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ID PMID Title PublicationDate abstract
22398880 A blind randomized controlled trial of cognitive versus behavioral versus cognitive-behavi 2012 BACKGROUND: Despite evidence that cognitive-behavioral therapy (CBT) is effective for rheumatoid arthritis (RA), little is known about which components of therapy are most efficacious. The present study compared the efficacy of CBT with cognitive therapy (CT) and behavioral therapy (BT) for patients with RA. We hypothesized that CBT would be more efficacious on a broader range of outcomes. METHODS: Participants (n = 104) with classic or definite RA were randomized to receive one of three active treatments (CBT, CT or BT) or a wait-list control (WLC). Participants were assessed at baseline, post-treatment and 6 months on a range of outcomes. Measures of disease activity, joint function, disability and psychological functioning were included. RESULTS: The results showed that participants who received cognitive components had greater improvements in tender joint counts and C-reactive protein at post-treatment. Those receiving either BT or CT alone improved more on anxiety than CBT or WLC. At 6 months, the three active treatment groups could only be distinguished on tender joints, which favored CT and CBT. CONCLUSIONS: CBT did not demonstrate the broader benefits to patients that we expected, nor was there evidence that BT produced effects that were superior to CT alone. CT was superior to at least one of the other two active treatment components on 3 of the 7 outcome measures at post-treatment. Effect sizes for the interventions that included cognitive components were similar to those reported in the literature. These results suggest that CT is an effective treatment for RA and need not necessarily include behavioral strategies.
21735355 Incidence of serious respiratory infections in patients with rheumatoid arthritis treated 2012 Feb We aimed to demonstrate the incidence of serious respiratory infections in patients with rheumatoid arthritis (RA) treated with tocilizumab (TCZ) monotherapy. We analyzed the incidence of serious respiratory infections in 601 RA patients enrolled in TCZ clinical trials and their extension studies (TCZ cohort) and in 601 age- and sex-standardized RA patients treated in daily clinical practice at Tokyo Women's Medical University (IORRA subsample cohort). The rates of serious respiratory infections were 1.77 per 100 patient-years from 1999 to 2008 in the TCZ cohort and 0.53 per 100 patient-years from 2000 to 2009 in the IORRA subsample cohort. With the IORRA subsample cohort regarded as a standard population, the standardized incidence ratio (SIR) of serious respiratory infection in the TCZ cohort was 3.64 [95% confidence interval (CI) 2.56-5.01], standardized for age and sex; 2.35 (95% CI 1.66-3.24), standardized for age sex, and corticosteroid use; 1.85 (95% CI 1.30-2.55), standardized for age sex, and pre-existing pulmonary involvement; and 2.41 (95% CI 1.68-3.34) standardized for age sex, and disease activity. The risk of serious respiratory infection in the TCZ cohort was approximately double that in the IORRA subsample cohort after standardizing for corticosteroid use, pre-existing pulmonary involvement, or disease activity. This is comparable to the risk reported when tumor necrosis factor (TNF) inhibitors are used.
20336460 Pattern-based diagnosis and screening of differentially expressed serum proteins for rheum 2011 Aug The objective of this study was to search for proteomic patterns distinguishing patients with rheumatoid arthritis (RA) from healthy controls, biomarker candidates specific for early RA, and proteins reflecting disease activity, by profiling of serum proteins using magnetic bead-based (MB) separation and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Magnetic chemical affinity beads were used to differentially capture serum proteins prior to MALDI-TOF analysis. Seventy serum samples from patients with RA and 50 from healthy controls were analyzed. The samples were randomly allocated to the training set or test set to develop a pattern by means of decision tree algorithm. ANOVA test was utilized to search for biomarkers for early RA. Pearson correlation analysis was employed to estimate the overexpressed peaks in relation to Disease Activity Score (DAS)28. The algorithm identified a pattern based on 3 peaks (m/z 2,490, 5,910.07, 6,436.73) that, in the training set, separated patients with RA from healthy controls with a sensitivity and specificity of 87.5 and 96.7%, respectively. Blind test data indicated a sensitivity of 86.7% and specificity of 90%. The peaks of m/z 1,014.92 and 1,061.38 were raised significantly in early RA group (disease duration <12 months) compared with those in non-early RA group (disease duration ≥12 months) and healthy controls. A positive correlation was found between the intensity of peak 9,591.47 and DAS28 scores. Using MB separation followed by MALDI-TOF-MS enabled rapid diagnosis of RA according to fingerprint pattern, a method which might also help to assess disease activity and identify early RA.
