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ID PMID Title PublicationDate abstract
21427306 Craniometric measurements in the assessment of craniovertebral settling: are they still re 2011 Apr OBJECTIVE: Craniovertebral settling is a serious complication of rheumatoid arthritis, and a number of radiographic measures at the craniocervical junction are in use to enable its diagnosis. However, these measures are hampered by the overlap of relevant bony landmarks. We aim to establish accurate values for these measures on CT to facilitate early diagnosis of this condition on cross-sectional imaging. MATERIALS AND METHODS: One hundred men and 100 women who underwent CT that included imaging of the craniocervical junction were retrospectively identified. Patients between the ages of 18 and 49 years were included. Two radiologists reformatted the images in the midsagittal plane and performed a series of measurements as follows: the Wackenheim line, McRae line, Chamberlain line, and McGregor line and measurements obtained using the Redlund-Johnell method and our modification of the method proposed by Ranawat et al. RESULTS: There were significant differences between the CT values and accepted radiographic measurements for the Wackenheim, Chamberlain, and McGregor lines. The McRae line was the easiest to measure, and the odontoid tip did not cross this line in any patient (distance from line: range, 0.6-10.4 mm). The CT measurements obtained using the Redlund-Johnell method were similar to the radiographic values, and we provide normal CT values for the modified Ranawat method (men > 23.7 mm, women > 24.2 mm). CONCLUSION: We propose that the McRae line should be used over other methods when assessing for craniovertebral settling on cross-sectional studies because it is the easiest measure to understand and remember. If the odontoid tip is eroded, the Redlund-Johnell and modified Ranawat methods are alternatives, and we have provided normal CT values for those measures as well.
22766134 Determinants and effects of vitamin D supplementation on serum 25-hydroxy-vitamin D levels 2012 Sep OBJECTIVES: Osteoporosis (OP) and increased risk of fracture are relevant features in patients with rheumatoid arthritis (RA). Low levels of serum vitamin D are frequently reported and correlate with a higher RA activity. This study evaluated factors related with the prescription of vitamin D supplements in RA patients and variables influencing the achievement of adequate vitamin D levels. METHODS: Study population was made up by 1168 consecutive RA patients from 22 Italian rheumatology centers. Demographic and clinical variables data were collected and 25OH serum vitamin D was measured in all patients. Insufficient serum 25OH vitamin D levels were defined as values lower than 20 ng/mL. RESULTS: The majority of patients (56.0%) was not taking vitamin D supplements. Among the 514 supplemented patients, 196 (38.1%) were taking insufficient dosages (≤440 IU/day). Variables related with the prescription of supplements were older age, female sex, previous bone density assessment and OP diagnosis. Among the 318 patients using daily supplements ≥800 IU, 88 patients (27.7%) did not reach adequate levels of vitamin D. In these patients a higher HAQ score (OR for 1 point=1.62, 95% CI: 1.06-2.49; p=0.03) and poor sun exposure (OR=2.38, 95% CI: 1.05-5.55; p=0.04) were predictors of vitamin D insufficiency. CONCLUSIONS: Vitamin D deficiency is common in patients with RA, even in patients who are regularly using supplements. Vitamin D supplementation is often ineffective even at the recommended dose of 800 IU/day in more disabled patients.
21695659 Assessment of biocorrelates for brain involvement in female patients with rheumatoid arthr 2012 Jan Central nervous system (CNS) abnormalities are rare in patients with rheumatoid arthritis (RA). Direct studies done to investigate brain involvement in RA are few or even absent. We hypothesized that CNS is not excluded from the inflammatory disease process in RA. Thus we systematically investigated markers of brain involvement in 55 females with RA. We examined patients' cognition using battery of sensitive psychometric testing [Mini-Mental State Examination, Stanford-Binet test (fourth edition) and Wechsler Memory Scale-Revised] and by recording P300 component of event-related potentials, a neurophysiological analogue. We also measured the serum levels of S100B and neuron-specific enolase (NSE), markers of glial and neuronal cells. Compared to control subjects, lower scores in cognitive testing were reported in 71% of the patients (n=39) and abnormal P300 latency and amplitude (P<0.001, 0.050). Patients had higher levels of S100B (P<0.029) and higher levels of S100B were correlated with lower total scores of cognitive functions (P<0.01), P300 latency (P<0.05), and NSE concentrations (P<0.01). However, cognitive scores did not correlate with disease activity or severity. Although depression scores were significant in patients with RA (P<0.001), but they did not correlate with cognitive scores. Seven patients had white matter hyperintensities in MRI brain suggesting vasculitis, ischemic brain lesions and dots of demyelination, and all had higher levels of S100B. Results of this study directly indicate that the disease process (inflammation and demyelination) is associated with cognitive deficits observed with RA.
