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ID PMID Title PublicationDate abstract
20796267 Burden of anemia in patients with osteoarthritis and rheumatoid arthritis in French second 2010 Aug 26 BACKGROUND: Arthritic disorders can be the cause of hospitalizations, especially among individuals 60 years and older. The objective of this study is to investigate associations between health care resource utilization in arthritis patients with and without concomitant anemia in a secondary care setting in France. METHODS: This retrospective cohort study utilized data on secondary care activity in 2001 from the Programme de Médicalisation des Systèmes d'Information database. Two cohorts were defined using ICD-10 codes: patients with an arthritis diagnosis with a concomitant diagnosis of anemia; and arthritis patients without anemia. Health care resource utilization for both populations was analyzed separately in public and private hospitals. Study outcomes were compared between the cohorts using standard bivariate and multivariable methods. RESULTS: There were 300,865 hospitalizations for patients with arthritis only, and 2,744 for those with concomitant anemia. Over 70% of patients with concomitant anemia were in public hospitals, compared with 53.5% of arthritis-only patients. Arthritis patients without anemia were younger than those with concomitant anemia (mean age 66.7 vs 74.6, public hospitals; 67.1 vs 72.2, private hospitals). Patients with concomitant anemia/arthritis only had a mean length of stay of 11.91 (SD 14.07)/8.04 (SD 9.93) days in public hospitals, and 10.68 (SD 10.16)/9.83 (SD 7.76) days in private hospitals. After adjusting for confounders, the mean (95% CI) additional length of stay for arthritis patients with concomitant anemia, compared with those with arthritis only, was 1.56 (1.14-1.98) days in public and 0.69 (0.22-1.16) days in private hospitals. Costs per hospitalization were €;480 (227-734) greater for arthritis patients with anemia in public hospitals, and €;30 (-113-52) less in private hospitals, than for arthritis-only patients. CONCLUSIONS: Arthritis patients with concomitant anemia have a longer length of stay, undergo more procedures, and have higher hospitalization costs than nonanemic arthritis patients in public hospitals in France. In private hospitals, concomitant anemia was associated with modest increases in length of stay and number of procedures; however, this did not translate into higher costs. Such evidence of anemia-related health care utilization and costs can be considered as a proxy for the clinical significance of anemia.
19531760 Which measure of inflammation to use? A comparison of erythrocyte sedimentation rate and C 2009 Aug OBJECTIVE: To assess clinical utility of measurements of C-reactive protein (CRP) versus Westergren erythrocyte sedimentation rate (ESR) in evaluating patients with rheumatoid arthritis (RA). METHODS: Data from 3 randomized clinical trials of golimumab involving 1247 patients with RA in which ESR and CRP were obtained at baseline and Week 24, along with standard measures of clinical disease activity [swollen and tender joint counts, global disease activity assessment, composite Disease Activity Scores (DAS) and Clinical Disease Activity Index (CDAI)], were utilized. Result. Both ESR and CRP were significant predictors of swollen joint count (p < 0.001 for each). Only 4.5% of patients with no swollen joints had elevated CRP and normal ESR, but 15.2% had elevated ESR and normal CRP. ESR and CRP correlated significantly (Pearson r = 0.59, p < 0.001) with each other. DAS-ESR and DAS-CRP were highly correlated (r = 0.96, p < 0.001) with each other, although DAS-ESR values were slightly lower than the DAS-CRP values at the upper end of the range (DAS > 8). Both ESR and CRP were significantly associated with CDAI (p < 0.001 for each). CONCLUSION: It is not necessary to obtain both ESR and CRP measures for clinical disease activity assessment in clinical trials of RA. Neither test adds significantly to clinical measures of disease activity including joint counts and global assessments. Where available, the CRP alone may be preferred for disease activity assessment as a simple, validated, reproducible, non age-dependent test.
