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ID PMID Title PublicationDate abstract
21327737 Pathogenesis of joint destruction in rheumatoid arthritis. 2011 Apr Synovial mesenchymal cells, matrix metalloproteinases (MMPs), and osteoclasts are the three major players directly responsible for the pathogenesis of rheumatoid joint destruction. First, synovial mesenchymal cells, internally driven by a transcription factor c-Fos/AP-1, not only directly invade cartilage and bone as a granulation tissue called "pannus" but also release inflammatory cytokine interleukin (IL)-1β. IL-1β induces MMPs and activates osteoclasts. Synovial cells can also present antigen to T cells to drive antigen-specific immune responses. Second, cartilaginous joint matrix can only be degraded after the first attack of collagen fibrils by MMPs, and importantly, most of the MMPs are under the control of c-Fos/AP-1 and IL-1β as well. Third, differentiation of osteoclast is driven internally by NFATc1, where NFATc1 is under the control of TRAF6, c-Fos/AP-1 and osteoclastogenic signaling complex. IL-1β has been shown to induce osteoclastogenesis directly and also indirectly via signaling through RANKL. Therefore, IL-1β and c-Fos/AP-1 influence each other's gene expression and activity, resulting in an orchestrated cross-talk that is crucial to arthritic joint destruction, and thus, blockade of IL-1β and/or c-Fos/AP-1 can be most promising as a therapeutic target, and in fact, a selective inhibition of c-Fos/AP-1 does resolve arthritic joint destruction.
20950987 Combined arthroscopic and radiation synovectomy of the knee joint in rheumatoid arthritis: 2011 Jan PURPOSE: To investigate the long-term outcome of combined arthroscopic and radiation synovectomy of the knee joint in early cases of rheumatoid arthritis (RA) with regard to knee function and the need for surgical re-interventions. METHODS: Between 1993 and 1997, a consecutive series of 38 RA patients with therapy-refractory synovitis of the knee joint and only mild cartilage lesions (not exceeding Outerbridge grade II at surgery) were treated with combined arthroscopic and radiation synovectomy. Knee function was assessed preoperatively; at 6 months, 1 year, and 5 years; and finally, at a mean of 14 years with 4 different functional scores. A Kaplan-Meier survival curve was calculated with "any re-intervention" and "total knee arthroplasty" as endpoints. RESULTS: Of 38 knees, 32 were available for the final 14-year follow-up with a total of 22 re-interventions: intra-articular steroid injection (n = 3), arthroscopic (n = 2) or radiation (n = 1) re-synovectomy, and total knee arthroplasty (n = 16). The remaining 10 patients with no re-intervention showed knee function not significantly different from the postoperative state. With any surgical re-intervention as the endpoint, the survival rate was 84% at 5 years (95% confidence interval [CI], 67.0% to 86.7%), 44% at 10 years (95% CI, 26.7% to 60.0%), and 32% at the 14-year assessment (95% CI, 16.0% to 49.3%). With total knee arthroplasty as the endpoint, the joint survival rate was 88.5% at 5 years (95% CI, 68.5% to 96.2%), 53.9% at 10 years (95% CI, 33.3% to 71.6%), and 39.6% at 14 years (95% CI, 18.9% to 48.6%). CONCLUSIONS: Combined arthroscopic and radiation synovectomy leads to a stable improvement of knee function for a minimum of 5 years, but surgical re-interventions were frequently observed at the 14-year assessment and challenge the long-term benefit of the procedure. Patients with no interventions had a significantly shorter history of disease (7 v 11 years). LEVEL OF EVIDENCE: Level IV, therapeutic case series.
22434264 Suppressive effects of N-acetyl-D-glucosamine on rheumatoid arthritis mouse models. 2012 Aug We examined effects of N-acetyl-D: -glucosamine (GlcNAc) on rheumatoid arthritis (RA) mouse models and effects of GlcNAc and glucosamine hydrochloride (GlcN) on several serum cytokine productions in RA mouse models. SKG/jcl mice were divided into control, GlcNAc, and GlcN groups. For 56 days, the control group received normal food, the GlcNAc group received 0.5 % GlcNAc-containing food, and the GlcN group received 0.5 % GlcN-containing food. GlcNAc and GlcN equally suppressed arthritis scores and histopathological scores compared to the control group. In the GlcN group, serum tumor necrosis factor-α and interleukin (IL)-6 concentrations were significantly decreased compared to the control group. In the GlcNAc group, serum IL-10, transforming growth factor β-1, and IL-2 concentrations were significantly increased compared to the control group. Our results indicated that GlcNAc also has suppressive effects on experimental RA in mouse models. The results of serum cytokine concentrations suggested that compared to GlcN, GlcNAc has a different suppressive mechanism in experimental RA models.
