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ID PMID Title PublicationDate abstract
17002483 The initial validation of a Markov model for the economic evaluation of (new) treatments f 2006 OBJECTIVE: Markov models are increasingly used in economic evaluations of (new) treatments for chronic diseases. In this study we propose a Markov model with health states defined by the disease activity score (DAS) to be used to extrapolate efficacy data from short-term clinical trials in rheumatoid arthritis to longer term cost-effectiveness results. Moreover, we perform an initial validation of this model. METHODS: To test the validity of the model, the expected disease course (according to the model) was first compared with the observed disease course in an inception cohort of newly diagnosed rheumatoid arthritis patients. Then the relationship of the health states with utility and costs was investigated. Finally, costs and QALYs were calculated for usual care of patients in the first 5 years of their disease using the model and compared with the literature. RESULTS: The model seemed to be able to extrapolate 1-year efficacy data as seen by a comparable distribution over the Markov states between the model results and the observational data. The health states had a significant relationship with costs and utility, and population characteristics had only a moderate effect on the cost and utility values of the Markov states. The distribution over the Markov states resulted in 3.266 expected QALYs per patient over 5 years. The expected medical and total costs per patient over 5 years were 6754 euro (1997 values) and 12,641 euro, respectively, for standard rheumatoid arthritis care in The Netherlands. CONCLUSION: The developed Markov model seems a valid model for use in economic evaluations in rheumatoid arthritis. The model produced similar utilities, but lower total costs, to those in previously published studies. Although the steps to develop and validate this Markov model were applied in the context of rheumatoid arthritis, they can be generalised to other chronic diseases.
17200064 Experienced health in older women with rheumatoid arthritis. 2006 This study explored how older women with chronic illness and disability experience their own health. Data were collected in in-depth interviews with ten older women with rheumatoid arthritis. Data analysis and interpretation was carried out within a phenomenological- hermeneutic frame of understanding, which revealed five major themes: health as coping with everyday life, health as freedom, health as absence of inconvenience, health as togetherness and health as mental well-being. For older people with chronic illness and disability, good health found expression in general well-being. It was perceived as a state of equilibrium that the respondents sought to maintain through their own active choices.
16855148 Epidemiological aspects of rheumatoid arthritis: the sex ratio. 2006 Jun Many rheumatic diseases, including rheumatoid arthritis (RA) are more frequent in females than males. The objective of this article was to examine the female versus male perspective regarding prevalence/incidence, etiological factors, disease severity/outcomes, access to therapy and therapeutic responses. We also present results from some new analyses from the patient registers in Oslo to supplement existing literature in this area. We found that the prevalence of RA is higher in females than males, the incidence is 4-5 times higher below the age of 50, but above 60-70 years the female/male ratio is only about 2. Smoking is a consistent predictor of RA in males, but findings have been more inconsistent in females. We could not confirm that health status is worse in females than males when corrections were made for different disease duration and for the underlying tendency of healthy females to report worse subjective health status than males. Some studies and data presented here indicate that females have less access to health services. We also found that female sex reduces the likelihood of achieving treatment response with methotrexate and anti-tumor necrosis factor (anti-TNF) drugs by 30-50%. More research is needed to fully describe the differences between males and females regarding epidemiological data.
17162371 Identification of patients with early rheumatoid arthritis: challenges and future directio 2006 Jun Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis that affects the adult population. Early diagnosis and treatment are the cornerstones to prevent joint damage and avoid long-term costs and disability. This article reviews the limitations of the currently available tools for the evaluation of patients with early arthritis, including clinical assessment, serologic markers and imaging modalities. It also discusses gene expression analysis, a newer and potentially promising approach to the early diagnosis of RA.
18240218 Predominance of T cells in the lymphocytic infiltrates of synovial tissues in rheumatoid a 2008 Feb Synovial tissues from 5 patients with rheumatoid arthritis (RA) were examined immunofluorescence microscopy for the presence of lymphocytes with either bone marrow-derived (B) or thymus-derived (T) surface markers. Five synovial tissues with severe to mild lymphocytic infiltrations by bright field microscopy were examined in parallel with immunofluorescence. B cells were identified with a pepsin-digested fluoresceinated anti-F (ab')2 antiserum and T cells were detected with a specific rabbit and anti-T lymphocyte antiserum. By these techniques 75-90% of the lymphocytes in these frozen sections were identified as T cells. Cell suspensions were also prepared by collagenase digestion of two of the five synovial tissues. The lymphocytes in these cell suspensions were predominantly T lymphocytes (78-85%) as shown by their ability to form spontaneous rosettes with sheep erythrocytes (E rosettes).
