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ID PMID Title PublicationDate abstract
17530669 Measuring disease activity and functionality during pregnancy in patients with rheumatoid 2007 Jun 15 OBJECTIVE: Pregnancy has a favorable effect on the course of rheumatoid arthritis (RA), although the magnitude of this effect is equivocal because RA assessment tools have never been validated in pregnancy. The goal of this study was to assess how pregnancy influences the scoring of the Disease Activity Score in 28 joints (DAS28) and the Health Assessment Questionnaire (HAQ), and how both scores perform in pregnant patients with RA. METHODS: Thirty-two healthy women and 30 pregnant patients with RA were prospectively studied during pregnancy and at postpartum. At each trimester and postpartum the components of the DAS28 (global health [GH], erythrocyte sedimentation rate [ESR], and C-reactive protein level [CRP]) and HAQ scores were determined. Maximal influences of healthy pregnancy on each component of the DAS28 were calculated. The performances of different DAS28 scores and the HAQ were also determined in RA patients. Furthermore, variants of the HAQ were developed within the HAQ scoring rules. RESULTS: The components of the DAS28 were influenced by healthy pregnancy, with average increases in DAS28 score of 0.22 (GH), 1.1 (ESR), and 0.25 (CRP). The DAS28 calculated with CRP (DAS28-CRP) and without GH performed the best in pregnant RA patients. In healthy pregnancy, the median HAQ increased to 0.50 in the third trimester and was reduced by the HAQ variants to 0.25. CONCLUSION: Pregnancy considerably influences the scoring of the DAS28 and HAQ. RA disease activity in pregnant patients should preferably be calculated with DAS28-CRP without GH. Even with HAQ variants, influences of pregnancy on the assessment of functionality cannot be precluded.
18641822 [Prevalence of ocular manifestation in 198 patients with rheumatoid arthritis: a retrospec 2008 May PURPOSE: To study the prevalence of eye manifestations in the local rheumatoid arthritis (RA) population, as well as to know if the presence of rheumatoid factor (RF) and antinuclear antibodies (ANA) affect this profile. To study if there is association between eye manifestations and patient's articular functional index, age at diagnosis and illness duration. METHODS: We reviewed 198 charts of rheumatoid arthritis patients followed-up from 2003 to 2006. They were studied for: prevalence of ophthalmologic manifestations, autoantibody profile, demographic data and Steinbrock's functional index. RESULTS: Secondary Sjögren's syndrome was seen in 12.1% of the patients being more common in women (p=0.049) and in patients with greater articular damage (p=0.016). Ulcerative keratitis and scleritis appeared in 2% of patients each. Antinuclear antibodies (ANA) and rheumatoid factor (RF) as well as illness duration and age at diagnosis had no influence in the appearance of eye manifestations. CONCLUSION: Secondary Sjögren syndrome was the most common ocular manifestation in patients with RA, mainly in women and patients with greater joint damage.
17963353 Femoral neuropathy in a patient with rheumatoid arthritis. 2007 Oct 31 Femoral mononeuropathy (FMN) as an extraarticular finding of rheumatoid arthritis (RA) is a phenomenon which has not been reported previously. We report a 53-year-old female patient with RA, presenting FMN findings during the course of the disease. On examination, right quadriceps and iliopsoas muscles showed grade 3 weakness on the Medical Research Council (MRC) scale. Sensory examination revealed sensory loss in the right medial leg and thigh. Patellar tendon reflex was absent in the right side. A diagnosis of a partial right femoral neuropathy was confirmed using nerve conduction study and electromyography. The probable mechanism of FMN was thought to be vasculitis.
