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ID PMID Title PublicationDate abstract
22323440 Novel genetic association of the VTCN1 region with rheumatoid arthritis. 2012 Apr OBJECTIVE: Based upon findings in juvenile idiopathic arthritis, the genetic contribution of the VTCN1 region to rheumatoid arthritis (RA) susceptibility and anticitrullinated protein antibody (ACPA) status was investigated. VTCN1 is known to play a pivotal role in regulation of the immune system and, in soluble form, has previously been associated with higher disease activity. METHODS: Ten VTCN1 polymorphisms were genotyped in 1237 Dutch patients with RA and 1055 healthy controls. Significant findings were replicated in two independent RA populations of northern European descent consisting of 2826 patients and 2122 healthy controls. Allele distribution was analysed using a χ(2) test and combined analysis of all studies was performed using the Mantel-Haenszel fixed effects method. RESULTS: A significant association with two polymorphisms was observed in the Dutch RA population. Replication of these findings showed an overall significant association with rs4376721 and rs10923217 (OR 1.13, 95% CI 1.03 to 1.24, p=0.013 and OR 0.78, 95% CI 0.67 to 0.91, p=0.0011, respectively). Stratification for ACPA status revealed an association in the ACPA-negative subset for rs4376721 (OR 1.19, 95% CI 1.05 to 1.35, p=0.0071), while no overall significance could be observed in the ACPA-positive population. rs10923217 was associated with both subsets of the disease. CONCLUSION: These results indicate a novel genetic association with the VTCN1 region in RA susceptibility.
22083220 Cardiovascular safety of biologic therapies for the treatment of RA. 2011 Nov 15 Cardiovascular disease represents a major source of extra-articular comorbidity in patients with rheumatoid arthritis (RA). A combination of traditional cardiovascular risk factors and RA-related factors accounts for the excess risk in RA. Among RA-related factors, chronic systemic inflammation has been implicated in the pathogenesis and progression of atherosclerosis. A growing body of evidence--mainly derived from observational databases and registries--suggests that specific RA therapies, including methotrexate and anti-TNF biologic agents, can reduce the risk of future cardiovascular events in patients with RA. The cardiovascular profile of other biologic therapies for the treatment of RA has not been adequately studied, including of investigational drugs that improve systemic inflammation but alter traditional cardiovascular risk factors. In the absence of large clinical trials adequately powered to detect differences in cardiovascular events between biologic drugs in RA, deriving firm conclusions on cardiovascular safety is challenging. Nevertheless, observational research using large registries has emerged as a promising approach to study the cardiovascular risk of emerging RA biologic therapies.
21440712 Multisensory hypersensitivity in women with fibromyalgia: implications for well being and 2011 Apr OBJECTIVE: To document sensory sensitivities to nonnoxious sensory stimuli in daily life for participants with fibromyalgia (FM). DESIGN: Descriptive study of a convenience sample using a self-report survey of sensory processing. SETTING: Participants were recruited from the general community. The procedure took place in a research room at the University of Wisconsin-Madison. PARTICIPANTS: Women with FM (n=27) were compared with women with rheumatoid arthritis (RA) (n=28) and healthy pain-free women (controls) (n=28) (N=83). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: A self-report measure of sensory sensitivity to stimuli encountered in daily life. Items ask participants if they are sensitive to sensations that do not seem to bother other people or avoid common activities or environments because of sensory stimuli. RESULTS: The FM group reported significantly increased sensory sensitivities to both somatic (tactile) and nonsomatic (eg, auditory and olfactory) sensory stimuli compared with the RA and control groups. The RA and control groups did not differ in reported hypersensitivities. CONCLUSIONS: Women with fibromyalgia reported increased sensitivities to stimuli in the environment and could experience more stress related to sensory conditions in daily life.
