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ID PMID Title PublicationDate abstract
15850994 Structural evaluation in the management of patients with rheumatoid arthritis: development 2005 May OBJECTIVES: To develop French evidence-based recommendations for the structural evaluation of rheumatoid arthritis (RA) in everyday practice. METHODS: A scientific committee selected 10 questions using the Delphi consensus procedure. Evidence-based responses to each question were sought by searching the PubMed and Ovid databases and the abstract databases for the 2002, 2003, and 2004 annual meetings of the French Society for Rheumatology, the EULAR, and the American College of Rheumatology. The following indexing terms were used: rheumatoid arthritis, arthritis, patient, diagnostic imaging, radiography, joint, erosion, and joint space width. All articles published in French or English prior to May 2004 were identified. The evidence from these articles was reported to a panel of 77 rheumatologists working in hospital or office practice. The panel developed detailed recommendations, filling gaps in evidence with their expert opinion. The strength of each recommendation was determined. RESULTS: The 10 questions probed the structural evaluation of RA by plain radiography, magnetic resonance imaging (MRI), and ultrasonography, both for diagnostic and monitoring purposes. The literature search retrieved 673 publications, of which 166 were selected and reviewed. The panel developed 10 recommendations, one for each question, which were accepted by consensus. CONCLUSION: Recommendations relative to the diagnosis or monitoring of structural involvement in patients with RA in everyday practice were developed. They should help to improve practice uniformity and, ultimately, to improve the management of RA.
16389738 Occupational therapy during the first 10 years of rheumatoid arthritis. 2005 OBJECTIVE: To describe disease development and occupational therapy during the first 10 years of rheumatoid arthritis (RA), and to assess patients' experiences of occupational therapy and comprehensive care. METHODS: A total of 168 early RA patients with variable disease severity were followed up with regular team visits. The occupational therapist evaluated hand function and activity and performed the necessary interventions. These were recorded and the number of visits generating interventions was calculated. Semi-structured interview of 11 patients regarding their views of occupational therapy and team contact was performed. RESULTS: Impairments of hand function were in general mild to moderate and remained fairly unchanged over time. Activity limitations increased slowly. Half of the follow-up visits generated interventions. Most common were prescriptions of assistive devices and orthoses, hand-training instructions and patient education. The patients interviewed were positive regarding occupational therapy and felt safe with comprehensive care. CONCLUSION: RA patients in all stages of the disease benefit from regular contact with an occupational therapist and team care.
16239392 Health economics: implications for novel antirheumatic therapies. 2005 Nov This paper discusses the pharmacoeconomics issues relating to the use of the newer therapies for rheumatoid arthritis (RA), namely the tumour necrosis factor (TNF) inhibitors. RESULTS: of recent studies have provided some evidence regarding the cost effectiveness of these agents. However, as the use of TNF inhibitors evolves--including their use in other systemic inflammatory diseases--this will be influenced by several factors including treatment of patients with early RA, longer term treatment, problems related to toxicity, quality of life, productivity, and market forces. Thus, pharmacoeconomic considerations are likely to remain a central factor in the use of novel therapies in rheumatology, and awareness about these will aid clinicians to select the most favourable therapies for their patients with arthritis.
16291811 Monetary value of lost productivity over a five year follow up in early rheumatoid arthrit 2006 Jul OBJECTIVE: To explore the monetary value of rheumatoid arthritis related loss of productivity in patients with early active disease. METHODS: In a prospective cohort substudy of the FIN-RACo Trial, 162 patients with recent onset rheumatoid arthritis, aged 18 to 65 years and available to the workforce, were followed up for five years. Loss of work productivity in euros 2002 was estimated by data on absence for sickness and on income (human capital approach) from official databases. Treatment responses were evaluated by area under the curve (AUC) of the ACR-N measure and by increase in number of erosions in radiographs of hands and feet. The health assessment questionnaire (HAQ) at six months was linked to the International Classification of Functioning, Disability and Health (ICF). RESULTS: In all, 120 (75%) patients, women more often (82%) than men (61%) (p=0.002), lost work days. The mean lost productivity per patient-year was euro7217 (95% confidence interval (CI), 5561 to 9148): for women, euro6477 (4858 to 8536) and for men, euro8443 (5389 to 12,898). There was an inverse correlation with improvement: euro1101 (323 to 2156) and euro14 952 (10,662 to 19,852) for the highest and lowest quartiles of AUC of ARC-N, respectively. Lost productivity was associated with increase in the number of erosions and with disability in "changing and maintaining body position" subcategory of the ICF. CONCLUSIONS: Despite remission targeted treatment with disease modifying antirheumatic drugs, early rheumatoid arthritis results in substantial loss of productivity. A good improvement in the disease reduces the loss markedly.