21140264 Synovial/serum leptin ratio in rheumatoid arthritis: the association with activity and ero 2012 Mar Reports suggest leptin, which was initially described as a hormone that regulates food intake and energy balance, has an intimate relationship, and interacts with the immune system. Leptin consumption in the synovial cavity in patients with rheumatoid arthritis (RA) reported to have protective effect against erosion. To determine the difference in serum leptin and synovial/serum leptin ratio between RA and control and to assess whether these parameters correlate with systemic inflammation in RA. Also, the hypothesis that synovial/serum leptin ratio could be linked to joint erosion in RA was evaluated. The study subjects consisted of 40 consecutive patients with RA, 30 patients of them had knee effusion, and 30 controls. Ten of these controls had acute knee injury and their synovial fluid was obtained for comparison of synovial/serum leptin ratio with patients with RA. The mean serum leptin in patients with RA was significantly higher than controls. Also, the synovial leptin and synovial/serum leptin ratio in the RA patients with effusion was significantly higher than in the 10 control subjects with traumatic effusion. Serum leptin in the 30 RA patients with effusion was higher than the matched synovial leptin. In RA patients with effusion, synovial/serum leptin ratio was also significantly higher in RA patients with erosion than RA patients without erosion. Serum leptin level and synovial/serum leptin ratio are significantly correlated with the RA duration, DAS28, ESR, CRP, TNF-α, and IL-6. Finally, in regression analysis, only the synovial/serum leptin ratio was positively associated with erosion in patients with RA. In RA, there is a significant increase in circulating leptin levels and synovial/serum leptin ratio compared to non-RA controls. Serum leptin and synovial/serum leptin ratio are significantly in erosive RA than non-erosive RA. Both parameters are correlated with disease duration and parameters of RA activity. In regression analysis, only the synovial/serum leptin ratio was positively associated with erosion in patients with RA. These results indicate that local consumption of leptin in the joint cavity has a protective role against the destructive course of RA.
19369462 Less radiographic progression with adalimumab plus methotrexate versus methotrexate monoth 2009 Jul OBJECTIVE: To determine the relationship between radiographic progression and clinical response for adalimumab plus methotrexate (MTX) versus either monotherapy in patients with early rheumatoid arthritis (RA) in the PREMIER study. METHODS: Patients with early RA who received adalimumab plus MTX (n = 240), adalimumab (n = 222), or MTX (n = 216) were grouped by American College of Rheumatology (ACR) response, 28-joint Disease Activity Score (DAS28), or remission-like state [tender joint count (TJC) = 0; DAS28 < 2.6; swollen joint count = 0; ACR100] at 26 and 104 weeks. Radiographic progression was assessed by cumulative probability plots, mean changes in total Sharp score (DeltaTSS), and percentages of progressors (DeltaTSS > 0.5). RESULTS: Across the spectrum of clinical outcomes, including ACR20 nonresponses and remission-like responses, therapy with adalimumab plus MTX permitted less radiographic progression at Weeks 26 and 104 than MTX monotherapy. Adalimumab monotherapy was generally intermediate. A strong, proportional relationship was observed between clinical response and radiographic efficacy only for MTX monotherapy. The monotherapies approximated the radiographic efficacy of adalimumab plus MTX only among remission-like responders, although progression was significantly greater with MTX monotherapy versus adalimumab plus MTX for patients with TJC = 0. Concurrent clinical (DAS28 < 2.6) and radiographic (DeltaTSS
19822047 Extra-articular manifestations. 2009 Jul Rheumatoid arthritis and spondyloarthritis, a concept which includes diseases like ankylosing spondylitis, psoriatic arthritis, and arthritis/spondylitis associated with inflammatory bowel disease, are both chronic inflammatory rheumatologic conditions. This article focuses on extra-articular manifestations, defined as diseases and symptoms not directly related to the locomotor system. The different manifestations are addressed per body system. Diagnostic and prognostic implications of these manifestations in daily practice are discussed.
