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ID PMID Title PublicationDate abstract
10908694 Transcription factor decoy for NFkappaB inhibits cytokine and adhesion molecule expression 2000 Jul OBJECTIVE: Numerous cytokines are expressed in lesions of synovial hyperplasia of patients with rheumatoid arthritis (RA), and their pathophysiological contributions have been the subject of speculation. These genes are regulated by the transcription factor NFkappaB which in turn is activated by tumour necrosis factor-alpha (TNF-alpha) and cytokines. In this study we examined the inhibition of the production of pro-inflammatory cytokines, adhesion molecule and matrix metalloproteinase (MMP) from synovial tissue of patients with RA by the introduction of synthetic double-stranded DNA with high affinity for the NFkappaB binding site. METHOD: NFkappaB decoy oligonucleotides (ODN) were introduced with the aid of the haemagglutinating virus of Japan (HVJ)-liposome method into synovial tissue or synovial cells derived from patients with RA. The levels of interleukin-1beta (IL-1beta), IL-6, TNF-alpha, intercellular adhesion molecule-1 (ICAM-1) and MMP-1 were determined by means of enzyme-linked immunosorbent assay (ELISA) and Northern blotting analysis. A cell counting kit was used to study the effect of NFkappaB decoy ODN on synovial cell proliferation. RESULTS: The production of these mediators was significantly inhibited by the introduction of NFkappaB decoy ODN compared with the effect of scrambled decoy ODN. Transfection of NFkappaB decoy ODN resulted in a significant inhibition of synovial cell proliferation as compared with that of scrambled decoy ODN. CONCLUSION: The results demonstrated in this study suggest the potential usefulness of NFkappaB decoy ODN for gene therapy of inflammatory synovitis of RA.
9765141 Rheumatoid nodule of the foot: MRI appearances mimicking an indeterminate soft tissue mass 1998 Aug Subcutaneous rheumatoid nodules occur commonly in advanced cases of rheumatoid arthritis, but only rarely appear in the feet. We present a case of a subcutaneous rheumatoid nodule arising in the heel pad of a 68-year-old man with a long history of rheumatoid arthritis, along with a review of the literature. The appearance of the mass on MRI is illustrated and correlated with the histologic findings. The MRI appearance of a subcutaneous rheumatoid nodule is that of a nonspecific ill-defined mass with long T1- and long T2-relaxation times. A differential diagnosis for similar appearing masses is offered.
11561115 Increased expression of the blood group-related Lewis Y antigen on synovial fluid granuloc 2001 Sep OBJECTIVE: To evaluate the expression of the carbohydrate structures Lewis Y (LeY), sialyl-LeX (sLeX) and Lewis X (LeX) on paired peripheral blood (PB) and synovial fluid (SF) granulocytes in patients with arthritic diseases. METHODS: Ten patients with rheumatoid arthritis (RA), seven patients with spondyloarthritis (SA) and eight patients with osteoarthritis (OA) were studied. Granulocyte expression of the Le oligosaccharides was analysed by fluorescence-activated cell sorting. RESULTS: SF granulocytes of patients with RA, SA and OA expressed higher levels of the LeY oligosaccharide than PB granulocytes. Increases in LeY on SF granulocytes were similar in all three underlying diseases. No differences in the expression of the Le antigens were detected between PB granulocytes of patients and healthy individuals. Expression of sLeX and LeX showed no variation between SF and PB neutrophils. CONCLUSION: The selective increase in LeY antigen on SF granulocytes in RA, SA and OA suggests a role of the LeY oligosaccharide in granulocyte traffic and inflammatory responses.
