Browse

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

ID PMID Title PublicationDate abstract
23032511 Rheumatoid arthritis: new treatments, better outcomes. 2012 Nov 10 There have been numerous changes regarding evidence-based care of patients with rheumatoid arthritis, a costly, chronic, autoimmune disease. This article provides an update on the factors that affect the safe use of biologic medications in this patient population.
22795504 Prevalence of airway and parenchymal abnormalities in newly diagnosed rheumatoid arthritis 2012 Oct BACKGROUND: Pulmonary disease is a well recognised and important extra-articular manifestation of rheumatoid arthritis (RA). The objective of this study was to determine the prevalence of airway and parenchymal abnormalities in newly diagnosed patients with RA and to correlate these with clinical measures of RA severity and laboratory tests. METHODS: 60 patients with a new (symptom duration <12 months) diagnosis of RA (43 females, 42 European, mean age 54, 33 ever smoker, (17 current) underwent lung function testing and high resolution computed tomography (HRCT) scored by two independent radiologists. RESULTS: Eighteen (30%) patients reported respiratory symptoms: dyspnoea (11), cough (11), and wheeze (8). Twelve (20%) patients had physiologic evidence of airflow obstruction and 24 (40%) had reduced gas transfer. The prevalence of HRCT abnormalities (in any lobe) was as follows: decreased attenuation 67%, bronchiectasis 35%, bronchial wall thickening 50%, ground glass opacification 18%, reticular changes 12%. All abnormalities were more common in the lower lobes. With the exception of reduced DLCO, there were no significant differences in the prevalence of HRCT patterns or lung function parameters between smokers and non smokers. Anti-CCP antibodies and rheumatoid factor (RF) correlated strongly with DLCO and variably with other physiologic measures but poorly with radiologic abnormalities. CONCLUSION: Patients with newly diagnosed RA have a moderate prevalence of airway and parenchymal abnormalities on HRCT and lower than predicted lung function parameters which cannot entirely be explained by smoking. These data suggest that pulmonary involvement is present early in the disease course in RA.
21312346 Serum free light chains as biomarkers for systemic lupus erythematosus disease activity. 2011 Jun OBJECTIVE: To evaluate serum free light chains (FLC) as a putative biomarker of systemic lupus erythematosus (SLE) activity. METHODS: Seventy-five SLE patients and 41 age- and sex-matched rheumatoid arthritis (RA) controls were enrolled. Disease activity was assessed using the Safety of Estrogens in Lupus Erythematosus: National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) definition and physician global assessments for SLE and the Disease Activity Score in 28 joints for RA. Serum FLC levels were compared against other biomarkers (IgG, C3, C4, double-stranded DNA [dsDNA] antibody). Nonparametric tests were used to compare 1) FLC and IgG in SLE versus RA and healthy controls, 2) FLC and IgG among different levels of activity in SLE, and 3) FLC in active versus nonactive RA. Correlation of FLC, C3, C4, dsDNA antibody, and IgG with the SLEDAI and modified SLEDAI (M-SLEDAI) were obtained. RESULTS: FLC was higher in SLE than in RA; both were higher than referent healthy controls. Total FLC was significantly higher in subjects with greater SLE disease activity than lower/no activity. There were no significant differences in IgG, C4, or dsDNA antibody stratified by disease activity. Total FLC and C3 showed moderate to strong correlation with the SLEDAI and M-SLEDAI. In RA, no differences were seen in FLC levels for different levels of disease activity. Similar results were seen after controlling for renal function, age, and sex. In multiple linear regression, FLC significantly explained 50% variance of the SLEDAI after adjusting for renal function, age, and sex. CONCLUSION: Serum FLC levels correlate strongly with disease activity in SLE, but not in RA. Serum FLC may be used as a biomarker of SLE disease activity.
