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ID PMID Title PublicationDate abstract
20722040 Do spouses know how much fatigue, pain, and physical limitation their partners with rheuma 2011 Jan OBJECTIVE: To determine whether perceptions of clinical manifestations (fatigue, pain, and physical limitation) of rheumatoid arthritis (RA) differ between spouses and their partners with RA, and to determine whether the differences are associated with the perception of beneficial and problematic spousal social support. METHODS: English-speaking adults with RA of ≥ 6 months' duration and their spouses (n = 222 couples) completed standardized questionnaires for fatigue, pain, physical limitation, beneficial spousal support, and problematic spousal support. Spouses completed questionnaires based on their perception of their partner with RA. Agreement scores for fatigue, pain, and physical limitation were calculated by subtracting spouse scores from the scores of the partner with RA. Agreement levels were defined a priori: agreement (within ± one-half of a minimum clinically important difference [MCID] unit), overestimator (< one-half an MCID), and underestimator (> one-half an MCID). Separate hierarchical linear regression models were used to measure the association between beneficial support and problematic support after adjusting for RA duration, physical health, sex, educational level, relationship duration, and satisfaction. RESULTS: Response rate for couples was 82%. Relative to participants with RA, spouses overestimated fatigue (26%), pain (29%), and physical limitation (39%), and underestimated fatigue (11%), pain (17%), and physical limitation (34%). After statistically controlling for demographic, disease, and psychosocial variables, participants with RA whose spouses underestimated fatigue received more problematic support (R(2) = 3.7%, P = 0.002), as did those whose spouses underestimated or overestimated physical limitation (R(2) = 3.4%, P = 0.017). CONCLUSION: Persons with RA perceived more problematic spousal support when their spouse underestimated fatigue, or underestimated or overestimated physical limitation levels.
21350382 Spiritual well-being in patients with rheumatoid arthritis. 2011 Mar BACKGROUND: Rheumatoid arthritis (RA) is a chronic, long-term, and non-life-threatening disease. Individuals with RA face various daily pressures that include physical symptoms as well as feelings of helplessness, dependency, threats to self-respect, interference with social activities, disruptions of family ties, and difficulties in continuing to work. Quality of life reflects a patient's spiritual well-being and can be used as an important indicator of adaptation to RA. PURPOSE: The aim of this study was to describe the status of spiritual well-being in RA patients. METHODS: This study used meta-synthesis with Sandelowski and Barroso's qualitative meta-summary technique. A comprehensive search of Academic Search Complete, CINAHL, MEDLINE, PsycARTICA LES, and SocINDEX using relevant keywords identified primary research studies that have previously explored spiritual well-being in patients with RA. Each study was systematically evaluated on the basis of the following inclusion criteria: (a) clear descriptions of research purposes and qualitative research, sampling strategies and techniques used; (b) statement of sample size and sample variables; (c) description of data analysis methods used; and (d) quality of research finding presentation. RESULTS: A total of 675 articles, published between 1995 and 2009, were found. Ten met the inclusion criteria. The results revealed four consistent themes related to RA patients' spiritual well-being, namely, living with the disease, reclaiming control, reframing the situation, and bolstering courage. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Multifaceted resources should be used to give patients spiritual support. These resources should include establishing cognition-based education programs that provide information about the disease and programs that offer strong support for patient groups. Curricula should address how to plan family education courses. Spiritual well-being as presented in this study should be integrated into quality-of-life evaluations of RA patients and provide an evaluation tool able to assess the effectiveness of various interventions.
23072741 Treat-to-target: not as simple as it appears. 2012 Jul Treat-to-target as a strategy for rheumatoid arthritis (RA) is now widely advocated based on strong evidence. Nonetheless, implementation of treat-to-target raises caveats, as is the case with all clinical care strategies. The target of remission or even low disease activity does not apply to all individual patients, some of whom are affected by concomitant fibromyalgia, other comorbidities, joint damage, and/or who simply prefer to maintain current status and avoid risks of more aggressive therapies. No single universal 'target' measure or index exists for all individual RA patients. An emphasis in most studies on radiographic progression, rather than physical function or mortality, as the most important outcome to document the value of treat-to-target may be inappropriate. Many reports imply that the only limitation to treating all RA patients with biological agents involves costs, ignoring effective results in most patients with methotrexate and other disease-modifying anti-rheumatic drugs (DMARDs) and adverse events associated with biological agents. Indeed, the best outcomes in reported RA clinical trials result from tight control with DMARDs, rather than from biological agents, as does better overall status of RA patients at this time compared to previous decades. Pharmacoeconomic reports may ignore that RA patients are older, less educated, and have more comorbidities than the general population, as well as critical differences in patient status according to the gross domestic product of different countries. While treating to a target of remission or low disease activity, including with biological agents, is appropriate for many patients, awareness of these concerns could improve implementation of treat-to-target for optimal care of all RA patients.