11588753 Two configurations of static magnetic fields for treating rheumatoid arthritis of the knee 2001 Oct OBJECTIVE: To assess the efficacy of a nonpharmacologic, noninvasive static magnetic device as adjunctive therapy for knee pain in patients with rheumatoid arthritis (RA). DESIGN: Randomized, double-blind, controlled, multisite clinical trial. SETTING: An American and a Japanese academic medical center as well as 4 community rheumatology and orthopedics practices. PATIENTS: Cohort of 64 patients over age 18 years with rheumatoid arthritis and persistent knee pain, rated greater than 40/100mm, despite appropriate use of medications. INTERVENTION: Four blinded MagnaBloc (with 4 steep field gradients) or control devices (with 1 steep field gradient) were taped to a knee of each subject for 1 week. MAIN OUTCOME MEASURES: The American College of Rheumatology recommended core set of disease activity measures for RA clinical trials and subjects' assessment of treatment outcome. RESULTS: Subjects randomly assigned to the MagnaBloc (n = 38) and control treatment groups (n = 26) reported baseline pain levels of 63/100mm and 61/100mm, respectively. A greater reduction in reported pain in the MagnaBloc group was sustained through the 1-week follow-up (40.4% vs 25.9%) and corroborated by twice daily pain diary results (p < .0001 for each vs baseline). However, comparison between the 2 groups demonstrated a statistically insignificant difference (p < .23). Subjects in the MagnaBloc group reported an average decrease in their global assessment of disease activity of 33% over 1 week, as compared with a 2% decline in the control group (p < .01). After 1 week, 68% of the MagnaBloc treatment group reported feeling better or much better, compared with 27% of the control group, and 29% and 65%, respectively, reported feeling the same as before treatment (p < .01). CONCLUSIONS: Both devices demonstrated statistically significant pain reduction in comparison to baseline, with concordance across multiple indices. However, a significant difference was not observed between the 2 treatment groups (p < .23). In future studies, the MagnaBloc treatment should be compared with a nonmagnetic placebo treatment to characterize further its therapeutic potential for treating RA. This study did elucidate methods for conducting clinical trials with magnetic devices.
11703379 Regulation of rheumatoid synoviocyte proliferation by endogenous p53 induction. 2001 Nov The p53 tumour suppressor protein protects cells from tumorigenic alterations by inducing either cell growth arrest or apoptosis. In the present study, we investigated the role of endogenous p53 expressed in rheumatoid arthritis synovial fibroblasts which show transformed-appearing phenotypes. Type B synovial cells (fibroblast-like synovial cells) were exposed to a proteasome inhibitor, carbobenzoxyl-leucinyl-leucinyl-leucinal (MG-132). During this process, the expressions of p53 and p21 were examined by Western blot. Cell cycle analysis of the synovial cells was determined by DNA staining using propidium iodide (PI). Inhibition of proteasome resulted in the accumulation of p53 which was followed by an increase in the amount of a cyclin-dependent kinase (CDK)-inhibitor, p21. As a consequence, the retinoblastoma gene product, Rb, remained in the hypophosphorylated state, thus preventing PDGF-stimulated synovial cells from progressing into S-phase. This study shows that endogenous p53, which is inducible in rheumatoid synovial cells, is functionally active based on the findings that its expression blocks the G1/S transition by inhibiting the CDK-mediated phosphorylation of Rb via p21 induction. Thus the induction of p53 using proteasome inhibitor may provide a new approach in the treatment of RA.
9021511 Pseudomeniscus following total knee arthroplasty as a cause of persistent knee pain. 1997 Jan Persistent pain following total knee arthroplasty is an uncommon complication that may have any of several causes. In the case reported here, a patient who had undergone total knee arthroplasty developed a symptomatic pseudomeniscus that was successfully treated by arthroscopic debridement. Histopathologic analysis of the pseudomeniscus revealed a unique fibrocartilaginous structure, which may give insight into its pathogenesis. Symptomatic pseudomeniscus is one of several postoperative complications of total knee arthroplasty for which arthroscopy may be indicated.