21528382 Comparison of QuantiFERON-TB Gold and the tuberculin skin test for detecting previous tube 2011 Dec The aim of the study was to compare the usefulness of the QuantiFERON-TB Gold (QFT-2G) with that of the tuberculin skin test (TST) for detecting previous infection of tuberculosis (TB) in Japanese rheumatoid arthritis (RA) patients. Before receiving biologic therapy, 97 RA patients were divided into two groups based on their chest computed tomography (CT) findings: the TB past infection group (n = 48), with old inflammatory changes due to prior pulmonary TB; and the non-TB infection group (n = 49), without such findings. The QFT-2G was not affected by methotrexate or prednisolone. Indeterminate results with a positive control had a low incidence (5.2%). A positive QFT-2G for the TB past infection group at cutoffs of 0.35 and 0.1 IU/ml (intermediate range) was seen in 5.8% and 20.8%, respectively. A TST >20 mm was significantly higher in the non-TB infection group (31%) than in the TB past infection group (13%). The correlation between the QFT-2G and TST was poor among all patients. Disagreement between these tests in the non-TB infection group was caused by the false-positive TST induced by previous Bacillus Calmette-Guérin (BCG) vaccination. Only 12 (12.4%) of 97 patients had a positive QFT-2G (≥0.1 IU/ml) and a negative TST (<20 mm), but in this subgroup, a high incidence (10, 83.3%) was detected in the TB past infection group. QFT-2G may be a good alternative to the TST to evaluate previous TB infection when it is necessary to determine whether isoniazid (INH) prophylaxis is needed before biologic therapy is begun.
21885517 A systematic literature review analysis of ultrasound joint count and scoring systems to a 2011 Sep OBJECTIVE: The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of synovitis in RA, a systematic analysis of the literature was performed. METHODS: A systematic literature search of Pubmed and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of synovitis. RESULTS: Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination. CONCLUSIONS: Ultrasound can be regarded as a valuable tool for globally examining the extent of synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed.
21667027 Autoimmunity against hNinein, a human centrosomal protein, in patients with rheumatoid art 2011 Sep Centrosomes are organelles involved in the organization of the mitotic spindle and may also be the targets of autoantibodies in autoimmune diseases. Human Ninein (hNinein) is a centrosomal autoantigen that is identified by autoimmune patient sera. However, none of the hNinein-specific fragments recognized by the autoantibodies in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) sera have been thoroughly characterized. We thus attempted to identify the fine specificity within the hNinein protein. In this study, four recombinant proteins in two isoforms of hNinein were used as autoantigens along with immunoassays as a molecular tool to investigate the prevalence of hNinein autoreactivity and its specificity in 22 RA and 32 SLE autoimmune disease sera. The data indicated a 50% higher prevalence of isoform 4 hNinein N-terminal autoantibodies in RA sera, whereas 22% of SLE patients were autoreactive to the N-terminal of isoform 4 hNinein compared to only a small percentage of autoreactive normal sera (5%). These results showed that autoepitopes on autoantigen hNinein are restricted to the N-terminal region and that a more significant proportion of RA patients exhibited centrosome reactivity.
21542890 Soluble IL-18 receptor complex: a new star in the firmament of rheumatoid arthritis diagno 2011 Apr 27 It has long been recognized that laboratory tests are useful in the diagnosis of disease and to monitor treatment outcome. Their performance has become even more demanding with the development of personalized medicine. In patients with rheumatoid arthritis (RA) the standard biochemical tests measure serological markers of disease, such as C-reactive protein, and RA-associated auto-antibodies, such as rheumatoid factor and anti-citrullinated protein antibodies. The information obtained from these markers does not, however, provide a complete picture of the disease and treatment efficacy. New biomarkers based on cytokine receptor complexes are promising for RA theragnostics.