21885519 Synovial tissue analysis for the discovery of diagnostic and prognostic biomarkers in pati 2011 Sep Rheumatoid arthritis (RA) is a chronic disease of unspecified etiology that is manifest by persistent inflammation of the synovium. Considerable efforts have been undertaken globally to study the microenvironment of the inflamed synovium, with many encouraging and enlightening results that bring us closer to unmasking the precise etiologies of RA. Subsequent to these efforts, it has been discovered that CD68-positive macrophages present in abundance in the synovial sublining of the inflamed synovium rescind with treatments that induce clinical improvement in RA. Examination of serial synovial biopsies is now commonly used for screening purposes during early drug development, and the number of centers able to perform synovial tissue biopsy sampling according to standardized methods is increasing. Having implemented the use of serial synovial tissue biopsies to evaluate the effects of new treatments on the group level in early proof of principle studies, it is the ambition of the OMERACT Synovial Tissue Group to identify synovial diagnostic and prognostic biomarkers that could be used in individual patients. Therefore, we started a prospective study termed the Synoviomics Project aimed at the identification of novel diagnostic and prognostic synovial biomarkers. We will use straightforward and powerful technologies to analyze patient material and assess clinical parameters to identify such biomarkers. These markers may be used in the future to identify patients who are at risk of having persistent and destructive disease and to start tailor-made targeted therapies in an early phase to prevent autonomous disease progression and irreversible joint damage.
21515629 Effect of biotherapies on fatigue in rheumatoid arthritis: a systematic review of the lite 2012 Jan OBJECTIVES: To assess the effect of biotherapies vs placebo on fatigue in two situations: inadequate response to conventional treatments (IR-DMARD) and inadequate response to anti-TNF (IR-anti-TNF) in RA. METHODS: A systematic review of the literature and meta-analysis were performed. We included randomized controlled trials (RCTs) assessing the effect of biotherapies vs placebo on fatigue, in combination with DMARDs. Fatigue was measured using the functional assessment of chronic illness therapy-fatigue (FACIT-F) or short-form 36 (SF-36) vitality scores at baseline and at Week 24. The results were in effect size (ES) for each biotherapy (or class of biotherapy) vs placebo. An ES of <0.5 was considered as small, between 0.5 and 0.8 as moderate and >0.8 as important. RESULTS: From the 763 published studies, 10 RCTs were included in the analysis: seven involved IR-DMARD RA and three IR-anti-TNF. Among the 3837 included patients with established RA, 1227 patients were treated with an anti-TNF, 420 with rituximab, 258 with abatacept, 205 with tocilizumab and 1727 received placebo. The overall ESs of all biotherapies vs placebo on fatigue were small (ES = 0.45; 95% CI 0.31, 0.58) as well as for anti-TNFs (ES = 0.36; 95% CI 0.21, 0.51). The ESs were small in IR-DMARD RA (ES = 0.38; 95% CI 0.30, 0.46), similar between anti-TNF and non-anti-TNF agents and moderate in IR-anti-TNF RA (ES = 0.57; 95% CI 0.27, 0.86). CONCLUSION: Few studies reported the impact of biotherapies on fatigue. The effect of biotherapies on fatigue in RA is small.
21278073 Comparison of the efficacy of sonography, magnetic resonance imaging and conventional radi 2011 Jun OBJECTIVE: To evaluate the reproducibility of US and to compare its efficacy with that of MRI and conventional radiography (CR) for the detection of bone erosion in RA patients. METHODS: A systematic literature search was performed in the Medline, Embase and Cochrane databases up to August 2009. Trials evaluating the reproducibility of US for bone erosion detection or comparing the number of erosions detected by the three imaging methods at patient and/or joint level were included. This last parameter was assessed using the odds ratio (OR) and 95% CI with the Mantel-Haenszel method (OR < 1 favours US). We explored the heterogeneity between the studies by subgroup analysis. RESULTS: Twenty-one studies including 913 patients were included in this meta-analysis. Intraobserver and interobserver reproducibility of US for erosion detection was good. US and MRI efficacies were comparable at both joint (OR = 1.19, P = 0.45; seven studies, 869 joints) and patient (OR = 1.76, P = 0.22; nine studies, 338 patients) levels. US detected significantly more erosion than CR at both joint (OR = 0.30, P < 0.00001; 4047 joints studied) and patient (OR = 0.31, P < 0.00001; 592 studied patients) levels. The number of patients to screen in order to detect an additional patient with an erosion in comparison with CR was 4, 95% CI (2.4, 5.9). CONCLUSION: US is more effective for erosion detection than CR and has a comparable efficacy to MRI with good reproducibility.