17394856 [Endothelial dysfunction is associated with insulin resistance in patients with rheumatoid 2007 Mar 24 BACKGROUND AND OBJECTIVES: There is an increased incidence of cardiovascular disease in rheumatoid arthritis (RA). Endothelial dysfunction is an early step in atherogenesis that is related to insulin resistance (IR). Our objective was to determine the relationship between endothelial dysfunction and IR in RA patients. The presence of other cardiovascular risk factors (CVRF) and their relationship with endothelial dysfunction and inflammatory markers was also evaluated. PATIENTS AND METHOD: Twenty RA patients without cardiovascular disease were studied. CVRF, treatments, body mass index, abdominal perimeter, clinical disease activity (DAS28), erythrocyte sedimentation rate, reactive C protein, lipid profile, homocysteine and insulin resistance (QUICKI) were determined. Endothelial function was measured by laser-doppler. RESULTS: We observed a positive correlation between the QUICKI index and microvascular endothelial function. We did not observe any relationship between endothelial function and inflammatory or clinical activity. CONCLUSIONS: In our population, the presence of IR in AR patients is associated with the development of endothelial dysfunction rather than with the degree of inflammatory response.
17037396 Nodular pulmonary amyloidosis. 2006 Sep A 72-year-old woman with a diagnosis of suspected rheumatoid arthritis was admitted with multiple pulmonary nodules in the bilateral lung field. To obtain a diagnosis, a nodule was resected using video-assisted thoracic surgery. Microscopically, amorphous eosinophilic acellular substances were surrounded by inflammatory infiltrates, which were confirmed to be amyloid deposits by congo red staining. Thus, a diagnosis of pulmonary amyloidosis was obtained. The clinical features and diagnostic process are discussed.
16646983 Bone erosions in rheumatoid arthritis can be repaired through reduction in disease activit 2006 We conducted the present study to determine whether repair of erosions occurs in patients with rheumatoid arthritis (RA) treated with conventional disease-modifying anti-rheumatic drugs (DMARDs) and to compare clinical characteristics between patients exhibiting and not exhibiting erosion repair. We included in the study a total of 122 RA patients who fulfilled the 1987 American College of Rheumatology criteria for RA; all patients had paired sequential radiographs of both hands and wrists showing erosive changes at baseline. Patients were classified into two groups according to the presence of repair of erosions at follow up, namely the 'repair observed' and 'repair not observed' groups. Clinical characteristics, disease activity, radiographic scores and treatment in the two groups were compared. Forty-four repairs were observed in 13 patients (10.7%). Compared with the repair not observed group, the functional class of the patients in the repair observed group was lower at baseline (P < 0.01) and the mean disease activity was lower at follow up (P < 0.005). The changes in radiographic scores per year (total radiographic score and erosion score) were lower (P < 0.05 and P < 0.01, respectively) in the repair observed group. No difference in treatment was observed. Repair of erosions was detected in 10.7% of RA patients treated with conventional DMARDs. Repairs were associated with low functional class at baseline and low disease activity at follow up. These observations support the importance of reduction in disease activity in RA patients. Because repair of erosions was detected in a substantial number of patients, assessment of erosion repair should be incorporated into the radiographic evaluation and scoring of RA.
18172572 Anti-cyclic citrullinated peptide-2 (CCP2) autoantibodies and extra-articular manifestatio 2008 Apr The objective of our study was to establish whether there is an association between rheumatoid arthritis with extra-articular manifestations (exRA) and anti-cyclic citrullinated peptide 2 (anti-CCP2) antibodies in Greeks. A retrospective study of 220 Greek patients with RA, 95 with exRA and 125 without extra-articular manifestations (cRA). Serum anti-CCP2 antibodies and IgM rheumatoid factor (RF) were measured. CCP2(+) were 65.3% of exRA and 58.4% of cRA patients. RF(+) were 69.5% of exRA and 60.0% of cRA patients. Among exRA patients, 37.9% had high serum anti-CCP2 antibody levels (>100 IU/ml) compared to 21.6% cRA patients (p = 0.008). Serositis and pulmonary fibrosis were found to be associated with high levels of anti-CCP2 antibodies (52.9 vs 26.6%, p = 0.02 and 63.6 vs 26.8%, p = 0.008, respectively). Serum RF levels were 265.0 +/- 52.0 IU/ml (mean +/- SEM) in exRA and 205.1 +/- 40.6 (mean +/- SEM) in cRA (NS). High serum RF levels (>268 IU/ml) were more likely to have sicca syndrome. In Greek patients with rheumatoid arthritis (RA), high serum anti-CCP2 antibodies are associated with serositis and pulmonary fibrosis. Therefore, anti-CCP2 antibodies have prognostic significance in patients with RA.
