Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
22941769 Timing the therapeutic window of opportunity in early rheumatoid arthritis: proposal for d 2012 Dec The effects of treatment in early rheumatoid arthritis (RA) and the consequences of delayed therapy represent important areas for research. The concept of a 'window of opportunity' is now well established and considerable attention has been paid to when it might close. However, in order to study how long the window of opportunity lasts, the timing of its opening must be precisely defined. An analysis of definitions of 'onset' in clinical studies reveals imprecision and heterogeneity, making accurate assessment of this important concept of the 'window of opportunity' very difficult. In this paper we propose that, in clinical trials in early RA, data on durations since onset of symptoms and onset of joint swelling as well as disease duration based on fulfilment of classification criteria should be routinely presented.
23078166 Patients' views about treatment with combination therapy for rheumatoid arthritis: a compa 2012 Oct 18 BACKGROUND: Combinations of disease-modifying anti-rheumatic drugs (DMARDs) are increasingly used to control active rheumatoid arthritis (RA); however there is little information about patients' perspectives, their expectations, concerns and experiences of this intensive treatment. METHOD: We interviewed a quota sample of 18 patients from a single tertiary outpatient clinic, stratified by gender, ethnicity and age, based on the outpatient clinic population. Patients with early RA (<2 years) received combined conventional DMARDs; patients with established RA (>2 years) received combined conventional DMARDs or DMARDs with biologics. RESULTS: Four main themes emerged from the analytical framework: (i) patients' expectations about the combined treatment focuses mainly on physical symptoms; (ii) the impact of the treatment on quality of life varied with the new medication in both groups (iii) concerns about new interventions concentrated mainly on potential side effects; and (iv) combination therapy can be self-managed in close collaboration with clinic staff, but this requires individualised management approaches. These themes resonate with von Korff's collaborative management of chronic illness model. CONCLUSION: To our knowledge this is the first qualitative study that examined systematically in patients with early and established RA their expectations, impact on quality of life, concerns about side effects and the management of the treatment when taking combined medication with DMARDs or DMARDs and biologics. Patients have generally positive views of combination DMARDs. Within routine practice settings, achieving medication concordance with complex combined DMARD regimens is challenging, and the concerns vary between patients; careful individual assessments are essential to successfully deliver such intensive treatment.
22803639 Functional disability and health-related quality of life in South Africans with early rheu 2012 Oct BACKGROUND: The severity and predictors of functional disability and health-related quality of life (HRQoL) in a cohort of South Africans with early rheumatoid arthritis (RA) were investigated. METHODS: Changes in the Health Assessment Questionnaire Disability Index (HAQ) and the 36-Item Short Form Health Survey (SF-36) following 12 months of traditional disease-modifying anti-rheumatic drugs (DMARDs) were studied in previously DMARD-naïve adults with disease duration ≤ 2 years. RESULTS: The majority of the 171 patients were female (82%), Black Africans (89%) with a mean (SD) symptom duration of 11.6 (7.0) months. In the 134 patients seen at 12 months, there were significant improvements in the HAQ and all domains of the SF-36 but 92 (69%) still had substantial functional disability (HAQ > 0.5) and 89 (66%) had suboptimal mental health [SF-36 mental composite score (MCS) < 66.6]. Multivariate analysis showed that female sex (p = 0.05) and high baseline HAQ score (p < 0.01) predicted substantial functional disability at 12 months. Unemployment (p = 0.03), high baseline pain (p = 0.02), and HAQ score (p = 0.04) predicted suboptimal mental health, with a trend towards a low level of schooling being significant (p = 0.08). CONCLUSIONS: Early RA has a broad impact on HRQoL in indigent South Africans, with a large proportion of patients still showing substantial functional disability and suboptimal mental health despite 12 months of DMARD therapy. Further research is needed to establish the role of interventions including psychosocial support, rehabilitation programmes, and biological therapy to improve physical function and HRQoL in this population.