10929414 Magnetic resonance imaging of rheumatoid arthritis in metacarpophalangeal joints. 2000 Jun OBJECTIVE: To report the development of high-resolution targeted magnetic-resonance imaging (MRI) techniques (not using injections of contrast media) to investigate and monitor rheumatoid arthritis (RA) in the metacarpophalangeal (MCP) joints. DESIGN AND PATIENTS: A total of 25 RA patients (age range 30-68 years) with varying degrees of disease severity ranging from early onset through active disease to the burnt-out stage, were imaged. (One patient subsequently underwent surgery and histological data was obtained.) A series of 10 control subjects were also studied--two for each 10-year age range. All the RA subjects were assessed for disease activity using standard clinical criteria and radiography as part of normal procedures. MRI was carried out using a targeted system and novel radiofrequency coil. Images of the MCP were performed at very high resolution with 1.5 mm slice thickness and in-plane resolution 130 microns. Standard gradient-echo (GE) sequences were used for anatomical imaging, multiple-echo GE sequences used to produce effective spin-spin relaxation time (T2*) maps and optimised binomialpulse presaturation used in conjunction with a GE sequence to generate magnetization-transfer (MT) ratio maps. RESULTS: High-quality high-resolution images of the MCP joints were obtained which highlighted normal anatomy and key features characterising the disease state (e.g. pannus, bone erosions, vascularity). Accurate measurements of T2* and MT with variations of +/- 4% and +/- 2% respectively were achieved. In active disease, variations in T2* and MT could be determined throughout areas of pannus, clearly demonstrating the heterogeneity of this erosive tissue. Pannus in MCP joints with active destruction was found to have high values of T2* varying from 25 ms to 40 ms with pockets up to 100 ms, whereas pannus present in chronic destruction, or burnt-out disease, had T2* values ranging from 21 to 29 ms. MT-active tissue was uniformly distributed in burnt-out disease, which was confirmed histologically in one case, compared with a more heterogeneous distribution in active disease. CONCLUSION: The MRI sequences and targeted system developed allow high-resolution studies of RA disease progression and activity. The data confirm the variable pattern of the disease and, in particular, heterogeneity of pannus.
9787332 Felty syndrome complicating juvenile rheumatoid arthritis. 1998 Sep PURPOSE: To describe a case of Felty syndrome (FS) in a child with (JRA) and review the previous literature on this rare entity. METHODS: Review of clinical data including results of serial blood counts, bone marrow aspirate, human leukocyte antigen (HLA)-typing, and abdominal sonography. RESULTS: Serial blood counts over 2 years revealed persistent leukopenia and thrombocytopenia. Bone marrow aspirate showed normal trilineage hematopoiesis, abdominal sonography demonstrated an enlarged spleen, but normal liver and portal circulation. HLA-typing was most significant for positivity of the DR 1 allele. CONCLUSION: This is only the third child, and the first preadolescent, to be reported with FS complicating juvenile rheumatoid arthritis. This condition needs to be considered in the differential diagnosis when leukopenia, thrombocytopenia, or both develop in patients with JRA.
10533510 New treatments for rheumatoid arthritis. Available and upcoming slow-acting antirheumatic 1999 Oct 1 No single therapeutic agent has been found to be universally effective for rheumatoid arthritis, so regimens using combinations of drugs have become the rule. Recently, several new agents with unique mechanisms of action have been introduced and found to produce various degrees of clinical benefit. Among these agents are folate and purine antagonists, alkylating agents, and antipyrimidines. Chimeric (mouse/ human) monoclonal antibody to tumor necrosis factor-alpha and human recombinant interleukin-1 receptor antagonist await approval for general use but have undergone considerable study.
9029834 Elevated levels of anti-proteus antibodies in patients with active rheumatoid arthritis. 1997 Jan We carried out this study to determine if our patient population with rheumatoid arthritis (RA) has elevated levels of antibodies to gut bacteria. Seventy patients with RA were categorised as being either active or inactive on clinical grounds. Antibodies to the H and O antigens of Proteus mirabilis and Salmonella typhi were determined by tube agglutination method in these patients, 18 patients with osteoarthritis and 82 healthy controls. There was no significant difference in the anti-proteus antibody titres between both the control groups and patients with inactive disease. However, antibody levels among patients with active disease were significantly higher than controls (P < 0.001). There was no significant difference in anti-salmonella antibody titres among the various disease and control groups. Elevated antibody levels could suggest a role for Proteus as an etiological agent in RA.
9385350 The safety profile of low-dose cladribine in refractory rheumatoid arthritis. A pilot tria 1997 Cladribine (2-chlorodeoxyadenosine, 2-CdA) is a newer purine analog with specific toxicity to lymphocytes. As lymphocytes play a major role in rheumatoid arthritis (RA), we assessed the safety profile of low-dose 2-CdA in patients who were refractory to more than three disease-modifying drugs. Five patients were given a subcutaneous dosage of 0.05 mg/kg 2-CdA weekly over a period of 8 weeks. Of the lymphocyte subsets, both T and B cells decreased below the normal range, whereas natural killer cells remained stable. These changes were the only side-effects noted during treatment and 4 weeks afterwards. In one patient a pacemaker was implanted for reasons unlikely to be related to 2-CdA administration. We conclude that even low-dose 2-CdA (0.05 mg/kg) can decrease T and B cell populations in patients with refractory RA, but other side-effects are unlikely. For assessing the possible clinical efficacy of low-dose 2-CdA further studies are warranted.
