients and to correlate our findings with personality traits. PATIENTS AND METHOD: We interviewed thirty-one 8 to 18 years old children and adolescents (average age 12 years) by means of a standardized questionnaire (Giessener Beschwerdefragebogen) and of a standardized personality questionnaire (HANES,KJ). The tested group comprised of 9 boys and 22 girls. 14 patients suffered from a chronic oligoarthritis, 9 from a chronic polyarthritis, 8 from a other rheumatic disease. Percentiles of more than 89 percent have been considered significant compared to norm collectives. RESULTS: 28% of the patients showed augmented values on the scales "exhaustion" and "intestinal pain", 25% on the scale "pain in joints". Only 3 respectively 2 patients showed augmented values on the scales "heart" and "symptoms of cold". 28% showed augmented values on the overall scale "feeling of discomfort". 35% showed augmented values on neuroticism, 61% values > 89. percentile on the scale "extraversion". There is a significant connection between augmented strong feelings of discomfort and augmented values of neuroticism on the level 0.1%. A context to the duration of the illness was not found. CONCLUSION: Experience of physical pains is not only limited to isolated symptoms of the basic illness but also associated with general features of personality.
10524689 Treatment with monoclonal anti-tumor necrosis factor alpha antibody results in an accumula 1999 Oct OBJECTIVE: In rheumatoid arthritis (RA), treatment with tumor necrosis factor alpha (TNFalpha) binding agents has proven to be highly effective. Downregulation of the proinflammatory cytokine cascade and a reduced migration of leukocytes into the joints have been proposed as modes of action of TNFalpha blockade. We investigated whether alterations in the number of circulating pro- and antiinflammatory T cell subsets contribute to the therapeutic effect of monoclonal antibodies (mAb) against TNFalpha in RA patients. METHODS: Phenotypic analysis of peripheral blood T cell subsets was performed on blood from RA patients before and after treatment with an anti-TNFalpha mAb. RESULTS: An accumulation of primed CD45RA- T cells of both the CD4+ and the CD8+ T cell population was seen shortly after treatment. Most notably, within the CD4+,CD45RA- T cell subset, the number of interferon-gamma-producing T cells was significantly increased after anti-TNFalpha mAb treatment, resulting in a significant rise in the Th1:Th2 ratio. In addition, an increase in the number of CD4+ T cells expressing the homing receptor CD49d in high density was observed after treatment, which correlated positively with the increase in the Th1:Th2 ratio. Conclusion. We show that the Th1:Th2 ratio in the peripheral blood is raised by anti-TNFalpha mAb treatment.
10708808 Methotrexate suppresses the interleukin-6 induced generation of reactive oxygen species in 2000 Apr Various cytokines and reactive oxygen species (ROS) play a fundamental role in the inflammatory and immunologic processes of rheumatoid arthritis (RA). Methotrexate (MTX) is one of the disease-modifying anti-rheumatic drugs and its effect may be partly due to the modulation of immunologic or inflammatory reactions by some cytokines. In the present study, we investigated the effects of MTX on the gene expression and synthesis of interleukin-6 (IL-6), and the proliferative activity and the production of ROS in the fibroblast-like synoviocytes (FLSs) obtained from the patient of RA. The expression or production of IL-6 was induced spontaneously, and augmented by the addition of recombinant human IL-6 or recombinant human IL-1 beta and TNF-alpha in FLSs. These spontaneous and augmented IL-6 expressions or productions were suppressed by treatment with low-concentration of MTX (1 microg/ml). Also, IL-6 stimulated the proliferation of FLSs, and this IL-6 driven proliferation was inhibited with the treatment of MTX or N-acetylcysteine (NAC, 1 mM). Furthermore, ROS production in FLSs was increased significantly by IL-6, and its effect was also abrogated in the presence of MTX or NAC. These results suggest that inflammatory reaction in the synovium of RA patients could be augmented by the autocrine or other cytokine-induced production of IL-6 with subsequent generation of ROS in the synoviocytes, and the modulations of IL-6 synthesis and ROS production may contribute to the therapeutic effects of MTX for RA.
9002026 Predicting length of stay after hip or knee replacement for rheumatoid arthritis. 1997 Jan OBJECTIVE: To identify predictors of the postoperative length of stay (LOS) after hip or knee replacement for rheumatoid arthritis (RA). METHODS: Demographic and clinical characteristics, medications, and postoperative course were abstracted from medical records of patients with RA who underwent total arthroplasties of the knee (TKA) or hip (THA) at our institution between 1987 and 1991. The relationship between these variables and the postoperative LOS was examined using life tables, linear regression, and multiple regression analyses. RESULTS: During the 5 years of the study, 137 patients with RA underwent 119 TKA and 105 THA. The average LOS was 16.9 +/- 8.7 days after THA and 19.5 +/- 11.4 days after TKA (p = 0.08). Significantly longer LOS was associated with age > or = 55 years, female sex, non-white ethnicity, poor functional status, known positive rheumatoid factor, use of bone cement, and operating room (OR) time longer than 6 hours. In a multivariate regression model, a preoperative Steinbrocker functional class 3 or 4 was associated with an increase in LOS of 3.98 days (95% confidence interval 0.78, 7.18) and 7.14 days (2.59, 11.69), respectively, while a known positive rheumatoid factor predicted an increase in LOS of 2.76 days (0.17, 5.35). Among operative factors, the use of bone cement was associated with a LOS that was longer by 3.50 days (0.80, 6.20), and each hour increase in OR time with a delay in discharge of 1.75 days (1.18, 2.33). Major postoperative wound complications increased LOS by 16.46 days (11.40, 21.52). CONCLUSION: Preoperative functional status is an important determinant of the rate of recovery of functional independence after surgery. Strategies for decreasing LOS after hip or knee replacements include optimization of preoperative functional status, early surgical intervention, and prevention of wound complications.