23070990 Effect of rheumatologist education on systematic measurements and treatment decisions in r 2012 Dec OBJECTIVE: To determine whether an educational intervention could result in changes in physicians' practice behavior. METHODS: Twenty rheumatologists performed a prospective chart audit of 50 consecutive patients with rheumatoid arthritis (RA) and again after 6 months. Ten were randomized to the educational intervention: monthly Web-based conferences on the value of systematic assessments in RA, recent evidence-based information, practice efficiency, and other topics; this group also read articles on targeting care in RA. The others were randomized to no intervention. RESULTS: One thousand serial RA charts were audited at baseline and 1000 at 6 months, with no between-group differences in patient characteristics: mean disease duration of 10 years; 77% women; 74% rheumatoid factor- positive; mean Disease Activity Score (DAS) 3.7; and 68% taking methotrexate, 14% taking steroids, and 27% taking biologics. At 6 months the intervention group collected more global assessments (patient global 53% preintervention vs 66% postintervention, and MD global 51% vs 60%; p < 0.05) and Health Assessment Questionnaires (37% vs 42%; p > 0.05; p = nonsignificant), whereas controls had no change in outcomes collected. For the intervention group there was a 32% increase in calculable composite scores [such as DAS, Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index; p < 0.05] but no change in the controls. There was more targeting to a low disease state. For those with SDAI between 3.3 and 11, the percentage of patients receiving a change in therapy was 66% in the intervention group and 36% in controls (p < 0.05). When DAS was between 2.4 and 3.6, 57% of the intervention group and 38% of controls made changes to treatment (p < 0.05). CONCLUSION: Small-group learning with feedback from practice audits is an inexpensive way to improve outcomes in RA.
21448233 Variants of gene for microsomal prostaglandin E2 synthase show association with disease an 2011 Aug Microsomal PGE synthase 1 (mPGES-1) is the terminal enzyme in the induced state of prostaglandin E(2) (PGE(2)) synthesis and constitutes a therapeutic target for rheumatoid arthritis (RA) treatment. We examined the role of the prostaglandin E synthase (PTGES) gene polymorphism in susceptibility to and severity of RA and related variations in the gene to its function. The PTGES gene polymorphism was analyzed in 3081 RA patients and 1900 controls from two study populations: Swedish Epidemiological Investigation of Rheumatoid Arthritis (EIRA) and the Leiden Early Arthritis Clinic (Leiden EAC). Baseline disease activity score (DAS28) was employed as a disease severity measure. mPGES-1 expression was analyzed in synovial tissue from RA patients with known genotypes using immunohistochemistry. In the Swedish study population, among women a significant association with risk for RA was observed for PTGES single-nucleotide polymorphisms (SNPs) in univariate analysis and for the distinct haplotype. These results were substantiated by meta-analysis of data from EIRA and Leiden EAC studies with overall OR 1.31 (95% confidence interval 1.11-1.56). Several PTGES SNPs were associated with earlier onset of disease or with higher DAS28 in women with RA. Patients with the genotype associated with higher DAS28 exhibited significantly higher mPGES-1 expression in synovial tissue. Our data reveal a possible influence of PTGES polymorphism on the pathogenesis of RA and on disease severity through upregulation of mPGES-1 at the sites of inflammation. Genetically predisposed individuals may develop earlier and more active disease owing to this mechanism.
22227873 The economic consequences of rheumatoid arthritis: analysis of Medical Expenditure Panel S 2012 Jan OBJECTIVE: Determine the prevalence and costs of rheumatoid arthritis (RA) during three consecutive years: 2004, 2005, and 2006. METHODS: Medical Expenditure Panel Survey was used for persons with RA. Regressions estimate health care costs and income loss. Absenteeism and age-adjusted workforce participation compared means and rates. RESULTS: The prevalence of RA was 0.40% in 2004, 0.44% in 2005, and 0.43% in 2006. Health care cost associated with RA was $4422, $2902, and $1882 (all P < 0.01) in 2004, 2005, and 2006, respectively. Rheumatoid arthritis sufferers were employed, 36.8%, 39.5%, and 44% compared with 70.5%, 69.8%, and 71%. Individuals with RA also missed more days of work, 4.86 in 2004 (P = 0.04), 1.70 in 2005 (P = 0.22), and 2.99 in 2006 (P = 0.04). Rheumatoid arthritis reduced income by $2404 (P = 0.03), $2207 (P < 0.001), and $1212 (P = 0.002). CONCLUSIONS: Costs of RA are considerable.