21059672 Gene profiling predicts rheumatoid arthritis responsiveness to IL-1Ra (anakinra). 2011 Feb OBJECTIVES: The overall non-response rate to biologics remains 30-40% for patients with RA resistant to MTX. The objective of this study was to predict responsiveness to the anakinra-MTX combination by peripheral blood mononuclear cell gene profiling in order to optimize treatment choice. METHODS: Thirty-two patients treated with anakinra (100 mg/day s.c.) and MTX were categorized as responders when their 28-joint DAS (DAS-28) had decreased by ≥1.2 at 3 months. Pre-treatment blood samples had been drawn. RESULTS: For seven responders and seven non-responders, 52 microarray-identified mRNAs were expressed as a function of the response to treatment, and unsupervised hierarchical clustering correctly separated responders from non-responders. The levels of seven of these 52 transcripts, as assessed by real-time, quantitative RT-PCR, were able to accurately classify 15 of 18 other patients (8 responders and 10 non-responders), with 87.5% specificity and 77.8% negative-predictive value for responders. Among the 52 genes, 56% were associated with IL-1β. CONCLUSION: This predictive gene expression profile was obtained with a non-invasive procedure. After further validation in other cohorts of patients, it could be proposed and used on a large scale to select likely RA responders to combined anakinra-MTX. Trial registration. Clinical Trials; NCT00213538 (http://www.clinicaltrials.gov).
22534375 The Sp1 transcription factor is essential for the expression of gliostatin/thymidine phosp 2012 Apr 25 INTRODUCTION: Gliostatin/thymidine phosphorylase (GLS/TP) has angiogenic and arthritogenic activities, and aberrant GLS production has been observed in the active synovial membranes of rheumatoid arthritis (RA) patients. The human GLS gene promoter contains at least seven consensus binding sites for the DNA binding protein Sp1. Here we examined whether Sp1 is necessary for GLS production in RA. We also studied the effects of the Sp1 inhibitor mithramycin on GLS production in RA fibroblast-like synoviocytes (FLSs). METHODS: FLSs from RA patients were treated with specific inhibitors. The gene and protein expression of GLS were studied using the quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and an enzyme immunoassay. Intracellular signalling pathway activation was determined by western blotting analysis, a luciferase assay, a chromatin immunoprecipitation (ChIP) assay and a small interfering RNA (siRNA) transfection. RESULTS: The luciferase and ChIP assays showed that Sp1 binding sites in the GLS promoter were essential for GLS messenger RNA (mRNA) expression. GLS production was suppressed in FLSs by siRNA against Sp1 transfection. Mithramycin decreased GLS promoter activity, mRNA and protein expression in FLSs. Tumour necrosis factor-α (TNF-α) significantly increased GLS expression in RA FLSs; this effect was reduced by pre-treatment with cycloheximide and mithramycin. CONCLUSIONS: Pretreatment of mithramycin and Sp1 silencing resulted in a significant suppression of GLS production in TNF-α-stimulated FLSs compared to controls. GLS gene expression enhanced by TNF-α was partly mediated through Sp1. As physiological concentrations of mithramycin can regulate GLS production in RA, mithramycin is a promising candidate for anti-rheumatic therapy.