17571272 [Disease-modifying effects of glucocorticoids in rheumatoid arthritis]. 2007 Oct Drugs used for managing rheumatoid arthritis (RA) are designated disease-modifying antirheumatic drugs (DMARDs) if they reduce inflammation and pain, limit joint destruction, and improve long-term disease outcome. Glucocorticoids have long been known to have anti-inflammatory, immunosuppressive, and pain-reducing effects. Moreover, they have been shown in recent clinical trials, and also very recently in a systemic analysis of the results of these studies, to contribute to inhibition of the radiographic progression of RA. For these reasons, glucocorticoids can be considered DMARDs if they are used to treat patients suffering from early RA and, according to the current knowledge, are used in combination with other DMARDs.
17338292 Classifying radiographic progression status in early rheumatoid arthritis patients using p 2007 Feb Various methods are used to measure radiographic joint damage in patients with rheumatoid arthritis (RA), but determining proportions of responsive patients is difficult. A key problem in observational studies when assessing damage outcomes is incorporating time to treatment initialization and adjusting for observed baseline differences. We examined five different definitions to select an appropriate index to classify radiographic damage in RA patients as progressive or nonprogressive. In addition, we compared different times from symptom onset to treatment and their effects on patient radiographic categorization. Propensity scores to adjust for baseline differences, including time since symptom onset, were used to match those treated early with those treated later using the stratification, radius, nearest neighbor and kernel methods. The mean effect of treatment on the treated was computed for each matching method. Observational data were analyzed for 185 early RA patients from the Western Consortium study followed six to sixty months (mean thirty-one months). For the selected index, 75 patients were categorized as nonprogressors; they had significantly lower disease activity, more clinical improvement and were treated earlier than the progressors. Of those treated within three months of symptom onset, 57% were classified as radiographically progressive versus 35% of those treated later (P = 0.0058). However, after propensity score adjustment for baseline differences, we noticed nonsignificant (P > 0.05) nonprogression in patients given earlier treatment. We conclude that propensity score analysis reduced but did not remove all bias.
17331241 A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well 2007 Mar 1 BACKGROUND: Hydrotherapy is highly valued by people with rheumatoid arthritis yet few studies have compared the benefits of exercises in heated water against exercises on land. In particular, data on quality of life is rarely reported. This is especially important because patients treated with hydrotherapy often report an enhanced sense of well-being. We report a randomised controlled trial in which we compared the effects of hydrotherapy with exercises on land on overall response to treatment, physical function and quality of life in patients with rheumatoid arthritis. METHODS: One hundred and fifteen patients with RA were randomised to receive a weekly 30-minute session of hydrotherapy or similar exercises on land for 6 weeks. Our primary outcome was a self-rated global impression of change--a measure of treatment effect on a 7-point scale ranging from 1(very much worse) to 7 (very much better) assessed immediately on completion of treatment. Secondary outcomes including EuroQol health related quality of life, EuroQol health status valuation, HAQ, 10 metre walk time and pain scores were collected at baseline, after treatment and 3 months later. Binary outcomes were analysed by Fisher's exact test and continuous variables by Wilcoxon or Mann-Whitney tests. RESULTS: Baseline characteristics of the two groups were comparable. Significantly more patients treated with hydrotherapy (40/46, 87%) were much better or very much better than the patients treated with land exercise (19/40, 47.5%), p < 0.001 Fisher's exact test. Eleven patients allocated land exercise failed to complete treatment compared with 4 patients allocated hydrotherapy (p = 0.09). Sensitivity analyses confirmed an advantage for hydrotherapy if we assumed non-completers would all not have responded (response rates 70% versus 38%; p < 0.001) or if we assumed that non-completers would have had the same response as completers (response rates 82% versus 55% p = 0.002). Ten metre walk time improved after treatment in both cases (median pre-treatment time for both groups combined 10.9 seconds, post-treatment 9.1 s, and 3 months later 9.6 s). There was however no difference between treatment groups. Similarly there were no significant differences between groups in terms of changes to HAQ, EQ-5D utility score, EQ VAS and pain VAS. CONCLUSION: Patients with RA treated with hydrotherapy are more likely to report feeling much better or very much better than those treated with land exercises immediately on completion of the treatment programme. This perceived benefit was not reflected by differences between groups in 10-metre walk times, functional scores, quality of life measures and pain scores.