9506872 The supply of and demand for informal and professional care for patients with rheumatoid a 1998 The objective of this study is to determine supply of, and demand for, informal care for rheumatoid arthritis (RA) patients and to evaluate the factors that contribute to the amounts of help needed and received from professional and informal care providers at home. Data were collected by questionnaire from 229 RA patients and 174 informal caregivers. Most of the help required is also received, though 24% of the patients did not receive help for one or more tasks. Most help given at home is by informal caregivers. The amount of help needed is related primarily to the patient's physical condition, sex, and self-efficacy expectations towards coping with RA. The amount of help received from informal caregivers is largely explained by the physical condition and the marital status of the patient, the sex of the caregiver, the patient's self-efficacy expectations towards coping with RA, and the age of the patient. The amount of help received from health professionals is related primarily to the marital status and the physical condition of the patient.
11523255 A randomized, controlled, single-blind trial of leflunomide in the treatment of rheumatoid 2001 The efficacy and safety of leflunomide (LEF) in the treatment of rheumatoid arthritis (RA) were evaluated and the comparison with methotrexate's (MTX's) was performed in a 12-week, single-blind, randomized, parallel trial for treating 81 patients with RA. There were 56 cases in LEF group and 25 cases in MTX group. The dose of LEF was 20 mg per day and MTX 15 mg per week. All patients took oxaproxin simultaneously at the 4th to 6th week after the trail. The results showed that the general effective rate and notable effective rate were 94.64% and 73.21% in LEF group, 72% and 44% in MTX group, respectively, with the differences being statistically significant between the two groups (P < 0.05). LEF and oxaprozin could obviously improve the symptoms, signs and joint functions. The incidence of side reactions was lower in LEF group (17.86%) than in MTX group (40.00%, P < 0.05). LEF had a good therapeutic effect for RA, especially for refractory RA and had slight side reactions, and could be regarded as a superior immunosuppressive agent used in the treatment of RA and other connective tissue diseases.
11327274 Minimal clinically important difference in radiological progression of joint damage over 1 2001 Apr To determine the minimal clinically important difference (MCID) between hand and foot films with a 1 year interval assessed with the Sharp/van der Heijde or Larsen/Scott scoring method. Progression scores of the 2 methods were compared with the opinion of an international expert panel on clinical relevance of radiological joint damage in 4 predefined clinical settings. The expert panel consisted of 3 rheumatologists, who evaluated 46 pairs of hand and foot films, taken with 1 year intervals, of patients with early rheumatoid arthritis. Receiver operating characteristics curves analyzed the accuracy of different threshold values (progression scores) of the 2 scoring methods to detect the presence or absence of clinically important difference, as defined by the expert panel as external criterion. The threshold value with the highest accuracy was subsequently chosen as the score representing the MCID. Five Sharp/van der Heijde units and 2 Larsen/Scott units were the best cutoffs. The accompanying sensitivities ranged from 77% to 100% for the Sharp/van der Heijde method and from 73% to 84% for the Larsen/Scott method for the 4 clinical settings. The specificities were between 78% and 84% for the Sharp/van der Heijde method and between 74% and 94% for the Larsen/Scott method. The smallest progression score that can be detected apart from interobserver measurement error, the smallest detectable difference (SDD), was equal to or larger than the calculated MCID, 5 Sharp/van der Heijde units and 6 Larsen/Scott units in our study, if the mean progression scores of the same 2 observers were used. The SDD is a conservative estimate of the MCID; our panel rated progression at or below this level as clinically significant.
