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ID PMID Title PublicationDate abstract
22955475 Efforts to increase public awareness may result in more timely diagnosis of rheumatoid art 2012 Sep BACKGROUND: Patients with rheumatoid arthritis (RA) in the United Arab Emirates (UAE) have previously been found to have a long delay to diagnosis and low utilization of disease-modifying antirheumatic drugs (DMARDs). Over the past 5 years, support groups, awareness programs, and public campaigns have been instituted in the region. AIM: This study aimed to assess whether such initiatives have affected the lag to diagnosis previously observed. METHODS: Demographic, disease, and treatment data on the first 100 patients meeting American College of Rheumatology (1987) criteria for RA, presenting to our practice for the first time, were compared with similar data from 2006 on patients presenting to a different musculoskeletal clinic. RESULTS: Subjects had a mean age of 40.2 (±11.0) years (42.2 [±12.3] years in the previous study; Student t test, P > 0.05). Rheumatoid factor was positive in 62% of subjects, whereas 73% were titer positive in the previous study (χ(2) test, P > 0.05). There was a mean reduction in lag time from symptom onset to diagnosis by 45.8%, from 14.4 (±15.6) to 7.8 (±12.1) months (Student t test, P = 0.001) between data sets. The lag to initial DMARD was also reduced by a mean of 34.9%, from 19.2 (±24) to 12.5 (±21.7) months (Student t test, P = 0.04). CONCLUSIONS: Findings suggest that the lag to diagnosis and initiation of DMARD therapy has reduced significantly among patients with RA in the United Arab Emirates, over the past 5 years. This may be attributed to the inception of patient support groups and increasing public awareness. Larger studies are needed to substantiate this further and to address whether shorter lag times can positively influence rates of disease remission and quality of life for our patients with RA (as this was a region specific study).
22802154 Lipid paradox in rheumatoid arthritis: changes with rheumatoid arthritis therapies. 2012 Oct Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality, related not only to traditional CV risk factors, but also to a chronic inflammatory state. However, lipid profiles in RA are different from those observed in the general population at risk of CV disease, where there is evidence of a positive relationship between disease and high cholesterol levels. In untreated patients with active RA this relationship is different, with a paradoxical effect resulting in lower levels of cholesterol associated with an increased risk of CV disease. In this review, we summarize the latest evidence on lipid abnormalities in the setting of RA and the interaction between inflammation and lipoproteins, as well as the effect of DMARDs and biologic therapies on lipid profiles and the possible implications for CV outcomes in this population.
22334269 Cervical spine radiographs in patients with rheumatoid arthritis undergoing anesthesia. 2012 Mar BACKGROUND: There is no consensus on the role of preoperative cervical spine radiographs to screen for instability in patients with rheumatoid arthritis (RA). OBJECTIVES: This study aimed to evaluate the preoperative use of cervical spine radiographs in patients with RA undergoing preoperative anesthesia assessment and to determine whether preoperative radiographic findings influenced anesthesia delivery techniques. METHODS: We reviewed all medical records of RA patients who underwent surgical procedures requiring general anesthesia with airway intubation or monitored anesthesia care without airway intubation. We examined cervical spine radiographs obtained up to 2 years before surgery and determined airway management techniques used during surgery. RESULTS: Overall, 215 patients with RA underwent 217 individual surgeries requiring anesthesia; of these, 176 (82%) underwent general anesthesia with airway management with direct laryngoscopy in 83%, fiber-optic intubation in 10%, and laryngeal mask in 7%. Ninety-two (52%) of the patients receiving airway management had radiographs available for cervical spine evaluation; of these, only 7 (8%) had complete radiographic examinations with which to evaluate possible atlantoaxial subluxation. Eighteen (20%) of the 92 patients receiving airway management had radiographic evidence of cervical spine abnormality. Multiple regression models were conducted to evaluate the association of patient demographics and airway management technique used and showed that the use of fiber-optic intubation or laryngeal mask was not influenced by radiographic results. A difficult oropharyngeal class/glottic visualization grade (3 or 4) as determined by the anesthesiologist was the only statistically significant predictor of fiber-optic intubation or laryngeal mask use. CONCLUSIONS: Cervical spine abnormalities were frequently noted in patients who underwent general surgery but did not influence the choice of airway management. Future prospective studies evaluating the utility of cervical spine radiographs in patients with RA and practice guidelines are needed to ensure appropriate and cost-effective perioperative cervical evaluation and management of patients with RA.