9431591 Antibodies to cytokeratins in inflammatory arthropathies. 1997 Dec OBJECTIVES: Cytokeratins are a major constituent of the cytoskeleton in eukaryotic cells and are vital for the maintenance of cell structure and function. Identification of increased levels of IgA antibodies to these intracellular structures has prompted increasing interest in the potential role between the gut and the immune system in the pathogenesis of inflammatory arthritis. This review examines the salient features of cytokeratin (CK) antibodies that are relevant to inflammatory arthropathies and discusses the meaning and potential applications of these findings in the context of the different arthropathies. METHODS: Review of the literature on antibodies to cytokeratins in inflammatory arthropathies, using MEDLINE and the key words (cyto)keratin and arthritis. The studies were interpreted and critiqued. RESULTS: Increased levels of IgA antibodies to CK-18 and epidermal keratins have been shown by enzyme-linked immunosorbent assay (ELISA) in rheumatoid arthritis and psoriatic arthritis. Levels were not increased in osteoarthritis or reactive arthritis. CONCLUSIONS: CK-18 is present within endothelial cells lining synovial blood vessels in patients with various rheumatic conditions, including rheumatoid arthritis, as well as in normal controls. Damage to synovial endothelial cells may lead to increased production of antibodies to CK-18. The CK antibody response is independent of the polyclonal immunoglobulin expansion typical of RA and is not specific for RA because an increased IgA response to CK-18 also has been shown in psoriasis and in psoriatic arthritis. Damage to synovial endothelial cells does not explain the increased autoantibody production in other conditions such as psoriasis. In this condition, damage to epithelial tissues in other regions of the body (e.g, skin, gut, kidney) may lead to production of keratin antibodies that recognize epitopes common to all CK, including CK-18. The reason for an elevated IgA anti-CK response rather than an IgG or IgM response is not clear. It cannot be explained by a general increase in serum IgA levels. Most of the conditions in which raised levels of these antibodies were found have been associated to different degrees with abnormalities of the gut mucosa or mucosal immune system. It appears that the nature of autoantibodies to CK-18 is probably natural rather than pathogenic. Currently there are no data on the source of the IgA antibodies to cytokeratins (i.e., mucosal or central immune system). Indeed, it may depend on the disease.
9251121 BMT for severe autoimmune diseases: an idea whose time has come. 1997 Jul Most patients with autoimmune diseases are thought to have a a normal life expectancy, and thus are treated conservatively. However, these diseases have a diverse clinical course. A small subset of patients have "severe autoimmune diseases," or SADS, which are rapidly progressive and are associated with early mortality. If patients with SADS can be identified before they develop irreversible organ damage, aggressive intervention would be indicated. Consequently, patients with SADS are now being enrolled in experimental protocols of immune ablation and hematopoietic stem-cell rescue (ie, bone marrow transplantation [BMT] at several US institutions. For various reasons, including the high cost of BMT, it will probably be years before the benefits, if any, of this procedure are known.
10555888 Thalidomide in the treatment of refractory rheumatoid arthritis. 1999 Nov OBJECTIVE: To review outcomes in 10 patients with rheumatoid arthritis (RA) treated with thalidomide. METHODS: We reviewed our experience with 10 patients treated with thalidomide using a standard therapeutic protocol and standard outcome measures. RESULTS: We observed no significant improvement in any outcome measure, likely as a consequence of the limited duration of therapy related to thalidomide toxicity. CONCLUSION: Formal studies of the efficacy of thalidomide in RA are required with alternative doses of the compound used by us, or with compounds derived from other sources.
11797400 [A case of rheumatoid arthritis associated with minimal change nephrotic syndrome]. 2001 Dec A 55-year-old Japanese woman has been treated with various kinds of anti-rheumatic drugs under a diagnosis of rheumatoid arthritis(RA) for 18 years of disease duration. She persistently had right elbow joint pain and swelling and X-ray showed bone erosion on humerus. Thus, the synovectomy was performed with typical histopathology of RA on April 1999. On the end of February 2000, she had suddenly fatigue and anasarca with profound proteinuria of nephrotic syndrome. The renal biopsy showed minimal change glomerulopathy and no cellular infiltration in interstitial tissue by light microscopy and partial fusion of foot process by electron microscopy. Renal function was sustained normally. All of anti-rheumatic drugs including D-penicillamine(D-Pc) except NSAID were stopped and she was treated with bed rest, diet therapy, diuretics and albumin infusion without steroid therapy. Edema and proteinuria gradually disappeared. Membranous and amyloid nephropathy in RA patients associated with nephrotic syndrome are found in high incidence in literature. In low incidence, MCNS is associated with NSAID or D-Pc induced nephropathy in RA. In our case, nephrotic syndrome disappeared in 6 weeks without discontinuation of NSAID and application of steroid therapy. Thus, MCNS might be co-incidentally associated with RA.