21810523 Official Positions for FRAX® clinical regarding rheumatoid arthritis from Joint Official 2011 Jul Rheumatoid arthritis is the only secondary cause of osteoporosis that is considered independent of bone density in the FRAX(®) algorithm. Although input for rheumatoid arthritis in FRAX(®) is a dichotomous variable, intuitively, one would expect that more severe or active disease would be associated with a greater risk for fracture. We reviewed the literature to determine if specific disease parameters or medication use could be used to better characterize fracture risk in individuals with rheumatoid arthritis. Although many studies document a correlation between various parameters of disease activity or severity and decreased bone density, fewer have associated these variables with fracture risk. We reviewed these studies in detail and concluded that disability measures such as HAQ (Health Assessment Questionnaire) and functional class do correlate with clinical fractures but not morphometric vertebral fractures. One large study found a strong correlation with duration of disease and fracture risk but additional studies are needed to confirm this. There was little evidence to correlate other measures of disease such as DAS (disease activity score), VAS (visual analogue scale), acute phase reactants, use of non-glucocorticoid medications and increased fracture risk. We concluded that FRAX(®) calculations may underestimate fracture probability in patients with impaired functional status from rheumatoid arthritis but that this could not be quantified at this time. At this time, other disease measures cannot be used for fracture prediction. However only a few, mostly small studies addressed other disease parameters and further research is needed. Additional questions for future research are suggested.
21901357 Structural damages disturb functional improvement in patients with rheumatoid arthritis tr 2012 Apr Tumor necrosis factor (TNF) inhibitors have produced improvements in clinical, radiographic, and functional outcomes in rheumatoid arthritis (RA) patients. However, it remains unclear whether factors affecting physical functions remain following TNF therapy. The objective of our study was to assess factors affecting improvement of physical functions and to shed light on relations to disease activity and structural changes in patients with RA treated with etanercept. The study enrolled 208 patients, all of whose composite measures regarding clinical, radiographic, and functional estimation both at 0 and 52 weeks after etanercept therapy were completed. Mean disease duration of 208 patients was 9.6 years, mean Disease Activity Score for 28 joints (DAS28) was 5.4, and mean van der Heijde modified total Sharp score (mTSS) was 94.6. Mean Health Assessment Questionnaire Disability Index (HAQ-DI) improved from 1.4 at 0 weeks to 1.0 at 52 weeks after etanercept therapy, a 31% reduction, which was much less than changes in DAS28 and mTSS. By multivariate analysis, HAQ-DI and mTSS at baseline were significantly correlated HAQ remission. Median HAQ-DI improved in 100 versus 20% of the HAQ-DI ≤ 0.6 versus ≥ 2.0 groups, respectively. The mTSS cutoff point at baseline to obtain HAQ remission was 55.5. During etanercept treatment in the mTSS <55.5 versus >55.5 groups, median HAQ-DI improved in 70 versus 39%; remission was achieved in 59 versus 33%; and there was no improvement in 14 versus 30%, respectively. HAQ-DI improvement was significantly correlated with that of DAS28 but not of mTSS. In conclusion, higher HAQ and mTSS at baseline inhibits HAQ-DI improvement within 1 year of etanercept treatment, and the cutoff point necessary for mTSS to improve physical functions in patients with RA was 55.5.
22718578 Future expectations and worst-case future scenarios of patients with rheumatoid arthritis: 2012 Dec OBJECTIVE: Over the past 15 years, developments in the treatment of rheumatoid arthritis (RA) have resulted in better clinical outcomes. The aim of the present study was to explore how patients think their RA will influence their lives in the future, and which of these future expectations would be the worst for them to experience. METHODS: A focus group study was performed in 16 RA patients. Three groups were heterogeneously composed, based on age group (18-40, 40-65, 65-80), gender and having a paid job or not. Patients were asked about the expected future impact of RA and worst-case future scenarios. Transcripts were coded by three researchers under the main components of the International Classification of Functioning, Disability and Health. The codes were discussed until agreement was reached about all codes. RESULTS: Dependency on others, increasing dependency on medication, inability to walk, activity limitations and worsening fatigue were mentioned as worst-case future scenarios. Further concerns were raised about the acceptance of RA and possible disappearance of physicians' expertise. Nevertheless, hope and positive feelings were expressed toward continuous medication improvements. CONCLUSION: The present study provided insight into RA patients' future expectations and worst-case future scenarios. The results may be of help in the development of support interventions to put concerns and worst-case future scenarios into a realistic perspective. Furthermore, insight into patients' worst-case future scenarios could be used to improve the validity and responsiveness of the Time Trade-Off, an instrument to measure preference-based health-related quality of life.