17237666 Individual differences in emotional processing and reactivity to pain among older women wi 2007 Feb The purpose of the current study was to determine whether the relationship between pain and emotion may be better understood by identifying people who are more vulnerable to emotional dysregulation and those who are able to regulate emotion. Data were collected from 81 women diagnosed with rheumatoid arthritis. We assessed affect intensity, emotion regulation, active coping, neuroticism as well as weekly reports of pain, positive affect, and negative affect. Results indicated that the joint effects of emotion regulation and emotional intensity predicted emotional responses to pain. The current study suggests that the emotional impact of pain is related to emotional intensity which can be tempered by the ability to regulate emotion.
17477482 Patient perspective: fatigue as a recommended patient centered outcome measure in rheumato 2007 May The Patient Perspective Workshop at OMERACT 8 considered evidence for the importance of fatigue to patients with rheumatoid arthritis (RA) and whether measurement of fatigue meets the requirements of the OMERACT filter. The workshop participants included 20 patients from 10 countries and 60 other OMERACT participants. Introductory papers and detailed notes for discussion group members set out the evidence from the literature and from recent analyses of clinical study data available to several participants. The workshop concluded that fatigue is a symptom that is important to patients, is commonly reported by patients, is often severe, can be measured by several current instruments that pass the OMERACT filter, is responsive to some interventions, and provides information additional to that commonly obtained from currently used outcomes. The final OMERACT plenary session endorsed by a very large majority (89%) the proposal that, in addition to the "core set" of outcome measures currently in widespread use, fatigue should be measured in future studies of RA whenever possible.
16834582 The effect of Benson Relaxation Technique on rheumatoid arthritis patients: extended repor 2006 Aug Rheumatoid arthritis (RA) is a chronic disease and has the highest rate of prevalence among rheumatic inflammatory diseases. The purpose of this study was to determine the effect of Benson Relaxation Technique (BRT) combined with medication on disease activity in patients with RA. Following ethical approval, 50 consecutive matched patients were selected and allocated into two groups, either an experimental or a control group. Patients in the experimental group received BRT combined with medication and patients in the control group were given only medication. Clinical symptoms, laboratory findings, anxiety, depression and feeling of well-being were measured before and after intervention to evaluate the effect of BRT. There was a significant difference between the two groups in anxiety, depression and feeling of well-being. Changes in clinical symptoms and laboratory findings were not large enough to be statistically significant between the two groups, but they indicated decline in disease progress. The results demonstrate that BRT can be an effective technique in reducing disease process in patients suffering from RA. However, in order to support the findings of this trial, studies with large sample size and > 8-week intervention are recommended.
18044796 Developing multidisciplinary guidelines for the management of early rheumatoid arthritis. 2008 Jun OBJECTIVE: To develop an evidence based guideline, for the multidisciplinary management of early rheumatoid arthritis (RA). METHODS: Recommendations were developed using both an evidence-based approach and expert opinion. The scientific committee, composed of key members of the rheumatology multidisciplinary team used a Delphi approach to evaluate topics and standard statements, which formed the basis for developing recommendations for management of RA in the first 2 years of disease. Evidence taken from literature was used to support these recommendations. RESULTS: 24 evidence based recommendations for the management of early RA, with a grade of recommendation from A to C, were developed. In addition an algorithm of care was designed to promote a clear multidisciplinary management pathway. A mechanism for audit was also identified. CONCLUSION: Involvement of the multidisciplinary rheumatology team has enabled a holistic guideline to be developed for the management of patients presenting with early RA. This guideline is based around best practice that is supported by published literature. Whilst most statements in the guideline are based on strong evidence, others have been formulated by expert consensus in the absence of data and should serve as an opportunity to improve current practice through future research and audit. The development and implementation of such a guideline should improve the care of patients with early RA.
