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ID PMID Title PublicationDate abstract
19121760 Pan-metatarsophalangeal joint arthrodesis for the severe rheumatoid forefoot deformity. 2009 Jan The standard approach for correction of severe painful rheumatoid forefoot deformities has involved resection of the metatarsal heads with realignment of the lesser toe deformities and first metatarsophalangeal joint (MTPJ) arthrodesis. Modifications of this procedure may include a pan-metatarsal head resection, including the first metatarsal head, or resection of the lesser metatarsal heads in conjunction with an interpositional arthroplasty of the first MTPJ. The authors describe a novel surgical approach that involves the correction of severe rheumatoid forefoot deformities through a pan-MTPJ arthrodesis. Arthrodesis of all five MTPJs for the surgical treatment of the painful rheumatoid forefoot deformity with chronic plantar callosities and dislocated digits has yet to be reported in the scientific literature. The goal of this article is to provide the treating physician with another alternative and safe surgical approach when dealing with the painful rheumatoid forefoot deformity.
20144599 Insulin resistance in early untreated rheumatoid arthritis patients. 2010 May OBJECTIVES: To assess insulin resistance in early untreated rheumatoid arthritis patients and its relation to the clinical, inflammatory and biochemical characteristics of these patients. PATIENTS AND METHODS: Sixty-six untreated rheumatoid arthritis (RA) patients with disease duration less than 1 year along with age and sex matched controls were studied. Disease activity score (DAS28) was used to assess disease activity. Plasma levels of C- reactive protein (CRP), glucose, insulin and complete lipid profile were measured. Insulin resistance (IR) was estimated by the homeostasis model assessment for insulin resistance (HOMA-IR). RESULTS: RA patients revealed high grade systemic inflammation compared to control group p<0.0001. Patients with high disease activity were more insulin resistant than patients with moderate disease activity P<0.0001. CONCLUSION: The findings of the present study showed that early untreated RA patients are characterized by a severe insulin resistant state that is driven primarily by disease activity and systemic inflammation.
19582459 Annual costs of rheumatoid arthritis in Turkey. 2010 Mar Objective of the present study is aimed to determine costs of rheumatoid arthritis (RA) based on reimbursement agencies perspective [Social Security Institution (SSI)] in Turkey. The international clinical guidelines for RA are followed for analysing the direct costs. Data were collected from hospital bills, social security institution price lists, and Ministry of Health drug price list. Direct costs of RA patients were estimated as euro 2,669.14 patient/year. Outpatient costs were found to be euro 240.40. Routine tests during the year were calculated as euro 98.85. Ten percent of patients are hospitalized per year, and 0.62% of these patients received arthroplasty and/or other interventions. The cost during hospital stay was euro 87.76. euro 2,238 was determined as being paid per year for medication alone (including anti-TNF) and euro 4 is spent on auxiliary materials annually. Our data show a remarkable economic impact of RA over society. We hope that the cost of RA studies will help package price practices for reimbursement agencies.
20408458 [Late-onset rheumatoid arthritis: clinical presentation and management]. 2010 Mar 17 Onset of rheumatoid arthritis in an elderly patient is common, in fact more common than in younger subject. If the reality of true differences in clinical presentation between younger and older subjects remained discussed, the central point remains that the prognosis is not better in older patients. Finally, conventional disease-modifying antirheumatic drugs (DMARD) and biological treatments are as efficient and safe than in younger patients, and the same strict management objectives used for younger subjects must be applied in the elderly.
19908947 Societal cost of rheumatoid arthritis patients in the US. 2010 Jan OBJECTIVE: To estimate comprehensive cost of rheumatoid arthritis (RA) patients to society and individual stakeholders, including patients/employees, employers, family members/caregivers, and government. RESEARCH DESIGN AND METHODS: Administrative claims databases covering privately insured and Medicare and Medicaid beneficiaries in the US were used to compute the excess payer and beneficiary-paid costs per patient with RA compared with matched controls. Similarly, per-person excess costs for caregivers and uninsured patients with RA were estimated. Costs were estimated for other burdens, including costs of work-loss to employers, adaptations to home and work environments, lost on-the-job productivity, informal and hired care/household help, and job turnover costs. Intangible costs associated with quality-of-life deterioration were estimated based on legal system jury awards, whereas costs for premature mortality were based on lifetime earnings data. Per-capita cost estimates were weighted by the relevant population to estimate societal costs. Because data were incomplete, several assumptions were required; these assumptions could lead to an over- or under-estimation of cost burdens. RESULTS: Annual excess health care costs of RA patients were $8.4 billion, and costs of other RA consequences were $10.9 billion. These costs translate to a total annual cost of $19.3 billion. From a stakeholder perspective, 33% of the total cost was allocated to employers, 28% to patients, 20% to the government, and 19% to caregivers. Adding intangible costs of quality-of-life deterioration ($10.3 billion) and premature mortality ($9.6 billion), total annual societal costs of RA (direct, indirect, and intangible) increased to $39.2 billion. CONCLUSIONS: Societal costs of RA in the US are $19.3 billion and $39.2 billion (in 2005 dollars) without and with intangible costs, respectively. This study was one of the first to attempt to quantify the comprehensive burdens of RA. Despite several assumptions made in areas in which few data exist, the findings generate useful insights into the full burden of RA.