21952736 Molecular imaging of cartilage damage of finger joints in early rheumatoid arthritis with 2012 Feb OBJECTIVE: To assess cartilage glycosaminoglycan content and cartilage thickness in the metacarpophalangeal (MCP) joints of patients with early rheumatoid arthritis (RA) and healthy volunteers. METHODS: After review board approval and informed consent were obtained, 22 subjects were prospectively enrolled (9 patients with early RA [7 women and 2 men with a mean ± SD age of 49 ± 13 years; range 25-68 years] and 13 healthy volunteers [10 women and 3 men with a mean ± SD age of 51 ± 12 years; range 25-66 years). In a total of 44 MCP joints of the index and middle fingers, measurements of cartilage thickness and delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index (T1 [msec]) were obtained using the variable flip-angle method and a 3T MR scanner. MRIs were evaluated for bone edema, erosions, and synovitis (using the RA MRI Scoring criteria). Student's t-test was used to test the significance of differences between groups. RESULTS: The mean ± SD dGEMRIC index was 497 ± 86 msec in healthy volunteers and was significantly lower in the early RA group (421 ± 76 msec) (P = 0.042). There was no joint space narrowing seen on standard radiographs. No significant difference was found between cartilage thickness in patients with early RA and that in controls (index finger mean ± SD 1.27 ± 0.23 mm in RA patients versus 1.46 ± 0.34 mm in controls [P = 0.16] and middle finger 1.26 ± 0.23 mm in RA patients versus 0.97 ± 0.47 mm in controls [P = 0.10]). No significant correlation was noted between cartilage thickness and dGEMRIC index (R = 0.36, P = 0.88 in RA patients; R = 0.156, P = 0.445 in controls). CONCLUSION: Our findings indicate that cartilage damage is present in the MCP joints of patients with early RA despite the absence of joint space narrowing on standard radiographs and MRI. Cartilage damage in RA can be imaged with dGEMRIC.
21477308 Distinguishing fibromyalgia from rheumatoid arthritis and systemic lupus in clinical quest 2011 Apr 8 INTRODUCTION: The purpose of this study was to explore a data set of patients with fibromyalgia (FM), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who completed the Revised Fibromyalgia Impact Questionnaire (FIQR) and its variant, the Symptom Impact Questionnaire (SIQR), for discriminating features that could be used to differentiate FM from RA and SLE in clinical surveys. METHODS: The frequency and means of comparing FM, RA and SLE patients on all pain sites and SIQR variables were calculated. Multiple regression analysis was then conducted to identify the significant pain sites and SIQR predictors of group membership. Thereafter stepwise multiple regression analysis was performed to identify the order of variables in predicting their maximal statistical contribution to group membership. Partial correlations assessed their unique contribution, and, last, two-group discriminant analysis provided a classification table. RESULTS: The data set contained information on the SIQR and also pain locations in 202 FM, 31 RA and 20 SLE patients. As the SIQR and pain locations did not differ much between the RA and SLE patients, they were grouped together (RA/SLE) to provide a more robust analysis. The combination of eight SIQR items and seven pain sites correctly classified 99% of FM and 90% of RA/SLE patients in a two-group discriminant analysis. The largest reported SIQR differences (FM minus RA/SLE) were seen for the parameters "tenderness to touch," "difficulty cleaning floors" and "discomfort on sitting for 45 minutes." Combining the SIQR and pain locations in a stepwise multiple regression analysis revealed that the seven most important predictors of group membership were mid-lower back pain (29%; 79% vs. 16%), tenderness to touch (11.5%; 6.86 vs. 3.02), neck pain (6.8%; 91% vs. 39%), hand pain (5%; 64% vs. 77%), arm pain (3%; 69% vs. 18%), outer lower back pain (1.7%; 80% vs. 22%) and sitting for 45 minutes (1.4%; 5.56 vs. 1.49). CONCLUSIONS: A combination of two SIQR questions ("tenderness to touch" and "difficulty sitting for 45 minutes") plus pain in the lower back, neck, hands and arms may be useful in the construction of clinical questionnaires designed for patients with musculoskeletal pain. This combination provided the correct diagnosis in 97% of patients, with only 7 of 253 patients misclassified.