22895735 [Rheumatic diseases with initial manifestations in middle age: gout, rheumatoid arthritis 2012 Sep Rheumatic diseases are manifested in all ages. First manifestations of gout are frequent between the ages of 40-60 years. Furthermore, the incidence of rheumatoid arthritis increases as well as anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides. Recently new treatment options for gout were established but colchicine, which has been used to treat gout for a long time was also further optimized in its use. Remarkable advantages in the treatment of rheumatoid arthritis towards remission have been made by the introduction of biological agents 10 years ago. In granulomatosis with polyangiitis (formerly Wegener's disease) therapeutic optimization has led to a reduction in toxicity and rituximab has proven to be an effective treatment option.
22699479 Organising pneumonia as the first manifestation of rheumatoid arthritis. 2011 Mar 24 Organising pneumonia (OP) is an inflammatory lung disease with distinctive clinicopathological features. OP can be evident during the course of rheumatoid arthritis (RA) with increased disease activity. The authors report an OP associated with RA case in which pulmonary symptoms preceded the onset of joint symptoms. An OP patient with elevated serum anticyclic citrullinated peptide antibody is likely to manifest RA in the near future, reflecting its high disease activity. Thus, an early rheumatologic consultation should be taken into consideration to make an early decision to initiate disease-modifying antirheumatic drugs therapy.
20981466 Achilles paratendonitis as the initial manifestation of rheumatoid arthritis. 2011 Apr We report a case of rheumatoid arthritis in which the earliest symptom was bilateral paratendonitis of the Achilles tendons, followed by paratendonitis of a finger extensor. A series of musculoskeletal ultrasonograms revealed a progression from paratendonitis of the extensor tendon to erosive synovitis of the adjacent metacarpophalangeal joint. High-resolution ultrasonography combined with power Doppler imaging seems to be a useful and convenient tool both for diagnosing paratendonitis early and for closely monitoring the progressing inflammation.
21936735 Six and 12 months' effects of individual joint protection education in people with rheumat 2012 Jul BACKGROUND: Joint protection (JP) education for people with rheumatoid arthritis (RA) is effective when applying psycho-educational teaching strategies. The Pictorial Representation of Illness and Self Measure (PRISM) was used to identify relevant JP education goals and life aspects, both supporting motivation and behaviour change. The objective of this study was to compare the effects of individual JP education, PRISM-based (PRISM-JP) vs. conventional (C-JP), in people with rheumatoid arthritis (RA). METHODS: An assessor-blinded randomized controlled trial was conducted in four rheumatology centres. Patients were randomized to PRISM-JP or C-JP, consisting of five JP education sessions over three months. Primary outcome was JP behaviour at six and 12 months. RESULTS: A total of 53 RA patients participated. The PRISM-JP group (n = 26) demonstrated significantly more JP behaviour at six months (effect size ES = 0.32; p = 0.02) and 12 months (ES = 0.28; p = 0.04) than the C-JP (n = 27). Within-group analysis showed that the JP intervention was successful at six and 12 months in both groups (p < 0.001). At 12 months the PRISM-JP group had better JP self-efficacy (p = 0.02) and grip strength (p = 0.04) compared with baseline. CONCLUSION: PRISM-JP was more effective than C-JP in terms of long-term JP behaviour at six and 12 months.