16487554 Tropical pyomyositis in a case of rheumatoid arthritis. 2006 Sep Tropical pyomyositis is very rarely associated with rheumatoid arthritis. We report tropical pyomyositis involving gastrocnemius muscle in both the legs with eosinophilia and elevated serum IgG and IgE levels in a case of rheumatoid arthritis. We suggest that the possibility of pyomyositis should be considered in all cases of rheumatoid arthritis presenting with muscle pain, fever and leucocytosis.
17149060 Rheumatoid arthritis-associated necrotizing scleritis and peripheral ulcerative keratitis 2006 Dec In patients with rheumatoid arthritis (RA), necrotizing scleritis, an ocular manifestation of a systemic vasculitic process, is associated with significant ocular morbidity and high mortality. We present a 60-year-old man with RA who developed necrotizing scleritis and peripheral ulcerative keratitis. The scleritis was refractory to local measures, systemic corticosteroids, and cyclophosphamide but responded rapidly to infliximab. Our case illustrates that biologic agents may be considered in refractory cases of sight- and life-threatening scleritis.
17679283 Best practice in the treatment of patients with rheumatoid arthritis. 2007 Jun 27 This article discusses the need for early referral and proactive management of patients with rheumatoid arthritis to achieve optimal treatment outcomes.
19036152 Trends towards an improved disease state in rheumatoid arthritis over time: influence of n 2008 INTRODUCTION: The disease activity in patients with rheumatoid arthritis has improved during the past decade. The availability of new drugs and also a better assessment of the disease have been proposed to be responsible for this improvement. In the present work we estimate the effect of these factors on disease activity and function in patients with rheumatoid arthritis at the beginning of the new century. METHODS: The Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide (EMECAR) cohort was assembled in 2000 from the random sampling of rheumatoid arthritis patients registered in 34 centers. The cohort was composed of 789 patients who underwent a baseline assessment plus four annual follow-up visits in which functional ability (Health Assessment Questionnaire score), the disease activity score obtained from 28-joint count with three parameters (DAS28-3) and radiological progression (Larsen score) were recorded. The effect of the calendar year on the DAS28-3, the Health Assessment Questionnaire score, and the Larsen score was obtained from adjusted models in which all treatments were included as dummy variables. RESULTS: The effect of time as the beta coefficient (95% confidence interval) for 2004, taking 2000 as a reference year, was -0.43 (-0.58 to -0.28) for the DAS28-3, 0.15 (0.07 to 0.22) for the Health Assessment Questionnaire score, and 4.4 (2.68 to 6.12) for the Larsen score. Treatment with new therapies, either leflunomide or TNF antagonists, increased in frequency from 1.1% (n = 8) in 2000 to 30.9% (n = 144) in 2004. Treatment with TNF antagonists (-0.28 (-0.5 to -0.05)) and with gold salts (-0.21 (-0.38 to -0.04)) was independently associated with a decrease in the DAS28-3 over time, whereas cyclosporin A treatment (0.45 (0.13 to 0.76)) was associated with an increase in disease activity. CONCLUSIONS: The mean disease activity of rheumatoid arthritis has improved from 2000 to 2004. An explanation is the introduction of new therapies, but not solely. Other factors related to the calendar year, plausibly a better management of available drugs, show a greater effect on improvement than the drugs used.