15708891 Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinic 2005 Mar OBJECTIVE: To compare the clinical assessment of overall inflammatory activity in patients with rheumatoid arthritis (RA) with grey scale and power Doppler (PD) ultrasonography (US). METHODS: Ninety four consecutive patients with RA were included. Demographic and clinical data, C reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) were recorded for each patient. The presence of tenderness, swelling, and a subjective swelling score from 1 to 3 were independently assessed by two rheumatologists, who reached a consensus in 60 joints examined in each patient. All patients underwent a US examination by a third blinded rheumatologist, using PD. US joint effusion, synovitis, and PD signal were graded from 1 to 3 in the 60 joints. Joint count and joint index for effusion, synovitis, and PD signal were recorded. A 28 joint count for clinical and US variables was calculated. Interobserver reliability of the US examination was evaluated by a fourth blinded rheumatologist. RESULTS: US showed significantly more joints with effusion (mean 15.2) and synovitis (mean 14.6) than clinical examination (mean 11.5, p<0.05). A significant correlation was found between joint count and joint index for swelling, US effusion, synovitis, and PD signal. The 28 joint count for effusion, synovitis, and PD signal correlated highly with the corresponding 60 joint counts. US findings correlated better with CRP and ESR than clinical measures. Interobserver reliability was better for US findings than for clinical assessment. CONCLUSION: US is a sensitive method for assessing joint inflammatory activity in RA, complementary to clinical evaluation.
16342108 Preventing work disability among employees with rheumatoid arthritis: what medical profess 2005 Dec 15 OBJECTIVE: To compare the perspectives of employees with rheumatoid arthritis (RA) with those of medical professionals regarding what persons with RA need to prevent work disability. METHODS: Concept mapping was conducted in a group session with 21 employees and by mail with 17 medical professionals. Each group was asked to formulate statements on what enables employees with RA to retain their jobs. Group members scored all statements for importance and clustered them into themes. Results were statistically aggregated at the group level. RESULTS: The concept mapping with employees yielded 59 statements, which were clustered into 7 themes. The 4 most important themes were employer support; understanding and acceptance of illness by employees themselves; suitable working conditions; and support from colleagues, health professionals, and the patient's organization. The concept mapping with medical professionals yielded 65 statements, which were clustered into 8 themes. The 6 most important themes were well-informed professionals who cooperate effectively; employees' coping capacities and commitment to work; financial regulations at the workplace; adequate social security provisions, medication, and therapy; a positive attitude on the part of employers and colleagues; and suitable working conditions. CONCLUSION: Factors that enable continued employment lie at different levels, including the psychosocial, practical, organizational, and social policy levels. Health professionals appear to underestimate factors that are important from the patient's perspective, especially support from employers. In discussing work with patients, health professionals need to address themes that are important from the patient's perspective.
17080523 Modified matched ulnar resection for arthrosis of distal radioulnar joint in rheumatoid ar 2006 The pain of distal radioulnar arthrosis in rheumatoid patients is often due to disease largely confined to the radioulnar rather than the ulnocarpal articulation. This is a retrospective study of 14 patients (14 wrists) who underwent selective shaving of the radial articulation of the ulnar head leaving the ulnocarpal articulation intact. The ulnar head is reduced to the circumference of its shaft and a dorsal retinacular flap is interposed between it and the distal radius. Average age of the patients and follow-up were 63.5 years and 31 months, respectively. All patients had rheumatoid arthritis. Pain improved in 14 out of 15 wrists. Overall results were 67% good to excellent and 33% fair based on the modified Mayo's wrist score. This novel procedure for DRUJ arthrosis produces predictable pain relief in low demand rheumatoid patient.