18557380 [The quality of life of patients who suffer from rheumatoid arthritis in reference to thei 2007 INTRODUCTION: A chronic inflammation leads to joints deformations, which in consequence results in disability and decrease in quality of life. In the 1960s, the evaluation of the treatment of patients with chronic disease started to include quality of life. THE AIM OF THE STUDY: to evaluate quality of life in patients with rheumatoid arthritis (RA) on the basis of chosen questionnaires; to determine the usefulness of chosen questionnaires in assessing quality of life of patients suffering from rheumatoid arthritis; to investigate whether quality of life of patients with rheumatoid arthritis depends on radiological and functional stage of disease, its duration, their age, sex and activity of the disease. MATERIAL AND METHODS: The study involved RA patients treated in the Department ofRheumatology and Rheumatologic Outpatient Clinic SPSK-1 in Szczecin. Patients' quality of life was evaluated with following questionnaires: Medical Outcomes Study 36-Item Short Form (SF-36), the Health Assessment Questionnaire (HAQ) and Arthritis Impact Measurement Scale (AIMS). The quality and understanding of all scales were tested with Cronbach test for reliability. The results were statistically analyzed using Spearman test, the chi2 test or the chi2 test with Yates' correction, Kruskal-Wallis test and analysis of variance and covariance. The study group consisted of 155 RA patients (117 females and 38 males). No significant differences were found between males and females in age and in degree of radiological changes. RESULTS: The value of alpha-Cronbach's reliability factor accounted 0.99, 0.93, 0.81 in AIMS, HAQ and SF-36 questionnaires respectively. There were significant correlations between questionnaires and their scales, particularly in regard to physical fitness. The correlation between HAQ score and AIMS Physical Functioning scales in total and SF Physical Functioning accounted 0.78 and 0.67 (p < 0.001) respectively. No differences in evaluation of quality of life between men and women were found. No correlation was found between both the duration of RA and the age of patients and the activity of the disease as measured with DAS 28 indicator; correlation coefficient accounted 0.07 (p = 0.39) and 0.11 (p = 0.16) respectively. However, older subjects with longer duration of a disease and more active inflammatory process assessed their quality of life as poorer (correlation coefficient between DAS 28 and HAQ, AIMS Physical Functioning scales in total, SF-36 Physical Functioning accounted = 0.44, 0.43, -0.41 respectively; p = 0.0000. In addition, the radiological and functional stage of disease influenced essentially the assessment of the quality of life in examined group. CONCLUSIONS: 1. The questionnaires used in the study: HAQ, AIMS and SF-36 were highly useful and they mutually correlated significantly in assessing quality of life of patients suffering from rheumatoid arthritis. 2. High mutual correlation of the questionnaires assessing Quality of Life of RA patients, that was found in the study, indicates, that each of them could be interchangeably used in everyday medical practice. 3. Quality of life of rheumatoid arthritis patients depends on: radiological and functional stage of the disease, its duration and activity.
17937471 Advantages and limitations of utility assessment methods in rheumatoid arthritis. 2007 Nov Utility assessment and cost-utility analyses such as costs/quality-adjusted life-years (QALY) are frequently presented to demonstrate the value of new treatment options in rheumatoid arthritis (RA). However, utility indicators require various methods that introduce significant methodological challenges, which directly influence the results and ensuing reimbursement decisions. Our objective was to review and discuss these challenges and the validity of frequently used utility assessment techniques in the context of RA. Coding the intensity of preferences or variations in patient satisfaction in order to assess utility implies extreme mathematical assumptions about a patient's rationality regarding his/her preferences towards different given health states. The construction and assumptions of commonly used "direct approaches" (standard gamble, time tradeoff, visual analog scale) and indirect approaches (EQ5D, HUI, SF6D) are presented. Other approaches such as transformation in utility of data from clinical (Health Assessment Questionnaire) or quality of life instruments ("mapping technique") are analyzed as they appear to generate uncertainty and a wide variation in estimated utility values in the context of RA. Utility assessment and cost-utility analyses in RA, which form the basis of the QALY, are frequently published and often requested by health technology assessment agencies to assist -reimbursement decisions. However, when interpreting the results, the medical community must take into consideration the limitations and significant uncertainty of these approaches. In light of these findings, real cost-effectiveness analyses based on observed clinical outcomes appear to be more robust and reliable to assist decision-making, particularly in the context of RA.