22584471 Serum osteoprotegerin concentration is associated with carotid atherosclerotic plaque in p 2013 Mar OBJECTIVE: Osteoprotegerin (OPG), a regulator of bone resorption, is involved in the pathogenesis of rheumatoid arthritis (RA) and atherosclerosis. OPG is elevated in patients with coronary artery disease, and high OPG levels are associated with cardiac disease severity and mortality in the general population. The purpose of this study was to investigate the relationship of serum OPG levels, traditional coronary risk factors, and RA-related factors to carotid atherosclerosis in RA patients. METHODS: Ninety-one RA patients were studied (85 % women, age 60 ± 10 years). Serum OPG levels were measured by an enzyme-linked immunosorbent assay. The prevalence of carotid plaque was assessed by ultrasonographic imaging in all patients. The relationship between various clinical characteristics, OPG, and carotid plaque was examined. RESULTS: Serum OPG levels were significantly higher in patients with carotid plaque than in those without plaque (median level 1,397 vs. 887 pg/mL, respectively; P = 0.006). There were no significant differences between RA patients with and without carotid plaque with respect to sex, duration of RA, blood pressure, body mass index, smoking, low-density lipoprotein cholesterol, Disease Activity Score-28, van der Heijde-modified Sharp score, and prednisolone dose. After adjusting for age, sex, and C-reactive protein, elevated levels of OPG were still associated with a higher prevalence of carotid plaque in patients with RA (P = 0.038). CONCLUSION: RA patients suffer from accelerated atherosclerosis and also have increased levels of OPG. The serum OPG level is independently associated with carotid plaque.
22050546 The effects of chronic periodontitis and rheumatoid arthritis on serum and gingival crevic 2012 Jun BACKGROUND: Chronic periodontitis (CP) and rheumatoid arthritis (RA) appear to share many pathologic features. Oxygen metabolism has an important role in the pathogenesis of both CP and RA. The aim of this study is to evaluate the relationship between these two chronic inflammatory diseases with regard to antioxidant and oxidant status. METHODS: A total of 80 participants were divided into four groups of 20 each: group RA-CP (patients with RA and CP), group RA (periodontally healthy patients with RA), group CP (systemically healthy patients with CP), and group C (periodontally and systemically healthy volunteers) were included in the study. After assessment of periodontal measurements, gingival crevicular fluid (GCF) samples were taken at one incisor, premolar, and molar tooth and stored with serum samples at -80°C for the antioxidant/oxidant assay. RESULTS: Although all clinical measurements in groups RA-CP and CP were statistically higher compared to those of C and RA groups (P <0.001), there were no differences between CP and RA-CP groups (P >0.05). GCF total oxidant status (TOS) values of CP and RA-CP groups were higher than those of the RA group (P <0.05). GCF oxidative stress index (OSI) values of the RA-CP group were higher than those of the RA group (P <0.05). There were no differences among the groups in terms of serum TOS and OSI values (P >0.05). CONCLUSIONS: Local OSI values in groups with patients with CP were higher, whereas systemic OSI values showed no difference among the groups. The presence of RA seems not to affect local and systemic OSI values in patients with CP.
21153621 Modeling the effect of susceptibility factors (HLA and PTPN22) in rheumatoid arthritis. 2011 Numerous genome-wide analyses on common multifactorial diseases have been recently published in providing, for each associated Single Nucleotide Polymorphism (SNP), an Odds Ratio (OR), either for one of the susceptibility variant allele versus none, or for two copies of it versus one copy. Besides the poor information attached to these measures, it is a simplistic idea to reduce the effect of a gene to the one of an allele or of an haplotype. It is a far cry from detecting a signal indicating the presence of a causative factor in a genomic region to its identification and the important task of estimating the disease risk due to it. The contrast between cases and controls may be used for the estimation of the genotype relative risks. However, the same population distribution of a marker can be coupled with different modes of inheritance of the trait, and hence different risk estimates. Other sources of information, in particular at familial level must be used and can be crucial in discriminating the genotypes according to the disease risk. Illustration is given on two susceptibility factors to Rheumatoid Arthritis: HLA and PTPN22. In both cases, thanks to the sharing of parental alleles in affected sibs, a refining of the modeling was obtained. Tezenas du Montcel et al. (Arthritis Rheum 52:1063-1068, 2005) show that six HLA genotypes can be distinguished with different RA risks. One HLA genotype confers a risk 6.6-fold higher than another HLA genotype. For PTPN22, Bourgey et al. (BMC Proc 1 (Suppl 1):S37, 2007) show that observed data is not explained by a single variant as initially reported and that using the information on 3 SNPs discriminates the genotypic relative risks (GRRs) from 1 to 4.7.