17080517 CD64 on neutrophils is a sensitive and specific marker for detection of infection in patie 2006 Dec OBJECTIVE: In inflammatory diseases, differentiation between infection and disease flares is often clinically difficult because of similar signs and symptoms, such as fever and elevation of inflammatory markers. In rheumatoid arthritis (RA), infection is not only one of the major complications but also one of the frequent causes of death. Use of biologic agents such as tumor necrosis factor-a blockers has been reported to increase the incidence of tuberculosis or opportunistic infections. We examined the utility of CD64 (FcgRI) expressed on neutrophils as a marker for detection of infection complicated with RA. METHODS: We measured the expression level of CD64 per neutrophil quantitatively by flow cytometry in 279 samples from 237 patients with RA with various levels of disease activity or types of infection, and in 52 samples from 36 controls including subjects with infection. RESULTS: CD64 expression was significantly higher among RA patients with infection (median 4156 molecules per neutrophil, interquartile range 2583-8587) than in those without infection (884, IQR 670-1262) (p < or = 0.001). The sensitivity of CD64 on neutrophils for the diagnosis of infection (using a cutoff value of 2000 molecules per cell) was 92.7% and specificity was 96.5%. CD64 expression was not affected by the disease activity of RA or the use of corticosteroids, disease modifying antirheumatic drugs, and biologic agents. CD64 was upregulated in infection by bacteria, viruses, fungi, and mycobacteria. CONCLUSION: Our results suggest that quantitative measurement of CD64 expression on neutrophils can be used as a sensitive and specific marker to detect infection complicating RA.
17080516 Development and validation of a preference weight multiattribute health outcome measure fo 2006 Dec OBJECTIVE: To develop and validate multiattribute measures for patients with rheumatoid arthritis (RA) to report health states and estimate preference weights. METHODS: Survey materials were mailed to 748 patients. Factor analysis, an item response theory-based model, and an internal consistency test were used to identify attributes and evaluate items. Two multiattribute preference weight functions (MAPWF) were constructed. Construct validity of the new measures was then tested. RESULTS: Four hundred eighty-seven patients returned the survey; 24 items on 6 health attributes were selected to form the new outcomes measure. Two MAPWF were derived with preference weights measured with time tradeoff and visual analog scales as dependent variables. All validity test results were statistically significant. CONCLUSION: Our results reveal that the new measures are reliable and valid in assessing health states and associated preference weights of patients with RA.
16652419 Patient's ethnicity does not influence utilization of effective therapies in rheumatoid ar 2006 May OBJECTIVE: Biological agents have revolutionized the treatment of rheumatoid arthritis (RA). Given the previously documented ethnic disparity in the health service literature, we sought to determine if ethnic difference exists in the lag time between the diagnosis of RA and use of first biological agent. METHODS: RADIUS 1 and 2 are observational studies designed to document how rheumatologists treat RA across the United States. The sample analyzed here included early patients with RA who entered RADIUS with the initiation of the first biological agent. Ethnic status was categorized as White (W), African American (AA), and Hispanic (H). Lag time (months from RA diagnosis to initiation of the first biological agent) was the principal outcome variable. RESULTS: Compared to W (n=1616), AA (n=147) and H (n=116) were more likely to be female, younger, and have less than a high school education. Despite similar swollen and tender joint counts, AA and H had more active disease on the basis of Health Assessment Questionnaire and patient global assessments. Almost 97% of patients had some type of insurance coverage. On multivariable analysis, ethnic affiliation was not associated with lag time (14.5 months W vs 14.9 AA vs 14.3 H; p=NS). Similarly, there were also no significant ethnic differences in time to first DMARD (e.g., methotrexate) initiation. CONCLUSION: In a national sample of patients with RA, most of whom were insured, the length of time from diagnosis of RA to initiation of the first biological agent was not significantly different among Whites, African Americans, and Hispanics.
16342099 Use of self-management behaviors to cope with rheumatoid arthritis stressors. 2005 Dec 15 OBJECTIVE: To examine self-management behaviors used to cope with 5 rheumatoid arthritis (RA)-related stressors (pain, fatigue, physical limitations, joint changes, and symptom unpredictability) and the relationship between use of self-management behaviors and ability to perform life activities. METHODS: Data were from telephone interviews of 511 persons with RA. Participants were presented with lists of self-management behaviors for each stressor and asked to indicate which they had used in the past year. Performance of life activities was assessed concurrently (baseline) and 1 year later (followup). The number of activities affected (difficulty performing or unable to perform) and the number that individuals were completely unable to perform were calculated. Multiple regression analyses were used to examine the association of perceived stressor impact and arthritis education with strategy use and the association of self-management behaviors with performance of life activities. RESULTS: Four self-management strategies were identified: accommodation, active remediation, social, and perseverance. Greater perceived impact of stressors was associated with use of more self-management strategies in total for each stressor (beta = 0.43-0.73, all P < 0.0001) and with use of accommodation (beta = 0.26-0.29, P < 0.0001), social (beta = 0.23-0.43, P < 0.0001), and perseverance (beta = 0.29-0.46, P < 0.0001) strategies. Greater use of accommodation strategies at baseline was associated with an increase in the number of activities affected at followup (beta = 0.11, P < 0.05); greater use of perseverance strategies was associated with a decrease in activities unable to perform (beta = -0.13, P < 0.01). CONCLUSION: Self-management behaviors are commonly used and may help prevent loss of the ability to perform life activities.