22096014 The incidence of permanent work disability in patients with rheumatoid arthritis in Sweden 2012 Feb OBJECTIVE: To explore the incidence of disability pension (DP) due to RA as an estimation of permanent work disability before and after introduction of biologic drugs. METHODS: The annual incidence of DP was derived from the Swedish National Social Insurance Register and rates of DP due to RA were compared with the total amount of new DPs. RESULTS: The incidence of DP due to RA has decreased over recent years, coinciding with earlier and more aggressive treatment with DMARDs and biologics. A similar declining incidence of DP was simultaneously seen in patients with all diagnoses in the general population. The decrease in DPs was, however, larger for RA and was evident even before introduction of biologics. In 1990, the proportion of DPs caused by RA was 1.9% out of total amount of DPs, decreasing to 1.5% in 2000 and to 1% in 2009. This may reflect effects of treatment, but may also be due to changing political policies as well as changes in age structure, increasing educational level and less physically demanding jobs. CONCLUSION: The decrease in DPs due to RA coincides with new treatment strategies as well as with decreasing levels of DPs in patients with all diagnoses. Prevailing political and economic conditions have a large impact on permanent work disability and may affect patients with various diagnoses in different ways. To determine if the decline is a true effect of better treatment, there is a need for further investigations, taking possible confounding factors into account.
21628943 Improvement of rheumatoid arthritis and autoimmune hepatitis in a patient treated with the 2011 We report a case of rheumatoid arthritis (RA) with autoimmune hepatitis (AIH) and Sjogren syndrome (SjS) that was treated with the tumor necrosis factor (TNF) inhibitor, etanercept (ETN). Both RA activity and transaminase levels improved as a result of treatment. Follow-up liver biopsy showed improvement of hepatitis. Although the efficacy of anti-TNF for RA patients with AIH remains controversial, this case suggests that treatment with ETN may result in a favorable clinical course in a certain subset of patients with RA and AIH.
21947196 Association of soluble apoptotic markers with impaired left ventricular deformation in pat 2011 Nov Myocardial function is impaired in rheumatoid arthritis (RA). Inhibition of interleukin (IL)-1 activity reduces experimental myocardial infarction by limiting apoptosis. We investigated whether a) soluble apoptotic markers are related with impaired left ventricular (LV) performance and b) treatment with anakinra, an IL-1 receptor antagonist, reduces apoptotic markers leading to improved LV performance in RA. We studied 46 RA patients. In an acute, double-blind cross-over trial, 23 patients were randomised to a single injection of anakinra or placebo and after 48 hours (h) to the alternative treatment. In a chronic trial, 23 patients who received anakinra for 30 days were compared with 23 patients who received prednisolone. At baseline, 3 h and 30 days after treatment, we measured circulating IL-1β, tumour necrosis factor (TNF)-α, Fas, Fas-ligand and caspase-9 to assess apoptosis. At baseline and 30 days after treatment, we assessed LV longitudinal strain, strain rate and E/Em ratio using 2D-speckle tracking and tissue Doppler echocardiography. At baseline, increased apoptotic markers were related with reduced LongSRS and increased E/Em (p<0.05). After 3 h and 30 days of anakinra, there was a reduction in Fas (median 481 vs. 364 vs. 301 pg/ml), Fas-ligand (median 289 vs. 221 vs. 190 pg/ml), caspase-9 (median 1.90 vs. 1.40 vs. 1.07 ng/ml), TNF-α and IL-1β (p<0.05 for all comparisons). E/Em, LongS and LongSRS were improved after anakinra (p<0.01) and their percent changes were related with the corresponding changes of Fas and caspase-9 (p<0.05). No changes of the examined parameters were observed after prednisolone. In conclusion, inhibition of IL-1 activity by anakinra reduces apoptotic markers leading to improved LV performance in RA.
