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ID PMID Title PublicationDate abstract
12734887 Prevalence of secondary amyloidosis in Asian North Indian patients with rheumatoid arthrit 2003 May OBJECTIVE: To study the prevalence of secondary amyloidosis in Asian North Indian patients with rheumatoid arthritis (RA) and to determine its clinical significance. METHODS: RA patients with disease duration > 5 years were included in this prospective study over a 2 year period. Abdominal subcutaneous fat pad aspiration (ASFA) was performed, and smears were stained with Congo red and observed for apple-green birefringence under polarized light microscopy. The amyloid deposits were graded from 1+ to 3+. Clinical, radiological, and laboratory variables of the patients were correlated with the presence or absence of amyloidosis. RESULTS: Thirty out of 113 patients were positive for amyloid by ASFA (26.5%). Out of these, 8 patients had features suggestive of clinical amyloidosis in the form of proteinuria, organomegaly, or symptomatic gastrointestinal involvement. In another 22 patients amyloidosis was subclinical. The majority of patients with clinical amyloidosis had either 2+ or 3+ deposits. CONCLUSION: Abdominal fat amyloid deposits are not uncommon in adult Asian North Indian patients with RA. However, only one-fourth of patients had evidence of clinical amyloidosis. A longer followup and a larger multicentric collaborative study is needed to determine the significance of subclinical amyloid deposits.
15381792 Rheumatology outcomes: the patient's perspective. A multicentre focus group interview stud 2005 Jan OBJECTIVES: Patients with rheumatoid arthritis (RA) and clinicians have different views about benefits from treatments. More knowledge is needed about how patients assess outcomes in order to update current measurements. METHODS: Focus group interviews were performed at four Swedish rheumatology clinics. A total of 25 patients with RA were included, representing a wide range of ages and disease duration. Predetermined topics relating to important outcomes from and satisfaction/dissatisfaction with RA treatments were discussed. RESULTS: The participants' initial outcome assessments included physical and psychosocial items, which comprised overall treatment goals such as impairment in social roles, fatigue, daily activities and self-confidence. The identified themes were 'Normal life', 'Physical capacity', 'Independence' and 'Well-being'. Satisfaction with treatment was associated with the quality of communication between staff and the patient. The participants assumed this as a prerequisite for a treatment to work. Patients wanted to be accepted as experts on their own bodies, and expected all clinicians to be experts on RA. This made it possible for patients to 'take charge' of their life situation. Good resources for and access to rheumatology care were desired. CONCLUSIONS: Suggesting a holistic approach to rheumatology care, the study results indicate that the illness and outcomes have to be evaluated within an individual RA patient's total life situation, described in the identified themes: 'Normal life', 'Physical capacity', 'Independence' and 'Well-being'. Development and validation of measurements covering these issues is suggested. More research is needed about communication and how patients experience their roles in the rheumatology clinic.
12598796 Social epidemiology and rheumatic disease. 2003 Mar Social epidemiology, a subdiscipline of epidemiology, aims to identify socioenvironmental exposures that may be related to a broad range of health status outcomes. The strong association throughout the developed world between lower levels of individual socioeconomic status and poorer health outcomes from many diseases, including arthritis, is well established. Although not yet well studied in arthritis, recent data suggest that community social determinants, the socioeconomic environment of an individual's neighborhood, may be operant in this regard as well. It is of considerable interest that the association of community social determinants with health outcomes appears to be independent of an individual's socioeconomic status, at least in some clinical situations. Both Healthy People 2010 and the National Arthritis Action Plan place high priority on reducing disparities in health outcomes in the United States. Development of effective prevention strategies will require (1) precise recognition of individual and community variables that are associated with health outcomes and (2) evaluation of the putative mediating mechanisms.