21885514 Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: resul 2011 Sep OBJECTIVE: In rheumatoid arthritis (RA), radiographic progression may occur despite clinical remission. This may be explained by subclinical inflammation. Magnetic resonance imaging (MRI) provides a greater sensitivity than clinical examination and radiography for assessing disease activity. Our objective was to determine the MRI characteristics of RA patients in clinical remission or low disease activity (LDA) state. METHODS: Databases from 6 cohorts were collected from 5 international centers. RA patients in clinical remission according to Disease Activity Score28-C-reactive protein (DAS28-CRP < 2.6; n = 213) or LDA-state (2.6 ≤ DAS28-CRP < 3.2; n = 81) with available MRI data were included. MRI were assessed according to the OMERACT RA MRI scoring system (RAMRIS). PATIENT CHARACTERISTICS: 70% women, median age 55 (interquartile range, IQR 43-63) years, disease duration 2.3 (IQR 0.7-5.1) years, DAS28-CRP 2.2 (IQR 1.8-2.6), Simplified Disease Activity Index, SDAI, 3.9 (IQR 1.9-6.5), Clinical Disease Activity Index, CDAI, 3.1 (IQR 1.5- 5.8), rheumatoid factor/anti-cyclic citrullinated peptide positivity 57%/54%, presence of radiographic erosions: 66%. Wrist and metacarpophalangeal MRI (MCP-MRI) data were available for 287 and 241 patients, respectively. MRI inflammatory activity in wrist and/or MCP joints was observed in the majority [synovitis: 95%, bone edema (osteitis): 35%] of patients. The median (IQR) RAMRIS score was 6 (3-9) for synovitis and 0 (0-2) for osteitis. Synovitis and osteitis were not less frequent in DAS28 clinical remission (synovitis/osteitis 96%/35%) than LDA (91/36). A trend towards lower frequencies of osteitis in patients in SDAI and CDAI remission was observed. CONCLUSION: Subclinical inflammation was identified by MRI in the majority of RA patients in clinical remission or LDA state. This may explain structural progression in such patients. Further work is required to understand the place of modern imaging in future remission criteria.
22305245 A network-based analysis of traditional Chinese medicine cold and hot patterns in rheumato 2012 Feb OBJECTIVE: Rheumatoid arthritis (RA) is a heterogeneous disease, and traditional Chinese medicine (TCM) can be used to classify RA into different patterns such as cold and hot based on its clinical manifestations. The aim of this study was to investigate potential network-based biomarkers for RA with either a cold or a hot pattern. METHOD: Microarray technology was used to reveal gene expression profiles in CD4(+) T cells from 21 RA patients with cold pattern and 12 with hot pattern. A T-test was used to identify significant differences in gene expression among RA patients with either cold or hot pattern. Cytoscape software was used to search the existing literature and databases for protein-protein interaction information for genes of interest that were identified from this analysis. The IPCA algorithm was used to detect highly connected regions for inferring significant complexes or pathways in this protein-protein interaction network. Significant pathways and functions were extracted from these subnetworks by the Biological Network Gene Ontology tool. RESULT: Four genes were expressed at higher levels in RA patients with cold pattern than in patients with hot pattern, and 21 genes had lower levels of expression. Protein-protein interaction network analysis for these genes showed that there were four highly connected regions. The most relevant functions and pathways extracted from these subnetwork regions were involved in small G protein signaling pathways, oxidation-reduction in fatty acid metabolism and T cell proliferation. CONCLUSION: Complicated network based pathways appear to play a role in the different pattern manifestations in patients with RA, and our results suggest that network-based pathways might be the scientific basis for TCM pattern classification.