22500891 A retrospective cohort study of cancer incidence among patients treated with radiosynovior 2012 Sep Radiosynoviorthesis (RS) is an intra-articular injection of a radioactive colloid for the treatment of synovitis administered most often to patients with rheumatoid arthritis or haemophilia. Although highly cost-effective in comparison with surgical or arthroscopic synovectomy, the risk of cancer associated with this treatment is not well known. We evaluated the incidence of cancer in a group of patients treated with RS. A cohort of 2412 adult patients with a variety of underlying conditions (mainly rheumatoid arthritis) and treated with at least one RS between January 1976 and December 2001, was recruited from two centres in Montréal. Cancer incidence and mortality data for cohort members over that time period were obtained from regulatory agencies using linkage. Background rates for all and specific types of cancer were obtained for the provincial (Québec) and national (Canada) population according to age, gender and calendar period categories. Category-specific rates in the cohort were compared with rates in similar categories from the general population generating standardized incidence ratios (SIR). The effects of specific isotope doses and of number of RS treatments were analysed using a Cox-regression model. No increase in the risk of cancer was observed (SIR 0.96; 95% confidence interval 0.82-1.12). There was no dose-response relationship with the amount of radioisotope administered or number of RS treatments. The study provides some indication for the safety of the procedure but homogenous diagnostic groups of younger patients (such as haemophilic patients) receiving RS will need more evaluation.
22595641 Can magnetic resonance imaging of the hand and wrist differentiate between rheumatoid arth 2012 Dec OBJECTIVE: To investigate whether rheumatoid arthritis (RA) and psoriatic arthritis (PsA) can be differentiated in the early stages of the disease (duration of symptoms ≤1 year) on the basis of magnetic resonance imaging (MRI) features of the hand and wrist. MATERIAL AND METHODS: Twenty early RA and 17 early PsA patients with symptomatic involvement of the wrist and hand joints and inconclusive radiographic studies were examined prospectively with contrast-enhanced MRI. Images were evaluated in accordance with the Outcome Measures in Rheumatology Clinical Trials recommendations. RESULTS: Certain MRI features, such as the presence of enthesitis or extensive diaphyseal bone marrow edema, were observed exclusively in PsA (P = 0.0001). These distinctive findings were present in nearly 71% (12/17) of PsA patients. Diffuse and, in some cases, pronounced soft-tissue edema spreading to the subcutis was also seen more frequently in patients with PsA (P = 0.002). There were no significant differences in the frequency of synovitis, bone erosions, subchondral bone edema, or tenosynovitis between the 2 groups. However, in RA extensor tendons were involved more often than the flexor tendons, whereas in PsA the opposite was observed (P = 0.014). With respect to the discriminatory power of the different MRI findings examined, only the presence of enthesitis or diaphyseal bone edema and, to a lesser extent, the pattern of hand tendon involvement and the presence of soft-tissue edema accurately differentiated PsA from RA (all these features achieved accuracies greater than 0.70). CONCLUSIONS: We observed significant differences in the MRI findings of the hand and wrist that can help to distinguish between RA and PsA in the early stages of disease. This imaging method could help to assist in the differential diagnostic process in selected patients in whom diagnosis cannot be unequivocally established after conventional clinical, biochemical, and radiographic examinations.
21109513 Cardiovascular disease in rheumatoid arthritis: state of the art and future perspectives. 2011 Jan Rheumatoid arthritis is associated with an increased risk for cardiovascular events, such as myocardial infarction and stroke. Epidemiological evidence suggests that classic cardiovascular risk factors, such as hypertension, dyslipidaemia, insulin resistance and body composition alterations are important but not sufficient to explain all of the excess risk. High-grade systemic inflammation and its interplay with classic risk factors may also contribute. Some associations between classic risk factors and cardiovascular risk in people with rheumatoid arthritis appear counterintuitive but may be explained on the basis of biological alterations. More research is necessary to uncover the exact mechanisms responsible for this phenomenon, develop accurate systems used to identify patients at high risk, design and assess prevention strategies specific to this population of patients.