12595621 Predictors of radiological progression and changes in hand bone density in early rheumatoi 2003 Feb OBJECTIVE: To identify predictors for radiological and functional outcome and bone loss in the hands in early rheumatoid arthritis (RA) during the first 2 yr of disease and to study the relationship between these variables. METHODS: An inception cohort of consecutively recruited patients was examined at baseline and after 12 and 24 months using X-rays of hands and feet, clinical [28-joint count, Health Assessment Questionnaire (HAQ), global visual analogue scale (VAS), grip strength] and laboratory (erythrocyte sedimentation rate, C-reactive protein, markers of bone formation and resorption) measurements and dual-energy X-ray absorptiometry measurements of the hands. RESULTS: Joint destruction increased significantly during the study, with the Larsen score at baseline as the strongest predictor. Radiological progression and bone loss over 24 months were significantly retarded in patients responding to therapy. The effects of the shared epitope and initial high inflammatory activity on radiological progression were overridden by the therapeutic response. Radiological progression correlated significantly with bone loss. Global VAS, Larsen score and HAQ at inclusion significantly predicted change in HAQ over time. CONCLUSIONS: Radiological progression and bone loss were retarded by early therapeutic response. Bone loss was related to radiological progression.
14769520 Agreement between rheumatologist visit and lay interviewer telephone survey for screening 2004 Jan OBJECTIVE: To evaluate agreement between a rheumatologist visit and a telephone interview by a patient organization member, regarding the diagnosis of rheumatoid arthritis (RA) or spondyloarthropathy (SpA) and the classification criteria for these two conditions. METHOD: Patients underwent a standardized interview and physical examination by hospital-based rheumatologists, who diagnosed RA in 230 cases, SpA in 175, and other conditions (controls) in 195. Members of patient organizations then used a standardized questionnaire to interview the patients by telephone about their diagnosis and about 1987 ACR classification criteria for RA and the ESSG criteria for SpA. RESULTS: Agreement between the two sources of data was poor for the classification criteria but satisfactory for the diagnosis (kappa, 0.84 (0.81-0.87) for RA and 0.78 (0.75-0.81) for SpA). CONCLUSION: Standardized telephone interviews conducted by patient organization members accurately identify the diagnosis made by rheumatologists based on a physical examination and medical record review, whereas agreement is poor regarding classification criteria for RA and SpA.
14677176 Relation between body mass index and radiological progression in patients with rheumatoid 2003 Nov OBJECTIVE: To determine if there is an influence of body mass index (BMI) on the radiological progression in early and longer duration rheumatoid arthritis (RA). METHODS: Fifty-four patients with RA were observed in a progressive 2 year followup for radiological progression of joint damage. At the beginning of study, 27 (50%) patients had a duration of complaints less than 6 months, grouped as early RA. BMI at the beginning and end of the study were monitored, together with HLA-DRB1 alleles, initial joint erosions, duration of disease, age, sex, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Outcome was defined as radiographic damage according to yearly increase of Larsen score. RESULTS: Increased radiographic joint damage of patients was significantly correlated with lower BMI at the beginning of the study (r = 0.363, p < 0.05), the presence of initial joint erosions (r = 0.341, p < 0.01), ESR (r = 0.315, p < 0.05), and CRP at study entry (r = 0.427, p < 0.01). Patients with an increase of Larsen score > or = 5.8/year were found to have a lower weight at the beginning of their complaints (BMI 24.8 +/- 4.7 vs 27.8 +/- 3.8; p < 0.05) as well as after the time of observation (BMI 24.6 +/- 3.7 vs 27.6 +/- 4.9; p < 0.05). Stepwise logistic regression analysis revealed a BMI < 27 at the beginning of disease (beta = 2.04, p = 0.003, odds ratio = 7.69), the presence of HLA-DR4 shared epitope (beta = 1.76, p = 0.015, OR 5.82), and joint erosions at study entry (beta = 1.56, p = 0.044, OR 4.78) as significant predictors for rapid joint damage. CONCLUSION: Together with the presence of HLA-DR4 shared epitope and erosive disease at study entry, a low BMI at the beginning of RA was found in association with higher radiographic progression in RA. Accordingly, BMI could be of interest as a sensitive and inflammation-independent predictor for radiological outcome of RA.