21864263 Anti-TNF treatment in rheumatoid arthritis. 2011 Rheumatoid arthritis (RA), the most common autoimmune disease, is characterized by persistent synovitis and systemic inflammation. Genetic predisposition as well as autoantibodies and environmental factors, such as smoking, are associated with an increased risk of RA. Traditionally RA has been treated with disease modifying anti-rheumatic drugs (DMARDs) but in the last 15 years or so the introduction of biological response modifiers has revolutionized the treatment of RA. Among these anti-tumor necrosis factor (TNF) agents were the first to be successfully used in treating RA. The goal in treating RA is to induce remission or very low disease activity; remission is now accepted as the ultimate therapeutic goal by adoption of a "treat to target" strategy to achieve tight disease control. Therefore early diagnosis, as well as immediate intervention, are of the utmost importance. This review of the role of TNF in RA pathogenesis describes the mechanisms of action of currently used anti-TNF agents and the adverse events and safety of these drugs. Guidance on the use of anti-TNFs during pregnancy and prior to surgical procedures is also discussed. The intense efforts currently being made to identify biomarkers of response to anti-TNF therapy and recent progress in defining genetic predictors of response using genome- wide association studies (GWAS) are covered. However, so far, none of these studies have been translated into clinical application. The development of biosimilars or follow-on biologicals is also discussed and the first reported study of a biosimilar, involving a multicenter study of an etanercept biosimilar, Etanar, is described.
22162990 Psychophysiological responses to stress after stress management training in patients with 2011 BACKGROUND: Stress management interventions may prove useful in preventing the detrimental effects of stress on health. This study assessed the effects of a stress management intervention on the psychophysiological response to stress in patients with rheumatoid arthritis (RA). METHODS: Seventy-four patients with RA, who were randomly assigned to either a control group or a group that received short-term stress management training, performed a standardized psychosocial stress task (Trier Social Stress Test; TSST) 1 week after the stress management training and at a 9-week follow-up. Psychological and physical functioning, and the acute psychophysiological response to the stress test were assessed. RESULTS: Patients in the intervention group showed significantly lower psychological distress levels of anxiety after the training than did the controls. While there were no between-group differences in stress-induced tension levels, and autonomic (α-amylase) or endocrine (cortisol) responses to the stress test 1 week after the intervention, levels of stress-induced tension and cortisol were significantly lower in the intervention group at the 9-week follow-up. Overall, the response to the intervention was particularly evident in a subgroup of patients with a psychological risk profile. CONCLUSION: A relatively short stress management intervention can improve psychological functioning and influences the psychophysiological response to stress in patients with RA, particularly those psychologically at risk. These findings might help understand how stress can affect health and the role of individual differences in stress responsiveness. TRIAL REGISTRATION: TrialRegister.nl NTR1193.
21503616 CTLA4 exon1 A49G polymorphism in Slovak patients with rheumatoid arthritis and Hashimoto t 2011 Oct Autoimmune thyroid diseases frequently overlaps with rheumatoid arthritis (RA). Among genetic factors, the role of the HLA antigens and CTLA4 gene polymorphisms in the overlapping has been suggested. The aim of this study was to investigate the alleles and genotypes frequency of the CTLA4 exon1 A49G polymorphism in Slovak patients with RA, Hashimoto thyroiditis (HT), both (RA + HT) and in healthy controls. Fifty-seven unrelated adults with RA, 57 patients with HT, 34 patients with both (RA + HT), and 51 normal subjects were studied. All were ethnic Slovaks living in the same geographical area. The CTLA4 exon1 A49G polymorphism was genotyped by using small amplicon melting analysis after real-time PCR. The CTLA4 49GG genotype and G allele frequency in the group with RA was not significantly higher in comparison with controls (10.53% vs. 9.8%, p = 0.62, OR 1.39, 95% CI 0.35-5.74 and 39.47% vs. 34.31%, p = 0.43, OR 1.25, 95% CI 0.72-2.18). The frequency of GG genotype was slightly but not significantly higher in patients with HT as compared with control group (19.3% vs. 9.8%, p = 0.17, OR 2.27, 95% CI 0.67-8.45). However, the frequency of GG genotype and G allele in patients with both RA and HT was significantly higher than that in controls (29.41% vs. 9.8%, p = 0.02, OR 4.49, 95% CI 1.20-18.54 and 51.47% vs. 34.31%, p = 0.03, OR 2.02, 95% CI 1.08-3.81). The frequency of GG genotype of CTLA4 A49G gene polymorphism in Slovak patients with RA is not significantly higher in comparison to control group. However, carriers of GG genotype with RA may be susceptible to develop HT.