9709178 The p68 autoantigen characteristic of rheumatoid arthritis is reactive with carbohydrate e 1998 Apr OBJECTIVE: The autoantigen p68 is a target of autoantibodies as well as autoreactive T cells with a high specificity in rheumatoid arthritis (RA). The binding characteristics of the autoantibodies to their antigen were now analysed biochemically and cytologically. METHODS: Deglycosylation techniques as well as lectin and sugar competition experiments were performed to p68 to discover if the antibodies detected a glycoepitope, Its antigenicity was investigated applying anti-p68 antibodies derived from RA patients in comparison with polyclonal rabbit anti-p68 antibodies. RESULTS: p68 specific antibodies from RA patients did not to bind to p68 that had been deglycosylated by alkaline beta-elimination, O-glycosidase or periodate treatment. In contrast, binding of p68 specific antibodies raised in rabbit was unaffected by either deglycosylation protocol. Furthermore, lectins specific for the carbohydrate N-acetylglucosamine competed with p68 specific antibodies from RA patients for antigen bindings. N-acetylglucosamine by itself also competed with patient derived anti-p68 antibodies for p68 binding. Again, rabbit and anti-p68 antibodies did not elicit these competitive effects. Applying cytoimmunofluorescence, p68 was present in the cytoplasm or endoplasmic reticulum and also in low abundance on the cell surface. Under heatshock conditions, p68 was detectable in the nucleus. CONCLUSIONS: Autoimmunity to p68 during RA is carried by anti-carbohydrate autoantibodies. The carbohydrate modification of p68 appears to be N-acetylglucosamine, which may reflect the regulation of intracellular localisation of the antigen. It is hypothesised that a shift in glycosylation pattern accompanied by an unphysiological localisation of the antigen could trigger antigenicity of p68 during the pathogenesis of IRA.
11352236 American College of Rheumatology criteria for improvement in rheumatoid arthritis should o 2001 May OBJECTIVE: Change in a patient's condition is expressed as a percentage of the baseline value for a core set of measures in the American College of Rheumatology (ACR) improvement criteria for rheumatoid arthritis (RA), and this is used as the basis to decide whether a patient has improved. The result is dependent on whether the underlying measure has a score that increases or decreases on improvement. We examined the importance of this effect in the application of the ACR improvement criteria. METHODS: Data were obtained from the COBRA trial, in which 155 patients with early active RA had been randomized to receive either combination treatment with step-down prednisolone, methotrexate, and sulfasalazine or sulfasalazine alone. Patient and physician global assessments were recoded to reflect decreasing scores on improvement. The effects of this difference in scoring systems were compared among 3 response criteria levels (20%, 50%, and 70%) that are currently being used to assess improvement in RA clinical trials. RESULTS: Analyses showed that the effects of a decreasing, versus increasing, score on the designation of improvement cannot be ignored, especially at higher percentages of improvement (e.g., 50%, 70%). CONCLUSION: We recommend that percentage improvement in RA be calculated only on scores that decrease on improvement. When necessary, raw data should be recoded before the ACR improvement criteria are applied.