21339219 Genetics of ACPA-positive rheumatoid arthritis: the beginning of the end? 2011 Mar Heritability is a measure for the contribution of genetic variation to the variation in liability to disease and for rheumatoid arthritis (RA) had previously been estimated to be about 60%. This has been recently confirmed and could show that the heritability of anti-citrullinated protein autoantibody (ACPA)-positive and ACPA-negative RA is similar. Apart from gender, the main known genetic factor is HLA, and its contribution to genetic variation has previously been estimated as 37% but recent studies indicate that this figure may be too high. HLA-linked genes, and in particular the HLA-DRB1 SE alleles, predispose much more strongly to ACPA-positive than to ACPA-negative RA. The same is true for the protective effect of DERAA-positive DRB1 alleles. It has been calculated that the contribution of the protective and predisposing HLA alleles to genetic variance is about 40% for ACPA-positive and 2% for ACPA-negative RA. A meta-analysis indicated that the protective effect may be confined to the HLA-DRB1*1301 allele. The search for non-HLA genes contributing to the genetic variation in RA susceptibility has implicated about 30 other loci/genes. The OR of the associations with these non-HLA polymorphisms is considerably lower than the ORs of sex and HLA as is their contribution to the genetic variation-namely, altogether only about 5%. This means that known genetic factors do not explain much more than 50% of the genetic variance of ACPA-positive RA. Until recently, the only established non-genetic factor contributing to RA susceptibility was smoking. It has recently been shown that non-inherited maternal HLA-DRB1 DERAA-positive antigens (NIMA) should be added to the environmental factors affecting RA susceptibility.
23137579 Infections and biologic therapy in rheumatoid arthritis: our changing understanding of ris 2012 Nov Patients with rheumatoid arthritis are at higher risk for serious infections and death from infection than the general public. Prednisone and biologic agents increase this risk, although the risk associated with biologics can be mitigated when such agents act as prednisone-sparing therapies. Some of the important causes of infectious morbidity in this setting are preventable with screening (eg, tuberculosis) or vaccination (eg, herpes zoster).
23257132 [Effects of Chinese herbal medicine Qianggu Capsule on patients with rheumatoid arthritis- 2012 Dec BACKGROUND: Rheumatoid arthritis (RA) is a kind of chronic autoimmune disease and osteoporosis is one of its complications. OBJECTIVE: To explore the effects of Qianggu Capsule, a compound traditional Chinese herbal medicine, on bone mineral density (BMD) and osteoporosis in patients with RA. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: Eighty-two patients with rheumatoid arthritis and osteoporosis, who were treated in Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine from January 2010 to December 2011, were divided into treatment group (42 cases) and control group (40 cases). The patients in the treatment group were administered with Qianggu Capsule and two disease-modifying antirheumatic drugs. The patients in the control group were administered with two common-used antirheumatic drugs. The course of treatment was 6 months. MAIN OUTCOME MEASURES: Blood levels of alkaline phosphatase (ALP), calcium, phosphorus, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were determined before and after the treatment. BMD in the lumbar spine, femur and the left distal radius were also examined before and after the treatment. RESULTS: The ALP level, a bone metabolic parameter, was significantly increased in patients of the treatment group after treatment compared with before treatment. BMD values in the lumbar spine, femur and the radius were higher after treatment than before treatment (P<0.05). There were no changes in ALP level and BMD in the patients of the control group after the treatment when compared with before treatment. CONCLUSION: Treatment with Qianggu Capsule can increase BMD of RA patients, and then ameliorate their osteoporosis.