21881979 Evaluation of cartilage degradation in arthritis using T1ρ magnetic resonance imaging map 2012 Sep T1ρ magnetic resonance imaging (MRI) can be used to map proteoglycan (PG) loss in cartilage. Here, we used T1ρ MRI to map cartilage degradation in osteoarthritis (OA) and rheumatoid arthritis (RA). Tissue samples were obtained from five RA patients and 14 OA patients following total knee arthroplasty (TKA). Three parameters were measured: First, macroscopic grading of cartilage sample tissues was performed on a 5-grade scale (G0: normal, G1: swelling, G2: superficial fibrillation, G3: deep fibrillation, G4: subchondral bone exposure). Second, semi-quantitative values of PG were assessed by measuring the optical density of Safranin-O-stained paraffin sections that had been digitally photographed. Third, cartilage was divided into superficial and deep layers and the T1ρ values were quantified. T1ρ values of OA and RA in the superficial layers showed significant differences between groups (G0/1 and G0/2 for OA; G0/2 and G1/2 for RA). In the deep layers, T1ρ values of OA and RA also differed significantly between groups. In both the superficial and deep layers, there was a significant correlation between the mean T1ρ values and macroscopic grading (P < 0.01 for OA, P < 0.001 for RA). We found a negative correlation between the score of Safranin-O staining and T1ρ values (r = -0.61 for OA, r = -0.79 for RA). In addition, RA subjects had significantly higher T1ρ values than OA subjects of similar morphologic grade. In conclusion, T1ρ MRI is able to detect and map the early stages of cartilage degradation in OA and RA. This method is reliable and useful for the evaluation of macromolecular changes in arthritic cartilage.
22813208 Extra-articular manifestations in a community-based sample of patients with rheumatoid art 2012 OBJECTIVES: To determine the incidence of severe extra-articular rheumatoid arthritis (ExRA) in a community-based cohort of RA patients, and to evaluate whether treatment with tumour necrosis factor (TNF) inhibitors has any effect on the risk of ExRA. METHODS: In a review of clinical records from 1 July 1997 to 31 December 2004, severe ExRA manifestations were classified according to predefined criteria. Patients were censored at the development of ExRA, death, emigration, or 31 December 2004. Exposure to anti-TNF treatment has continuously and independently been recorded as part of a regional follow-up system. RESULTS: During treatment with TNF inhibitors, there were two patients with new onset of ExRA in 408 person-years at risk (pyr) [0.49/100 pyr, 95% confidence interval (CI) 0.06-1.77]. Among those without anti-TNF treatment there were 63 patients with ExRA in 5425 pyr (1.16/100 pyr, 95% CI 0.89-1.49). The relative risk comparing those treated to those not treated with TNF inhibitors was 0.42 (95% CI 0.10-1.73). CONCLUSION: Our data show a lower incidence of ExRA in patients treated with TNF inhibitors but further studies with a larger sample size are needed for a more accurate estimate of the size of the effect.