20524027 Body image in patients with rheumatoid arthritis. 2010 Oct We investigated body image in patients with rheumatoid arthritis (RA), correlating it with self-esteem, function, and quality of life. Forty-three RA patients and 39 control individuals from the community between 18 and 70 years of age and paired for gender, age, and body mass index (BMI) were evaluated. Patients were assessed for body image [Body Dysmorphic Disorder Examination (BDDE)], self-esteem (Rosenberg Self-Esteem Scale), function [Health Assessment Questionnaire (HAQ)] and quality of life [Short Form-36 (SF-36)]. The RA group had a mean age of 51.6 years, BMI 26.01, and disease duration 12.2 years. Most participants were categorized in functional class I. The BDDE score of the RA group (51.8) was significantly higher than in the control group (22.6) (p < 0.001). Rosenberg Self-Esteem Scale, HAQ and some SF-36 subscales were worse in the RA group than in the control group. These scores had a direct correlation with body image scores (p < 0.001). Individuals with RA had a worse body image than individuals without this condition. Body image was directly correlated with self-esteem, function, and quality of life.
20809061 Validation of the comprehensive ICF Core Set for rheumatoid arthritis: the perspective of 2010 Sep OBJECTIVE: The "Comprehensive ICF Core Set for rheumatoid arthritis" represents the typical spectrum of problems in functioning of patients with rheumatoid arthritis according to the International Classification of Functioning, Disability and Health (ICF). The objective of this study was to validate this ICF Core Set from the perspective of physicians. METHODS: Physicians experienced in rheumatoid arthritis treatment were asked about the problems they commonly treat in patients with rheumatoid arthritis in a 3-round survey using the Delphi technique. Responses were linked to the ICF. RESULTS: Seventy-nine physicians in 41 countries named 512 patients' problems. Two hundred and 27 ICF categories were linked to these answers. Twenty-six ICF categories were not represented in the Comprehensive ICF Core Set for rheumatoid arthritis and 19 aspects were not covered by the ICF. CONCLUSION: The content validity of 3 ICF components was well supported. However, several body functions were identified that are not covered and need to be investigated further.
19332634 Remission in rheumatoid arthritis: physician and patient perspectives. 2009 May OBJECTIVE: To examine the prevalence of remission in rheumatoid arthritis (RA) as determined by physicians and patients independently, and to determine the degree of agreement among methods, the strength of predictor variables of remission, and the length of remission. METHODS: Eight hundred patients with RA completed a remission questionnaire on the day of their rheumatologist visit and their rheumatologists completed a separate questionnaire the same day. The question(s) were: "Given all your experience with disease activity in RA, are you [is your patient] currently in remission?". Patients also completed 0-10 visual analog scales for RA activity, pain, and functional limitation. RESULTS: The percentage of patients in remission by physician and patient assessment was 34.8% [95% confidence interval (CI) 31.4-38.2] and 30.9% (95% CI 27.7-34.20), respectively. The percentage of patients classified concordantly (full agreement) was 78.6%, and the associated kappa statistic was 0.54 (95% CI 0.45-0.58). The median duration of remission was 2.0 years. The median RA activity, pain, and functional scores were 1.0, 1.5, and 1.25 for patient-determined remission and 1.5, 1.5, and 1.5 for physician-determined remission. CONCLUSION: Physician and patient estimates of remission in RA are similar (34.8% to 30.9%), and agreement was 78.6% (kappa 0.53). Based on previous data and the observed presence of disease activity, this definition of remission appears to be a measure of minimal disease activity rather than true remission. The problem of remission rates will not be solved until a consensus definition that has relevance in research and the clinic is developed.