22915624 Impact of intravenous abatacept on synovitis, osteitis and structural damage in patients w 2013 Aug OBJECTIVES: This randomised, double-blind, placebo-controlled phase IIIb study evaluated the impact of abatacept on MRI pathology as a primary outcome in methotrexate (MTX)-refractory patients with rheumatoid arthritis. METHODS: Patients received intravenous abatacept (∼10 mg/kg) or placebo, on background MTX, for 4 months, followed by an 8-month open-label extension (OLE; all patients received abatacept plus MTX). Patients had 1.5T MRI with intravenous contrast at baseline, Months 4 and 12; wrist synovitis (three locations assessed), and wrist and hand (15 and eight locations assessed, respectively) osteitis and erosion were scored using OMERACT-RAMRIS. RESULTS: 26/27 abatacept- and 23/23 placebo-randomised patients completed Month 4 and entered the OLE; 26 and 21 completed Month 12. The primary endpoint was not achieved; mean change (SD) from baseline in synovitis was -0.44 (1.47) for abatacept versus 0.52 (1.38) for placebo (p=0.103) at Month 4. For mean change in synovitis adjusted for baseline score (sensitivity analysis), the difference between groups was -0.69, p=0.078. Adjusted mean changes (SE) in osteitis and erosion were -1.94 (0.86) and 0.45 (0.43) for abatacept, and 1.54 (0.90) and 0.95 (0.45) for placebo. Further MRI improvements were observed up to Month 12 for abatacept and from Months 4 to 12 for placebo-treated patients switched to abatacept at Month 4. Clinical efficacy was shown with abatacept and sustained to Month 12. CONCLUSIONS: Despite small patient numbers, MRI detected structural and synovial benefit, sustained to Month 12 in abatacept+MTX-treated patients, and improvements in structural and inflammatory outcomes for placebo+MTX-treated patients following addition of abatacept. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov NCT00420199.
23255070 Synovitis and bone inflammation in early rheumatoid arthritis: high-resolution multi-pinho 2013 Jan PURPOSE: We aimed to assess the relationship between bone inflammation in multi-pinhole single-photon emission computed tomography (MPH-SPECT) and synovitis detected by magnetic resonance imaging (MRI) in early rheumatoid arthritis patients. MATERIALS AND METHODS: MPH-SPECT with technetium dicarboxypropanedisphosphonate (Tc-99mDPD) and 3 Tesla MRI were performed in 10 early rheumatoid arthritis patients. Eighty finger joint sites were assessed for increased osteoblastic activity using visual and region-of-interest (ROI) analysis. Presence of joint inflammation in MRI was investigated using the subscores of the rheumatoid arthritis MRI score. RESULTS: Tc-99mDPD uptake was increased in 38 (47.5%) and 22 (27.5%) joint sites as determined by visual and ROI analysis, respectively. A total of 32 (84.2%) sites with increased bone metabolism showed a normal MRI bone signal. The MPH-SPECT uptake ratio was elevated only in the subgroup with severe synovitis (P < 0.001). CONCLUSION: In early rheumatoid arthritis, molecular imaging with MPH-SPECT detects higher rates of inflammatory bone involvement compared to MRI. Our preliminary data suggest that osteitis is related to severe synovitis.
22551352 PAD4 is not essential for disease in the K/BxN murine autoantibody-mediated model of arthr 2012 May 2 INTRODUCTION: Both murine and human genome-wide association studies have implicated peptidyl arginine deiminase (PAD4) as a susceptibility gene in rheumatoid arthritis (RA). In addition, patients with RA commonly have autoantibodies which recognize PAD4 or and/or citrullinated peptides. This study aims to evaluate the role of PAD4 in the effector phase of arthritis. METHODS: PAD4 knock out (KO) and wild type (WT) C57BL/6J mice were injected with K/BxN sera to induce disease. Progression of disease was monitored by measuring paw and ankle swelling and clinical indexes of disease, and pathogenesis was assessed by indexing of clinical progression on paws collected from WT and PAD4 KO mice injected with K/BxN serum. PAD4 activity was determined by visualization of neutrophil extracellular traps (NETs) and immunohistological analysis of histone citrullination. RESULTS: PAD4 activity is readily detectable in the inflamed synovium of WT but not PAD4 deficient animals, as demonstrated by histone citrullination and NET formation. However, PAD4 WT and KO animals develop K/BxN serum transfer disease with comparable severity and kinetics, with no statistically significant differences noted in clinical scores, swelling, joint erosion or joint invasion. CONCLUSIONS: PAD4 WT and KO mice develop disease in the K/BxN serum transfer model of arthritis with similar severity and kinetics, indicating that PAD4 is dispensable in this effector phase model of disease.