15130901 Pain and joint mobility explain individual subdimensions of the health assessment question 2005 Jan OBJECTIVE: To explore the associations between individual subdimensions of the health assessment questionnaire (HAQ) and clinical variables in patients with rheumatoid arthritis. METHODS: 304 patients with rheumatoid arthritis (73% female, mean (SD) age, 58 (13) years; disease duration 6 (9) years, 69% rheumatoid factor positive) completed the HAQ for functional capacity (0-3) and a 100 mm visual analogue scale for pain. Grip strength, range of motion of the large joints, Larsen score for radiographic damage of hand and foot joints, and the number of tender and swollen joints were recorded. A logit regression model was used to study associations between subdimensions of the HAQ and other variables. RESULTS: Mean (range) total HAQ score was 0.92 (0 to 2.88) and varied from 0.73 to 1.04 in the subdimensions. Disability was lowest in the "walking" and highest in the "reach" subdimension. Pain was an explanatory variable in all individual subdimensions. Decreased grip strength, limitation of shoulder and wrist motion, and a larger number of swollen and tender joints in the upper extremities were related to several subdimensions. A higher pain score and swollen joint count in the upper extremities, decreased grip strength, and limited motion of wrist, shoulder, and knee joints explained increased disability (higher total HAQ scores). CONCLUSIONS: In patients with rheumatoid arthritis, pain and range of movements of joints have the greatest impact on individual subdimensions of the HAQ. Extent of radiographic damage in peripheral joints and the number of swollen and tender joints are of lesser importance for function.
16213997 Long-term results of total knee arthroplasty in young patients with rheumatoid arthritis. 2005 Oct Forty-seven cemented total knee arthroplasties in 32 patients with rheumatoid arthritis who were 55 years or younger (average, 43) were followed until death or a minimum of 15 years. The average follow-up was 18 years. There were 6 revisions; 5 of 6 revisions had severe polyethylene wear and osteolysis. All revisions occurred after 17 years (range, 17-23). Three of these had fracture of the tibial component associated with polyethylene wear through; the remaining 2 had loose tibial and femoral components. One patient sustained a distal femoral periprosthetic fracture requiring revision of the total knee. Cemented total knee arthroplasty in the young patient with rheumatoid arthritis is reliable and durable at an average 18 years of follow-up with an estimated survivorship of 100% at 15 years and 93.7% at 20 years.
15696565 Disease activity measurement of rheumatoid arthritis: Comparison of the simplified disease 2005 Feb 15 OBJECTIVE: To assess the reliability and congruency of the Simplified Disease Activity Index (SDAI) compared with the Disease Activity Score including 28 joints (DAS28) in daily practice. METHODS: In 399 consecutive rheumatoid arthritis patients (307 women, 92 men), the SDAI and the DAS28 were calculated. Additionally, 115 of them were observed for 1 year and changes of both values were recorded. Joint assessments were performed by 4 experienced physicians. DAS28 and SDAI values and the respective changes were compared by correlation and regression analyses. Reliability assessment and factor analyses were performed. Disease activity categorizing was compared by the Wilcoxon's rank sum test. RESULTS: The median +/- SD scores were 3.42 +/- 1.45 for the DAS28 and 11.50 +/- 11.50 for the SDAI. Spearman's rho was 0.897 (P < 0.0001). Score changes were also significantly correlated. Reliability testing and factor analysis revealed that both scores can be regarded as monocomponent. Categorizing patients according to the European League Against Rheumatism response criteria (EULARC) or the SDAI revealed statistically significant differences between the 2 scales (P < 0.0001). CONCLUSION: SDAI values are considerably shifted to the left compared with DAS28 levels. Internal consistency and reliability of both scores are comparable. For the differences in disease activity categorizing due to the SDAI compared with the EULARC, a major limitation of the application of this newly developed disease activity score is given, unless these incongruencies can be cleared.