21046421 Management of rheumatoid arthritis: consensus recommendations from the Hong Kong Society o 2011 Mar Given the recent availability of novel biologic agents for the treatment of rheumatoid arthritis (RA), the Hong Kong Society of Rheumatology has developed consensus recommendations on the management of RA, which aim at providing guidance to local physicians on appropriate, literature-based management of this condition, specifically on the indications and monitoring of the biologic disease-modifying anti-rheumatic drugs (DMARDs). The recommendations were developed using the European League Against Rheumatism (EULAR) recommendations for the management of early arthritis as a guide, along with local expert opinion. As significant joint damage occurs early in the course of RA, initiating therapy early is key to minimizing further damage and disability. Patients with serious disease or poor prognosis should receive early, aggressive therapy. Because of its good efficacy and safety profile, methotrexate is considered the standard first-line DMARD for most treatment-naïve RA patients. Patients with a suboptimal response to methotrexate monotherapy should receive step-up (combination) therapy with either the synthetic or biologic DMARDs. In recent years, combinations of methotrexate with tocilizumab, abatacept, or rituximab have emerged as effective therapies in patients who are unresponsive to traditional DMARDs or the anti-tumor necrosis factor (TNF)-α agents. As biologic agents can increase the risk of infections such as tuberculosis and reactivation of viral hepatitis, screening for the presence of latent tuberculosis and chronic viral hepatitis carrier state is recommended before initiating therapy.
21557523 Role of magnetic resonance imaging in the diagnosis and prognosis of rheumatoid arthritis. 2011 May OBJECTIVE: To systematically evaluate the literature addressing the role of magnetic resonance imaging (MRI) in the diagnosis and prognosis of early undifferentiated inflammatory arthritis and rheumatoid arthritis (RA). METHODS: We performed a systematic literature review of the performance characteristics of MRI for diagnosing and prognosticating RA. We searched Ovid, supplementing this with manual searches of bibliographies, journals, meeting proceedings, and the ClinicalTrials.gov web site. To identify diagnostic studies, we included studies of any duration that prospectively examined whether MRI findings predicted RA diagnosis and reported adequate information to calculate sensitivity and specificity. To identify prognostic studies, we included prospective studies with at least a 12-month followup period that measured both baseline MRI findings and clinical and/or radiographic outcomes. RESULTS: For diagnostic studies (n = 11), sensitivity and specificity of MRI findings for RA diagnosis ranged from 20-100% and 0-100%, respectively, depending upon the criteria used. Diagnostic performance of MRI improved when lower-quality studies or studies with longer disease duration were excluded. For prognostic studies (n = 17), MRI findings did not predict clinical remission, and the ability to predict radiographic progression varied significantly (range 18-100% for sensitivity and 5.9-97% for specificity). Restricting the analysis to specific MRI findings or earlier disease improved MRI prognostic performance. The only prognostic study reporting 100% of a priori quality criteria found MRI bone edema to be the strongest predictor of radiographic progression. CONCLUSION: Data evaluating MRI for the diagnosis and prognosis of early RA are currently inadequate to justify widespread use of this technology for these purposes, although MRI bone edema may be predictive of progression in certain RA populations.
20300755 The relationship between vitamin D and disease activity and functional health status in rh 2011 Jul We aimed to establish the relationship between serum vitamin D levels and disease activity and health status in rheumatoid arthritis. Sixty-five patients with RA fulfilling ACR criteria for the classification of rheumatoid arthritis and forty healthy controls were included in this study. Disease activity was assessed according to the Disease Activity Score including 28 joint counts. C-reactive protein (CRP, mg/dl) was determined by the nephelometric method. Erythrocyte sedimentation rate (ESR, mm/h) was determined by the Westergren method. Rheumatoid factor (RF, IU/ml) was also determined by the nephelometric method, and RF > 20 IU/ml was defined as positive. 25-OH Vitamin D EIA Kit was used to measure serum 25-OH Vitamin D levels. We found that the mean of the 25-OH D vitamin levels of the patients with RA was not different than that of controls (P = 0.936). We divided patients with RA into three groups according to DAS28 as low activity group (group 1, n = 25), moderate activity group (group 2, n = 25), and high activity group (group 3, n = 15). 25-OH vitamin D levels of the patients in the high activity group (group 3) were found to be the lowest (P < 0.001), and the patients with moderate disease activity had lower levels than those in the mild group (P = 0.033). Serum 25-OH vitamin D levels were significantly negatively correlated with DAS28, CRP, and HAQ (respectively, r = -0.431, P = 0.000, r = -0.276, P = 0.026, and r = -0.267, P = 0.031). Serum vitamin D levels in patients with RA were similar those in the healthy controls, while it significantly decreases in accordance with the disease activity and decreasing functional capacity.