21755301 [Diagnosis and treatment of osteoporosis and rheumatoid arthritis in accordance with Germa 2011 Sep In a cross-sectional study the prevalence of osteoporosis and osteopenia in patients with rheumatoid arthritis (ORA study) was investigated. Additionally, patients, their family doctors and rheumatologists were surveyed on their awareness of osteoporosis in RA, prevention, diagnosis, treatment and use of guidelines.In the years 2005 and 2006 a total of 532 patients with RA (98 men, 434 women) aged 23-87 years were consecutively recruited from 9 German centers for rheumatology. Clinical examination included a detailed documentation of osteoporosis medication. Dual-energy X-ray absorptiometry (DXA) was used to measure bone mineral density (BMD) at the lumbar spine and neck of the femur. Questionnaires on osteoporosis were sent to 119 family doctors (87 men, 32 women) and 44 rheumatologists (30 men, 14 women).The survey showed that rheumatologists had a higher awareness of osteoporosis in RA and compared to family doctors they estimated a higher frequency and tested RA patients more often for osteoporosis. In line with osteoporosis guidelines rheumatologists and family doctors saw an indication for densitometry in RA patients on steroid therapy and/or low intensity trauma fractures. In contrast to the 2006 recommendations of osteoporosis guidelines 50% of family doctors and rheumatologists preferred bisphosphonate off-label-therapy for premeopausal women with RA and comorbid glucocorticoid-induced osteoporosis. On the other hand 50% of premenopausal RA patients with osteoporosis did not receive any osteoporosis medication.The survey revealed a high degree of guideline compliance in diagnosing osteoporosis in RA but deficits were observed in the administration of osteoporosis medication, especially in premenopausal women.
21954539 Can the patient-reported outcome instruments determine disease activity in rheumatoid arth 2011 OBJECTIVES: The aim of this study was to investigate the indicative value of the patient-reported outcome instruments (PROs) on disease activity in rheumatoid arthritis (RA). METHODS: Three hundred sixty eight patients with RA were included in this cross-sectional study. Disease activity was evaluated using both the Disease Activity Score 28 (DAS 28) and the Clinical Disease Activity Index (CDAI). Patients who had DAS 28 score < 3.60 points and CDAI score <10.00 points were allocated into the "low disease activity" group and those who had DAS 28 score > or = 3.60 points and CDAI score > or = 10.00 points into the "moderate or high disease activity" group. The Health Assessment Questionnaire (HAQ), Nottingham Health Profile (NHP), Rheumatoid Arthritis Quality of Life (RAQoL), and Short Form 36 (SF 36) were used as PROs. Logistic regression analysis was used to find variables, which had an indicative value for disease activity. RESULTS: HAQ, pain and emotional reaction subscales of NHP, and bodily pain, general health and social functioning subscales of SF 36 had independent indicative values, when DAS 28 was used as dependent variable. On the other hand, HAQ, pain and emotional reaction subscales of NHP, and general health and emotional role limitation subscales of SF 36 had indicative values when CDAI was used as dependent variable. DAS 28 and CDAI both showed HAQ as the parameter with the highest odds ratio (OR). But RAQoL had shown no independent indicative value for projecting disease activity. CONCLUSION: It was concluded that HAQ could determine disease activity in RA better than other PROs included in this study (Tab. 4, Ref. 36).