16909326 CPPD complicating other forms of inflammatory arthritis. 2007 Jul Calcium pyrophosphate deposition (CPPD) disease is confirmed as equally common in rheumatoid arthritis by synovial fluid and macroscopic skeletal examination. Furthermore, differential frequencies in rheumatoid arthritis and spondyloarthropathy provide additional insights to the "lumper-splitter" question.
17166868 Development and validation of a patient-centred Measure of Activity Limitation (MAL) in rh 2007 Apr OBJECTIVE: This study sought to understand patients' experiences of activity limitation in rheumatoid arthritis (RA) to inform the development and preliminary validation of a new patient-centred assessment tool. METHODS: Interviews, focus groups and diaries provided insight into patients' experiences of change in activity limitation. These data informed item generation for the Measure of Activity Limitation (MAL) questionnaire. Postal surveys, comprising the MAL, Short Form 36 (SF36) and Health Assessment Questionnaire (HAQ), were used to inform item reduction and assess the MAL's validity, reliability and sensitivity. RESULTS: Qualitative exploration of activity limitation with 30 patients led to the development of a 36-item questionnaire addressing the impact of symptoms on activity, difficulty in global function and difficulty in task performance. Analysis of data from a postal survey of 168 patients led to the development of a 19-item questionnaire which demonstrated moderate correlations with the HAQ and relevant scales of the SF36. A second postal questionnaire, completed on two occasions by 308 patients, assessed test-retest reliability. One hundred and ninety-three people reporting no change in disease showed mean change in MAL score between the two completions of 0.41 [95% confidence interval (CI) -0.38 -1.22)], demonstrating test-retest reliability. Thirty-two patients reporting improvement showed a mean change of -7.84 (95% CI -11.15 to -4.54) and 83 reporting deterioration showed mean change of 4.63 (95% CI 3.09-6.16), suggesting that the MAL is sensitive to self-reported clinical change. CONCLUSION: Our results suggest that the MAL is valid, reliable and sensitive to self-reported change. The MAL may provide a useful patient-centred adjunct to existing measures of activity limitation.
16968131 Harmful waste products as novel immune modulators for treating inflammatory arthritis? 2006 Sep Cope discusses a new study in rats suggesting that oxidative burst inducers might have a role to play in treating inflammatory arthritis.
16261283 Tryptophan degradation increases with stage in patients with rheumatoid arthritis. 2006 May Immune system activation is known to be involved in the progression of rheumatoid arthritis (RA). The proinflammatory cytokine interferon-gamma in various cells, including monocytes, induces the enzyme indoleamine (2,3)-dioxygenase (IDO), which converts tryptophan to kynurenine. In sera of 22 patients (17 women and 5 men) with RA stages 1 to 4 according to Steinbrocker, the concentrations of tryptophan and kynurenine were measured by high-pressure liquid chromatography. To estimate IDO activity, the kynurenine to tryptophan ratio (kyn/trp) was calculated. In parallel, concentrations of the macrophage activation marker neopterin were determined by enzyme-linked immunosorbent assay. Tryptophan concentrations were lower in patients with RA, and the decrease in serum tryptophan correlated with increase in stage (p<0.05). Kyn/trp correlated well with neopterin concentrations, which were elevated in most patients. Whereas higher C-reactive protein concentrations and erythrocyte sedimentation rates were observed in patients with greater disease activity, tryptophan and neopterin concentrations did not differ between patients with different subjective disease activity graded by the physician. Deficiency of the essential amino acid tryptophan in patients with RA most likely results from immune activation involved in the pathogenesis of the disease. It could also be relevant for the mood of patients, as tryptophan is the precursor of serotonin.