21036875 Comorbidity affects all domains of physical function and quality of life in patients with 2011 Feb OBJECTIVE: Comorbidities have been reported to influence physical function, but it is not clear which activities are predominantly impaired, or which other domains of health status are affected in addition to physical function. In this study, we investigated the impact of comorbidities on individual activities of daily living, and other aspects of quality of live in patients with RA. METHODS: In 380 patients with established RA, we quantified comorbidity levels according to the age-adjusted Charlson Comorbidity Index (CCI(A)) and functional disability by serial measures of the HAQ over 1 year. In a subset of 185 patients, we assessed quality of life using Short Form-36 (SF-36). To analyse the relationship between comorbidities, different activities of daily living and health status, we divided patients into four subgroups of CCI(A) and performed analysis of variance (ANOVA) and multivariable general linear regression models adjusted for gender, disease duration and disease activity. RESULTS: ANOVA showed significant (P < 0.03) increase of disability within each domain of HAQ with increasing level of comorbidity. Similar results were observed using the physical component score (P = 0.003) of the SF-36 and its domains, whereas mental component score (P = 0.31) and its domains were unaffected by comorbidities. In a sub-analysis stratifying patients into different levels of disease activity, we found increase in almost all domains of HAQ within respective groups of CCI(A). CONCLUSIONS: Activities of daily living represented by HAQ are equally affected by comorbidities. More generally, health status was only affected with respect to its physical but not its mental domains.
22804691 Elicitation of health state utilities associated with differing durations of morning stiff 2012 OBJECTIVE: Specific symptoms of rheumatoid arthritis (RA), including joint stiffness and functional disability, are most severe in the morning. 'Morning stiffness' has a negative impact on health-related quality-of-life (HRQoL); however, how HRQoL is correlated to morning stiffness duration is unknown. The objective of this study was to obtain population-based utility values associated with different durations of morning stiffness in RA. DESIGN AND METHODS: The time-trade-off (TTO) approach was used to elicit utility values for four different health states (HS), which differed in morning stiffness duration. One hundred and nine members of the UK general public rated each HS in individual face-to-face interviews with trained investigators. TTO scores were converted into utility values. Visual Analog Scale (VAS) scores were obtained to validate TTO scores. RESULTS: On a scale of 0 (death) to 1 (full health), a mean utility value of 0.45±0.29 was elicited for ∼3 h of morning stiffness (anchor HS), 0.50±0.28 for 2-3 h of morning stiffness (HS1), 0.61±0.25 for 1-2 h of morning stiffness (HS2) and 0.78±0.20 for <1 h of morning stiffness (HS3). The difference between each HS was statistically significant (p<0.01). Mean VAS utility scores followed the same trend. Utility incrementally increased with each HS associated with a shorter duration of morning stiffness. Limitations of this research include potential bias from the TTO method due to the discounting effect of time, scale compatibility, and loss aversion. CONCLUSIONS: The UK population-based utility values show a reduction in morning stiffness duration in RA is associated with improved HRQoL. Despite the impact of morning stiffness on HRQoL, it is rarely evaluated and little is known as to how it is affected by current treatments. The results of this study can be applied in future cost-utility analyses of healthcare interventions which target an improvement in morning stiffness duration for RA patients.