22046267 A new methodology to associate SNPs with human diseases according to their pathway related 2011 Genome-wide association studies (GWAS) with hundreds of żthousands of single nucleotide polymorphisms (SNPs) are popular strategies to reveal the genetic basis of human complex diseases. Despite many successes of GWAS, it is well recognized that new analytical approaches have to be integrated to achieve their full potential. Starting with a list of SNPs, found to be associated with disease in GWAS, here we propose a novel methodology to devise functionally important KEGG pathways through the identification of genes within these pathways, where these genes are obtained from SNP analysis. Our methodology is based on functionalization of important SNPs to identify effected genes and disease related pathways. We have tested our methodology on WTCCC Rheumatoid Arthritis (RA) dataset and identified: i) previously known RA related KEGG pathways (e.g., Toll-like receptor signaling, Jak-STAT signaling, Antigen processing, Leukocyte transendothelial migration and MAPK signaling pathways); ii) additional KEGG pathways (e.g., Pathways in cancer, Neurotrophin signaling, Chemokine signaling pathways) as associated with RA. Furthermore, these newly found pathways included genes which are targets of RA-specific drugs. Even though GWAS analysis identifies 14 out of 83 of those drug target genes; newly found functionally important KEGG pathways led to the discovery of 25 out of 83 genes, known to be used as drug targets for the treatment of RA. Among the previously known pathways, we identified additional genes associated with RA (e.g. Antigen processing and presentation, Tight junction). Importantly, within these pathways, the associations between some of these additionally found genes, such as HLA-C, HLA-G, PRKCQ, PRKCZ, TAP1, TAP2 and RA were verified by either OMIM database or by literature retrieved from the NCBI PubMed module. With the whole-genome sequencing on the horizon, we show that the full potential of GWAS can be achieved by integrating pathway and network-oriented analysis and prior knowledge from functional properties of a SNP.
21953645 Prescribing practices in a US cohort of rheumatoid arthritis patients before and after pub 2012 Mar OBJECTIVE: To examine prescribing practices in the use of biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs) to treat patients with rheumatoid arthritis (RA), before and after publication of the American College of Rheumatology (ACR) treatment recommendations. METHODS: Biologics-naive RA patients under the care of a rheumatologist in the US were identified from the Consortium of Rheumatology Researchers of North America registry. Patients were included if their visits occurred prior to and/or at least 6 months after publication of the ACR treatment recommendations (time periods of February 2002-June 2008 versus December 2008-December 2009). The population was divided into 2 mutually exclusive cohorts: 1) methotrexate (MTX) monotherapy users, and 2) multiple nonbiologic DMARD users. Initiation or dose escalation of biologic and nonbiologic DMARDs in response to active disease was assessed cross-sectionally and longitudinally in comparison to the ACR recommendations. The impact of the publication of the ACR recommendations on treatment practices was assessed using logistic regression, stratified by disease activity and adjusted for clustering of physicians and geographic region. RESULTS: After 1 visit, 24-37% of patients receiving MTX monotherapy who had moderate disease activity and a poor prognosis or high disease activity received care consistent with the ACR recommendations; after 2 visits, 34-56% of the MTX monotherapy group received care consistent with the recommendations. In the patients receiving multiple nonbiologic DMARDs, 31-47% of those with moderate or high disease activity received care consistent with the recommendations after 1 visit, and 43-51% received such care after 2 visits. Publication of the recommendations did not significantly change treatment patterns for those with active disease. CONCLUSION: Substantial numbers of RA patients with active disease did not receive care consistent with the current ACR treatment recommendations. Innovative approaches to improve care are necessary.
21384332 A signature of aberrant immune responsiveness identifies myocardial dysfunction in rheumat 2011 Jun OBJECTIVE: Heart failure is an important cause of death in patients with rheumatoid arthritis (RA). Evidence suggests that immune mechanisms contribute to myocardial injury and fibrosis, leading to left ventricular diastolic dysfunction (LVDD). The purpose of this study was to identify a signature of LVDD in patients with RA by analyzing the responsiveness of the innate and adaptive immune systems to stimulation ex vivo. METHODS: RA patients (n=212) enrolled prospectively in a population-based cohort underwent echocardiography, and LV function was classified as normal, mild LVDD, or moderate-to-severe LVDD. The release of 17 cytokines by blood mononuclear cells in response to stimulation with a panel of 7 stimuli or in media alone was analyzed using multiplex immunoassays. Logistic regression models were used to test for associations between a multicytokine immune response score and LVDD, after adjusting for clinical covariates. RESULTS: An 11-cytokine profile effectively differentiated patients with moderate-to-severe LVDD from those with normal LV function. An immune response score (range 0-100) was strongly associated with moderate-to-severe LVDD (odds ratio per 10 units 1.5 [95% confidence interval 1.2-2.1]) after adjusting for serum interleukin-6 levels, brain natriuretic peptide values, and glucocorticoid use, as well as other RA characteristics and LVDD risk factors. CONCLUSION: The major finding of this study was that aberrant systemic immune responsiveness is associated with advanced myocardial dysfunction in patients with RA. The unique information added by the immune response score concerning the likelihood of LVDD warrants future longitudinal studies of its value in predicting future deterioration in myocardial function.