22283139 Dynamic gadolinium-enhanced magnetic resonance imaging allows accurate assessment of the s 2012 Mar OBJECTIVE: To determine whether dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) evaluated using semi-automatic image processing software can accurately assess synovial inflammation in rheumatoid arthritis (RA) knee joints. METHODS: In 17 RA patients undergoing knee surgery, the average grade of histological synovial inflammation was determined from four biopsies obtained during surgery. A preoperative series of T(1)-weighted dynamic fast low-angle shot (FLASH) MR images was obtained. Parameters characterizing contrast uptake dynamics, including the initial rate of enhancement (IRE), were generated by the software in three different areas: (I) the entire slice (Whole slice); (II) a manually outlined region of interest (ROI) drawn quickly around the joint, omitting large artefacts such as blood vessels (Quick ROI); and (III) a manually outlined ROI following the synovial capsule of the knee joint (Precise ROI). Intra- and inter-reader agreement was assessed using the intra-class correlation coefficient (ICC). RESULTS: The IRE from the Quick ROI and the Precise ROI revealed high correlations to the grade of histological inflammation (Spearman's correlation coefficient (rho) = 0.70, p = 0.001 and rho = 0.74, p = 0.001, respectively). Intra- and inter-reader ICCs were very high (0.93-1.00). No Whole slice parameters were correlated to histology. CONCLUSION: DCE-MRI provides fast and accurate assessment of synovial inflammation in RA patients. Manual outlining of the joint to omit large artefacts is necessary.
21258051 The long-term impact of early treatment of rheumatoid arthritis on radiographic progressio 2011 Jun OBJECTIVE: To measure the long-term rate of radiographic progression in a cohort of patients treated early vs late with conventional DMARDs. METHODS: The long-term rate of radiographic progression in patients included in the Swiss clinical quality management in rheumatoid arthritis (SCQM-RA) registry who initiated treatment with conventional DMARDs within the first year of symptom onset (early DMARD) vs patients who initiated treatment 1-5 years after symptom onset (late DMARD). Radiographic progression was assessed in 38 joints using a validated score (Ratingen Score). The rate of progression was calculated using a multivariate regression model for longitudinal data, adjusting for potential confounders. RESULTS: A total of 970 RA patients were included. The 368 patients in the early DMARD group started therapy after a median symptom duration of 6 months, whereas the 602 patients in the late DMARD group initiated therapy after median 2.5 years. RF, MTX use and other risk factors for erosive disease progression were similar between the two groups. However, the estimated rate of radiographic progression at baseline was higher in the early DMARD vs the late DMARD group (1.8 vs 0.6, P < 0.01). In spite of this, the long-term rate of radiographic progression was significantly lower in the early DMARD group after adjustment for confounding factors (-0.35 at 5 years, P = 0.012). CONCLUSION: This result supports the concept of a therapeutic window of opportunity early in the disease course and suggests that early initiation of DMARD therapy results in a long-lasting reduction of radiographic damage.
20840015 Expression of β-catenin in rheumatoid arthritis fibroblast-like synoviocytes. 2011 Jan OBJECTIVE: β-Catenin is the key mediator of the Wnt signal and also a component of E-cadherin complexes at the intercellular adhering junction, which mediates cell-cell adhesion. We hypothesized that β-catenin might be involved in the long-lasting changed phenotype of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) and could play a role in the pathogenesis of RA. In this study we investigated the expression of β-catenin in RA-FLS. METHODS: Synovial tissues were obtained during joint replacement surgery or arthroscopy from six patients with RA, six patients with osteoarthritis (OA), and six patients with joint trauma (Trauma group). Immunohistochemical analysis of β-catenin was performed in the synovial tissues from the three groups. Synovial tissues from three patients in each group were selected at random for FLS isolation. Expression of β-catenin in FLS from the three groups was evaluated at the protein level by western blotting and at the mRNA level by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Immunohistochemistry revealed that the expression of β-catenin in synovial lining cells of the RA samples was significantly greater than that of the OA or trauma samples (p < 0.01). Western blotting and RT-PCR showed that β-catenin expression was elevated in RA-FLS compared with that in OA-FLS or Trauma-FLS (p < 0.05) at the protein level but no difference was found at the mRNA level. CONCLUSIONS: Expression of β-catenin is elevated in RA-FLS, not only in vitro but also in vivo. The increase is due to activation of Wnt/β-catenin signalling. Wnt/β-catenin signalling is activated in RA-FLS, and contributes to the stable activation of RA-FLS.