17181923 Comparison of functional disability scales and their relevance to radiological progression 2006 Sep OBJECTIVE: To look for any correlations between radiological scores and hand functions evaluated with two different methods in patients with rheumatoid arthritis in remission. METHODS: Forty-two patients diagnosed with rheumatoid arthritis (RA) in remission according to ACR criteria were assessed for their hand functions with Duruöz's Hand Index (DHI), and with Sollerman Function Test (SHFT) as well as with Health Assessment Questionnaire (HAQ). Hand X-rays were evaluated according to Modified Sharp Index; joint space narrowing score (JSNS), erosion score (ES), and total score (TS) were calculated. The X-rays were assessed by the same rheumatologist three times. RESULTS: Mean HAQ score, mean DHI score and mean SHFT scores were 0.88+/-0.68, 17.74+/-17.81, 72.24+/-9.23 respectively. Radiologic scores were as follows: JSN 35.04+/-28.14, ES 25.19+/-36.23, TS 60.26+/-66.21. Intraobserver reliability was high (r=0,98). There was a positive correlation between HAQ and DHI (p<0.001), a negative correlation between SHFT. There was also a negative correlation between DHI and SHFT. The correlations between JSNS, ES and TS with respect to HAQ and SHFT were strong (p<0.0001) along with DHI (p<0.05). CONCLUSION: HAQ was found correlated with DHI and SHFT. Modified Sharp scores were found correlated with the general disability and hand functions. SHFT, with respect to DHI, takes a longer period of time, depends on equipment and needs an observer. On the contrary, DHI offers a more practical and economical way of assessment.
15761803 Rehabilitation of orthopedic and rheumatologic disorders. 4. Rheumatoid arthritis and calc 2005 Mar This self-directed learning module highlights a clinical vignette of 2 patients: (1) a woman with bilateral, distal, upper-limb pain assessed by differential diagnosis, laboratory work-up, and treatment of rheumatologic disorders frequently seen in the physiatric practice setting and (2) a 57-year-old man with an acute recurring monoarthritis of the knee and addresses clinical presentation, assessment, medical management, and rehabilitation approaches. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on 2 aspects: (1) the differential diagnosis of polyarthralgia, distal upper-limb pain, criteria for classification of rheumatoid arthritis, synovial fluid analysis, and comprehensive treatment of rheumatoid arthritis, both pharmacologic and nonpharmacologic and (2) the differential diagnosis, clinical diagnostic considerations, current pharmacotherapy, invasive procedure options, and orthotic and exercise interventions for a patient with calcium pyrophosphate dehydrate-induced monoarthritis of the knee. OVERALL ARTICLE OBJECTIVES: (a) Clinical evaluation, diagnosis, management, and rehabilitation strategies in persons with initial presentations of inflammatory distal upper-limb pain and (b) clinical evaluation of an individual with crystal-induced monoarthritis and differentiation of the pathophysiology, assessment, and treatment of chondrocalcinosis.
16465655 Revalidation of the original Cedars-Sinai health-related quality of life in rheumatoid art 2006 Feb OBJECTIVE: To assess the psychometric characteristics of the original 33-item Cedars-Sinai Health-Related Quality of Life in Rheumatoid Arthritis Questionnaire (O-CSHQ-RA) and 11-item CSHQ-RA Short Form (SF) using a representative population of patients with rheumatoid arthritis (RA) from 55 sites across the United States. METHODS: Data were from a 24-week multicenter, open-label, single-arm study of 312 RA patients receiving anakinra. Cronbach's alpha coefficient was used to indicate the internal consistency. Test-retest reliability was assessed by establishing the intraclass correlation coefficient (ICC) for screening and baseline visit responses. Convergent validity was tested with the Pearson correlation coefficient. Analysis of variance was performed to determine discriminant validity. A Wilcoxon signed-rank test and analysis of covariance were used to assess the responsiveness. A discriminant function was generated to determine the clinically meaningful change. RESULTS: Test-retest reliability was demonstrated for both versions of the CSHQ-RA, with ICC ranging from 0.82 to 0.94. Cronbach's alpha coefficients were > or = 0.9, indicating good internal consistency. Pearson correlations between health-related quality of life instruments and CSHQ-RA measures ranged from -0.33 to -0.73 and 0.39 to 0.76, demonstrating good convergent validity. Scores on both versions of the CSHQ-RA differed significantly (p < 0.0001) for patients with different levels of physical disability as measured by the Stanford Health Assessment Questionnaire. Both instruments were responsive to differences in patient health as measured by the general health question (p < 0.0001). Clinically meaningful changes were calculated for all 5 domains of the O-CSHQ-RA (6.9-14.0) and the overall O-CSHQ-RA SF (12.7). CONCLUSION: These results support the validity and reliability of both the original CSHQ-RA and the 11-item CSHQ-RA SF when tested in a representative patient population.