21347802 Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis. 2011 Aug The aim of this report was to review the use of orthopedic surgeries performed to manage rheumatoid arthritis (RA). Our review of studies published in English indicates that there has been a decrease in RA-associated surgeries in Western countries. Improvements in medical treatment may partly explain the reduction in numbers of orthopedic joint surgeries, which also suggests a worldwide trend toward improved long-term outcomes. However, the results of our multicenter study in Japan indicate that the number of RA-associated operations has not decreased, and that the numbers of operations performed annually have been relatively stable from 1998 to 2008. Although there definitely has been a decline in the numbers of synovectomy surgeries, the numbers of operations on the upper limbs and foot arthroplasties have increased. With the trend toward milder disease because of improved medical treatment, we speculate that RA patients may want and need better function for the activities of daily living. The combination of medical treatment and surgical intervention is thought to improve outcomes in RA patients who will develop joint destruction. Additional studies, including analyses of RA databases containing long-term data on a variety of surgical interventions, are needed.
22023900 Update on glucocorticoid-induced osteoporosis. 2011 Aug Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis, and fractures are the most frequent adverse effects of this medication. Glucocorticoids have several direct and indirect adverse effects on bone, primarily through reduction in osteoblasts and osteocyte activity, and life span. Recent advances in the pathophysiology and prevention of this complication of therapy provide hope for its amelioration in patients being treated with glucocorticoids. Several effective pharmacologic agents are now available, and guidelines for the prevention and treatment of GIOP have been published. Despite these advances, many patients still do not receive proper prevention or therapy.
21365737 Men's experiences of rheumatoid arthritis: an inductive thematic analysis. 2011 Jun OBJECTIVES: There is a lack of evidence for understanding the clinical needs of men with rheumatoid arthritis (RA). This study investigated the psychosocial experience of this group, to inform clinical practice and generate further research. METHODS: Twelve adult male patients with RA were interviewed once. Interview data were analysed using an inductive thematic analysis procedure. Categories and themes were validated by a second researcher and a male RA patient research partner. RESULTS: Four themes were generated: loss of power and control; use of power and control; adjustment; influencing factors (age, pain, medication, relationships and health staff communication). Loss of power and control left participants vulnerable to low mood. Participants asserted power and control over RA by adopting a problem-solving stance in order to continue with ordinary life. An accepting attitude characterized the adjustment theme where men respected their bodies' limits. The final theme consisted of factors which influenced these three themes. DISCUSSION: These data suggest that when RA results in loss of personal power and control, patients experience distress, which they may not express to their clinicians. Findings indicate directions for further research investigating the possibility that men and women may have differing clinical needs.
23083038 Comparative study on the level of B lymphocyte stimulator (BlyS) and frequency of lymphocy 2012 Oct AIM: To investigate the differences of B lymphocyte stimulator (BlyS) level and frequency of lymphocytes between sero-negative and sero-positive rheumatoid arthritis (RA) patients. METHODS: Sixty-nine RA patients were enrolled into this study and their clinical data were recorded. The BlyS levels in plasma, frequency of T and B lymphocytes, as well as T-helper (Th) subgroups were compared between sero-negative and sero-positive RA patients. Furthermore, the correlations between clinical features and immunological features were analyzed. RESULTS: The plasma BlyS level in sero-negative RA was higher compared to the sero-positive RA patients (1.73±1.71 vs. 0.99±0.59 ng/mL, P<0.05) and osteoarthritis (OA) patients (1.73±1.71 vs. 0.59±0.12 ng/mL, P<0.05). Plasma BlyS level was correlated with disease activity score (DAS-28, erythrocyte sedimentation rate and C-reactive protein), but had no correlation with the titers of rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. The patients with more advanced changes in X-rays had high plasma BlyS levels. No significant differences in the frequency of T lymphocytes, Th subpopulations and B lymphocytes in peripheral blood were observed between sero-negative and sero-positive RA patients. CONCLUSIONS: Plasma BlyS level was correlated with disease activity and radiological progress, which indicates that plasma BlyS level may become a useful biological marker to reflect DAS and to predict RA prognosis.