23068060 Does digital X-ray radiogrammetry have a role in identifying patients at increased risk fo 2012 Oct 15 INTRODUCTION: The aim of this study was to investigate the role of hand bone mineral density (BMD) loss analyzed with digital X-ray radiogrammetry (DXR) in early rheumatoid arthritis (RA) as a predictor for progression of joint damage. METHODS: In 379 patients with early RA, baseline and one-year hand BMD was measured with DXR and the hand bone loss (HBL) was analyzed using the smallest detectable change (HBLsdc) and tertiles (HBLtertiles). Joint damage in hands and feet were scored according to the Sharp van der Heijde (SHS) method at baseline and at one, two, five and eight years. At the same time-points Disease Activity Score (DAS28) was calculated and functional disability assessed. Rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) were analyzed at baseline. RESULTS: Sixty-six percent of the patients had hand BMD loss in the first year of RA determined by HBLsdc and 65% by HBLtertiles. Radiographic progression after two, five and eight years was associated with hand bone loss defined by HBLsdc. By HBLtertiles there were significant associations at all time-points except at eight years. The change in DXR at one year (ChDXR1yr) correlated significantly and inversely with the change in SHS (ChSHS) at two, five and eight years. Multivariate analysis showed that only change in SHS during the first year and the presence of anti-CCP were independent predictors of long-term progressive joint damage. If radiographic scores were not included, DXR-BMD loss was an independent predictor. Patients with great bone loss by HBLtertiles had significantly more often high disease activity after two years. However, neither bone loss by HBLsdc or HBLtertiles nor by ChDXR1yr was an independent predictor of remission after two, five and eight years. CONCLUSIONS: This study confirms previous reports of an association of decrease in DXR-BMD during the first disease year with progression of radiographic joint damage over an extended period of time. This association was independent in a regression model only when radiological findings were excluded suggesting a possible predictive role of DXR-BMD in clinical practice when radiographic evaluation is not available. However, further studies are required before this can be established.
22215043 Early diagnosis of rheumatoid arthritis: an introduction to the newly designed Iran Criter 2013 Jan More than 14 years of clinical practice in rheumatology led the author to discover the prognostic role of anti-citrullinated protein antibody (ACPA) as well as the erosions found by MRI, in detecting the RA patients resulting in establishing a new set of criteria by revising the 1987 ACR classification-Iran Criteria for Rheumatoid Arthritis. Medical records of 243 patients at the outpatient Rheumatology Clinic of the author (private sector) were reviewed for the data on the criteria of the 1987 ACR, 2010 ACR/European League against Rheumatism (EULAR), and Iran Criteria for RA. In addition to modifying the 1987 ACR classification, Iran Criteria for RA adds some additional information to the ACR criteria (including ACPA and bony erosions detected by MRI), and any patient who satisfies 6 out of 12 points is considered as a definite RA patient. Sensitivity of the three classifications was calculated considering the clinical diagnosis by a single rheumatologist as the gold standard. A total of 63 male and 180 female patients with a mean follow-up duration of 28.24 ± 50.19 months were considered. Mean age at diagnosis and mean disease duration were 49.16 ± 15.38 years and 7.04 ± 6.87 months, respectively. The sensitivity for Iran Criteria for RA, 1987 ACR classification, and 2010 ACR/EULAR criteria were calculated as 98.4, 59.7, and 66.3%, respectively. Comparing Iran Criteria for RA with ACR and ACR/EULAR criteria, it was concluded that our newly introduced criteria is a more sensitive instrument in determining RA patients in the early stages of the disease.