22057143 The major determinants of arterial stiffness in Korean patients with rheumatoid arthritis 2012 Nov Patients with rheumatoid arthritis are at increased risk of cardiovascular morbidity and mortality. This study was undertaken to investigate the prevalence of peripheral arterial disease, and to identify factors, especially those related to rheumatoid arthritis, influencing arterial stiffness in Korean patients with rheumatoid arthritis. A total of 262 patients with rheumatoid arthritis managed in a tertiary clinic were included. Ankle-brachial index and brachial-ankle pulse wave velocity were measured. Rheumatoid arthritis-related factors were determined, as well as the traditional cardiovascular risk factors. The prevalence of peripheral arterial disease was only 1.5%. Mean pulse wave velocity was 1,559 ± 354 cm/s. Age, body mass index, blood pressure, lipid profile, and glucose, not rheumatoid arthritis-related factors such as disease duration, seropositivity and disease activity, were significantly correlated with pulse wave velocity. Moreover, stepwise multiple regression analysis revealed that only age over 65 (OR = 9.1, 95% CI 4.3-19.1, P < 0.001), systolic blood pressure over 140 mmHg (OR = 15.7, 95% CI 7.4-33.1, P < 0.001), and corticosteroid use (OR = 2.1, 95% CI 1.03-4.3, P = 0.04) were independent risk factors for high pulse wave velocity. The prevalence of peripheral arterial disease in Korean patients with rheumatoid arthritis is very low. Among the many factors related to arterial stiffness, only old age, high systolic blood pressure, and, to a certain extent, corticosteroid use appear to be major determinants, especially in clinical setting with relatively well controlled patients with rheumatoid arthritis.
22151924 Abatacept with methotrexate versus other biologic agents in treatment of patients with act 2011 INTRODUCTION: The goal of this study was to compare the efficacy in terms of Health Assessment Questionnaire change from baseline (HAQ CFB), 50% improvement in American College of Rheumatology criterion (ACR-50) and Disease Activity Score in 28 joints (DAS28) defined remission (< 2.6) between abatacept and other biologic disease modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) who have inadequate response to methotrexate (MTX-IR). METHODS: A systematic literature review identified controlled trials investigating the efficacy of abatacept (three studies), etanercept (two studies), infliximab (two), adalimumab (two), certolizumab pegol (two) ritixumab (three), and tocilizumab (two) in MTX-IR patients with RA. The clinical trials included in this analysis were similar with respect to trial design, baseline patient characteristics and background therapy (MTX). The key clinical endpoints of interest were HAQ CFB, ACR-50 and DAS28 < 2.6 measured at 24 and 52 weeks. The results were analysed using network meta-analysis methods that enabled calculation of an estimate for expected relative effect of comparative treatments. Analysis results were expressed as the difference in HAQ CFB score and odds ratio (OR) of achieving an ACR-50 and DAS28 response and associated 95% credible intervals (CrI). RESULTS: The analysis of HAQ CFB at 24 weeks and 52 weeks showed that abatacept in combination with MTX is expected to be more efficacious than MTX monotherapy and is expected to show a comparable efficacy relative to other biologic DMARDs in combination with MTX. Further, abatacept showed comparable ACR-50 and DAS28 < 2.6 response rates with other biologic DMARDs at 24 and 52 weeks, except for ACR-50 compared to certolizumab pegol at 52 weeks and for DAS28 < 2.6 compared to tocilizumab at 24 weeks. Sensitivity analyses confirmed the robustness of the findings. CONCLUSIONS: Abatacept in combination with MTX is expected to result in a comparable change from baseline in HAQ score and comparable ACR-50 and DAS28 < 2.6 response rates in MTX-IR patients compared to other approved biologic agents.