22462422 The role of interleukin (IL)-17 in anxiety and depression of patients with rheumatoid arth 2012 Apr BACKGROUND: Pro-inflammatory cytokines are found to be elevated in patients with anxiety and depression but whether their serum levels are related to anxiety and depression is unknown. We used rheumatoid arthritis (RA) as an inflammatory disease model to explore such relationships. METHODS: Eighteen RA patients and 18 healthy controls matched for age and gender were assessed for the severity of anxiety and depression with the hospital anxiety and depression scale (HADS). Disease activity of RA and pain were assessed by the Disease Activity Scale (DAS-2)8 and visual analogue scale of pain, respectively. Serum pro-inflammatory cytokine levels, including tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-17 were determined by enzyme-linked immunosorbant assay. The differences in cytokine levels between RA patients and healthy controls, as well as within the RA group with and without anxiety and depression, were compared by using the Mann-Whitney U-test. The correlations between anxiety, depression and pro-inflammatory cytokines were explored by Spearman's rank correlation. Multiple linear regression was used to adjust for DAS-28 and pain. RESULTS: Serum TNF-α, IL-6 and IL-17 levels were significantly higher in RA patients than those of healthy subjects (P < 0.001, P = 0.012 and P = 0.016, respectively). Within the RA group, serum IL-17 level was significantly higher in those with anxiety than those without (P = 0.044). Additionally, IL-17 level was positively correlated with the severity of anxiety, even after adjustment for DAS-28 and pain. CONCLUSION: Serum IL-17 was elevated in RA patients, especially in those with anxiety. In addition, IL-17 level was independently associated with higher anxiety score.
22325679 Current limitations in the management of cardiovascular risk in rheumatoid arthritis. 2012 Mar OBJECTIVES: Rheumatoid arthritis (RA) is associated with excess cardiovascular (CV) disease. Many studies have shown subclinical atherosclerosis in RA is associated with CV risk factors and inflammation. Their relationship with CV events has however received less attention. Furthermore, except for hypertension CV risk factor management has not been examined in a UK RA population. We therefore evaluated the contribution of RA specific and CV risk factors to CV events alongside the management of CV risk factors in RA patients. METHODS: We assessed the prevalence, screening and treatment of CV risk factors in a cross-sectional survey of RA patients consecutively attending specialist clinics. We used binary logistic regression to examine relationships between CV events and RA and CV risk factors. RESULTS: We enrolled 309 patients (81% female; median age 60 years; median disease duration 8 years). 27 (9%) had previous CV events. 56% had hypertension, 42% hyperlipidaemia, 11% diabetes, 52% were ex/current smokers and 26% obese. Lipid status was unknown in one third. 47% of patients on anti-hypertensive agents were undertreated. CV events were associated with hyperlipidaemia (OR 13.5; 95% CI 3.9, 45.9), hypertension (OR 6.4; 95% CI 1.9, 21.9), having ever smoked (OR 2.7; 95% CI 1.1, 6.5), RA duration (OR 1.09; 95% CI 1.06, 1.13) and erosions (OR 2.9; 95% CI 1.1, 8.2). CONCLUSIONS: CV events are prevalent in RA. They are associated with CV risks and RA factors. Despite this burden we found CV risk factors were inadequately managed. A robust system to identify and treat CV risks in RA is required.