21647203 Anti-CCP antibodies: the past, the present and the future. 2011 Jun 7 Rheumatoid arthritis (RA) is an autoimmune disease characterized by autoantibodies against citrullinated antigens. The importance of citrulline for the epitopes bound by these autoantibodies, referred to as ACPA (anti-citrullinated peptide/protein antibodies), was first described in 1998. In addition to citrullinated proteins, cyclic citrullinated peptides (CCP) can also be used as test substrates for detecting ACPA. The standard test for these antibodies is the second-generation CCP (CCP2) test, which is one of the best in terms of sensitivity and specificity. The generation of ACPA is an early event in the disease course, and is dependent on the presence of certain MHC class II alleles. ACPA in the inflamed synovium have been shown to associate with citrullinated antigens to form immune complexes, resulting in progression of the inflammatory process. The involvement of ACPA in the chronicity of RA is probably the reason why ACPA-positive patients have a more erosive disease course than ACPA-negative patients. The presence of ACPA has been included in the 2010 RA classification criteria. Thus, it is important to further standardize ACPA testing, for example by including an internal serum standard, which may lead to a better distinction between low and high ACPA levels.
21704035 Citrullination of autoantigens: upstream of TNFα in the pathogenesis of rheumatoid arthri 2011 Dec 1 Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by synovial inflammation and destruction of joints. Over 20 years ago, tumour necrosis factor alpha (TNFα) was identified as a key player in a cytokine network, whose multifunctional effects could account for both the inflammation and destruction in RA. The remarkable efficacy of TNF inhibitors in the treatment of RA has resulted in extensive research addressing the regulation of TNFα production responsible for this excessive production. The discovery of autoimmunity to citrullinated protein/peptide antigens (ACPA) has led the concept that ACPA may be the essential link between disease susceptibility factors and the production of TNFα, which ultimately accounts for the disease phenotype. In this review we will consider (1) the mechanisms of citrullination, both physiological and pathological, (2) how known genetic and environmental factors could drive this peculiar form of autoimmunity and (3) how the immune response could lead to excessive production of TNFα by the synovial cells and ultimately to the disease phenotype (Fig. 1).
20012868 Functional capacity in rheumatoid arthritis patients: comparison between Spanish and Brazi 2011 Feb The main objective of this study is to compare Spanish and Brazilian self-reported health-related functional capacity in patients with rheumatoid arthritis (RA). 197 patients diagnosed with RA were studied in Spain (n = 127) and Brazil (n = 70). Pain (Visual analog scale) and functional capacity (Health Assessment Questionnaire/HAQ) were assessed. Patients were questioned about regular exercise practice. Comparisons between groups were performed with Chi-square tests and Student t test. Pearson's correlation coefficient and linear regression models were used to analyze the associations. Brazilian patients were younger (p = 0.013), had worse levels of pain (p = 0.001) and a trend to experience worse functional capacity (p = 0.057) than Spanish ones. Spanish RA patients had higher body mass index (BMI) (p = 0.019) and longer disease duration (p = 0.001). Also, a higher percentage of subjects with RA from the Spanish cohort had been elected to take early retirement when compared with Brazilian patients (p = 0.010). Spanish RA patients had received more drugs than Brazilians (oral corticosteroids p = 0.010, Leflunomide p = 0.023, Methotrexate p = 0.072, non-steroidal anti-inflammatory drugs p = 0.064, biologic therapies p = 0.001). The functional capacity (HAQ) was correlated with age (p = 0.001), disease duration (p = 0.001), age at diagnosis (p = 0.001), pain (p = 0.001) and BMI (p = 0.001) in Spanish patients. In Brazilian, these correlations were only found with disease duration (p = 0.004) and pain (p = 0.001). In conclusion, our data suggest a better management of RA in Spanish when compared with Brazilians. Even with less pain and functional capacity, they receive more drug treatment and a higher percentage of them are retired early.