21518724 Sick leave and disability pension before and after initiation of antirheumatic therapies i 2011 Aug OBJECTIVE: To investigate sick leave and disability pension in rheumatoid arthritis (RA) in relation to the initiation of biological and non-biological antirheumatic therapies in clinical practice. METHODS: Patients aged 19-60 years initiating non-biological mono (n=2796) or combination disease-modifying antirheumatic drug (DMARD) therapy (n=973), or biological agents (n=4787) were identified in the Swedish Rheumatology Quality Register between 1999 and 2007. Sick leave and disability pension data (1995-2010) were retrieved from national registers. RESULTS: During the year before the start of mono DMARD, combination DMARD and biological treatment, 10%, 12% and 43% of patients received disability pension benefits, respectively. The corresponding combined annual sick leave and disability pension days were 78 (54+25), 132 (105+27) and 190 (79+111). Irrespective of treatment type, initiators were characterised by a history of increasing sick leave and disability pension. Treatment start was associated with a break in this trajectory: sick leave decreased while disability pension increased, resulting in a net stabilisation of total days. Higher levels of days on sick leave and disability pension at treatment start were observed in patients initiating biologics in 1999 (236 days/year) compared with 2007 (150 days/year; p<0.001), but the trajectory thereafter remained largely similar and contrasted markedly with the level in the general population. CONCLUSION: Sick leave and disability pension increased rapidly before the initiation of antirheumatic therapy, which was associated with a halt but not a reversal of this development. Work ability is a metric of importance for clinical practice, signalling large remaining needs in the RA population, and the need for intervention earlier in the disease process.
22114016 Antibodies to mutated citrullinated vimentin and anti-cyclic citrullinated peptide antibod 2012 Sep BACKGROUND: Antibodies that react with citrullinated proteins (anti-mutated citrullinated vimentin [anti-MCV] and second-generation anti-cyclic citrullinated peptide antibodies [anti-CCP2]) are markers for rheumatoid arthritis. Recent studies have demonstrated that these antibodies are present in other arthropathies including the spondyloarthritis, psoriatic arthritis, and juvenile idiopathic arthritis. Arthritis associated with inflammatory bowel disease (IBD) takes various forms, with some shared similarities with classic spondylarthropathies. Our objective was to investigate the role of anti-MCV and anti-CCP2 as potential biomarkers in IBD and related arthritis. METHODS: In all, 125 IBD patients (71 males, 54 females) were compared to 81 age- and sex-matched healthy controls. Anti-MCV and Anti-CCP2 IgG were measured using an enzyme linked immunosorbent assay. RESULTS: In the 125 IBD patients (mean age 32.6 ± 12.3 years), 44 (35.2%) had ulcerative colitis and 81 (64.8%) had Crohn's disease. Forty-four (35.2%) IBD patients developed arthritic manifestations. Antibody positivity was observed in 24/125 (19.2%) IBD patients and in 18/81 (22.2%) healthy subjects. The proportion of anti-MCV positivity among IBD patients and healthy individuals were similar: 16.8% vs. 16.0%, P = 0.887. Anti-CCP2 positivity among IBD patients and healthy individuals was also comparable: 6.4% vs. 6.2%, P = 0.948. Similarly, the presence of anti-MCV and anti-CCP2 antibodies was not different among IBD patients with and without arthritis. The mean titers of antibodies were low: anti-MCV (29.6 ± 7.5 U/mL) and anti-CCP2 (27.6 ± 4.0 U/mL) in IBD patients with arthritis. CONCLUSIONS: Autoantibodies to citrullinated proteins were low in IBD-related arthritis. These findings suggest that these antibodies are not useful biomarkers in IBD to predict who may develop IBD-related arthropathy.
22397300 [The long-term remission of rheumatoid arthritis with a single cycle of rituximab]. 2012 Jan INTRODUCTION: Rituximab selectively targets CD20+ B cells and presumably protects joints in rheumatoid arthritis. Complete remissions after a single treatment with rituximab, in some cases for longer than 1 year, are observed in only the minority of patients. We reported a patient suffering from refractory rheumatoid arthritis who responded to rituximab with sustained remission. CASE REPORT: A 78-year-old woman was diagnosed with seropositive rheumatoid arthritis in 2001. The disease remained active despite conventional disease modifying drugs. In February 2007 the disease was highly active. Two infusions of rituximab 1 000 mg on days 1 and 15 were performed. Concomitant treatment consisted of metotrexate 10 mg/week and prednisolone 5 mg/day. The patients were assessed every month after receiving rituximab. Remission was achieved three months later. The patient was retreated with a second cycle of rituximab in December 2009 due to arthritic flare. CONCLUSION: This case report showed that the rituximab treatment was feasible and led to a clinically relevant and long lasting improvement in disease activity.