18693126 Association of transforming growth factor beta1 gene polymorphism with rheumatoid arthriti 2009 Jan OBJECTIVE: Cytokine genes play important roles in the pathogenesis of rheumatoid arthritis (RA). In RA, the plasma and synovial fluid levels of transforming growth factor beta1 (TGFbeta1) have been shown to be raised. The aim of this study was to investigate the relationship between the TGFbeta1 T869C polymorphism and RA in a Turkish population. METHODS: One hundred and thirty-one patients with a clinical diagnosis of RA and 133 healthy controls were enrolled in this study. Analyses of TGFbeta1 T869C gene were made by the polymerase chain reaction-restriction fragment length polymorphism technique. RESULTS: There was no significant difference in genotypic frequency of TGFbeta1 T869C polymorphism between the patients with RA (TT:TC:CC=42.7%:41.2%:16%) and controls (TT:TC:CC=36.1%:48.1%:15.8%) (p=0.48). The age at first occurrence of clinical symptoms of RA did not differ significantly in relation to TGFbeta1 T869C genotypes (p=0.07). Furthermore, there was no significant association between TGFbeta1 T869C genotypes and the presence or absence of radiographic erosions in the patient group (p=0.67). But presence of T allele was associated with 1.92-fold increased risk for RF positivity (p=0.02, OR=1.92, 95% CI=1.08-3.40). CONCLUSION: The allele frequencies for TGFbeta1 T869C polymorphism in RA patients were similar to those in the control group. However, the T allele carriers had 1.92-fold increased risk for RF positivity. Further studies on larger numbers of cases and on the other polymorphic regions of this gene are needed before definite conclusions can be drawn about the role of TGFbeta1 in the etiology of RA.
19228658 Hidden cost of rheumatoid arthritis (RA): estimating cost of comorbid cardiovascular disea 2009 Apr OBJECTIVE: To examine resource utilization and direct healthcare cost associated with comorbid cardiovascular disease (CVD) and depression among patients with prevalent rheumatoid arthritis (RA) based on analyses of retrospective healthcare claims data. METHODS: The index date was set as the first observed claim with an RA diagnosis. Patients were required to be >or=18 years of age, to have received RA-related treatment during the pre-index period, and to have 12-month pre- and post-index data. Based on pre-index utilization, patients were classified into 4 diagnosis groups: RA alone, RA+CVD, RA+depression, and RA+CVD+depression. Analyses focused on annual differences in costs between patients with RA alone and those with CVD and/or depression. A generalized linear model was applied to control for demographic and clinical characteristics and to estimate cohort-specific adjusted mean annual healthcare cost. RESULTS: Of 10,298 patients, 8,916 had RA alone (86.6%), 608 had RA+CVD (5.9%), 716 had RA+depression (7.0%), and 58 had RA+CVD+depression (0.5%). All patients with CVD and/or depression incurred significantly higher followup costs compared with patients with RA alone. Adjusted annual mean healthcare costs were highest for RA+CVD (US$14,145), followed by RA+CVD+depression ($13,513), RA+depression ($12,225), and RA alone ($11,404). Although patients with CVD and/or depression had a greater rate of RA-related hospitalization, adjusted RA-related healthcare costs did not reflect any statistically significant differences as compared to the RA-alone cohort. CONCLUSION: A significant proportion (13.4%) of patients with prevalent RA have comorbid CVD and/or depression. The presence of these conditions significantly affects annual healthcare costs as well as specific RA-related utilization patterns.
20510231 Preclinical rheumatoid arthritis: identification, evaluation, and future directions for in 2010 May Rheumatoid arthritis (RA) likely develops in several phases, beginning with genetic risk, followed by asymptomatic autoimmunity, then finally, clinically apparent disease. Investigating the phases of disease that exist prior to the onset of symptoms (ie, the preclinical period of RA) will lead to understanding of the important relationships between genetic and environmental factors that may lead to disease, as well as allow for the development of predictive models for disease, and ultimately preventive strategies for RA.