21303478 A cross-sectional study of diastolic dysfunction in rheumatoid arthritis and its associati 2011 Feb AIMS: The aim of this study was to evaluate the left ventricular (LV) diastolic dysfunction in rheumatoid arthritis (RA) patients without clinically evident cardiovascular manifestations and to estimate whether there is any correlation between RA disease severity and disability and LV diastolic dysfunction. METHODS: The study was a cross-sectional study involving 53 patients (47 female and 6 male) with RA without clinically evident heart disease and 53 healthy subjects (47 female and 6 male) who served as a control group. Both groups were matched for age and sex. Echocardiographic and Doppler studies were conducted in all patients with RA and control subjects. RESULTS: Of 17 cardiac parameters assessed, only two were abnormal. None of the specific cardiac diastolic dysfunction parameters were significantly different in RA patients compared to the control group. There was no significant correlation between diastolic function values in RA patients and value of Disease Activity Score 28 (DAS-28) and value of Health Assessment Questionnaires Disability Index (HAQDI). Atrial (A) wave velocity was greater in RA patients compared to the control group (0.71 [0.58-0.83] vs. 0.61 [0.51-0.71]; P < 0.04). However, interventricular relaxation time (IVRT) ([73.08 ± 9.92 vs. 70.74 ± 9.02], P = 0.207), lower E/A ratio (1.27 [1.02-1.56] vs. 1.42 [1.20-1.68], P = 0.102), diastolic dysfunction parameters according to Redfield Classification (25 [47.2%] vs. 27 [50.9%] P = 0.56), diastolic dysfunction using E/A (P = 0.321) and tissue doppler imaging (E/E') (P = 0.148) were not different. CONCLUSION: Prevalence of diastolic dysfunction in the rheumatoid arthritis group (47.2%) was not different from controls (50.9%). LV diastolic function had no significant correlation with RA disease severity and duration of disease.
21499909 An autopsy case of necrotizing fasciitis with rapidly progressive purpura caused by hemoly 2011 Dec A 77-year-old woman with rheumatoid arthritis was admitted as an emergency because of pain in the right leg with purpura. She was diagnosed with severe cellulitis and sepsis and started on intravenous antibiotics; however, the lesion rapidly extended to the proximal thigh and she died only 38 h after the onset of the first symptom. Autopsy and tissue culture revealed necrotizing fasciitis caused by Streptococcus dysgalactiae subspecies equisimilis. Physicians should consider that necrotizing fasciitis may be present when soft-tissue disorder is suspected in patients receiving corticosteroid therapy, which is associated with tissue fragility and immunosuppression.
22726111 Personalized therapies in pediatric inflammatory and autoimmune diseases. 2012 Pediatric inflammatory and autoimmune diseases are a wide array of systemic or organ-specific conditions, characterized by an exaggerated immune reactivity, which generally occurs in immunogenetically predisposed children. Among the most important ones, in terms of their diffusion and morbidity in the population worldwide, pediatric inflammatory bowel disease (IBD) and juvenile rheumatoid arthritis (JRA) have to be considered. The aim of personalized therapy is to give to each patient the most appropriate drug and dose regimen, in order to maximize treatment response and reduce the risk of adverse events. In general, several therapeutic options exist for pediatric inflammatory and autoimmune conditions, therefore the perspective of pharmacological tools that allow identification of patients with increased risk of treatment issues related to a particular medication, in terms of lack of efficacy or increased probability of adverse events, is particularly desirable and promising. The present review will be focused on the personalized therapy approaches already available or in development for pediatric patients with IBD or JRA, comprising pharmacokinetic, pharmacodynamic and pharmacogenetic assays.
21862768 Assessing rheumatoid arthritis with ultrasound of the hands. 2011 Sep OBJECTIVE: The purpose of this video article is to show the sonographic techniques and findings in evaluating the joints of the hands in patients with possible inflammatory arthritis and to review the sonographic appearance and grading of synovitis. CONCLUSION: This video article shows the value of a targeted approach for musculoskeletal ultrasound of the hand and wrist in patients with rheumatoid arthritis. On completion of this video article, the participant should be able to develop an appropriate diagnostic and therapeutic approach using ultrasound for the treatment of patients with rheumatoid arthritis.
23272690 Rheumatoid arthritis and Alzheimer's disease: genetic and epigenetic links in inflammatory 2012 Dec Controversial data are available about the relationship between Alzheimer's disease (AD) and rheumatoid arthritis (RA). An inverse relationship between AD and RA, due to different factors, was previously described. Similarly to RA, AD pathogenesis is multifactorial and different findings support the inflammatory pathogenetic hypothesis. Several inflammatory mediators are involved in the disease onset and progression regulated by genetic and epigenetic mechanisms. Among them, inteleukin-6 (IL-6) and interleukin-1 (IL-1) as pro-inflammatory soluble factors produced by monocytes-macrophages and tumor necrosis factor alpha (TNF-α) produced by activated macrophages and mononuclear cells represent key molecules in the induction and maintenance of chronic inflammation in RA. In particular a link with the T allele of the SNP 3953 T/C in the IL-1 gene and an overexpression of miR-146a appears to be common to both RA and AD. In this review we will discuss the genetic and epigenetic regulation of the inflammatory cascade in RA and AD to find out the possible links between RA and AD onset.