22170508 Increased recycling of polyamines is associated with global DNA hypomethylation in rheumat 2012 Jun OBJECTIVE: Global DNA hypomethylation in rheumatoid arthritis synovial fibroblasts (RASFs) contributes to their intrinsic activation. The aim of this study was to investigate whether increased polyamine metabolism is associated with a decreased level of S-adenosyl methionine (SAM), causing global DNA hypomethylation. METHODS: Synovial fibroblasts were isolated from synovial tissue obtained from 12 patients with RA and from 6 patients with osteoarthritis (OA). The cells were stained for S-adenosyl methionine decarboxylase (AMD), spermidine/spermine N1-acetyltransferase (SSAT1), polyamine-modulated factor 1-binding protein 1 (PMFBP1), solute carrier family 3 member 2 (SLC3A2), DNA methyltransferase 1 (DNMT-1), α9 integrin, and β1 integrin and analyzed by flow cytometry. Nuclear 5-methylcytosine (5-MeC) was measured by flow cytometry, the expression of diacetylspermine (DASp) in cell culture supernatants and cell extracts was determined by enzyme-linked immunosorbent assay, and SAM expression in cell extracts was measured by fluorometry. RESULTS: The expression of SSAT1, AMD, and PMFBP1 was significantly increased in RASFs compared with OASFs. The expression of DASp in cell culture supernatants and the expression of SLC3A2 were significantly elevated in RASFs. The levels of SAM in cell culture extracts, as well as the levels of DNMT-1 protein and 5-MeC, were significantly reduced in RASFs. Parameters of polyamine metabolism were negatively correlated with the expression of SAM, DNMT-1, and 5-MeC. CONCLUSION: These data clearly show that intrinsic elevations of PMFBP1 and SSAT1 enhance the catabolism and recycling of polyamines in RASFs and suggest that high consumption of SAM via this pathway is an important factor contributing to global DNA hypomethylation in these cells.
21281314 Shifting normalities: interactions of changing conceptions of a normal life and the normal 2011 May Biographical disruption and related concepts have been widely applied in chronic illness. Different conceptualisations of normalisation have also been proposed in order to explain individuals' diverse responses to illness on their biography, but as yet, not clearly related to changing bodily experience or normalisation of symptoms. This article aims to examine the relevance of these concepts in rheumatoid arthritis (RA), an unpredictable autoinflammatory disease characterised by painful and swollen joints, disability, fatigue and joint damage. Interviews were conducted with 23 people living with RA, and analysed using Framework, to enable people's whole narratives and context to be considered. Six typologies of normality emerged from the data: disrupted; struggling to maintain; fluctuating; resetting; returning; and continuing normality. Multiple normalities were often present in individuals' narratives, with one normality typology usually dominating at the time of the interview. The typologies connect to several biographical concepts, and instances of 'biographical reinstatement' were also found, where participants described returning to normal life, through perceived effective medication rather than reconceptualisation of health. The concept of 'shifting normalities' is proposed, providing a dynamic explanatory model of chronic illness that captures the interaction of changing conceptions of a normal life and the normalisation of symptoms.
21905252 Relationship between beliefs, motivation, and worries about physical activity and physical 2011 Dec OBJECTIVE: To determine the relationship between beliefs, motivation, and worries about physical activity and physical activity participation in persons with rheumatoid arthritis (RA). METHODS: A cross-sectional study used baseline data from 185 adults with RA enrolled in a randomized clinical trial assessing the effectiveness of an intervention to promote physical activity. Data included patients' self-reported beliefs that physical activity can be beneficial for their disease, motivation for physical activity participation, worries about physical activity participation, and average daily accelerometer counts of activity over a week's time. Body mass index (BMI), sex, age, race, and disease activity were measured as potential statistical moderators of physical activity. RESULTS: Physical activity participation was greater for those with higher scores on scales measuring beliefs that physical activity is beneficial for their disease (P for trend = 0.032) and motivation for physical activity participation (P for trend = 0.007) when adjusted for age, sex, BMI, race, and disease activity. There was a positive but nonsignificant trend in physical activity participation in relation to worries. CONCLUSION: Stronger beliefs that physical activity can be helpful for managing disease and increased motivation to engage in physical activity are related to higher levels of physical activity participation. These data provide a preliminary empirical rationale for why interventions targeting these concepts should lead to improved physical activity participation in adults with RA.