19995752 The role of cell-substrate interaction in regulating osteoclast activation: potential impl 2010 Jan Analysis of tissues retrieved from the bone-pannus interface from patients with rheumatoid arthritis (RA) and studies in animal models of inflammatory arthritis provide strong evidence that osteoclasts, the cells that are essential for physiological bone resorption, are responsible for articular bone destruction in RA. However, current treatments that specifically target osteoclast-mediated bone resorption in RA have not been successful in preventing bone erosions, and new therapeutic strategies are needed. It has been noted that, although osteoclast precursors are present within the bone microenvironment at sites of pathological bone resorption, cells expressing the full morphological and functional properties of mature osteoclasts are restricted to the immediate bone surface and adjacent calcified cartilage. These findings provide evidence that, in addition to requirements for specific cytokines, interaction of osteoclast precursors with these mineralised matrices results in activation of specific signal pathways and the induction of unique gene products that are essential for terminal osteoclast differentiation and activation. These studies are designed to define the gene products and signalling pathways regulated by bone and calcified cartilage, to identify new molecular targets and novel therapeutic approaches for preventing osteoclast-mediated joint destruction in RA and related forms of pathological bone loss.
19950322 Neurologic outcome of surgical and conservative treatment of rheumatoid cervical spine sub 2009 Dec 15 OBJECTIVE: Rheumatoid arthritis commonly involves the upper cervical spine and can cause significant neurologic morbidity and mortality. However, there is no consensus on the optimal timing for surgical intervention: whether surgery should be performed prophylactically or once neurologic deficits have become apparent. METHODS: A systematic review of the literature was performed to analyze neurologic outcome (Ranawat) and survival time (Kaplan-Meier) after surgical or conservative treatment using the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation system) criteria. RESULTS: Twenty-five observational studies were selected. No randomized controlled trials (RCTs) could be found. All of the studies had a high risk of bias. Twenty-three studies reported the neurologic outcome after surgery for 752 patients. Neurologic deterioration rarely occurred in Ranawat I and II patients. Ranawat III patients did not fully recover. The 10-year survival rates were 77%, 63%, 47%, and 30% for Ranawat I, II, IIIA, and IIIB, respectively. The Ranawat IIIB patients had a significantly worse outcome. Another 185 patients treated conservatively were described in 7 studies. Neurologic deterioration rarely occurred in Ranawat I patients, but was almost inevitable in Ranawat II, IIIA, and IIIB patients. The Kaplan-Meier analysis showed a 10-year overall survival rate of 40%. CONCLUSION: There are no RCTs that compared surgery with conservative treatment. In observational studies, surgical neurologic outcomes were better than conservative treatment in all patients with cervical spine involvement, and in asymptomatic patients with no neurologic impairment (Ranawat I) the outcomes were similar; however, the evidence is weak. Survival time of surgical and conservative treatment could not be compared.
20473760 Cost-effectiveness treatment with Rituximab in patients with rheumatoid arthritis in real 2011 Nov The cost-effectiveness of treatments that have the potential to change the "natural history" of a chronic progressive disease has to be evaluated over the long term. Cost-effectiveness estimates have been based on the concept that, with treatment, patients will not progress to the next level(s) of disease severity or will take a longer time to progress, thus avoiding or delaying the high costs and low utility associated with more severe disease. This analysis focused on the use of Rituximab in treating patients with moderate to severe RA for whom at least one anti-TNFα blocking agent had failed. The aim of our study was to evaluate the cost-effectiveness in 32 patients with rheumatoid arthritis in therapy with a single infusion of Rituximab 1,000 mg given on days 1 and 15 of each month for 1 year. After 6 months of treatment, we observed for all 32 patients a total quality-adjusted life year (QALY) gained of 11,840 with an average of 0.37 QALY for a single patient, a treatment cost of euro 5,610 and a QALY/cost ICER (incremental cost-effectiveness ratio) of euro 15,114. After 1 year of treatment, we observed data for 28 patients with a total QALY gained of 11,480 with an average of 0.41 QALY for a single patient, a treatment cost of euro 9,690 and a QALY/cost ICER (incremental cost-effectiveness ratio) of euro 23,696. The benefit of using Rituximab is cost-effectiveness with a QALY/gained under the acceptable threshold of euro 50,000 in our observational study. These are important data for discussion from the economic point of view when we choose a biologic therapy for rheumatoid arthritis in clinical practice.