22009331 The balance of tissue repair and remodeling in chronic arthritis. 2011 Oct 18 The introduction of targeted therapies has dramatically changed the prognosis of patients with chronic joint diseases such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). As control of inflammation, and hence of symptoms of disease, is increasingly achieved, more attention is given towards the long-term consequences of these disorders, to the structural damage in the skeletal tissues and to the resulting disability. In AS, bone remodeling with new cartilage and bone formation leading to ankylosis is a striking feature. Clinically successful TNF antagonists do not inhibit radiographic progression of disease. New insights into the molecules involved in ankylosis (such as bone morphogenetic proteins and Wnts) have suggested that the classical paradigm linking inflammation and ankylosis can be challenged, and new concepts of disease onset and progression, with a focus on cell stress and damage, are rapidly evolving. In RA, inhibition of Wnt signaling and defective osteoblast function have been associated with lack of repair. As restoration of tissue integrity and homeostasis is the ultimate goal of therapy, these findings suggest new roads for therapeutic intervention. For patients with AS or RA, such strategies will be critically dependent on further research that defines individual risk factors and need for interventions.
22382335 Anticitrullinated protein antibody, but not its titer, is a predictor of radiographic prog 2012 Apr OBJECTIVE: To study the contribution of anticitrullinated protein antibody (ACPA), and especially of its titer, to radiographic progression and disease activity in rheumatoid arthritis (RA). METHODS: Patients with RA (n = 396) who attended a Japanese clinic within 2 years after disease onset were divided into the following groups according to second-generation (ACPA-2) ACPA titer on their first visit: negative (0-4.4 U/ml; n = 115), low-positive (4.5-121 U/ml; n = 141), and high-positive (> 121 U/ml; n = 140). The ACPA-2-positive groups were further subdivided into lowest (4.5-32 U/ml), low (33-121 U/ml), high (122-277 U/ml), and highest (> 278 U/ml) quartiles. All patients were treated with disease-modifying antirheumatic drugs (DMARD) including methotrexate, but not biologics. Subsequent radiographic progression and disease activity for 2 years were prospectively evaluated using the van der Heijde-modified Sharp score (SHS) and 28-joint Disease Activity Score (DAS28). RESULTS: After treatment with DMARD, the disease activity (including number of swollen joints, number of tender joints, duration of morning stiffness, DAS28-erythrocyte sedimentation rate, and DAS28-C-reactive protein) was significantly decreased in all patient groups. Disease activity and radiographic progression as revealed by the change in SHS remained relatively higher in the ACPA-2 low- and high-positive groups as compared with the ACPA-2-negative group. The relationship between the titer of ACPA-2 at baseline and subsequent radiographic progression was not exactly linear, and the extent of disease activity or radiographic progression was similar between ACPA-2 low- and high-positive groups and also between ACPA-2 lowest- and highest-positive quartile groups. The results were demonstrable in cumulative SHS probability plots, and also repeatable in seronegative patients, which indicated that the titer of ACPA-2 is not a predictor of disease activity or radiographic progression in RA, and ACPA-2-negative patients, especially those with < 3 U/ml, showed minimal radiographic progression. CONCLUSION: Presence of ACPA-2, but not its titer, at baseline is a predictor of radiographic progression or disease activity, where radiographic progression is minimal in ACPA-2-negative patients.
21956828 [Prescription of TNF-alpha inhibitors and regional differences in 2010]. 2011 Dec Tumor necrosis factor alpha (TNF-α) inhibitors are an important treatment option for rheumatoid arthritis and other chronic inflammatory diseases. However, attention should be paid to severe adverse drug reactions and very high costs of therapy. The objective of this study was to examine the prescription and costs of TNF-α inhibitors as well as regional differences at the district level in Germany. For this purpose, prescription claims data of a German health fund with 9.1 million insured persons from the year 2010 were analyzed. A total of 45,229 packs (0.1% of all prescribed drugs) and 3.15 million defined daily doses (DDD) of TNF-α inhibitors were prescribed. This leads to a total pharmacy revenue of 163.18 million Euro (share 4.1%) and 1 DDD costs on average 51.61 Euro. For 10,078 patients at least one TNF inhibitor was prescribed (prescription prevalence 111 per 100,000) with a higher proportion of women (125 vs. 92 per 100,000). The average revenue per insured person was often higher in districts of eastern Germany (>30 Euro) for reasons unknown. Provided that use is appropriate to indications there are only low saving potentials.