21743086 Quality appraisal of clinical practice guidelines on the use of physiotherapy in rheumatoi 2011 Oct OBJECTIVE: To assess the quality of guidelines published in peer-reviewed literature concerning the role of physiotherapy in the management of patients with RA. METHODS: A systematic literature search for clinical practice guidelines that included physiotherapy interventions was performed in four electronic databases. We assessed the quality of the selected guidelines using the appraisal of guidelines for research and evaluation (AGREE) instrument. In addition, the recommendations of guidelines with the highest quality scores were summarized. RESULTS: Eight clinical practice guidelines fulfilled the inclusion criteria. Scope/purpose was the most often adequately addressed AGREE domain (in seven of the eight guidelines) and applicability the least (in two of the eight guidelines). Based on the AGREE domain scores, six guidelines could be recommended or strongly recommended for clinical use. Five out of these six (strongly) recommended guidelines included a recommendation on exercise therapy and/or patient education, with these interventions being recommended in every case. Transcutaneous electrical nerve stimulation and thermotherapy were recommended in four of these six guidelines. US, thermotherapy, low-level laser therapy, massage, passive mobilization and balneotherapy were addressed in one or two of these six guidelines. CONCLUSION: Six of eight clinical practice guidelines addressing physiotherapy interventions were recommended or strongly recommended according to the AGREE instrument. In general, guideline recommendations on physiotherapy intervention, from both the recommended guidelines as well as from the not recommended guidelines, lacked detail concerning mode of delivery, intensity, frequency and duration.
22410544 Chronobiology and the treatment of rheumatoid arthritis. 2012 May PURPOSE OF REVIEW: As circadian rhythms and biological signaling occur in a complex network with cyclical 24-h period interactions (chronobiology) between the central and the autonomic nervous systems, the endocrine glands and the immune system, this review will explore the involvement of this emerging network in the disease pathophysiology and management. RECENT FINDINGS: Recent advances regarding nocturnal hormones such as melatonin and prolactin that activate the nighttime immune response, and the successive rise of cortisol that dowregulates the ongoing immune reactivity very early in the morning, will be discussed within the circadian neuroendocrine immune network. In addition, the role of sleep and the daily distribution of body energy, which are important factors for the homoeostatic regulation of circadian physiological/pathological processes of the immune network will be reviewed.In chronic immune/inflammatory conditions such as rheumatoid arthritis (RA), stiffness and functional disability are evident in the early morning hours as under the chronic stress of the disease the nighttime adrenal cortisol production becomes insufficient to inhibit ongoing nocturnal immune/inflammatory activity. SUMMARY: Currently, the most advanced approach to optimizing the risk-benefit ratio for long-term glucocorticoid treatment in RA seems to be low-dose chronotherapy with modified nighttime release prednisone (release at 3 a.m.). A similar chronotherapeutical approach could also be effective with disease-modifying antirheumatic drugs such as methotrexate.
21872842 Step performance in persons with rheumatoid arthritis: a case-control study. 2011 Oct OBJECTIVE: To investigate factors that could lead to falls in patients with rheumatoid arthritis (RA). DESIGN: Case-control study. SETTING: Hospital. PARTICIPANTS: Patients with RA (n=15) and age- and sex-matched controls (n=15; mean ± SD age, 60.5 ± 7.1y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Performance of participants on a step task. Furthermore, manual performance was assessed, as well as questionnaires for balance confidence, fear of falling, and activity level. RESULTS: Patients with RA showed nonsignificantly increased RTs (time to anticipatory postural adjustment and foot lift) and significantly increased movement times (MTs). Push-off force and step velocity were significantly lower in patients with RA. During a manual task, delayed RTs and MTs were seen. Moreover, lower levels of balance confidence and more fear of falling were reported in patients with RA. There were no differences in activity levels. CONCLUSIONS: When performing a quick step, patients with RA show delayed MT and step velocity and decreased push off. Because quick stepping often is used to avoid falls, the increase in step execution time might have undesirable consequences. Furthermore, patients with RA have lower balance confidence and more fear of falling than healthy controls; these factors also contribute to higher fall risk.
20553292 Targeting inflammation as a therapeutic strategy in accelerated atherosclerosis in rheumat 2011 Aug Rheumatoid arthritis (RA) is an autoimmune disease affecting approximately 1% of the population. Patients have reduced life expectancy and the leading cause of death is cardiovascular disease (CVD), with patients experiencing at least a 2-fold increased risk of myocardial infarction. RA is recognized as an independent risk factor for CVD. Inflammation is a key contributor to the pathogenesis of atherosclerosis and cardiovascular events. As a common catalyst of both diseases, inflammation is the likely cause of increased prevalence of CVD in the RA population. Abating disease-related inflammation in RA may be an effective strategy in reducing CVD risk. Several other therapies used to modify cardiovascular risk factors in the general population such as statins and angiotensin-converting enzyme inhibitors are under investigation in patients with RA. This review discusses the parallels in the pathology of RA and atherosclerosis and discusses current therapies for RA and how they affect cardiovascular risk.