22802010 Ultrasonography is a potent tool for the prediction of progressive joint destruction durin 2013 May OBJECTIVES: Although "clinical remission" has been a realistic goal of treatment in rheumatoid arthritis (RA), there is evidence that subclinical synovitis is associated with ongoing structural damage even after clinical remission is achieved. In the study reported here, we assessed whether ultrasonography (US) can predict progressive joint destruction during clinical remission of RA. METHODS: Thirty-one patients with RA in clinical remission based on the disease activity score in 28 joints were recruited for this study. Bilateral wrists and all of the metacarpophalangeal and proximal interphalangeal (PIP) joints were examined by power Doppler (PD) ultrasonography (US), and the PD signals were scored semiquantitatively in each joint. The total PD score was calculated as the sum of individual scores for each joint. RESULTS: Among 22 RA patients who maintained clinical remission during the 2-year follow-up period, seven showed radiographic progression. Radiographic progression was strongly associated with total PD score at entry, with all patients showing radiographic progression having a total PD score of ≥ 2 at entry and none of the patients with a total PD score of ≤ 1 showing any radiographic progression. There was no significant association of therapeutic agents with progressing or non-progressing cases. CONCLUSIONS: PD-US detects synovitis causing joint destruction even when the patient is in clinical remission. Thus, remission visible on US is essential to reach "true remission" of RA.
22548748 Anti-type II collagen antibodies are associated with early radiographic destruction in rhe 2012 May 1 INTRODUCTION: We have previously reported that high levels of antibodies specific for native human type II collagen (anti-CII) at the time of RA diagnosis were associated with concurrent but not later signs of inflammation. This was associated with CII/anti-CII immune complex (IC)-induced production of pro-inflammatory cytokines in vitro. In contrast, anti-cyclic citrullinated peptide antibodies (anti-CCP) were associated both with late inflammation and late radiological destruction in the same RA cohort. We therefore hypothesized that anti-CII are also associated with early erosions. METHODS: Two-hundred-and-fifty-six patients from an early RA cohort were included. Baseline levels of anti-CII, anti-CCP and anti-mutated citrullinated vimentin were analyzed with ELISA, and rheumatoid factor levels were determined by nephelometry. Radiographs of hands and feet at baseline, after one and after two years were quantified using the 32-joints Larsen erosion score. RESULTS: Levels of anti-CII were bimodally distributed in the RA cohort, with a small (3.1%, 8/256) group of very high outliers with a median level 87 times higher than the median for the healthy control group. Using a cut-off discriminating the outlier group that was associated with anti-CII IC-induced production of proinflammatory cytokines in vitro, baseline anti-CII antibodies were significantly (p = 0.0486) associated with increased radiographic damage at the time of diagnosis. Anti-CII-positive patient had also significantly increased HAQ score (p = 0.0303), CRP (p = 0.0026) and ESR (p = 0.0396) at the time of diagnosis but not during follow-up. The median age among anti-CII-positive subjects was 12 years higher than among the anti-CII-negative patients. CONCLUSION: In contrary to anti-CCP, anti-CII-positive patients with RA have increased joint destruction and HAQ score at baseline. Anti-CII thus characterizes an early inflammatory/destructive phenotype, in contrast to the late appearance of an inflammatory/destructive phenotype in anti-CCP positive RA patients. The anti-CII phenotype might account for part of the elderly acute onset RA phenotype with rather good prognosis.