19698804 Psychological stress in rheumatoid arthritis patients: a comparative Polish-German study: 2010 Feb Cultural differences in experiencing individual stress in rheumatoid arthritis (RA) patients might be observed. The aim of the study was to assess quality of life and psychological stress (distress) in RA patients, and to evaluate socio-demographic and disease specific variables predicting stress of patients. The study covered 300 Polish and 137 German RA patients. SF-36v2 scale was used to evaluate the patients' health. Psychological stress was defined as the feeling of "social isolation" and "being a burden" as demanding help in everyday activities. In both countries, the mental and physical health of patients deteriorated and about 50% of patients required support in everyday activities. 95% of Polish and 62% of German patients felt rejected from social activities. For the psychological stress perceived, functional capacity class 3 and male gender were shown to be predictive in Polish patients and living in a small town - in German patients. In the Polish group, the tertiary/bachelor level of education was linked with lower distress level. RA has a serious impact on the mental health owing to a great disease burden. Awareness of impact of the disease on quality of life and psychological stress of patients should be considered in routine clinical practice.
20473757 Incidence of malignancy in Japanese patients with rheumatoid arthritis. 2011 Nov To determine the incidence of malignancy and site-specific malignancies in Japanese patients with rheumatoid arthritis (RA). In a prospective large observational cohort study named IORRA, 7,566 patients with RA were enrolled from April 2001 to April 2005 and were followed up to October 2005. Occurrence of malignancy was originally collected by patient reports of IORRA survey biannually from April 2001 to October 2005, and was confirmed by medical records. Standardized incidence rate (SIR) of the observed-to-expected cancer incidence and 95% confidence intervals (95% CI) were then calculated. Factors obtained at first enrollment in IORRA were assessed for association with risk of malignancy using the Cox proportional hazards model. A total of 177 malignancies in 173 patients (58 in men, 115 in women) were identified during the observation period of 25,567 person-years. The age- and sex-standardized incidence rate of malignancy was 437.1 (men, 706.8; women, 366.1) per 100,000 person-years. The SIR of malignancy was slightly excess (SIR 1.18, [95% CI 1.02-1.37]) in all patients, but 1.29 (95% CI 0.99-1.67) in men, and 1.13 (95% CI 0.94-1.36) in women. A significant excess of lymphoma (SIR 6.07, [95% CI 3.71-9.37]) and lung cancer (SIR 2.29, [95% CI 1.57-3.21]), whereas decreased incidence of colorectal cancer (SIR 0.49, [95% CI 0.26-0.83]), were found. Male gender and older age were identified as risk factors for malignancy. A slight excess in the incidence of overall malignancy and highly excess of lymphoma in Japanese RA patients was demonstrated.
21049240 Wrist ultrasound analysis of patients with early rheumatoid arthritis. 2011 Jan In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS) and gray scale ultrasound (GSUS) with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men) with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP). The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz) transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546), GSUS of right wrist and swelling of left wrist (r = 0.511), PDUS of right wrist and pain in left wrist (r = 0.436), PDUS of right wrist and C-reactive protein (r = 0.466). Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.
21044428 How does methotrexate suppress inflammation? 2010 Sep Methotrexate remains the most widely used agent for the treatment of rheumatoid arthritis and other chronic inflammatory diseases. Although introduced as a chemotherapeutic agent for the treatment of malignancies, it is clear that, in the doses used, the mechanism of action in the suppression of inflammation differs from simply suppression of purine and pyrimidine metabolism, resulting in inhibition of proliferation. Here we review the proposed mechanisms of action of methotrexate.
20084988 Socio-demographic and clinical aspects of rheumatoid arthritis. 2009 May OBJECTIVE: To determine the socio-demographic profiles and some clinical aspects of patients with rheumatoid arthritis (RA). DESIGN: Prospective, cross-sectional study. SETTING: Ambulatory out- patient clinics of Kenyatta National Hospital (KNH), a public national and referral hospital. SUBJECTS: Out of 180 patients interviewed and examined, 60 met American College of Rheumatology (ACR) diagnostic criteria of RA. RESULTS: Of the 60 patients recruited 52 (87%) were females with male: female ratio of 1: 6.5. The mean age of patients was 41.38(+/- 16.8) years. There were two peaks of age of occurrence, 20-29 and 40-49 years. In 75% of the study patients, one or more of metacarpophalangeal joints of the hand were involved in the disease. Other frequently involved sites were--wrists, elbows, knees, ankles and glenohumeral joints of shoulders in a symmetrical manner. Serum rheumatoid factor was positive in 78.9% while rheumatoid nodules were present in 13.3% of the study patients. A large majority of patients (88%) had active disease with 18% having mild disease, 38% moderate activity and 32% having severe disease. Only 12% of patients had disease in remission. Forty six point seven per cent (46.7%) of the study patients were on at least one Disease Modifying anti Rheumatic Drugs (DMARD) from a selection of methotrexate, sulphasalazine, hydroxychloroquine and leflunamide. The most frequent drug combination was methotrexate plus prednisolone at 30% of the study population; while 66.7% were on oral prednisolone with 25% of the study patients taking only Non-Steroidal anti Inflammatory Drugs (NSAIDS). CONCLUSION: A large majority of ambulatory patients with RA had active disease. Most of them were sub-optimally treated, especially the use of DMARDS. About two thirds were on oral steroids. Sub-optimal therapy in relatively young patients, peak 20-29 and 40-49 years is likely to impact negatively on their disease control and quality of life.