21069486 Can reverse shoulder arthroplasty be used with few complications in rheumatoid arthritis? 2011 Sep BACKGROUND: Many patients with rheumatoid arthritis develop superior migration of the humeral head because of massive cuff tears, causing loss of active motion. Reverse shoulder arthroplasty could potentially restore biomechanical balance but a high incidence of glenoid failure has been reported. These studies do not, however, typically include many patients with rheumatoid arthritis (RA) and it is unclear whether the failure rates are similar. QUESTIONS/PURPOSES: We therefore (1) evaluated pain relief and shoulder function after reverse arthroplasty in RA; (2) compared results between primary and revision procedures; (3) determined the incidence of scapular notching; and (4) determined the complication rate. METHODS: We identified 29 patients with RA who had 33 reverse arthroplasties from among 412 patients having the surgery. Six patients were lost to followup. Twenty three patients (27 shoulders) were evaluated after a minimum followup of 18 months (mean, 56 months; range, 18-143 months), including 18 primary and nine revision arthroplasties. All patients were evaluated preoperatively and 23 shoulders postoperatively by an independent physiotherapist and four were assessed postoperatively by phone. Level of pain, range of motion, and Constant-Murley score were recorded and new radiographs taken. RESULTS: Visual Analog Scale score for pain decreased from 8.0 to 1.0. Constant-Murley score increased from 13 to 52. Primary procedures had higher scores compared with revisions. Three patients had revision surgery. Notching occurred in 52% of shoulders but no loosening was seen. CONCLUSIONS: Reverse arthroplasty in rheumatoid arthritis improved shoulder function with a low incidence of complications. We believe it should be considered in elderly patients with rheumatoid arthritis with pain and poor active range of motion resulting from massive cuff tears. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
22879462 Rheumatoid arthritis and falls: the influence of disease activity. 2012 Nov OBJECTIVE: To examine the correlation between disease activity of RA and the risk of falling. METHODS: Seventy-eight patients were tested. Disease activity was measured with acute-phase reactants, autoantibodies, swollen and tender joint count (SJC28, TJC28), pain on a visual analogue scale (VAS pain), patient and evaluator global assessment of disease activity (PGA, EGA), HAQ disability index (HAQ-DI), 28-joint DAS (DAS-28) and the clinical and simple disease activity indexes (CDAI, SDAI). The risk of falling was evaluated by a fall assessment consisting of Tinetti test (TIT), timed get up and go test (TUG), chair-rising test (CRT), tandem walk and tandem stand test. RESULTS: During the last 12 months, 26.9% of the participants reported a fall and 46.2% mentioned the fear of falling. The most evident link [Spearman's correlation (r(s))] with the results of the fall assessment was found in HAQ-DI (CRT: r(s) = 0.523, TUG: r(s) = 0.620, TIT: r(s) = -0.676), CDAI (CRT: r(s) = 0.460, TUG: r(s) = 0.504, TIT: r(s) = -0.472), VAS pain (CRT: r(s) = 0.441, TUG: r(s) = 0.616, TIT: r(s) = -0.548) PGA (CRT: r(s) = 0.473, TUG: r(s) = 0.577, TIT: r(s) = -0.520) and TJC (CRT: r(s) = 0.488, TUG: r(s) = 0.394, TIT: r(s) = -0.385). Patients with higher disease activity achieved poorer results in the fall assessment. CONCLUSION: The strongest correlation with falls was evident for patient-reported outcomes. Pain seems to be the common ground of these parameters. At the same time, disease activity influences pain. The results suggest an increased attention towards the risk of falling with patients of higher levels of disease activity or pain, and physio- or ergotherapeutical interventions as needed.
21946268 Microglial signalling mechanisms: Cathepsin S and Fractalkine. 2012 Apr A recent major conceptual advance has been the recognition of the importance of immune system-neuron interactions in the modulation of spinal pain processing. In particular, pro-inflammatory mediators secreted by immune competent cells such as microglia modulate nociceptive function in the injured CNS and following peripheral nerve damage. Chemokines play a pivotal role in mediating neuronal-microglial communication which leads to increased nociception. Here we examine the evidence that one such microglial mediator, the lysosomal cysteine protease Cathepsin S (CatS), is critical for the maintenance of neuropathic pain via cleavage of the transmembrane chemokine Fractalkine (FKN). Both CatS and FKN mediate critical physiological functions necessary for immune regulation. As key mediators of homeostatic functions it is not surprising that imbalance in these immune processes has been implicated in autoimmune disorders including Multiple Sclerosis and Rheumatoid Arthritis, both of which are associated with chronic pain. Thus, impairment of the CatS/FKN signalling pair constitutes a novel therapeutic approach for the treatment of chronic pain.