22089287 A systematic review of the reverse shoulder replacement in rotator cuff arthropathy, rotat 2011 Dec The reverse shoulder arthroplasty prosthesis was originally designed for rotator cuff arthropathy, and provided good results. Over time, the indications have expanded to include, among others, irreparable rotator cuff tears and rheumatoid arthritis, and the results have become more variable. There are also fundamental differences in the designs of the original Delta III prostheses and the later developed reverse shoulder prosthesis, and many studies that provide the results in reverse shoulder arthroplasties do not consider these 2 prostheses separately. In this systematic review, we analyze the clinical outcomes of the reverse shoulder arthroplasty in rotator cuff arthropathy, rotator cuff tears without arthropathy, and rheumatoid arthritis. We also analyze the results of the 2 prostheses separately to provide a more accurate comparison.
22388645 Advances in imaging. 2012 May PURPOSE OF REVIEW: Imaging of inflammatory activity is of increasing importance, and among available modalities, ultrasonography and magnetic resonance imaging (MRI) seem to be of highest impact. The present review includes recent studies describing several aspects of these modalities as well as short descriptions of other promising imaging methods in rheumatoid arthritis (RA). RECENT FINDINGS: High reliability has been shown for evaluation of ultrasonography still images. Recently excellent reliability was found when an atlas was used as reference for scoring dynamic images with ultrasonography. The optimal number of joints to examine by ultrasonography for follow-up during therapeutic interventions needs to be further explored. Use of ultrasonographic guidance for injections has showed improved clinical results when compared with blind injections. Ultrasonographic pathology, especially power Doppler, was found to be of predictive value in patients with arthritis. Cartilage damage is an important aspect of structural joint damage in RA, and a reliable assessment system of joint space narrowing has been developed for use with conventional MRI, and various biochemical MRI techniques are being developed to visualize cartilage quality, of which delayed gadolinium-enhanced magnetic resonance imaging of cartilage seems to be the most promising method in RA. SUMMARY: Novel imaging modalities, especially ultrasonography and MRI, will be of increasing importance to visualize joint inflammation and aid in the diagnosis, treatment and follow-up of patients with RA.
22198659 Serum ghrelin in female patients with rheumatoid arthritis during treatment with inflixima 2013 Jun Ghrelin is a gastric hormone that posses multiple functions, including induction of growth hormone release, regulation of proinflammatory cytokines and control of food intake and energy homeostasis. A few reports on serum ghrelin level in chronic inflammatory states revealed contradictory results. The study was undertaken to determine ghrelin in patients with rheumatoid arthritis receiving infliximab, a TNF-α blocking agent. Serum ghrelin was determined in 18 female rheumatoid patients before the treatment with infliximab, 1 week after the first infusion and after 53 weeks of medication and compared with 15 age-matched healthy women. Serum ghrelin level was shown to be increased in the patients. A decrease in serum ghrelin level was found after the first infusion of infliximab and similarly decreased ghrelin level but still higher than in the control was shown in the 53rd week of medication. The obtained results suggest that ghrelin level is related to inflammation, and its serum level in patients with severe rheumatoid arthritis behaves similarly to acute-phase reactants.
21337725 Greater likelihood of remission in rheumatoid arthritis patients treated earlier in the di 2011 Jun OBJECTIVE: To examine whether disease duration is an independent predictor of achieving remission in rheumatoid arthritis (RA) patients initiating therapy. METHODS: RA patients in the Consortium of Rheumatology Researchers of North America registry newly prescribed a nonbiologic disease-modifying antirheumatic drug (DMARD) or anti--tumor necrosis factor (anti-TNF) with at least one followup visit were identified. Achievement of remission was defined using the Clinical Disease Activity Index (CDAI; score ≤2.8) and 28-joint Disease Activity Score (DAS28; score <2.6) at any followup visit within one year; sustained remission was defined as remission during any two successive visits. Likelihood of remission was examined through logistic regression based on 5-year increments of disease duration, adjusting for baseline covariates. RESULTS: Among the 1,646 nonbiologic DMARD initiators, CDAI remission occurred in 21.3% of those with ≤5 years of disease duration, 19.6% with 6-10 years, and 13.5% with ≥11 years (P < 0.001); sustained remission occurred in 10.2%, 8.8%, and 2.5%, respectively (P < 0.001). Results were similar among the 3,179 anti-TNF initiators (CDAI remission in 22.3%, 17.7%, and 12.8%, respectively [P < 0.001]; CDAI sustained remission in 9.7%, 9.5%, and 4.2%, respectively [P < 0.001]). DAS28 results were similar in both groups. In adjusted analyses, an increase of disease duration by 5 years was associated with a reduced likelihood of CDAI remission in nonbiologic DMARD (odds ratio [OR] 0.91, 95% confidence interval [95% CI] 0.83-0.99) and anti-TNF initiators (OR 0.88, 95% CI 0.83-0.94). A similar result was seen for sustained remission using the CDAI (nonbiologic DMARD: OR 0.61, 95% CI 0.48-0.76; anti-TNF: OR 0.85, 95% CI 0.75-0.97). CONCLUSION: Earlier treatment was associated with a greater likelihood of remission.