21885515 Development and preliminary validation of a magnetic resonance imaging joint space narrowi 2011 Sep OBJECTIVE: To develop and validate a magnetic resonance imaging (MRI) method of assessment of joint space narrowing (JSN) in rheumatoid arthritis (RA). METHODS: Phase A: JSN was scored 0-4 on MR images of 5 RA patients and 3 controls at 15 wrist sites and 2nd-5th metacarpophalangeal (MCP) joints by 8 readers (7 once, one twice), using a preliminary scoring system. Phase B: Image review, discussion, and consensus on JSN definition, and revised scoring system. Phase C: MR images of 15 RA patients and 4 controls were scored using revised system by 5 readers (4 once, one twice), and results compared with radiographs [Sharp-van der Heijde (SvdH) method]. RESULTS: Phase A: Intraobserver agreement: intraclass correlation coefficient (ICC) = 0.99; smallest detectable difference (SDD, for mean of readings) = 2.8 JSN units (4.9% of observed maximal score). Interobserver agreement: ICC = 0.93; SDD = 6.4 JSN units (9.9%). Phase B: Agreement was reached on JSN definition (reduced joint space width compared to normal, as assessed in a slice perpendicular to the joint surface), and revised scoring system (0-4 at 17 wrist sites and 2nd-5th MCP; 0: none; 1: 1-33%; 2: 34-66%; 3: 67-99%; 4: ankylosis). Phase C: Intraobserver agreement: ICC = 0.90; SDD = 6.8 JSN units (11.0%). Interobserver agreement: ICC = 0.92 and SDD = 6.2 JSN units (8.7%). The correlation (ICC) with the SvdH radiographic JSN score of the wrist/hand was 0.77. Simplified approaches evaluating fewer joint spaces demonstrated similar reliability and correlation with radiographic scores. CONCLUSION: An MRI scoring system of JSN in RA wrist and MCP joints was developed and showed construct validity and good intra- and interreader agreements. The system may, after further validation in longitudinal data sets, be useful as an outcome measure in RA.
23227611 [Management of patients with rheumatoid arthritis in remission]. 2012 Oct Remission is the main goal to achieve in rheumatoid arthritis (RA) treatment. Several definitions of RA remission exist and are actually based on clinical and biological features. The last definition was obtained thanks to collaboration between European and American experts. Those definitions are nevertheless insufficient because of the persistence of sub clinical inflammation in a large percentage of patients as explored by ultrasound and MRI. In future, we can assume that remission definition may change taking into account ultrasound and/or MRI data. Acquiring a real remission for a long time is necessary to avoid relapse, structural progression and to discuss therapeutic strategies. Actually RA patients (less medication) practicians (decreased therapeutics and follow up) and society (decreased costs) are asking for decreased treatments for patients who are in remission. This objective seems to be achievable.
22627729 The epidemiology of rheumatoid arthritis in Kinshasa, Democratic Republic of Congo--a popu 2012 Sep OBJECTIVE: To determine the prevalence of RA and its distribution among linguistic groups in the urban area of Kinshasa. METHODS: Investigators questioned all individuals living in randomly chosen streets in five randomly chosen health areas in Kinshasa. Age, sex, linguistic group and rheumatic complaints were noted. RA diagnosis by 1987 ACR classification criteria was checked in all suspect cases. Disease activity (DAS-28), functionality (HAQ), X-ray damage, ACPA and RF positivity were assessed in patients confirmed with RA. RESULTS: A total of 5000 individuals were questioned, with 2700 females and 2300 males [average age 25.7 (1.8) years]. Linguistic group definitions were obtained in 4587 subjects: 44.3% had Kongo roots, 16.9% Ngala, 16.7% Luba, 11% Swahili, 3.6% Tetela and 7.6% miscellaneous. Thirty persons (age ± 53 years) fulfilled the ACR criteria with a female/male sex ratio of 5. Mean age at disease onset was 47.7 years. Kongo people had the highest RA prevalence (1%). Mean DAS-28 was 6.5, mean HAQ was 1.3. One-third of patients were RF and ACPA positive and had classical X-ray findings. CONCLUSION: The prevalence of RA in Kinshasa is 0.6 and 0.9% in people aged >18 years. Disease activity was high, but RF and ACPA positivity was not frequent. The Kongo seems to be the most affected linguistic group.