17321049 Effects of day-to-day affect regulation on the pain experience of patients with rheumatoid 2007 Sep Individual differences in the regulation of affect are known to impact pain and other symptoms in rheumatoid arthritis. However, no studies have yet used a rigorous daily diary methodology to address the question of whether current pain is reduced when positive or negative affects are effectively regulated. We used a prospective, repeated daily sampling design to infer the regulation of affect from day-to-day changes in affect intensity and examined how these changes in affect were prospectively related to pain from rheumatoid arthritis. Ninety-four adult patients diagnosed with rheumatoid arthritis completed daily measures of pain and positive and negative affect over a period of 30 days. Information on demographic and disease status variables was collected during a medical evaluation. Results of hierarchical linear model analyses indicated that the regulation of both positive and negative affect from the prior day to the current day predicted significantly greater decreases in pain that day, resulting in up to a 28% reduction in pain intensity. These findings were partly influenced by disease status and demographic variables. This study suggests that the day-to-day regulation of negative and positive affect is a key variable for understanding the pain experience of individuals with rheumatoid arthritis and is a potentially important target for intervention.
17518868 The relationship between disability and self-care agency of Turkish people with rheumatoid 2007 Mar AIM: This study aims to determine the relationship between disability levels and self care agency scores in Turkish patients with rheumatoid arthritis and to investigate the factors affecting them. BACKGROUND: Self-care agency is the complex acquired ability to meet one's constant requirements for care that regulates life processes, maintains or promotes the integrity of human structure, functioning and development, and promotes well-being. DESIGN AND METHODS: Forty-three consecutive patients with Rheumatoid Arthritis (M/F: 11/32; mean age 49.53 +/- 13.37 years; disease duration 118.32 +/- 76.55 months), being followed up by Ege University Rheumatology Outpatient Department and all fulfilling ACR 1987 criteria were included in this study. Data collection instruments used in this study were Informative-Demographic Data Form, Health Assessment Questionnaire (including disability index and pain scale) and Self-as-Carer Inventory. RESULTS: The mean disability index, the mean pain score and the mean self-care agency score of patients were 0.53 (SD 0.45), 1.48 (SD 0.74) and 80.95 (SD 27.80) were respectively. Self-care agency of patients found moderate level. It was found that a positive correlation between the disability index and the self-care agency scores (r = 0.488; p < 0.01). It was found that in male (t = 0.907; p = 0.000), in patients graduate from university (F = 0.271; p = 0.001), the self-care agency was better than other patients. CONCLUSION: In conclusion we found that in Turkish patients with Rheumatoid Arthritis, the higher the disability rate was, the lower the self-care agency score was. RELEVANCE TO CLINICAL PRACTICE: Disability, pain and their impact on self-care agency should be focused on in everyday care for Rheumatoid Arthritis patients. These areas are most important in nursing care and should be considered while organizing the medical treatment and rehabilitation programme.
18715389 Self-determination of patients with rheumatoid arthritis: model development during action 2008 Aug The purpose of this article is to describe the content and the development of the model to promote self-determination of patients with rheumatoid arthritis from a point of view of patients and nurses. For the patients the data were gathered using semistructured interviews and for the nurses through three focus groups in the initial and evaluation phases. The data were analysed by themes using qualitative content analysis. The model consisted of the concept of self-determination, impediments to and preconditions for self-determination, promoting and focusing on consequences. Patient's activity was a new view of the concept. Impediments to self-determination were linked to limitations and preconditions to patients' freedom to express themselves. Support developed an important factor promoting self-determination. The results indicate a clear need for various types of supportive nursing care to promote self-participation in patient care.
19065298 Amyloidosis is frequently undetected in patients with rheumatoid arthritis. 2008 Dec Prevalence of AA amyloid in rheumatoid arthritis (RA) is still unclear. The objective of this retrospective study was whether dedicated re-examination of autopsy tissues from RA patients increases the detection rate of amyloid compared to routine examination. Amyloid was re-examined in tissue samples and detection rate compared with original reports of 369 consecutively autopsied RA patients and 370 non-RA patients matched for sex, age, and year of autopsy between 1952 and 1991. Re-examination of 90% of the 739 cases showed doubling of the prevalence of amyloid compared with the original reports: from 18 to 30% in RA and from 2 to 4% in non-RA patients. In RA patients, cardiac amyloid was as frequent as renal amyloid. In RA patients with amyloid at re-examination, amyloidosis had been diagnosed before autopsy in 37%, and these patients had more inflammation and longer disease duration than RA patients without amyloid. Only 56% of RA patients with renal amyloid were known to have proteinuria. In conclusion, this autopsy study shows that amyloid in RA is a common finding which remains frequently undetected. In patients with active and long-lasting RA, a systematic search for amyloid may enable early diagnosis of amyloidosis, which will require effective suppression of inflammation.