19444453 Association of anti-CCP positivity with serum ferritin and DAS-28. 2009 Dec Antibodies to cyclic citrullinated peptides (anti-CCP) are highly specific for the diagnosis of rheumatoid arthritis (RA) with a marginal increased prediction of the disease. In this study, we aimed to investigate the relation of the presence of anti-CCP with clinical manifestations and disease activity in a cohort of RA patients. A total of 61 RA patients were included in this study. Data of disease-related parameters such as duration of disease, medications, degree of pain (visual analog scale, VAS), disease activity score 28 (DAS-28) and health assessment questionnaire (HAQ) were recorded. Laboratory workup included erythrocyte sedimentation rate (ESR), plasma C-reactive protein (CRP), rheumatoid factor (RF), anti-CCP, complete blood count and anemia parameters. Anti-CCP positivity was associated with higher scores of DAS-28, longer duration of morning stiffness, serum RF positivity and low levels of serum ferritin, while it was not associated with disease duration, VAS, HAQ, ESR, CRP and hemoglobin.
19924712 Multistage analysis strategies for genome-wide association studies: summary of group 3 con 2009 This contribution summarizes the work done by six independent teams of investigators to identify the genetic and non-genetic variants that work together or independently to predispose to disease. The theme addressed in these studies is multistage strategies in the context of genome-wide association studies (GWAS). The work performed comes from Group 3 of the Genetic Analysis Workshop 16 held in St. Louis, Missouri in September 2008. These six studies represent a diversity of multistage methods of which five are applied to the North American Rheumatoid Arthritis Consortium rheumatoid arthritis case-control data, and one method is applied to the low-density lipoprotein phenotype in the Framingham Heart Study simulated data. In the first stage of analyses, the majority of studies used a variety of screening techniques to reduce the noise of single-nucleotide polymorphisms purportedly not involved in the phenotype of interest. Three studies analyzed the data using penalized regression models, either LASSO or the elastic net. The main result was a reconfirmation of the involvement of variants in the HLA region on chromosome 6 with rheumatoid arthritis. The hope is that the intense computational methods highlighted in this group of papers will become useful tools in future GWAS.
20010395 C1-C2 transarticular screw fixation for atlantoaxial instability due to rheumatoid arthrit 2009 Dec 15 STUDY DESIGN.: Observational study. Retrospective analysis of prospectively collected data. OBJECTIVE.: The purpose of this article was to report long-term (minimum 7 years) clinical and radiologic outcome of our series of patients with Rheumatoid Arthritis who underwent transarticular screw fixation to treat atlantoaxial subluxation. SUMMARY OF BACKGROUND DATA.: The indications for intervention in patients with atlantoaxial instability are pain, myelopathy, and progressive neurologic deficit. The various treatment options available for these patients are isolated C1-C2 fusion, occipitocervical fusion with or without transoral surgery. Review of current literature suggests that C1-C2 transarticular screw fixation has significant functional benefits, although there is discrepancy in this literature regarding improvement in function following surgery. METHODS.: Myelopathy was assessed using Ranawat myelopathy score and Myelopathy Disability Index. Pain scores were assessed using Visual Analogue Scale. The radiologic imaging was assessed and the following data were extracted; atlanto-dens interval, space available for cord, presence of signal change on T2 weighted image, and fusion rates. RESULTS.: Thirty-seven patients, median age 56, were included in the study. Average duration of neck symptoms was 15.8 months. Average duration of rheumatoid arthritis before surgery was 20.6 years. Preoperative symptoms: suboccipital pain in 26 patients; neck pain, 32; myelopathy, 22; and 5 were asymptomatic. After surgery: suboccipital pain, 2; neck pain, 3; and myelopathy, 10. Ninety percent patients with neck and suboccipital pain improved after surgery in their Visual Analogue pain scores, with all of them having >50% improvement in VAS scores (6.94-2.12 [P < 0.05]).Preoperative Ranawat grade was as follows: grade 1 in 15 patients, grade 2 in 7, and grade 3a in 14, grade 3b in 1.After surgery: grade 1 in 27 patients, grade 2 in 7, grade 3a in 1, and grade 3b in 2. The mean myelopathy score improved after surgery (59.62-32.75, P < 0.05).The space available for the cord was improved in 63%, unchanged in 33%, and worse in 4%.Twenty-seven percent had T2 signal change and 18% had cervicomedullary compression; 97% had bony fusion. BILATERAL SCREWS WERE USED IN 33 PATIENTS AND UNILATERAL SCREWS IN 4 PATIENTS (ABERRANT VERTEBRAL ARTERY).: Computer image guidance was used in 73%. CONCLUSION.: C1-C2 transarticular screw fixation is a safe technique for atlantoaxial subluxation for patients with rheumatoid arthritis. This study clearly demonstrates improvement in Visual Analogue Scale, Ranawat grading and the Myelopathy Disability Index even at long-term follow up.