12382303 Contribution of progression of erosive damage in previously eroded joints in early rheumat 2002 Oct 15 OBJECTIVE: In rheumatoid arthritis (RA) in the context of a drug trial, prevention of erosions in undamaged joints is often considered more important than prevention of progression in already damaged joints, although a clear rationale is lacking. The aim of this study is to evaluate the relative contribution of separate components of the erosion score of the modified Sharp/van der Heijde method in early RA. METHODS: Different aspects of erosive damage were evaluated by their ability to discriminate between the 2 treatments in an early RA trial (the COBRA trial). RESULTS: The contribution of progression of already eroded joints to the total erosion score clearly increased during the 1.5 years of the trial. When the periods 0-28, 28-56, and 56-80 weeks were analyzed separately, the erosion score showed a significant difference between the groups in the first 2 periods (P < 0.0001, P < 0.03, and P < 0.64, respectively). Similar differences were seen in rates of progression in previously eroded joints (P = 0.005, P = 0.003, P = 0.35). On the other hand, rates of progression in newly eroded joints showed no significant difference between the 2 treatment groups in the second and third period (P < 0.0001, P < 0.16, P < 0.87). Analyses on joint and patient level showed analogous results. CONCLUSION: Subanalyses on progression rates in noneroded joints and already eroded joints can provide additional information. However, important information and discriminative strength may be lost when assessment is limited to the development of erosions in undamaged joints.
15301239 Prevalence and associated factors of anterior atlantoaxial luxation in a nation-wide sampl 2004 Jul OBJECTIVE: To estimate the prevalence of anterior atlantoaxial subluxation (AAS) in patients with rheumatoid arthritis (RA), and to analyse its association with disease markers. METHODS: Cross-sectional analysis of a cohort of RA patients randomly selected from the clinical registries of 34 centres. AAS, defined as an atlantoaxial displacement in cervical spine X-rays greater than 3 mm on flexion films, was actively searched for. Bivariate and multivariate analysis was performed to examine its association with clinical, functional, and treatment variables. RESULTS: AAS was found in 88 out of 736 patients with available cervical radiographs, (prevalence and 95% confidence interval [CI]: 12% [9.7-14.2]). The presence of AAS was highly associated with a Larsen score (0-150) over 50 (OR and 95% CI: 5.31 [2.68-10.55]), RA duration of more than 10 years (4.48 [2.70-7.44]), disease onset before age 50 (4.15 [2.42-7.12]), eye involvement (3.93 [1.63-9.46]), and previous RA related surgery (3.90 [2.46-6.19]). No association was found with rheumatoid factor. Multivariate analysis showed that a disease onset before the age of 50, the number of previous DMARD, and, above all, a Larsen score greater than 50 were important independent factors associated with AAS. There is a 33% increased risk for AAS every 10 units up in the Larsen score. CONCLUSION: AAS is frequent in RA patients, particularly in those with markers of erosive disease.