22302059 The provisional ACR/EULAR definition of remission in RA: a comment on the patient global a 2012 Jun OBJECTIVES: The provisional ACR/European League Against Rheumatism (EULAR) definition of remission in RA requires a score of ≤1 on the patient global assessment (PGA, 0-10 scale). We explored the relation between the PGA criterion and the patient's clinical disease state in an observational dataset. METHODS: Data of 512 newly diagnosed RA patients of the Dutch Rheumatoid Arthritis Monitoring (DREAM) remission induction cohort were analysed. Both 28-joint counts and more comprehensive joint counts (tender joint count-53, swollen joint count-44) were used. RESULTS: ACR/EULAR remission was present in 20.1% of the patients when using 28-joint counts and in 17.4% of the patients when applying more comprehensive joint counts. In 108 patients, the PGA score was >1 despite fulfilment of the remaining criteria (TJC28, SJC28 and CRP in mg/dl ≤1). Residual disease activity was observed in 31.5% (34/108) and median (interquartile range) scores on PGA, pain and fatigue were 2.4 (1.8-4.0), 2.0 (1.1-3.0) and 2.7 (1.3-5.0), respectively. Applying more comprehensive joint counts showed comparable results. In 19.5% (100/512) of patients, disease activity was absent (TJC53 = 0, SJC44 = 0, and CRP ≤1). In 41% (n = 41) of these patients, the PGA score was >1. Receiver operating characteristic analysis showed moderate accuracy of the PGA to discriminate between fulfilment and no fulfilment of all remaining criteria. CONCLUSION: Frequently, patients did not meet the PGA criterion despite a good clinical disease state. Apparently the PGA is not solely influenced by RA disease activity. In patients with marked divergence between the PGA and objective clinical measurements, caution should be taken when applying the provisional ACR/EULAR definition of remission.
21209239 Fostamatinib, a Syk-kinase inhibitor, does not affect methotrexate pharmacokinetics in pat 2011 Sep Fostamatinib (R788) is being investigated as an add-on therapy for the treatment of rheumatoid arthritis (RA) in patients with inadequate response to methotrexate (MTX). This study evaluated the potential pharmacokinetic interaction between R788 and MTX. Sixteen RA subjects on a stable weekly MTX regimen were enrolled and received MTX on days 1 and 8. Twelve subjects received 100 mg of R788 orally, and 4 subjects received a matching placebo twice daily from days 4 to 8 and once daily on days 3 and 9. Blood samples were collected on days 1 and 8 for MTX and 7-hydroxymethotrexate (7-OH-MTX), and days 3 and 9 for R788 and its active metabolite, R406. MTX and 7-OH-MTX pharmacokinetic parameters were similar on days 1 and 8. In the R788 group, the mean day 8 to day 1 ratios (90% confidence intervals) of maximum concentration and area under the plasma concentration-time curve estimates were 1.01 (0.85-1.20) and 1.12 (0.90-1.40) for MTX and 1.06 (0.82-1.35) and 1.06 (0.83-1.36) for 7-OH-MTX, respectively. Urinary excretion of MTX and 7-OH-MTX was also similar with or without R788, averaging 58% to 69% and 4% to 5% of the MTX dose, respectively. The data suggest that there is no clinically significant pharmacokinetic interaction of R788 and MTX in RA patients.