21113712 Anti-cyclic citrullinated peptide antibody predicts functional disability in patients with 2012 Feb To clarify the clinical significance of anti-cyclic citrullinated peptide antibody (anti-CCP) in the long-term outcome of RA, we established a large observational cohort of RA patients (IORRA) in our institute beginning in 2000. Essentially all RA patients who consulted our institute were registered, and clinical parameters, including disease activity and drug use, were assessed biannually based on patient reports, physician examinations, and laboratory data. In the third phase (October 2001) of the IORRA survey, anti-CCP levels were measured in 1,226 RA patients. In a cross-sectional analysis, clinical variables were compared in anti-CCP-positive versus -negative patients and in RF-positive versus -negative patients. In a longitudinal analysis, subsequent progression of disability was analyzed in anti-CCP-positive versus -negative and in RF-positive versus -negative patients. A verified Japanese version of the Health Assessment Questionnaire (J-HAQ) was used to measure functional disability. In the cross-sectional analysis, anti-CCP-positive patients (84.2%) had a significantly longer disease duration and higher disease activity score and more frequently used corticosteroids and methotrexate compared to anti-CCP-negative patients statistically. Similar phenomena were noted between RF-positive and -negative patients. In contrast, the longitudinal analysis revealed that J-HAQ slopes-a measure of progression of functional disability-were strongly associated with anti-CCP positivity but not with RF positivity. In a linear regression model, J-HAQ scores significantly worsened in anti-CCP-positive patients compared to anti-CCP-negative patients at the third year (annual progression 0.0317, P = 0.001) and the fifth year (annual progression 0.0199, P = 0.0012); however, J-HAQ progression was not influenced by RF status. Anti-CCP is a better predictive and discriminative marker for progression of disability in the long-term outcome of RA patients compared to RF.
21933396 Derivation and preliminary validation of an administrative claims-based algorithm for the 2011 INTRODUCTION: Administrative claims data have not commonly been used to study the clinical effectiveness of medications for rheumatoid arthritis (RA) because of the lack of a validated algorithm for this outcome. We created and tested a claims-based algorithm to serve as a proxy for the clinical effectiveness of RA medications. METHODS: We linked Veterans Health Administration (VHA) medical and pharmacy claims for RA patients participating in the longitudinal Department of Veterans Affairs (VA) RA registry (VARA). Among individuals for whom treatment with a new biologic agent or nonbiologic disease-modifying agent in rheumatic disease (DMARD) was being initiated and with registry follow-up at 1 year, VARA and administrative data were used to create a gold standard for the claims-based effectiveness algorithm. The gold standard outcome was low disease activity (LDA) (Disease Activity Score using 28 joint counts (DAS28) ≤ 3.2) or improvement in DAS28 by > 1.2 units at 12 ± 2 months, with high adherence to therapy. The claims-based effectiveness algorithm incorporated biologic dose escalation or switching, addition of new disease-modifying agents, increase in oral glucocorticoid use and dose as well as parenteral glucocorticoid injections. RESULTS: Among 1,397 patients, we identified 305 eligible biologic or DMARD treatment episodes in 269 unique individuals. The patients were primarily men (94%) with a mean (± SD) age of 62 ± 10 years. At 1 year, 27% of treatment episodes achieved the effectiveness gold standard. The performance characteristics of the effectiveness algorithm were as follows: positive predictive value, 76% (95% confidence interval (95% CI) = 71% to 81%); negative predictive value, 90% (95% CI = 88% to 92%); sensitivity, 72% (95% CI = 67% to 77%); and specificity, 91% (95% CI = 89% to 93%). CONCLUSIONS: Administrative claims data may be useful in evaluating the effectiveness of medications for RA. Further validation of this effectiveness algorithm will be useful in assessing its generalizability and performance in other populations.
23214024 [The coronary arteries and the determinants of coronary atherosclerosis in rheumatoid arth 2012 Jul Fifty-three women, including 32 patients with rheumatoid arthritis (RA) (a study group) and 21 individuals (a control group), were examined. In the study and control group, the patients' mean age was 49 +/- 7.4 and 47 +/- 9 years, respectively. The coronary arteries were examined using a GE LightSpeed VCT 64-slice computed tomograph. Coronary calcium was measured by SmartScore software; calcium index was determined by the Agatston score. Coronary artery changes were diagnosed in 44 and 19% in the study and control groups, respectively. Coronary artery calcification was detected in 27% of the patients with RA. In the latter, there was a predominance of multiple coronary artery lesions with more severe stenosis and a number of atherosclerotic plaques. Hemodynamically relevant stenoses were diagnosed only in patients with RA. Coronary artery atherosclerosis was found to be associated with the duration of menopause, the higher levels of total cholesterol and low-density lipoproteins, the lower levels of superoxide dismutase, the high activity of RA and the number of involved joints. The degree of coronary stenosis is associated with the level of systolic blood pressure.