15868612 Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sec 2005 May OBJECTIVE: To investigate the frequency and the severity of radiological cervical spine involvement in patients with rheumatoid arthritis (RA). METHODS: We investigated 165 consecutive unselected patients with RA who fulfilled the revised American College of Rheumatology criteria for RA. All patients had a complete physical and laboratory evaluation. Patients had a radiological evaluation that included hand and wrist radiographs, as well as cervical spine radiographs in anteroposterior, lateral, and lateral in full flexion views. Hand radiographs were evaluated according to the Larsen criteria, while cervical radiographs were evaluated according to Winfield classification. RESULTS: There were 143 women and 22 men, with a mean age of 59.6 +/- 12.5 and disease duration 12.3 +/- 13.9 years. Positive rheumatoid factor was found in 63.6% of patients. One hundred forty-six patients presented radiological findings related to cervical spine involvement: atlantoaxial subluxations were found in 20.6% and erosions of the odontoid process in 2.4%; none presented vertical subluxation. Subaxial subluxations were found in 43.6%, disc space narrowing at C2-C3, C3-C4, C4-C5 levels in 66.1%, and vertebral plate sclerosis and erosions in 43.6%. CONCLUSION: Cervical spine radiological involvement is a frequent finding in our patients with RA, but the severity of the disease is rather mild, possibly related to the ethnic background.
16207336 Antibodies to citrullinated proteins and differences in clinical progression of rheumatoid 2005 Antibodies to citrullinated proteins (anti-cyclic-citrullinated peptide [anti-CCP] antibodies) are highly specific for rheumatoid arthritis (RA) and precede the onset of disease symptoms, indicating a pathogenetic role for these antibodies in RA. We recently showed that distinct genetic risk factors are associated with either anti-CCP-positive disease or anti-CCP-negative disease. These data are important as they indicate that distinct pathogenic mechanisms are underlying anti-CCP-positive disease or anti-CCP-negative disease. Likewise, these observations raise the question of whether anti-CCP-positive RA and anti-CCP-negative RA are clinically different disease entities. We therefore investigated whether RA patients with anti-CCP antibodies have a different clinical presentation and disease course compared with patients without these autoantibodies. In a cohort of 454 incident patients with RA, 228 patients were anti-CCP-positive and 226 patients were anti-CCP-negative. The early symptoms, tender and swollen joint count, and C-reactive protein level at inclusion, as well as the swollen joint count and radiological destruction during 4 years of follow-up, were compared for the two groups. There were no differences in morning stiffness, type, location and distribution of early symptoms, patients' rated disease activity and C-reactive protein at inclusion between RA patients with and without anti-CCP antibodies. The mean tender and swollen joint count for the different joints at inclusion was similar. At follow-up, patients with anti-CCP antibodies had more swollen joints and more severe radiological destruction. Nevertheless, the distribution of affected joints, for swelling, bone erosions and joint space narrowing, was similar. In conclusion, the phenotype of RA patients with or without anti-CCP antibodies is similar with respect to clinical presentation but differs with respect to disease course.
16277697 Does a positive anti-CCP test identify a distinct arthritis entity? 2005 The introduction of tests recognizing 'anti-citrullinated protein antibodies' (ACPA) has caused a revolution in rheumatology. Immunization against citrullinated proteins is a feature almost unique for rheumatoid arthritis, although ACPA may occur long before the onset of symptoms. Even if the presence of ACPA does not seem to reveal a distinct arthritis phenotype at symptom onset, it predicts an aggressive disease course with unfavourable outcome. Despite the very high diagnostic specificity for rheumatoid arthritis, ACPA-positivity does not always accord with a traditional diagnosis of rheumatoid arthritis at clinical presentation. However, even when these patients are judged to suffer from mild undifferentiated arthritis, they call for follow-up and special attention by rheumatologists.