21898070 Temperature changes in rheumatoid hand treated with nitrogen vapors and cold air. 2012 Oct The aim of the study was the thermovisual comparison of mean temperature of hand surface changes after local cryotherapy with vapors of nitrogen (-160°C) and cold air (-30°C). Forty-seven patients with rheumatoid arthritis (39 women and 8 men; average age 56.2 ± 10.5 years) were included in the study. They had the application of topic cryotherapy using nitrogen vapors or cold air on one hand. Main outcome measure was surface temperature of dorsal sides of the cooled and contralateral hands. Thermal images of both hands were taken before and up to 3 h after the treatment. One minute after application, nitrogen vapors induced decrease in surface skin temperature of the cooled hand from 28.9 ± 1.8°C to 17.9 ± 2.2°C, P < 0.05, whereas cold air from 29.4 ± 2.4°C to 23.1 ± 2.2°C, P < 0.05. However, significantly lower temperature was obtained with vapors of nitrogen (P < 0.05). Just after the treatment, a rapid rewarming occurred and hands reached baseline temperature in 15 min in both applications and they did not differ till the end of the procedure. Both nitrogen vapors and cold air induce similar temperature changes in hands with the exclusion of temperature obtained 1 min after the treatment. Changes in non-cooled hands indicate contralateral reaction.
22351523 Are personal characteristics associated with exercise participation in patients with rheum 2012 Jun BACKGROUND: Organized exercise programs for patients with rheumatoid arthritis (RA) are useful to enhance physical activity and fitness. However, participation and adherence rates of these programs are low. This study aimed to identify demographic, personal and disease-related factors interfering with implementing an exercise program for RA. METHODS: A random sample of ambulatory RA patients from a single centre was divided into two groups, depending on their willingness to participate in an exercise program. Subsequently, demographic data (gender, age, disease duration and educational level) and disease-related and personal factors were obtained (Disease Activity Score; Short Form 36 [SF-36]; Health Assessment Questionnaire; Global Disease Activity; and also the Utrecht Coping List [UCL], Illness Cognition Questionnaire; TAMPA scale and modified Baecke questionnaire). RESULTS: Of the 154 people completing the survey, 113 (73%) indicated that they were willing to participate in an exercise program. These positive responders (PR) were more often female (p<0.05), and had a higher educational level (p<0.05). In the negative responders (NR), higher scores were found in the general health perception (54.7; [SD 18.3] versus 47.4; [SD 20.8]) and vitality (61.6 [SD 19.8] versus 53.7 [SD 20.1] sections of the SF-36, and a lower score was found on the reassuring thoughts subscale of the UCL (11.9 [SD 2.7] versus 12.9 [SD 2.7]) compared with the PR (all p<0.05). CONCLUSIONS: Although few differences were found between the groups, some insights regarding pitfalls in implementing an exercise program were highlighted. Further insights into external and personal motivators for patients are needed.
22628091 It means everything: continuing normality of everyday life for people with rheumatoid arth 2012 Sep OBJECTIVE: The aim of this follow-up study was twofold: firstly, to explore how people who were clinically regarded to be in a state of remission experienced their everyday lives with rheumatoid arthritis (RA); secondly, to explore the experiences of people in early remission with healthcare provision and their perceived support needs. METHODS: Two focus group interviews were conducted with 11 participants in total. Interview data were analysed using content analysis methods. RESULTS: All participants felt that they were able to continue their normal everyday activities at home, at leisure and at work. They were also able to maintain their normal roles. Continuing the normality of everyday life seemed to be the most important defining variable for experiencing being in remission. Support needs were directly related to the participants' positive experiences of actual support from the healthcare providers and were related to the continuity of the care provider, coherence, being taken care of, having a personal and trusting relationship with the health professionals and being properly informed about RA and how to manage it. CONCLUSION: The participants wanted to concentrate on wellness and tended to avoid thinking of possible side effects, being chronic ill and the development of RA in the future.