15072038 [Comparison of standard and acupuncture methods of transcutaneous electric nerve stimulati 2003 The comparison of standard high frequency (ST-TENS) and acupuncture-like TENS (AL-TENS) in patients with rheumatoid arthritis is presented. Thirty-three patients (26 women and 7 men) with rheumatoid arthritis (according to modified ACR criteria), and with the duration of the disease 10.7 +/- 8.8 years are investigated. Each subject received ST-TENS (75 Hz) at the selected joint and AL-TENS (4 Hz) at the contralateral joint respectively. No significant difference between left and right side in pre-treatment pain was the main criterion for selecting the treated joint. Treatment was performed during 12 days. The initiation, duration, level of hypolgesia (according to Ritchie's pain assessment scale and VAS), patients' global assessment and possible reduction of dosage of analgetics/antirheumatics were measured. There was a significant reduction in pain level on ST-TENS site (48.6%), and on AL-TENS site (40.8%), measured on VAS. Results of Ritchie's index showed significant difference before and after application (for each type of TENS P < 0.05). There was no statistical difference between both types of TENS regarding the reduction of pain level, as well as the initiation of analgesic effect, whilst it was noted a slightly longer, although statistically not significant, hypoalgesic effect of AL-TENS. Patients' global assessment also did not differ relating to ST-TENS and AL-TENS, as well as their opinion on possible dosage reduction of analgetics/antirheumatics. Side effects for both types of TENS were negligible. The findings showed that ST-TENS and AL-TENS provided hypoalgesic effect in the similar degree in patients with long-standing rheumatoid arthritis.
12737326 Reumacon (CPH82) showed similar x-ray progression and clinical effects as methotrexate in 2003 OBJECTIVES: To study x-ray development and clinical effects, tolerability and safety after 2 years treatment of RA patients with Reumacon (CPH82) or methotrexate (MTX). PATIENTS AND METHODS: This study is a 74 week open continuation of a 24 week double blind comparison of 100 patients with early RA (disease duration less than 2 years) treated either with Reumacon or MTX. RESULTS: The mean Larsen scores and the mean number of erosions increased significantly from baseline to 24 weeks and from 24 weeks to endpoint in both groups with no significant difference between them. Both groups had improved significantly in all clinical variables after 24 weeks and this improvement was sustained after two years. CONCLUSIONS: Radiological progression in patients treated with CPH82 was similar to that in patients treated with MTX. The clinical effect of the two drugs was sustained over the two year trial in both treatment groups.
12949685 Potentiated antibodies to tumor necrosis factor-alpha in the therapy of patients with rheu 2003 Jan We studied the efficiency and safety of a new homeopathic preparation Artrofoon containing affinely purified antibodies to tumor necrosis factor-alpha in the therapy of patients with rheumatoid arthritis. Artrofoon produced a positive antiinflammatory effect on the course of rheumatoid arthritis. This preparation reduced the severity of arthralgia (indexes of Li and Ritchie) and morning stiffness and decreased the erythrocyte sedimentation rate and contents of rheumatoid factor and C-reactive protein. One-month therapy improved the state of patients. Artrofoon was well tolerable. The preparation did not cause the ulcerogenic and nephrotoxic effects. Artrofoon holds much promise for combination therapy of patients with rheumatoid arthritis (including severe articular-and-visceral forms) and complications after treatment with nonsteroid antiinflammatory preparations.
15338190 Acute erythroleukemia in a rheumatoid arthritis patient during low-dose methotrexate thera 2005 May Acute leukemia is uncommonly seen with rheumatoid arthritis during or following treatment with low-dose methotrexate, a safe and effective treatment for the arthritic condition. We describe here a 68-year-old woman with rheumatoid arthritis who developed acute erythroleukemia during low-dose methotrexate therapy (total dose 1702.5 mg). This may be the first such case reported in the literature.
12687510 Validation of a novel satisfaction questionnaire for patients with rheumatoid arthritis re 2003 Apr 15 OBJECTIVES: To develop and validate a questionnaire for measuring satisfaction with different forms of complex multidisciplinary care in patients with rheumatoid arthritis (RA). METHODS: The satisfaction questionnaire (score range 0-100) comprised 28 items covering 11 domains. Together with a visual analog scale (VAS, range 0-100) on overall satisfaction, the questionnaire was applied in 210 RA patients who participated in a randomized trial comparing 3 types of multidisciplinary care. RESULTS: The questionnaire was returned by 174 patients (83%). The questionnaire and VAS scores in the total group were 75 (SD 12) and 83 (SD 20), respectively. Reliability analysis showed Cronbach's alpha of the questionnaire was 0.91. Spearman's correlation coefficient between the satisfaction questionnaire score and VAS score was 0.58 (P < 0.01). Mean total satisfaction questionnaire scores were 72 (SD 9), 76 (SD 14), and 78 (SD 11), in the nurse specialist, inpatient and day patient groups, respectively (nurse specialist versus day patient, P = 0.004). Significant differences between nurse specialist and day patients were seen in the following domains: waiting time during the treatment, autonomy, coordination, non-financial access, and quality of general information (all P < 0.05). CONCLUSION: Overall, patients were highly satisfied with the multidisciplinary care they received. Major differences regarding the organization of care were reflected in the results of the questionnaire scores. The satisfaction questionnaire appears to be a useful instrument for measuring satisfaction with complex multidisciplinary care in RA patients.