22935437 Characteristics of patients with rheumatoid arthritis in clinical remission: the many aspe 2012 Nov OBJECTIVES: The aim of this study was to observe the clinical characteristics, including the extent of foot and ankle involvement, of Korean patients with rheumatoid arthritis (RA) in remission, defined as Disease Activity Score in 28 joints (DAS28) <2.6. METHODS: Data from a registry of RA patients who visited a rheumatology clinic of a university-affiliated hospital and who were regularly evaluated with DAS28, including the ankle and foot metatarsophalangeal (MTP) joints were enrolled. Patients who were treated with disease-modifying anti-rheumatic drugs for at least three months and who were in DAS28 remission were included in this study. RESULTS: Two hundred and thirteen episodes of DAS28 remission were observed in 147 patients. The mean DAS28 value at the time of remission was 1.84 (range, 0.14-2.59). The mean numbers of swollen joints and tender joints (of the 28 joints examined for DAS28) at the time of remission was 0.4 (range, 0-6) and 1.5 (range, 0-13), respectively. Overall, 11.7% and 38% of the patients in clinical remission had foot MTP/ankle swollen and tender joints, respectively. Additionally, 7% and 8.9%, respectively, of the patients in clinical remission had foot MTP/ankle swollen and tender joints without any involvement of the 28 joints included in the DAS28. CONCLUSIONS: Our results show that RA patients in DAS28 remission frequently have residual disease activity in the ankle and foot joints. Given that fore-foot disease activity can lead to joint damage and disability with respect to weight-bearing activities, these joints should be included in the clinical examination.
21078720 Improvement of thyroid function in hypothyroid patients with rheumatoid arthritis after 6 2011 Feb OBJECTIVE: Rheumatoid arthritis (RA) is characterized by high levels of cytokines such as tumor necrosis factor (TNF). TNF appears to have an etiologic role in thyroid dysfunction, and thyroid dysfunction is a common comorbidity in RA. Anti-TNF treatment might limit thyroid dysfunction. Thus, changes in thyroid hormones were studied during TNF-blocking therapy in patients with RA. METHODS: At baseline and after 6 months' treatment with adalimumab, thyroid function [thyroid-stimulating hormone (TSH), free thyroxine (fT4), and antibodies against thyroid peroxidase (TPOabs)] were assessed in 138 consecutive adalimumab-treated patients with RA who were naive for TNF-blocking agents. Patients were categorized as hypothyroid, hyperthyroid, or euthyroid. In these groups, changes in thyroid function were determined. RESULTS: Prevalences of hypothyroidism, hyperthyroidism, and TPOabs were 13%, 5%, and 15%, respectively. After 6 months, TPOabs decreased from 267 to 201 IU/ml (p = 0.048). In hypothyroid patients without concomitant L-thyroxine, a trend for declining levels of TSH was observed. Subgroup analysis revealed that in patients who were hypothyroid and TPOabs-positive and L-thyroxine-naive, TSH levels decreased significantly, from 12.5 (interquartile range 6.7-18.4) to 7.1 (interquartile range 4.9-13.8) mU/l (p = 0.043). CONCLUSION: Anti-TNF treatment improves thyroid function in hypothyroid patients with RA (especially in those who are L-thyroxine-naive and TPOabs-positive), providing further evidence that inflammatory cytokines such as TNF have a pathogenic role in thyroid dysfunction.
23137751 Hearing loss in fibromyalgia? Somatic sensory and non-sensory symptoms in patients with fi 2012 Nov OBJECTIVES: It has been proposed that fibromyalgia can be understood as a disorder of central sensitisation and dysregulation (CD) and that characteristic somatic symptoms are the result of 'central augmentation'. We examined this hypothesis by analysing sensory and non-sensory variables in the context of the updated (2010) American College of Rheumatology definition of fibromyalgia and the fibromyalgianess (polysymptomatic distress) scale. METHODS: We studied 11,288 patients, including those with fibromyalgia, rheumatoid arthritis (RA) and osteoarthritis (OA). We divided somatic symptoms into sensory (hearing difficulties) and evaluative (easy bruising and hair loss) non-sensory symptoms, and included a non-symptom that was neutral as to psychological content or meaning (influenza vaccination). Data were analysed by logistic regression and adjusted for age and sex. RESULTS: Fibromyalgia patients reported more sensory and non-sensory symptoms than patients with RA and OA, but not more non-symptoms. At all levels of fibromyalgianess (or fibromyalgia intensity) the probability of sensory and non-sensory symptoms was similar across all rheumatic diseases, and this association occurred in FM criteria (+) and criteria (-) patients. No association was noted with the non-symptom control question. CONCLUSIONS: While the CD hypothesis is consistent with hearing problems in fibromyalgia, there is no medical explanation for the evaluative symptoms of hair loss and bruising being increased. The associations between fibromyalgia/fibromyalgianess and evaluative (not sensory) symptoms must occur through mechanisms other than central sensitization and augmentation, and are consistent with over-reporting that has a psychological basis. However, augmentation of sensory symptoms does not preclude simultaneous over-reporting.