21794797 [Manolo Hugué: from sculpture to painting due to arthritis]. 2011 Mar There are several artists that have suffered rheumatic diseases. Even then, they continued their creative activity. Paul Klee suffered from systemic sclerosis, Dufy and Renoir suffered from rheumatoid arthritis and Gaudí and Boticelli had systemic-onset juvenile idiopathic arthritis. The famous noucentism sculptor, Manolo Hugué, presented chronic polyarthritis that suggested rheumatoid arthritis. Although he underwent several treatments, such as hydrotherapy or diathermic therapy, he had to stop sculpting. Using the chisel was too painful for his hands. He began, then, painting and composing poetry.
19822051 Clinical measures in rheumatoid arthritis and ankylosing spondylitis. 2009 Jul Except for morning stiffness, the clinical symptoms and the history of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) usually differ: the location in RA is mostly the hands and feet, and in AS rather the back. Patients with RA tend to be older (>50 years) and female, while in AS there are somewhat more often male and younger (<30 years) at onset of inflammatory back pain, the leading clinical symptom. The clinical examination of patients in the early phase of the disease is usually easier in RA, although arthralgia and arthritis may be difficult to differentiate. Joint counts are useful in states of high disease activity with polyarticular flares and more established disease. In comparison, in AS, young patients with back pain frequently show normal physical examens, a reduction of lateral spinal flexion and chest expansion are often the earliest signs which are also sensitive to change on therapy with biologics. The cervical spine may be affected in RA and AS - more frequently in advanced disease stages but rather early cases have been reported.
19273450 Mannose-binding lectin gene polymorphisms are associated with disease activity and physica 2009 Apr OBJECTIVE: To study the association between polymorphisms in the mannose-binding lectin gene (MBL2) and disease activity, physical disability, and joint erosions in patients with newly diagnosed rheumatoid arthritis (RA). METHODS: Patients with early RA (n=158) not previously treated with disease modifying antirheumatic drugs, participating in a treatment trial (CIMESTRA study) were examined at inclusion for MBL2 pooled structural genotypes (O/O, A/O, A/A), regulatory MBL2 promoter polymorphism in position -221 (XX, XY, YY), anti-cyclic citrullinated peptide 2 antibodies (anti-CCP2), disease activity by Disease Activity Score-28 (DAS28 score), physical disability by Health Assessment Questionnaire (HAQ) score, and erosive changes in hands and feet (Sharp-van der Heijde score). RESULTS: Eight patients were homozygous MBL2 defective (O/O), 101 belonged to an intermediate group, and 49 were MBL2 high producers (YA/YA). Anti-CCP was present in 93 patients (59%). High scores of disease activity, C-reactive protein-based DAS28 (p=0.02), and physical disability by HAQ (p=0.01) were associated with high MBL2 expression genotypes in a gene-dose dependent way, but only in anti-CCP-positive patients. At this early stage of the disease there was no association with erosion score from radiographs. CONCLUSION: The results point to a synovitis-enhancing effect of MBL in anti-CCP-positive RA, whereas such an effect was not demonstrated for joint erosions.