12375318 "5D" Outcome in 52 patients with rheumatoid arthritis surviving 20 years after initial dis 2002 Oct OBJECTIVE: Evaluation of a complex and variable disease such as rheumatoid arthritis (RA) poses a challenge particularly over the medium to long term. A practical framework to evaluate clinically relevant outcomes over the long term is the "5D" approach of Fries, described in 1980. We describe the 20 year outcome in 52 survivors of a 123 patient cohort in terms of change in discomfort, disability, drug side effects, dollar costs, and deaths. METHODS: We studied 123 patients with RA allocated to their first disease modifying antirheumatic drug (DMARD) between 1977 and 1979. All were under the overall care of one physician over the 20 years and were maintained where possible taking a single DMARD. Baseline demographic variables, the Ritchie Articular Index (RAI), Lee functional index, and erythrocyte sedimentation rate (ESR) were initially recorded. The extent to which the demographic and disease variables contributed to need for joint replacement surgery was assessed. Therapies for comorbidity were also documented. RESULTS: At cohort inception mean age was 50 years, RAI was 35, and median disease duration 5.5 years. F:M ratio was 90:33; 96% of patients were positive for rheumatoid factor (RF). Initial median ESR was 55 mm/h. At 20 years, 9 patients (7% of original cohort, 14% of survivors) were lost to followup and 62 (50%) had died. In the 52 survivors RAI, a surrogate for disability, showed a significant improvement (p < 0.0001), but disability measured by Lee functional index showed a deterioration (p = 0.018); 50% underwent joint replacement surgery. Initial ESR and mean ESR over the first 10 years of followup were significantly higher in those who required surgery. Nonsteroidal antiinflammatory drug (NSAID) use declined, but at least 2 deaths and 4 renal deaths that may have been related to therapy were attributed to NSAID use. No unexpected DMARD toxicity or mortality occurred. Concomitant therapy for comorbidity, in particular for cardiovascular disease, osteoporosis, and gastrointestinal disease, increased: more than 60% were on these therapies at 20 year followup. CONCLUSION: Strategies to improve the outcome of RA in all dimensions should include: earlier referral for expert assessment; avoidance of NSAID gastrointestinal and nephrotoxicity; a more intensive effort to identify effective management of comorbidity and those likely to have a poor outcome. Such patients require sustained, intensive therapy to minimize later disability.