18314370 Gastric bleeding in a patient with rheumatoid arthritis complicated by immune thrombocytop 2008 May Rheumatoid arthritis, in common with other systemic autoimmune diseases, can involve several other organs presenting with complex immunological manifestations. Immune thrombocytopenic purpura caused by an autoimmune reaction against platelets is an infrequent haematological complications. A female patient with rheumatoid arthritis rapidly developed extremely severe immune thrombocytopenic purpura upon suspending oral corticosteroid therapy. Besides the involvement of the mucosa of the coecum, ascending colon and the gastric antrum, the situation was further complicated by bleeding of a gastric polyp, at the nadir of the thrombocytopenic crisis. The bleeding was managed by endoscopic intervention and platelet count recovered upon high dose corticosteroid treatment within a couple of days.
15940551 Rheumatoid arthritis in a patient with common variable immunodeficiency: difficulty in dia 2006 Feb Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency syndrome in adults with equal sex prevalence. The syndrome typically presents as recurrent infections, with onset in childhood or young adulthood (between 20 and 30 years). CVID patients also have a higher prevalence of autoimmune diseases. A 38-year-old woman presented to the Rheumatology Department with polyarthralgia and fever of 39 degrees C of several months' duration. She had recurrent respiratory and gastrointestinal tract infections and pernicious anemia. Immunological studies showed decreased levels of IgG, IgM, complete IgA deficiency, increased percentage of CD8 lymphocytes, and a reduced CD4:CD8 ratio. HLA-DR typing was performed and we identified HLA-DRB1*01. Adequate intravenous immune globulin substitution as well as antibiotic and anti-inflammatory treatment resulted in the remission of arthritis. Hand radiograms repeated after 12 months showed narrowing of the intra-articular space in the right metacarpophalangeal and radiocarpal joints with multiple bone cysts and erosions. Erosions were found in both humeral heads as well. This prompted the diagnosis of rheumatoid arthritis. Arthritis can be a presenting symptom of primary immunodeficiency in adults, especially when accompanied by recurrent infections or autoimmune diseases. These patients require more advanced diagnostic procedures and therapeutic cooperation of different specialists.
17042467 Life satisfaction in early rheumatoid arthritis: a prospective study. 2006 Sep The aim of this study was to describe life satisfaction prospectively in patients with early rheumatoid arthritis (RA) and to investigate its correlation with disease activity. The early RA group was compared with RA patients with longstanding disease and with a reference group. Gender differences were also compared. Patients with early RA, treated by a multidisciplinary team, reported their life satisfaction by completing a questionnaire. Disease activity score, patient global assessment, and pain were scored at onset of disease and after two years. The patients with early RA were less satisfied with life as a whole at disease onset compared with the reference group, as was a cohort of patients with longstanding disease. Patients with early RA also reported low levels of satisfaction with self-care activities, work, and sexual life. The women reported themselves more satisfied than men. After two years, a slight increase in the reported levels of satisfaction could be seen for life as a whole and for five of the eight domains. No correlation was found between disease activity variables and satisfaction with life as a whole. There were, however, positive correlations between disease activity and satisfaction both with partnership and with family life after two years, i.e. the higher disease activity the higher satisfaction with partnership relation and family life. In contrast, patients with greater disease activity were less satisfied with self-care activities. The results of this study indicate that greater effort is needed to assist patients with early RA to cope with problems concerning self-care activities, sexual life, and work.