22089458 Sex differences in response to anti-tumor necrosis factor therapy in early and established 2012 Jan OBJECTIVE: To investigate sex differences in response to anti-tumor necrosis factor-α (TNF-α) therapy over time in early versus established rheumatoid arthritis (RA). METHODS: Patients with RA who initiated anti-TNF therapy between January 2003 and June 2008 in Denmark were selected from the DANBIO Registry. Sex differences in baseline disease features were examined using chi-square, Mann-Whitney U tests, and t tests. Using a generalized estimating equations (GEE) model for repeated measures, we examined European League Against Rheumatism (EULAR) responses in men and women over 48 months of followup, adjusting for baseline values of age, 28-joint Disease Activity Score (DAS28), disease duration, and anti-TNF, methotrexate, and prednisolone use. RESULTS: At initiation of anti-TNF therapy (baseline), 328 women and 148 men had early RA (≤ 2 yrs), and 1245 women and 408 men had established RA (> 2 yrs). In both early and established RA, men and women had active disease with similar DAS28 scores (mean ± SD 5.2 ± 1.1), physician global scores, swollen joint counts, and radiographic changes. In early RA, men were significantly more likely to achieve a EULAR good/moderate response over 48 months compared to women (GEE; p = 0.003), and a significant interaction between sex and followup time (GEE; p < 0.0005) suggested that men achieved this response sooner than women. CONCLUSION: Better responses to anti-TNF therapy among men compared to women in early but not established RA suggest that disease duration at initiation of therapy may be an important factor to consider when investigating sex differences in treatment responses.
22984493 Characterization of rheumatoid arthritis subtypes using symptom profiles, clinical chemist 2012 OBJECTIVE: The aim is to characterize subgroups or phenotypes of rheumatoid arthritis (RA) patients using a systems biology approach. The discovery of subtypes of rheumatoid arthritis patients is an essential research area for the improvement of response to therapy and the development of personalized medicine strategies. METHODS: In this study, 39 RA patients are phenotyped using clinical chemistry measurements, urine and plasma metabolomics analysis and symptom profiles. In addition, a Chinese medicine expert classified each RA patient as a Cold or Heat type according to Chinese medicine theory. Multivariate data analysis techniques are employed to detect and validate biochemical and symptom relationships with the classification. RESULTS: The questionnaire items 'Red joints', 'Swollen joints', 'Warm joints' suggest differences in the level of inflammation between the groups although c-reactive protein (CRP) and rheumatoid factor (RHF) levels were equal. Multivariate analysis of the urine metabolomics data revealed that the levels of 11 acylcarnitines were lower in the Cold RA than in the Heat RA patients, suggesting differences in muscle breakdown. Additionally, higher dehydroepiandrosterone sulfate (DHEAS) levels in Heat patients compared to Cold patients were found suggesting that the Cold RA group has a more suppressed hypothalamic-pituitary-adrenal (HPA) axis function. CONCLUSION: Significant and relevant biochemical differences are found between Cold and Heat RA patients. Differences in immune function, HPA axis involvement and muscle breakdown point towards opportunities to tailor disease management strategies to each of the subgroups RA patient.