12847891 [Synovial membrane in the early stage of rheumatoid arthritis: clinico-morphological compa 2003 AIM: To evaluate implications of pathomorphological alterations of synovial membrane at an early stage of rheumatoid synovitis (RS) for further course of rheumatoid arthritis (RA) and prognosis of the disease. MATERIAL AND METHODS: 92 new cases of RA (22 males, 70 females, mean age 31.1 +/- 10.5 years, mean duration of RA 5.99 +/- 3.27) subjected to puncture biopsy of the synovial membrane of the knee joint in 1967-1983. At admission to hospital 54.3, 45.7 and 29.3% patients had polyarthritis, mono- and oligoarthritis, rheumatoid factor, respectively. The RA diagnosis was confirmed in 68 (73.9%) patients, 26 (28.3%) of them were observed for 1-2 years, 42 (45.6%)--for 11.8 +/- 8.8 years, on the average. In 9 (9.8%) patients the diagnosis was changed for Bechterew's disease (n = 6), polymyositis (n = 1), rheumatism (n = 1), reactive arthritis (n = 1), 15 (16.3%) patients with seronegative oligoarthritis of large joints were lost for follow-up. Now (the beginning of 2002) synovial biopsies were investigated in "blind" mode by one morphologist (using the semiquantitative method) and compared to clinical and x-ray evidence. RESULTS: The most frequent changes were the following: proliferation of lining synovial cells (82.6%), lymphoid infiltration (64.1%), angiomatosis (60.9%), fibrinoid changes (60.9%). Accumulation of large amounts of macrophages and lymphocytes in the infiltrate was detected in RA significantly more often than in non-RA patients. Among 68 patients with definite RA morphological picture in biopsies obtained from the knee joints with manifest synovitis (69.1%) and from clinically intact joints (30.9%) was practically the same. The most important morphological sign was angiomatosis associated with early polyarticular involvement, early development of joint erosions and early disability (patients with marked angiomatosis were disabled after 4 years of illness, on the average, without angiomatosis--after 11 years). Statistically significant associations of parameters of RA development with other histological signs of synovitis were not detected. CONCLUSION: Angiomatosis in the synovial membrane occurs at early (including preclinical) stages of RA and, as a manifestation of angiogenesis, is an unfavorable prognostic factor of early polyarticular involvement, early development of joint erosions and early disability. Synovial biopsy at an early stage of arthritis is of differential-diagnostic value and helps to define a long-term outcome. Therefore, synovial biopsy of the knee joint must be in the list of standard examinations of patients with early RA.
14991276 [Rheumatologic manifestations of endocrine disorders]. 2004 Feb Diseases of different endocrine organs may cause symptoms at the locomotor system leading the patient to the rheumatologist. A correct interpretation of symptoms and findings the right may allow diagnosis and a causal treatment may be introduced. In this review the manifestations of disorders of the hypophysis, the thyroid, the parathyroid, the cortex and of diabetes mellitus at peripheral joints, the vertebral column, muscles, bones, and, as far as important for the rheumatologist, the peripheral nerve system are summarized. Carcinoid arthropathy is also mentioned.
15586215 [Diagnosis of initial changes in patients suffering from rheumatoid arthritis. Two years f 2004 Dec Besides conventional x-ray, in the diagnostic work up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The AIM of this study was to compare the diagnostic value of a newly developed low field MRI with proven methods such as conventional x-ray and 3P-Sz. PATIENTS, METHODS: 42 patients were studied using a one days protocol with 3P-Sz, MRI, and x-ray of the hands with yearly follow up examinations. Images were visually assessed by two blinded nuclear medicine physicians and radiologists and classified as RA-typical and non-RA-typical changes. All methods were compared to the summarised findings interpreted by a rheumatologist in consideration of the Ritchie articular index as gold-standard. RESULTS: 24/42 patients presented with clinical symptoms of initial changes by rheumatoid arthritis. Conventional x-ray revealed in 20/24 patients within the correct diagnosis in the study period. On the other hand 3P-Sz and low field MRI concordantly showed all 24 patients with initial changes due to RA. Time of detection showed variations with a tendency to later findings by conventional x-ray. CONCLUSIONS: In the diagnostic work up of initial changes conventional x-ray should be the first choice in imaging. Our findings suggest that MRI represents an equally sensitive method for the diagnosis of initial changes due to RA in the region of the hands as compared to the 3P-Sz. The limitation of the low field MRI is the small field of view, so we prefer 3P-Sz or high field MRI in the diagnosis of patients with suspected RA.