20452290 Sex differences in the relations of positive and negative daily events and fatigue in adul 2010 Dec Fatigue is a common, disabling symptom for individuals with rheumatoid arthritis (RA). This study 1) examined sex differences in the relations between daily changes in positive and negative interpersonal events and same-day and next-day fatigue and 2) tested positive affect and negative affect as mediators of the associations between changes in interpersonal events and fatigue. Reports of fatigue, number of positive and negative interpersonal events, and positive and negative affect were assessed daily for 30 days via diaries in 228 men and women diagnosed with RA. Days of higher than average daily positive events were associated with both decreased same-day fatigue and increased next-day fatigue, but only among women. Sex differences in same-day relations between positive events and fatigue were mediated by increases in positive affect. For both sexes, days of higher than average daily negative events related to increased same-day and next-day fatigue, and the same-day relations between negative events and fatigue were mediated by increases in negative affect. A more nuanced understanding of similarities and differences between men and women in the associations between changes in interpersonal events and fatigue may inform future interventions for RA fatigue. PERSPECTIVE: This article presents an examination of sex differences in the links between changes in daily interpersonal events and fatigue in chronic pain patients. The findings can help clinicians target the psychosocial factors that potentially can ameliorate their patients' experience of fatigue.
21063156 Serum matrix metalloproteinase-3 as predictor of joint destruction in rheumatoid arthritis 2010 Sep 30 BACKGROUND: Rheumatoid factor (RF), anti-citrullinated peptide antibody (ACPA), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) have been studied extensively as prognostic markers of rheumatoid arthritis (RA). However, despite the fact that matrix metalloproteinase-3 (MMP-3) is linked to RA activity, few studies have evaluated MMP-3 as prognostic marker. OBJECTIVE: To evaluate the performance of MMP-3 as predictor of joint destruction in RA treated with non-biological disease modifying anti-rheumatic drugs. METHODS: In a retrospective study of 58 early to moderate stage RA patients who consulted the Department of Clinical Pathology and Immunology, Kobe University Hospital between May 2002 and April 2009, we evaluated the performance of MMP-3 and other biomarkers as predictors of joint destruction, by comparing them between radiographically progressive and non-progressive group. RESULTS: Serum levels of RF at entry and ACPA, but not MMP-3 at entry, were significantly higher for the progressive group. Ratios of patients with MMP-3 levels higher than healthy control were not significantly different for the two groups. However, cutoff values determined through receiver operating characteristic analysis showed that the ratio of patients with elevated RF was significantly higher in the progressive group (p=0.001), while MMP-3 (p=0.092), ACPA (p=0.052), CRP (p=0.056), and ESR (p=0.069) tended to be more elevated in the progressive group. Multiple logistic regression analysis using the cutoff value identified MMP-3 positive and RF positive, but not ACPA, CRP or ESR, as significant factors for radiographic progression (OR 16.79 [95% CI: 1.34-414.19]). CONCLUSION: MMP-3 can be a useful marker for prediction of joint destruction.
20857155 Radiographic study on the pattern of wrist joint destruction in rheumatoid arthritis. 2011 Mar When planning therapy for rheumatoid arthritis (RA) in the wrist joint, knowing the pattern of joint destruction is important. There were a few studies using the Larsen and modified Larsen method to evaluate RA wrist joint destruction. However, these methods are inadequate for thoroughly assessing the severity of joint destruction because joint bone erosion and joint space narrowing could not be evaluated individually in these methods. To clarify the pattern of RA wrist joint destruction in the different zones of the wrist, we conducted a large-scale radiographic study. We modified the van der Heijde/Sharp method to assess radiographic images. Subjects were 191 RA patients (22 men and 169 women; mean age 57.0 years) who were examined at our center between 2001 and 2003 and underwent plain X-ray of both wrist joints (n = 382). Using X-ray images of the wrist joint, classification was performed based on the severity of wrist joint surface bone erosion and joint space narrowing at different zones, and the results were statistically analyzed. The results showed that joint space narrowing in the midcarpal joint (MCJ) advanced faster than in the radiocarpal joint (RCJ). Conversely, bone erosion in the RCJ advanced faster than in the MCJ. In X-ray diagnosis of RA wrist joint disorders, knowing the pattern of destruction is useful for assessing the presence or absence of early joint destruction and in planning therapy.