19806287 Diagnosis and referral of rheumatoid arthritis by primary care physician: results of a pil 2010 Jan The aims of the present study were to evaluate, in the city of Pisa: (1) the prevalence of rheumatoid arthritis; (2) the reliability of the prevalence estimated by primary care physicians, using the rheumatologist's diagnosis as the "gold standard" and (3) the economic impact of the disease. The Tuscany registry of primary care physicians constituted the framework from which a sample of subjects was selected. The rheumatoid arthritis (RA) subjects >18 years followed by each primary care physician constituted the population studied. Each general practitioner (GP) was asked to fill out a questionnaire regarding their patients affected by RA and to send it to the tertiary rheumatologic centre, where the diagnosis was confirmed/discarded, the clinical and epidemiological data were collected in a standardized form and a number of data for the estimation of costs were gathered. The estimated prevalence of RA was 5.1 per thousand (CI, 4.4-5.7). The reliability of general practitioners in the diagnosis of rheumatoid arthritis was on the whole 69%. However, when an analysis of every physician was carried out, a high degree of heterogeneity in the prevalence of RA per physician was found. Overall, the mean annual cost per patient with RA was estimated at about 5,878 euro (euro; median, 6,434 euro; inter quartile range, 669-7,052 euro), with a high variability mainly dependent on the degree of patient disability. More than 90% of the overall annual cost per patient was due to the medical and non-medical direct components of costs. The prevalence of RA in Tuscany seems highly comparable with similar prevalence studies in Italy. The annual cost per patient with RA was highly variable and strictly dependent on the level of disability. More than 90% of the overall cost was due to the direct burden of costs.
21161308 Early rheumatoid arthritis-do we really know what it means? Consistency and distribution o 2011 Apr This study aims to characterize patients with early rheumatoid arthritis (RA) based on different definitions of early RA (disease duration, fulfillment of the American College of Rheumatology (ACR) criteria), and to determine whether these different definitions affect magnetic resonance imaging (MRI) findings of the hand. A cohort of 58 patients with early RA previously described was re-evaluated. There were 43 women and 15 men with a median age of 49 years, a disease duration of less than 2 years, and negative radiographs who were followed up for 6-41 months. MR images of the hand and wrist of these patients were retrospectively evaluated for the presence of synovitis, erosions, and tenosynovitis. The presence and distribution of these MRI findings were analyzed in three groups: fulfillment of 1987-ACR criteria, 6-month disease duration, and 12-month disease duration. Median disease duration was 11 months (range 1-24 months). Thirty patients (52%) fulfilled the ACR criteria. More patients fulfilling ACR criteria had MCP erosions and carpal synovitis compared with those not fulfilling the criteria; however, the difference was not significant. No significant difference was seen in the prevalence of synovitis, tenosynovitis, or erosions between the three groups. Patients with early RA of 2-years duration and negative hand X-ray findings are a homogenous group, regarding their MRI findings.
19252253 [IL-6 targeting therapy to retard structural joint damage in patients with rheumatoid arth 2009 Mar Tocilizumab has been shown to have strong effect to retard the progression of structural joint damage in patients with rheumatoid arthritis. It was approved not only for signs and symptoms but also structural joint damage of rheumatoid arthritis in Japan. In this review, the efficacy, utility, positioning, and the future prospect will be discussed.