23271170 Prevention of joint destruction by tacrolimus in patients with early rheumatoid arthritis: 2013 Nov OBJECTIVES: A multicenter, randomized, double-blind, placebo-controlled study of the oral calcineurin inhibitor tacrolimus was performed in patients with early rheumatoid arthritis who had responded poorly to disease-modifying antirheumatic drugs (DMARDs), and factors related to suppression of joint destruction were investigated. METHODS: The change in the total Sharp score (∆TSS) was assessed by univariate analysis in patients with X-ray films to identify the main determinant of a ∆TSS of <0.5 in week 52. Patients with this factor were then investigated further. RESULTS: Univariate analysis showed that a baseline C-reactive protein (CRP) level of <1.5 mg/dL was the major determinant of ∆TSS <0.5 at week 52 in the tacrolimus group. Detailed analysis of patients with a baseline CRP of <1.5 mg/dL revealed no significant differences in background factors between the two groups. In week 52, ∆TSS was significantly smaller in the tacrolimus group than in the placebo group (2.67 ± 5.40 vs. 8.05 ± 10.32, respectively, p = 0.017). Both groups had a similar incidence of adverse reactions. CONCLUSIONS: Adding tacrolimus to DMARDs significantly suppressed disease activity and joint destruction in patients with early rheumatoid arthritis, a disease duration ≤3 years, a CRP <1.5 mg/dL, and a poor response to oral DMARDs.
23223424 Trends in the first decade of 21st century healthcare utilisation in a rheumatoid arthriti 2013 Jul PURPOSE: To study 21st century trends in healthcare utilisation by patients with rheumatoid arthritis (RA) compared with the general population. METHODS: Observational cohort study. Using Swedish healthcare register data, we identified 3977 Region Skåne residents (mean age in 2001, 62.7 years; 73% women) presenting with RA (International Classification of Diseases-10 codes M05 or M06) in 1998-2001. We randomly sampled two referents from the general population per RA patient matched for age, sex and area of residence. We calculated the year 2001-2010 trends for the annual ratio (RA cohort/referents) of the mean number of hospitalisations and outpatient clinic visits. RESULTS: By the end of the 10-year period, 62% of patients and 74% of referents were still alive and resident in the region. From 2001 to 2010, the ratio (RA cohort/referents) of the mean number of hospitalisations for men and women decreased by 27% (p=0.01) and 28% (p=0.004), respectively. The corresponding decrease was 29% (p=0.005) and 16% (p=0.004) for outpatient physician care, 34% (p=0.009) and 18% (p=0.01) for nurse visits, and 34% (p=0.01) and 28% (p=0.004) for physiotherapy. The absolute reduction in number of hospitalisations was from an annual mean of 0.79 to 0.69 in male patients and from 0.71 to 0.59 in female patients. The corresponding annual mean number of consultations in outpatient physician care by male and female RA patients changed from 9.2 to 7.7 and from 9.9 to 8.7, respectively. CONCLUSIONS: During the first decade of the 21st century, coinciding with increasing use of earlier and more active RA treatment including biological treatment, overall inpatient and outpatient healthcare utilisation by a cohort of patients with RA decreased relative to the general population.
23224181 Potential of optical spectral transmission measurements for joint inflammation measurement 2012 Aug Frequent monitoring of rheumatoid arthritis (RA) patients enables timely treatment adjustments and improved outcomes. Currently this is not feasible due to a shortage of rheumatologists. An optical spectral transmission device is presented for objective assessment of joint inflammation in RA patients, while improving diagnostic accuracy and clinical workflow. A cross-sectional, nonrandomized observational study was performed with this device. In the study, 77 proximal interphalangeal (PIP) joints in 67 patients have been analyzed. Inflammation of these PIP joints was also assessed by a rheumatologist with a score varying from 1 (not inflamed) to 5 (severely inflamed). Out of 77 measurements, 27 were performed in moderate to strongly inflamed PIP joints. Comparison between the clinical assessment and an optical measurement showed a correlation coefficient r=0.63, p<0.001, 95% CI [0.47, 0.75], and a ROC curve (AUC=0.88) that shows a relative good specificity and sensitivity. Optical spectral transmission measurements in a single joint correlate with clinical assessment of joint inflammation, and therefore might be useful in monitoring joint inflammation in RA patients.