16096333 The shared epitope is a marker of severity associated with selection for, but not with res 2006 Mar OBJECTIVE: To determine whether joint destruction, indication for, and response to infliximab in rheumatoid arthritis are associated with the shared epitope (SE) or selected cytokine gene polymorphisms (interleukin (IL) 1B, IL1-RN, and tumour necrosis alpha). METHODS: In a large rheumatoid arthritis population of 930 patients from the same area (Rhône-Alpes, France), patients with (n = 198) or without infliximab treatment (n = 732) were compared according to their genetic status. Clinical, biological, and radiological data were collected. Typing for SE status and cytokine polymorphisms was carried out using enzyme linked oligosorbent assay. Statistical analysis was by chi(2) testing and calculation of odds ratios (OR). RESULTS: A dose relation was observed between the number of SE copies and joint damage in the whole rheumatoid population (OR, 1 v 0 SE copy = 2.38 (95% confidence interval, 1.77 to 3.19), p<0.001; OR 2 v 0 SE copy = 3.92 (2.65 to 5.80), p<0.001. The SE effect increased with disease duration but was not significant before two years. Selection for infliximab treatment (n = 198) was associated with increased disease activity, joint damage, and the presence of the SE with a dose effect. In all, 66.2% patients achieved an ACR20 improvement. No clinical or genetic factors were able to predict the clinical response to infliximab. CONCLUSIONS: This post-marketing study in a large cohort of rheumatoid arthritis patients indicates a linkage between rheumatoid arthritis severity, selection for treatment with infliximab, and the presence and dose of the SE.
16679433 Joint surgery in the Utrecht Rheumatoid Arthritis Cohort: the effect of treatment strategy 2006 Nov OBJECTIVE: To investigate the prevalence and prognostic factors of joint surgery in a large cohort of patients with rheumatoid arthritis, whose treatment, clinical and radiographic data have been assessed at predefined points in time since disease onset. METHODS: Data on surgical interventions were retrospectively obtained from 482 patients with rheumatoid arthritis whose follow-up data for at least 2 years were available, including treatment and response to treatment during the first 2 years. Survival time until the first surgical intervention and until the first major surgical intervention was determined for the total study population by Kaplan-Meier survival curves. Three separate Cox regression analyses were carried out to determine which variables measured at baseline, during the first year and during the first 2 years were predictors for joint surgery. RESULTS: 27% of the patients underwent surgical interventions. Mean survival time until the first surgical intervention was 10.4 years. The percentage of patients with a surgical intervention was 10% lower in the group with response to treatment when compared with the non-response group. Next to a delayed start with disease-modifying antirheumatic drugs, fast radiographic progression during the first year and first 2 years was a predictor of joint surgery in the multivariate regression analyses. CONCLUSION: Treatment with disease-modifying antirheumatic drugs immediately after diagnosis results in less joint surgery when compared with a delayed start. Furthermore, joint surgery is carried out more often in patients who do not respond to treatment.
18796511 Adaptive coping with rheumatoid arthritis: the transforming nature of response shift. 2008 Sep OBJECTIVE: Qualitative investigations of patients' perspectives of coping can offer insights into a wide array of adaptive coping patterns selectively used to deal with illness-related challenges. The purpose of this qualitative study was to examine adaptive coping patterns reported by a sample of women with rheumatoid arthritis (RA). METHODS: Using thematic analysis, interviews from 19 participants were analysed until theoretical saturation was achieved. The interviews were coded, with narrative excerpts collated within each code, sorted by codes into potential themes, and then collated within identified themes. These themes were then further defined, providing specific adaptive coping strategies for each major theme. RESULTS: Major themes included accepting role limitations, reclaiming control, reframing their situation, and bolstering courage. Women described accepting more realistic performance standards, accepting their limitations and dependence on others, and altering their basis of self-worth. They reclaimed control of their lives by changing priorities, pacing themselves, being flexible, delegating to others, and setting appropriate boundaries. Reframing their situation enabled them to change their perspective, minimize threats from RA, re-prioritize their values, and find meaning and positive changes associated with their suffering. To bolster courage, they turned to a variety of sources for encouragement, including confidence from past successes, inspiring role models, and social support. CONCLUSIONS: The data reflect adaptive strategies similar to response shift processes. A link between response shift processes and higher levels of perceived control is discussed.
16879719 Aspects of early arthritis. Definition of disease states in early arthritis: remission ver 2006 With regard to rheumatoid arthritis, remission as currently used in the literature can have two meanings: either a state with persistent absence of clinical and radiological signs of disease activity without being treated for a specific time period, or it may point to a disease state with minimal disease activity during antirheumatic treatment. A risk factor for the first is absence of autoantibodies, with the anti-CCP-antibodies as best predictors, whereas risk factors for achieving a drug-induced state of minimal disease activity are not well defined. These definitions of remission refer to different disease states; therefore, we propose that the term remission is reserved for patients that are not treated with antirheumatic drugs.