21813061 A comparison of utility measurement using EQ-5D and SF-6D preference-based generic instrum 2011 Jul OBJECTIVES: The purposes of this study were to analyse and compare aspects of validity (concurrent and discriminant) of the two widely used indirect utility instruments, the EuroQol-5D (EQ-5D) and the Short Form-6D (SF-6D) in a representative cohort of patients with rheumatoid arthritis (RA). METHODS: Five hundred and eighty-three consecutive adult patients (435 women, 148 men) with RA and referred to the outpatient Clinic were evaluated. Patients were asked to complete EQ-5D and SF-36. SF-6D utility scores were calculated using the eight mean SF-36 scores, according to published algorithms. Disease-related characteristics included disease duration, co-morbidities, a measure for disease activity [Disease Activity Score-28 joint (DAS28)] and for radiographical damage (Sharp van der Heijde scoring method, SHS). The agreement between the utility instruments was evaluated by Bland-Altman analysis. Construct validity was assessed using the Kruskal-Wallis test, Mann-Whitney U-test, Spearman's correlations, and receiver operating characteristic (ROC) curves. Multivariate analyses were used to assess the relationship among HRQoL and disease-related characteristics and socio-demographic data. RESULTS: A comparison of means showed that SF-6D values exceeded EQ-5D values (p<0.0001). Agreement between both measures was only moderate. Utility scores and domains and summary scores of the SF-36 were highly correlated. The EQ-5D and SF-6D both detected change in different health status (<0.0001). The discriminatory power of both indexes was good, without significant difference, with an AUC of 0.869 and 0.820, respectively for EQ-5D and SF-6D. The EQ-5D and SF-6D both detected change over different health status among RA patients (both al level of p<0.0001) although EQ-5D was more efficient in detecting differences between groups in almost all cases. Comparison of EQ-5D and SF-6D scores within VAS groups showed that, for less healthy individuals (VAS scores 0-50), the median EQ-5D score was significantly lower than the median SF-6D score. The multivariate regression models for EQ-5D and SF-6D included both SHS and DAS28 (p=0.0001). The relative contribution of these domains differed substantially between patients with short and long standing disease duration. The presence of multiple chronic conditions also appeared to contribute to reduce the levels of utility of both instruments. CONCLUSIONS: Although EQ-5D and SF-6D appeared to measure similar constructs, these instruments are quite different from each other in the assessment of RA. For worse health status the median EQ-5D scores were significantly lower than the median SF-6D scores. Moreover, EQ-5D and SF-6D appeared both significantly influenced by disease activity, radiological damage and co-morbidity. For that reason, we advise caution in the employment of these preference-based instruments, especially in RA patients with severe disease.
21285117 Performance of the 2010 ACR/EULAR criteria for rheumatoid arthritis: comparison with 1987 2011 Jun OBJECTIVE: Early identification of patients with rheumatoid arthritis (RA) is essential to allow the prompt institution of therapy. The 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, which replace the 1987 classification criteria, have been developed to facilitate such identification in patients with newly presenting inflammatory arthritis. This study therefore assesses the performance of these new criteria in patients with early synovitis. METHODS: Data were analysed from patients with synovitis seen within 3 months of the onset of inflammatory arthritis. Patients were followed for 18 months to determine outcomes, and data on the cumulative fulfilment of 2010 and 1987 criteria and therapy were recorded. RESULTS: 265 patients were included in the study. 60 had alternative diagnoses at baseline. Of the remaining 205 patients, 20% fulfilled both 1987 and 2010 criteria, 3% fulfilled only 1987 criteria and 22% fulfilled only 2010 criteria at baseline. The 2010 criteria, when applied at baseline, detected more patients who eventually required disease-modifying antirheumatic drugs (DMARD) (65 (62%) vs 40 (38%); p<0.001), especially methotrexate (50 (68%) vs 31 (42%); p<0.01), within the first 18 months. However, more patients whose disease eventually resolved without ever requiring DMARD were classified at baseline as RA according to the 2010 criteria than with the 1987 criteria (16 (8%) vs 5 (2%); p=0.01). CONCLUSION: The 2010 ACR/EULAR criteria allow more rapid identification of patients requiring methotrexate compared with the 1987 ACR criteria when applied at baseline. However, overdiagnosis is an important issue to consider if these criteria are to be used in very early disease.