21123324 Direct cost-modeling of rheumatoid arthritis according to disease activity categories in F 2011 Mar OBJECTIVE: The objective of this cost-of-illness study was to assess the use of direct medical resources, excluding drug costs, by patients with rheumatoid arthritis (RA) in France, and to construct cost estimates according to level of disease activity. METHODS: Three categories of RA disease activity were defined according to Disease Activity Score 28-joint count (DAS28) thresholds: remission (DAS28 < 2.6), low disease activity state (LDAS; i.e., DAS28 ≤ 3.2), and moderate to high disease activity (MHDAS; i.e., DAS28 > 3.2). Eight resource utilization items were defined: medical visits, laboratory tests, hospitalization, imaging, physiotherapy, nursing, adaptive aids, and transportation. Resource utilization and unit costs from the national-payer perspective were estimated through expert opinion and simulated using distribution ranges for each item. Cost distributions were computed by Monte-Carlo simulations estimating overall costs per 6 months over a 2-year period. RESULTS: For patients achieving remission, costs were estimated at a mean of €771 (SD 199) for the first 6 months and at €511 (SD 162) for each subsequent 6-month period. For patients achieving LDAS, costs were estimated at €905 (SD 263) for the first 6 months and €696 (SD 240) for each subsequent 6-month period. For patients in MHDAS, costs were estimated at €1215 per 6 months (SD 405). CONCLUSION: This cost-of-illness assessment provided current estimates of direct medical costs for RA according to disease activity in France. The findings suggest that achieving remission or LDAS is associated with substantially lower medical costs for RA versus being in MHDAS.
19643759 Disparities in rheumatoid arthritis disease activity according to gross domestic product i 2009 Nov OBJECTIVE: To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country. METHODS: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 "high GDP" countries with GDP per capita greater than US$24,000 and 11 "low GDP" countries with GDP per capita less than US$11,000. RESULTS: Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between "high GDP" and "low GDP" countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents. CONCLUSIONS: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in "low GDP" than in "high GDP" countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries.
20544165 Prediction of walking disability by disease-related factors in patients with rheumatoid ar 2010 May OBJECTIVE: To investigate the relationship between disease-related factors and walking disability in different phases of rheumatoid arthritis; and to predict future walking disability in rheumatoid arthritis, using disease-related factors assessed 2 years after diagnosis. METHODS: A cohort of 848 newly diagnosed patients with rheumatoid arthritis was followed up for a maximum of 8 years. Walking disability and several disease-related and demographic factors were recorded during follow-up. A logistic regression model was used to study associations between walking disability and these factors at different time points. A multilevel logistic regression model for longitudinal data was used to predict walking disability during follow-up from potential predictors at year 2. RESULTS: Global pain and disease activity were consistently related to walking disability at almost every time point. Significant predictors of future walking disability were: walking disability, knee pain, global pain, the passage of time during follow-up, and age. CONCLUSION: Global pain and disease activity are related to walking disability during the first 8 years of RA. Walking disability, knee pain, and global pain at 2 years follow-up predict walking disability later in the disease. In addition, the risk for walking disability increases during the disease process and with higher age at diagnosis.
21071175 Novel autoantibody markers for early and seronegative rheumatoid arthritis. 2011 Feb Approximately one-third of rheumatoid arthritis (RA) patients are seronegative for the 2 serological RA markers, rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (ACCP). Moreover, the sensitivities of both markers are lower in the diagnostically important early disease phase. The aim of this study was to identify additional autoantibody markers for early RA and for RF-negative, ACCP-negative (seronegative) RA. We screened an RA synovium cDNA phage display library with autoantibodies in plasma from 10 early (symptoms of maximum 1 year) and 10 seronegative (RF-negative, ACCP-negative) RA patients with validation in 72 additional RA patients and 121 controls (38 healthy controls, 43 patients with other inflammatory rheumatic diseases, 20 osteoarthritis patients and 20 subjects with mechanical joint complaints). Fourteen novel autoantibodies were identified that showed a 54% sensitivity and 90% specificity for RA. For 11 of these autoantibodies, an exclusive presence was demonstrated in RA patients (100% specificity, 37% sensitivity) as compared to controls. All early RA patients were positive for at least one of the identified autoantibodies and antibody-positivity was associated with a shorter disease duration (P = 0.0087). 52% of RA patients who initially tested negative for RF and ACCP, tested positive for at least one of the 14 novel autoantibodies, resulting in a 19% increase in sensitivity compared to current serological testing. Moreover, 5 identified autoantibodies were detected more frequently in seronegative RA patients, indicating that these autoantibodies constitute novel candidate markers for this RA subtype. We demonstrated that the targets of 3 of these 5 autoantibodies had an increased expression in RA synovial tissue compared to control synovial tissue, pointing towards a biological rationale for these auto antibody targets in RA. In conclusion, we identified novel candidate autoantibody markers for RA that can be detected in early and seronegative RA patients indicating the potential added value for RA diagnostics.