23441768 Cardiovascular morbidity in rheumatoid arthritis patients in North Canterbury, New Zealand 2013 Feb AIM: Cardiovascular disease is a substantial contributor to increased morbidity and mortality in rheumatoid arthritis (RA). The aim of this audit was to determine the rate of cardiovascular events in a cohort of newly diagnosed RA patients. METHOD: The inpatient clinical database from Christchurch Hospital, Christchurch, New Zealand, was searched using the International Classification of Diseases 9th Revision (ICD9) and 10 codes representing RA and cardiovascular disease between 1 January 1999 and 31 December 2008. Notes were reviewed with additional demographic and medication data sought. Outpatient data for RA patients was collated from the Rheumatology Department's letter database. RESULTS: Four hundred and six patients were identified with combined ICD9 or 10 codes for RA and ischemic heart disease, of whom 194 had a confirmed myocardial event. Of these, 34 were diagnosed with RA between January 1999 and December 2008 prior to their myocardial event. Kaplan-Meier analysis showed risk of a cardiovascular event at 1 and 10 years was 0.64% and 9.4%, respectively. There were 26 confirmed deaths in the study period. The risk of death at 1 and 10 years was 0.48% and 8.16%, respectively. CONCLUSION: We have shown a relatively low prevalence of cardiovascular events in this RA population diagnosed within a 10 year period. This is consistent with other reports and likely reflects the short follow-up period. Prospective longer-term studies will be required to further investigate the relative contribution of disease activity and other parameters to cardiovascular events in patients with early RA.
22445857 Identification of rheumatoid arthritis patients with vertebral fractures using bone minera 2012 Jul The aim of this study was to test bone mineral density (BMD), trabecular bone score (TBS), and their combination, for detection of rheumatoid arthritis (RA) patients with vertebral fractures (VFs). One hundred eighty-five women aged 56.0 ± 13.5 yr, with RA since 15.5 ± 9.9 yr were studied. Lumbar spine, total hip, and femoral neck BMD were assessed by dual-energy X-ray absorptiometry (DXA). TBS was calculated from anteroposterior image of lumbar spine BMD. VFs from T4 to L4 were evaluated using Vertebral Fracture Assessment software on DXA device. The proportions of patients with VF and T-scores ≤-2.5 were only 24.2%, 21.2%, and 33.3% at lumbar spine, total hip, and femoral neck, respectively. T-scores were significantly lower in patients with VF than in patients without VF, the largest difference being observed at femoral neck (p=0.0001). TBS was significantly lower in patients with VF vs without VF (p=0.0001). The areas under the curves were 0.621, 0.704, 0.703, 0.719, and 0.727 for lumbar spine BMD, TBS, lumbar spine BMD+TBS, total hip BMD, and femoral neck BMD, respectively. The threshold of 1.173 for TBS had the best sensitivity (63%) and specificity (74%). TBS measured at the lumbar spine has a better discrimination value than lumbar spine BMD, and similar to femoral neck BMD, for prediction of presence of VF in patients with RA. In RA subjects with osteopenia, the proportion of patients with VF was higher in the lowest tertile of TBS when compared with the highest tertile. In this population, at low risk according to BMD, TBS could help to detect patients with VF.