22903258 Overexpression of microRNA-223 in rheumatoid arthritis synovium controls osteoclast differ 2013 Jul OBJECTIVES: MicroRNAs, a class of noncoding RNAs, play roles in human diseases. MicroRNA-223 (miR-223) is reported to play critical roles in osteoclastogenesis. The purpose of this study was to analyze the expression pattern of miR-223 in rheumatoid arthritis (RA) synovium and examine the suppression of osteoclastogenesis from human peripheral blood mononuclear cells (PBMC) by overexpression of miR-223. METHODS: Expression of miR-223 in synovium from RA patients was analyzed by quantitative reverse transcription polymerase chain reaction (RT-PCR) and section in situ hybridization. MiR-223 was overexpressed in an osteoclastogenesis coculture system with PBMC and RA synovial fibroblast. At 3 weeks after transfection of double-stranded miR-223, the formation of tartrate-resistant acid phosphatase (TRAP)-stained multinucleated cells was analyzed to evaluate the inhibitory effect of miR-223 on osteoclastogenesis. RESULTS: MiR-223 was more highly expressed in RA synovium than in osteoarthritis (OA) synovium due to the increased number of miR-223-positive cells in RA synovium. MiR-223 was expressed in the superficial and sublining layers, and macrophages, monocytes, and CD4 T cells also expressed miR-223. The number of TRAP-positive multinucleated cells was significantly decreased by overexpression of miR-223 in a dose-dependent manner. The expression of osteoclastogenesis marker genes was significantly down-regulated by miR-223 overexpression. CONCLUSION: MiR-223 is intensely expressed in RA synovium, and overexpression of miR-223 suppresses osteoclastogenesis in vitro. This study demonstrates the possibility of gene therapy with miR-223 to treat bone destruction in RA patients.
22324954 Familial rheumatoid arthritis in patients referred to rheumatology clinics of Tabriz, Iran 2012 Feb BACKGROUND: The familial clustering of rheumatoid arthritis (RA) in first and second degree relatives of patients supports the role of genetic factors. The proportion of heredity in its development is roughly 60%; however, most individuals closely related to someone with RA do not get the disease. Considering the lack of sufficient data on the familial aggregation of RA in Iran, we designed this study for clarifying the familial prevalence of RA. OBJECTIVE: To determine the prevalence of RA among relatives of patients with RA and to evaluate the mean disease onset age in relatives. METHODS: In a longitudinal study from July 2008 to July 2010, we followed 210 unrelated patients with RA and their first and second degree relatives (FDR+ and SDR+), by interviewing and physical examination of those with symptoms, to ascertain prevalence. Familial RA was defined by presence of at least two siblings fulfilling the 1987 ACR criteria for RA. RESULTS: We demonstrated that 17.6% of patients have at least one affected relative. The prevalence of RA in the family of studied patients was 0.83% (42 people). Thirty-two in FDR+ and 10 people in SDR+ (2.53% and 0.26% of all family), also 1.12% in female relatives and 0.39% in male relatives had RA. The odds ratio for FDR/SDR was 2.52. The mean age at disease onset in relatives was 42.30 ± 1.51 years in FDR+ and 34.40 ± 2.10 years in the SDR+ group (0.03). CONCLUSION: The risk of RA is greatest in FDR+ and is likely to be due to a combination of inherited and environmental factors.
23078880 Biosimilars in rheumatology: pharmacological and pharmacoeconomic issues. 2012 Jul Rheumatoid arthritis (RA) societal costs are high because the disease may cause not only restricted joint mobility, chronic pain, fatigue, and functional disability, but also psychological distress. Direct health care costs represent about one-fourth of all costs and are prevalently represented by in-patient care expenditures. The introduction of biologics disease-modifying anti-rheumatic drugs (B-DMARDs), has really changed the perspectives of the patients not fully responding to conventional DMARDs, but the direct costs for drugs has really modified the expenditure for this disease and many other diseases, i.e. psoriatic arthritis, spondyloarthropathies. Increasing pressure for lower cost versions of biological medicines, the scientific technology (particularly analytical technology) that continues to improve will lead to the introduction through reverse ingeneering of biosimilar drugs in rheumatology. The hope is to provide cost savings, which may broaden access to biopharmaceuticals and stimulate further research. The need for patients to have a biosimilar product, with comparable efficacy and safety, will be discussed in this paper along with all the possible issues that will govern the assessment of the bioequivalence and of the interchangeability.