20888281 Anti-CCP antibodies are associated with early age at onset in patients with rheumatoid art 2011 Mar OBJECTIVES: To determine factors influencing the age at onset of rheumatoid arthritis (RA). METHODS: A sample of 152 Colombian patients was investigated. Hazard ratios (HRs) that measured the effect size of risk factors on the age at RA onset were computed by using Cox regression models. RESULTS: Positive anti-CCP antibodies were associated with an increased risk of early RA onset (HR = 1.60; 95% confidence interval, [1.06, 2.4]), whereas the presence of the protective (70)DERAA(74) sequence was associated with a delayed onset (HR = 0.55; [0.33, 0.92]). After controlling for both anti-CCP antibodies and the (70)DERAA(74) sequence, the following variables did not influence significantly the age at RA onset: gender, ever cigarette smoking, family RA history, the TNF-308 A polymorphism, HLA shared epitope, and the presence of rheumatoid factor. CONCLUSION: Anti-CCP antibodies and the HLA-DRB1 (70)DERAA(74) sequence influence the age at onset of RA.
22828520 Rheumatoid arthritis educational series: a nurse-led project. 2012 Jul Nurses in the rheumatology clinic at New York University Hospital for Joint Diseases realized a need to provide patients with rheumatoid arthritis with more healthcare information than was routinely given during clinic visits. This project goal was to support patient involvement in decision making and encourage participation in treatment planning. To address these concerns, a team of staff registered nurses developed an educational program based on various arthritis-related topics. This article shares the experiences of these nurses as they developed and led a patient education project. Various elements of the project are discussed, including institutional history, program needs, project start-up, challenges, outcomes, and the lessons learned.
22730908 Construct validity of the interview time trade-off and computer time trade-off in patients 2012 Jun 25 BACKGROUND: The Time Trade-Off (TTO) is a widely used instrument for valuing preference-based health-related quality of life (HRQoL). The TTO reveals preferences for own current health ('utilities') on a scale anchored between death (0) and perfect health (1). Limited information on the external validity of the TTO is available. Aim of this pilot study was to examine the construct validity of both an interview TTO and a computer-based TTO in patients with rheumatoid arthritis (RA). METHODS: Thirty patients visiting the outpatient rheumatology clinic participated. Construct validity was assessed by measuring convergent and discriminative validity. Convergent validity was assessed by calculating Spearman's correlations between the utilities obtained from the TTOs and pain, general health (rating scales), health-related quality of life (SF-36 and SF-6D) and functional status (HAQ-DI). Discriminative power of both TTO measures was determined by comparing median utilities between worse and better health outcomes. RESULTS: Correlations of both TTO measures with HRQoL, general health, pain and functional status were poor (absolute values ranging from .05 to .26). Both TTOs appeared to have no discriminative value among groups of RA patients who had a worse or better health status defined by six health outcome measures. About one-third of respondents were zero-traders on each of the TTO measures. After excluding zero-traders from analysis, the correlations improved considerably. CONCLUSIONS: Both the interview TTO and computer TTO showed poor construct validity in RA patients when using measures of HRQol, general health, pain and functional status as reference measures. Possibly, the validity of the TTO improves when using an anchor that is more realistic to RA patients than the anchor 'death'.
22580535 Effect of ESR1 and ESR2 gene polymorphisms on rheumatoid arthritis treatment with methotre 2012 Rheumatoid arthritis (RA) is a complex autoimmune disease with clinical prevalence in women. Moreover, women have poorer response to treatment than men. Possible reasons for gender differences in response to treatment could be explained on the basis of sex hormones and their receptors. The optimal strategy in treatment of RA is to use effective disease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX). The aim of the present study was to examine the association between polymorphisms in the ESR1 and ESR2 genes and the response to treatment of RA patients with methotrexate. The study was carried out on 156 women diagnosed with active rheumatoid arthritis, treated with MTX. Good responders were defined as patients who were receiving MTX and had a DAS28 of ≤ 2.4 after 6 months of therapy (patients with remission of disease symptoms). Poor-responders were defined as patients who were receiving MTX and had a DAS28 of > 2.4. There were no statistically significant associations of ESR1 and ESR2 gene polymorphisms with response to treatment. The results of the present study suggest that the polymorphisms rs9340799:A>G and rs2234693:T>C in ESR1 gene and rs4986938:G>A and 1256049:G>A in ESR2 gene are not associated with response to RA treatment with MTX.