9251634 Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine 1997 Aug 2 BACKGROUND: The value of intensive combination therapy in early rheumatoid arthritis is unproven. In a multicentre, double-blind, randomised trial (COBRA), we compared the combination of sulphasalazine (2 g/day), methotrexate (7.5 mg/week), and prednisolone (initially 60 mg/day, tapered in 6 weekly steps to 7.5 mg/day) with sulphasalazine alone. METHODS: 155 patients with early rheumatoid arthritis (median duration 4 months) were randomly assigned combined treatment (76) or sulphasalazine alone (79). Prednisolone and methotrexate were tapered and stopped after 28 and 40 weeks, respectively. The main outcomes were the pooled index (a weighted change score of five disease activity measures) and the Sharp/Van der Heijde radiographic damage score in hands and feet. Independent health-care professionals assessed the main outcomes without knowledge of treatment allocation. FINDINGS: At week 28, the mean pooled index was 1.4 (95% CI 1.2-1.6) in the combined treatment group and 0.8 (0.6-1.0) in the sulphasalazine group (p < 0.0001). At this time, 55 (72%) and 39 (49%) patients, respectively, were improved according to American College of Rheumatology criteria. The clinical difference between the groups decreased and was no longer significant after prednisolone was stopped, and there were no further changes after methotrexate was stopped. At 28 weeks, the radiographic damage score had increased by a median of 1 (range 0-28) in the combined-therapy group and 4 (0-44) in the sulphasalazine group (p < 0.0001). The increases at week 56 (2 [0-43] vs 6 [0-54], p = 0.004), and at week 80 (4 [0-80] vs 12 [0-72], p = 0.01) were also significant. Further analysis suggests that combined therapy immediately suppressed damage progression, whereas sulphasalazine did so less effectively and with a lag of 6 to 12 months. There were fewer withdrawals in the combined therapy than the sulphasalazine group (6 [8%] vs 23 [29%]), and they occurred later. INTERPRETATION: This combined-therapy regimen offers additional disease control over and above that of sulphasalazine alone that persists for up to a year after corticosteroids are stopped. Although confirmatory studies and long-term follow-up are needed, this approach may prove useful in the treatment of early rheumatoid arthritis.
11578012 Survival study of rheumatoid arthritis patients in Madrid (Spain). A 9-year prospective fo 2001 OBJECTIVE: To determine the risk and causes of death in rheumatoid arthritis (RA) patients in Madrid. METHODS: A longitudinal survival analysis was made. 182 RA patients of the rheumatology clinic of a tertiary care hospital were studied. 42 (23%) males and 140 (77%) females. All were followed-up for a 9-year period or to the date of death. Kaplan-Meier survival curves for both male and female cohorts were performed. The logrank test was used to compare both distributions and to determine the statistical significance. RESULTS: The mortality rate for the RA patient cohort was 15.4 deaths/1000 person-years (10.2/1000 for the female and 34.2/1000 for the male cohorts). The mortality rate ratio was 3.3. The logrank test showed a statistical difference (p=0.0023). The standardized mortality ratio was 1.85 for RA patients. The causes of death were: cardiovascular diseases 5 (21%), infections 5 (21%). amyloidosis 4 (17%), malignant diseases 2 (8%). CONCLUSIONS: Mortality is nearly two times higher in our population of RA patients. Male patients have a much lower survival probability than females. Cardiovascular diseases, infections and amyloidosis were the most common causes of death.
10668524 Leflunomide improves quality of life in rheumatoid arthritis. 1999 Functional disability in rheumatoid arthritis (RA) interferes with activities of daily living and severely affects patient quality of life. It results in increased levels of work disability and high medical costs. A new goal of RA therapy is to reduce or prevent functional disability. Patients' perception of overall health status in RA was assessed using several instruments (HAQ, MHAQ, SF-36, and PET) in Phase III double-blind, placebo-controlled, randomized trials comparing the new DMARD, leflunomide to sulfasalazine and methotrexate. Leflunomide significantly improved patient quality of life compared to placebo in both the European (P = 0.0001) and North American (P = 0.0001) studies. Reduction in HAQ scores with leflunomide (-0.50 vs -0.29; P = 0.0086) was significantly greater than sulfasalazine. Leflunomide also significantly reduced MHAQ scores versus methotrexate (-0.29 vs -0.15; P < or = 0.05). These changes were seen as early as Week 4. These results highlight the efficacy of leflunomide in RA therapy.
9632066 Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continu 1998 Jun OBJECTIVE: Patients with rheumatoid arthritis (RA) have reduced life expectancy; however, there are few data on the changing pattern of causes of death with longterm followup, or on the longterm effect of early presentation. The objectives of this study were (1) to examine the effect of early presentation on subsequent mortality; (2) to compare the causes of death early and late in the followup period; and (3) to compare survival of the cohort with that of the general population (adjusted for age and sex) over a followup period of up to 27 years. METHODS: A cohort of 448 patients with RA (inpatients and outpatients), assembled 1968-74, were followed to December 31, 1990. Death certificates were obtained for all who had died and coded using the International Classification of Diseases. Kaplan-Meier survival curves were constructed. RESULTS: By the end of the study, 266 patients (59%) had died. The standardized mortality ratio (SMR) was 2.7 (95% CI 2.4-3.1). Patients who presented early continued to do well. Most excess deaths were due to cardiovascular disease. SMR due to infection, renal failure, and non-Hodgkin's lymphoma rose with disease duration. CONCLUSION: Patients with RA should be referred early, and those with chronic disease should be closely monitored for evidence of infection and renal impairment.