23219774 Different effects of biological drugs in rheumatoid arthritis. 2013 Mar Biological drugs have brought new hope to patients with rheumatoid arthritis (RA) in whom previously existing treatments could not control inflammation, joint destruction, or the progression of disability. The five currently available TNF blockers are approved for treating RA patients, but they have different structures, morphology, pharmacokinetic properties, and activity. Randomised clinical trials (RCTs) have shown that they improve the signs and symptoms of both early and long-standing RA and other inflammatory arthritides, prevent radiographic progression, and improve the patients' health-related quality of life. However, they are more effective in combination with methotrexate (MTX) than alone. Combined treatment is generally well tolerated, and seems to be relatively safe in the short term, as confirmed by RCTs, long-term observational studies and in clinical practice. Patients who fail to respond or develop adverse effects - when treated with one anti-TNF agent can be successfully treated with a second TNF antagonist. However, in the case of primary failure, it is possible that biological agents with a different mechanism of action may be more successful. Tocilizumab alone or in combination with MTX is more effective than MTX monotherapy in reducing disease activity over 24 weeks. Abatacept is well tolerated and retains its efficacy over time, as does rituximab in non-responders to other anti-TNF drugs. Finally, although these drugs improve the quality of life of RA patients, they considerably increase direct medical costs.
22467923 Peripheral blood gene expression and IgG glycosylation profiles as markers of tocilizumab 2012 May OBJECTIVE: Tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, has recently been approved as a biological therapy for rheumatoid arthritis (RA) and other diseases. It is not known if there are characteristic changes in gene expression and immunoglobulin G glycosylation during therapy or in response to treatment. METHODS: Global gene expression profiles from peripheral blood mononuclear cells of 13 patients with RA and active disease at Week 0 (baseline) and Week 4 following treatment were obtained together with clinical measures, serum cytokine levels using ELISA, and the degree of galactosylation of the IgG N-glycan chains. Gene sets separating responders and nonresponders were tested using canonical variates analysis. This approach also revealed important gene groups and pathways that differentiate responders from nonresponders. RESULTS: Fifty-nine genes showed significant differences between baseline and Week 4 and thus correlated with treatment. Significantly, 4 genes determined responders after correction for multiple testing. Ten of the 12 genes with the most significant changes were validated using real-time quantitative polymerase chain reaction. An increase in the terminal galactose content of N-linked glycans of IgG was observed in responders versus nonresponders, as well as in treated samples versus samples obtained at baseline. CONCLUSION: As a preliminary report, gene expression changes as a result of tocilizumab therapy in RA were examined, and gene sets discriminating between responders and nonresponders were found and validated. A significant increase in the degree of galactosylation of IgG N-glycans in patients with RA treated with tocilizumab was documented.
22247366 The influence of individual joint impairment on functional disability in rheumatoid arthri 2012 Mar OBJECTIVE: To clarify the influence of individual joint impairment on functional capacity through a retrospective study with a 3-year interval, using a large cohort of Japanese patients with rheumatoid arthritis (RA). METHODS: Subjects included 3457 patients with RA who participated in a large observational cohort study in both April 2004 and April 2007; 43 joints were assessed and classified into 10 joint areas. Impairment of each joint area was scored based on the presence of swelling or tenderness: score 0 (no swelling or tenderness in either joint), score 1 (swelling or tenderness in a unilateral joint), and score 2 (swelling or tenderness in bilateral joints). Score change was defined as the difference between scores from 2004 and 2007. The Japanese validated version of the Health Assessment Questionnaire is the J-HAQ; ΔJ-HAQ score was determined by subtracting J-HAQ score in 2007 from that in 2004. The relationship between score change and ΔJ-HAQ score, and the effect of joint impairment on ΔJ-HAQ score were assessed. RESULTS: Major joint areas that contributed to ΔJ-HAQ score included the wrist (31%), shoulder (21%), knee (13%), and ankle (10%). The shoulder, wrist, knee, and ankle in the worsening group were associated with a J-HAQ score increase of 0.13 to 0.18 compared to the improvement group. CONCLUSION: Our study demonstrated that impairment of the shoulder, wrist, knee, and ankle significantly affects functional capacity in patients with RA. Care of these joints is suggested to be especially important for better functional outcomes.