12730516 Women with established rheumatoid arthritis perceive pain as the predominant impairment of 2003 Aug OBJECTIVE: The aim of this study was to characterize perceptions of health and well-being in women with established rheumatoid arthritis (RA). METHODS: Women aged between 40 and 60 yr with RA for more than 3 yr, and who were receiving stable doses of anti-rheumatic drug therapy, were selected for study. The Arthritis Impact Measurement Scales 2 (AIMS2) was employed to quantify current health status impairments, the impairments that were attributed to RA, perceptions of current health status compared with other women of the same age, and perceptions of future health status. RESULTS: Fifty-eight patients were studied. The full range of 12 AIMS2 dimensions was used when quantifying impairments in health status. The dominant impairment was pain. Moreover, 88% of patients attributed current pain to RA. Fifty-two per cent perceived their health status to be fair, poor or very poor compared with other women of the same age. Twenty-five per cent expected poor future health status, compared with 10% who perceived poor current health status. Only one patient (2%) expected excellent future health status. CONCLUSION: In this study, a large majority of women perceived impairments of health status that they attributed to RA. Pain was perceived as the predominant impairment. Deterioration in health status was anticipated by many. The inclusion of patient perceptions of health status and disease impact as outcome measures in both cross-sectional and longitudinal clinical research protocols merits further study.
14705217 Value of Disease Activity Score 28 (DAS28) and DAS28-3 compared to American College of Rhe 2004 Jan OBJECTIVE: To assess the criteria for remission based on Disease Activity Score 28 (DAS28) and DAS28-3 (excluding patients' evaluation of disease activity) compared to American College of Rheumatology (ACR) preliminary criteria in established rheumatoid arthritis (RA), and to examine the value of each ACR criterion individually. METHODS: The EMECAR study was designed to assess the burden of comorbidity and inflammatory activity for RA in Spain. A random sample of 788 patients with RA from 34 Spanish centers was selected. Remission was defined by preliminary ACR criteria applied specifically and the clinical activity assessed by the DAS28 and the DAS28-3. A receiver operating characteristics curve analysis was performed to identify cutoff values with the highest usefulness in defining remission on both DAS indices. RESULTS: Thirty-two patients (4.1%) were in ACR-defined remission, 62 (7.9%) if fatigue was excluded from the criteria. The frequency of any single criterion that patients in remission fulfilled: no fatigue and joint pain by anamnesis in 31 patients (96.9%); morning stiffness < 15 min in 26 (81.3%); no swelling in joints in 21 (65.6%); normal erythrocyte sedimentation rate (ESR) in 29 (90.6%); and no joint tenderness in 21 (65.6%) patients. The positive predictive value for remission of each criterion: normal ESR 6.5%; morning stiffness < 15 min 8.4%; no fatigue 8.7%; no joint tenderness 13%; no swelling in joints 15.8%; and no joint pain by anamnesis 27.7%. The DAS28 cutoff values with higher discriminatory power for remission were 3.14 (sensitivity 87%; specificity 67%) when all the ACR criteria were used, and 2.81 (sensitivity 84%; specificity 81%) when fatigue was omitted. The equivalent cutoffs for the DAS28-3 were 3.52 (sensitivity 84%; specificity 66%) and 2.95 (sensitivity 82%; specificity 83%), respectively. CONCLUSION: DAS28 and DAS28-3 are good tools to define remission in established RA. No joint pain by anamnesis is the criterion with the highest value in defining remission, while normal ESR, an absence of morning stiffness, and fatigue are the least effective.
12537273 Large geodes in rheumatoid arthritis without joint destruction. 2002 Dec Although subchondral geodes are a well-known radiological feature of rheumatoid arthritis (RA), large geodes are uncommon. Progressive bone damage with pathological fractures has been reported. We report the case of a 49-year-old man with seropositive RA in whom large, rapidly progressive geodes in the wrists, hands, and feet contrasted with the absence of joint destruction, good functional tolerance, and moderate abnormalities of markers for inflammation. The location and rapid progression of the cyst-like lesions in this patient were highly unusual.