11289630 MR imaging of the wrist in rheumatoid arthritis using gadobenate dimeglumine. 2001 Jan OBJECTIVE: To determine the dosage of gadobenate dimeglumine (Gd-BOPTA) necessary for MRI of rheumatoid arthritis of the wrist. DESIGN AND PATIENTS: Seven wrists inflamed with rheumatoid arthritis were imaged using a dedicated 0.2-T MR unit. Four cumulative dosages of 0.0125, 0.025, 0.05 and 0.1 mmol/kg body weight (BW) Gd-BOPTA were tested. Three-dimensional T1-weighted gradient-recalled echo sequences (GRE; TR: 100 ms, TE: 18 ms, flip angle 90 degrees , 4:55 min) were acquired prior to an intravenous injection and after each additional dosage of Gd-BOPTA. Relative enhancement, signal-difference-to-noise ratios (SDNRs) and the size of the inflamed tissue were quantified. Three radiologists independently evaluated the image quality, the size and the contrast of the enhancing tissue. RESULTS: The readers agreed on a dose of 0.05 mmol/kg BW as satisfactory for the evaluation of the size of the inflammatory tissue and for determination of bone involvement (kappa = 0.9, P < 0.001). Highly inflammatory pannus was depicted with adequate image contrast using 0.025 mmol/kg BW Gd-BOPTA. According to the SDNR and relative enhancement findings, a dose of 0.05 mmol/kg BW suffices for both off-center and centered regions of tissue inflammation (t-test, P < 0.05). CONCLUSION: Gadolinium-BOPTA is an alternative contrast agent for MRI of rheumatoid disease. This study shows that a dose of 0.05 mmol/kg BW suffices at low field strength.
10782829 Hyaluronic acid inhibits the expression of u-PA, PAI-1, and u-PAR in human synovial fibrob 2000 Apr OBJECTIVE: Intraarticular administration of hyaluronic acid (HA) has been widely used for the treatment of osteoarthritis (OA). Fibrinolysis is closely related to the pericellular proteolysis involved in inflammation. However, the role of HA in the regulation of fibrinolytic factors is not yet known. We investigated the effect of HA on the pericellular fibrinolytic system of human synovial fibroblasts derived from OA and rheumatoid arthritis (RA). METHODS: Human synovial fibroblasts obtained from OA and RA were cultured in the presence and absence of HA. The antigen of urokinase-type plasminogen activator (u-PA) and plasminogen activator inhibitor-1 (PAI-1) were measured by ELISA, and u-PA activity was evaluated by electrophoretic enzymography. The binding assay of u-PA and the immunohistochemical analysis of u-PA were employed to detect u-PA receptor (u-PAR). RESULTS: HA suppressed the secretion of both u-PA and PAI-1 antigens from the synovial fibroblasts of OA to their conditioned medium. Suppression of u-PA activity in OA synovial fibroblasts was more marked than in those of RA. The u-PA binding assay of OA and RA synovial fibroblasts revealed a single class of binding site: dissociation constant (Kd) 23.7 nM, maximal number of binding sites (Bmax) 3.11x10(4) binding sites/cell; Kd 16.5 nM, Bmax of 9.88x10(4) binding sites/cell, respectively. HA decreased Bmax in fibroblasts of both OA and RA. Immunohistochemical analysis showed that u-PAR was constitutively expressed in both synovial fibroblasts, but if these cells were treated with HA, the decrease of the staining of u-PAR was more pronounced in the cells of RA than in OA. CONCLUSION: Pericellular fibrinolytic activity mediated by the u-PA/u-PAR system and PAI-1 was attenuated by HA in synovial fibroblasts derived from OA and RA. Thus, HA may be a useful agent to inhibit the inflammation of arthritis.
10870653 How does the short form 36 health questionnaire (SF-36) in rheumatoid arthritis (RA) relat 2000 The aim of the study was to show that the SF-36 is a practical tool for use on outpatients with RA, to examine the relationship between the SF-36 and indices of outcome in RA, and to compare the results with population norms and other disease states. Eighty-six consecutive RA patients attending the Haywood Hospital in Stoke-on-Trent and starting or changing second-line therapy were enrolled. Disease outcome was assessed using the American College of Rheumatology core set and all subjects completed the SF-36 health questionnaire. The cohort had moderately active disease (median ESR 46) and appreciable disability (median HAQ 1.875). Impairment of health status was moderate to marked by the SF-36, with significant differences from population norms and chronic disease states such as low back pain. Good correlations were observed between HAQ and physical function (r>0.75, p<10(-6)) and HAQ and social function (r>0.61, p<10(-6)). In contrast, SF-36 scales for physical and emotional role showed no association with activity measures. We concluded that, SF-36 is a practical tool for use in patients with RA. HAQ is associated with its physical and social function scales. Other SF-36 scales, such as physical and emotional role, are not associated with activity core set measures; this suggests different information is involved. RA has a considerable impact on health status compared to other diseases.