21362764 Rapid improvement in the signs and symptoms of rheumatoid arthritis following certolizumab 2011 Jun OBJECTIVE: To assess the kinetics of response to certolizumab pegol (CZP), and association between rapid response and longterm outcomes, in patients with active rheumatoid arthritis (RA). METHODS: This was a post-hoc analysis of the randomized, double-blind RAPID 1 study in patients who received methotrexate (MTX) and either CZP 200 mg subcutaneously or placebo every 2 weeks for 52 weeks. Clinical and radiographic outcomes at Week 52 were evaluated based on the Disease Activity Score 28 (DAS28) ≥ 1.2 and American College of Rheumatology 20% (ACR20) responses at Week 6 and Week 12. RESULTS: Clinical responses [European League Against Rheumatism (EULAR), DAS28 ≥ 1.2, and ACR20 responses] were rapid in CZP-treated patients. Week 12 DAS28 ≥ 1.2 responders had better clinical and radiographic outcomes at Week 52 compared with nonresponders. Among Week 12 responders, incremental benefit of earlier response was observed: Week 6 DAS28 ≥ 1.2 responders and ACR20 responders had significantly higher ACR response rates and were more likely to achieve remission at Week 52 than Week 12 responders. Patients with a clinical response at Week 6 had faster, more meaningful sustained improvements in patient-derived outcomes than those responding by Week 12 only. CONCLUSION: Rapid attainment of clinical response in patients with RA is associated with improved longterm outcomes. Analysis of the kinetics of response to CZP during the first 12 weeks of therapy potentially permits informed prediction of clinical success or need to alter treatment. In patients not achieving a clinical response at Week 12 treatment adjustment should be considered. Trial registration NCT00152386.
22812556 When is switching warranted among biologic therapies in rheumatoid arthritis? 2012 Jun Switching among biologic therapies is common practice in patients with rheumatoid arthritis who have an inadequate response or intolerable adverse events. Evidence from observational studies and association guidelines supports the use of sequential biologic therapy for these reasons. Owing to recent economic pressures on healthcare budgets, patients with rheumatoid arthritis who are well controlled on and tolerant of their current biologic therapy may be switched to alternative biologics, despite limited evidence supporting this practice. Clinical research and experience suggest that TNF antagonists are not interchangeable, as meaningful differences have been observed in their efficacy and safety profiles. Additional research is needed to assess the risk:benefit ratio of specific sequences of biologic therapies and the validity of switching biologic therapies for nonclinical purposes.
21565597 Fibromyalgia: unspeakable suffering, a prevalence study of alexithymia. 2011 May BACKGROUND: Fibromyalgia patients often present with multiple somatic concerns in a pattern suggestive of underlying depression. The psychological construct of alexithymia complicates the recognition of psychiatric disorders. OBJECTIVE: To measure the prevalence of alexithymia among fibromyalgia patients and compare this with the prevalence among general medicine and rheumatoid arthritis patients. METHODS: The Toronto alexithymia scale (TAS-20) and the Beck depression inventory (BDI) were administered to 50 patients in each of three experimental groups: fibromyalgia, general medicine and rheumatoid arthritis. Logistic regression was used to test for differences in the prevalence of alexithymia among experimental groups, first unadjusted and then adjusted for baseline and demographic variables. In addition, ANOVA was used to analyze the numeric scores of the TAS-20, the BDI and the three alexithymia components measured by the TAS-20. RESULTS: The prevalence of alexithymia in fibromyalgia patients (44%) was significantly higher than in either the general medicine group (8%; P=0.001) or the rheumatoid arthritis group (21%; P=0.023). Alexithymia was strongly associated with moderate to severe depression χ2=49.3, P<0.001), and when the mood disturbance was controlled for, no group differences were detected. CONCLUSION: Fibromyalgia patients are more likely than general medicine patients or patients with rheumatoid arthritis to have difficulty identifying and describing feelings, and to have higher alexithymia scores. Moderate to severe depression is also more prevalent in fibromyalgia patients, and, when controlled for, the difference in alexithymia scores becomes insignificant.