21371999 Treatment strategies aiming at remission in early rheumatoid arthritis patients: starting 2011 Jul OBJECTIVE: To perform a modelling study on the cost-effectiveness of three outcome-directed strategies in early RA patients: Strategy 1: starting MTX monotherapy, followed by the addition of LEF, followed by MTX with addition of anti-TNF; Strategy 2: start with MTX and LEF combination followed by MTX with anti-TNF; and Strategy 3: immediate start with MTX and anti-TNF. METHODS: A validated Markov model was used to evaluate the cost-effectiveness of the three strategies. Effectiveness of the strategies was determined using daily practice data from two cohorts and used as input parameter in the model. Patients treated according to the strategies were matched for baseline 28-joint DAS (DAS-28). Using Monte Carlo simulation, expected costs, quality-adjusted life-years (QALYs) and incremental cost per QALY gained for a 5-year time horizon were calculated following both a health-care and a societal perspective. RESULTS: The percentage of patients in remission and number of QALYs were comparable between the three strategies. Starting with a combination (MTX plus LEF or anti-TNF) was more costly than starting with MTX alone. This resulted in an unfavourable incremental cost-effectiveness ratio for starting on anti-TNF vs initially MTX: health-care perspective of €138,028 and from a societal perspective of €136,150 per QALY gained over 5 years. CONCLUSION: In this modelling study, starting with MTX or anti-TNF has comparable effectiveness. However, initial anti-TNF was far more expensive than starting with MTX monotherapy. Therefore, based on this study, a treatment strategy starting with MTX monotherapy is favoured over a strategy with MTX and anti-TNF right away in early RA patients.
22101553 Anti-microtubule organizing center with microtubule by autoimmune target test is also usef 2013 Mar Seropositivity of rheumatoid factor (RF) or anti-cyclic citrullinated peptide antibody (anti-CCP) is one domain of scoring system in new American College of Rheumatology/European League against Rheumatism classification criteria for rheumatoid arthritis (RA). We investigated usefulness of antiperinuclear factor (APF) and autoantibody to microtubule organizing center with microtubule (anti-MTOC-MT), which was detected by autoimmune target (AIT) test, as serological markers for the diagnosis of early RA. The test results of 3,503 patients from the outpatient clinic of The Hospital for Rheumatic Diseases who underwent test for RF, APF, anti-CCP and anti-MTOC-MT simultaneously for the work-up of RA were analyzed. Four kinds of tests showed same results only in 53.1% (1,861/3,503) of all subjects. The kappa coefficient between each test was distributed from -0.011 to 0.622. The agreement was best between RF and anti-CCP (kappa coefficient: 0.622), but the agreement was poor between anti-MTOC-MT and other 3 tests (kappa coefficient: 0.007 to -0.025). In both of RF- and anti-CCP-negative patients, the patients who showed positive result for APF were 4.6% (160/3,503) and for anti-MTOC-MT were 13.2% (464/3,503). RF and anti-CCP positivity could not include all of APF and anti-MTOC-MT positivity. Anti-MTOC-MT detected by AIT test was independent serological marker, and it might be also helpful for the diagnosis of early RA. Therefore, the combined detection of all four serologic markers can be useful for the evaluation of suspected RA patients.
21080350 Abnormal bone geometry at the metacarpal bone shaft of rheumatoid arthritis patients with 2011 Mar OBJECTIVE: Metacarpal juxtaarticular bone is altered in rheumatoid arthritis (RA). However, a detailed analysis of disease-related geometric adaptations of the metacarpal shaft is missing. The aim of the present study was to assess the role of RA disease, forearm muscle cross-sectional area (CSA), age, and sex on bone geometry at the metacarpal shaft. METHODS: In 64 RA patients and 128 control subjects, geometric properties of the third metacarpal bone midshaft and forearm muscle CSA were measured by peripheral quantitative computed tomography (QCT). Linear models were performed for cortical CSA, total bone CSA, polar stress-strain index (SSI; a surrogate for a bone's resistance to bending and torsion), cortical thickness, and the metacarpal index (MI; cortical CSA/total CSA), with the explanatory variables muscle CSA, age, RA status, and sex. RESULTS: Forearm muscle CSA was associated with cortical and total metacarpal CSA and polar SSI. RA group status was associated with all bone parameters except cortical CSA. There was a significant interaction between RA status and age, indicating that the RA group had a greater age-related decrease in cortical CSA, cortical thickness, and the MI. CONCLUSION: Bone geometry of the metacarpal shaft is altered in RA patients compared to healthy controls. Whereas bone mass of the metacarpal shaft is adapted to forearm muscle mass, cortical thickness and the MI are reduced, but outer bone shaft circumference and the polar SSI increased in RA patients. These adaptations correspond to an enhanced aging pattern in RA patients.
19847427 Development of antisynthetase syndrome in a patient with rheumatoid arthritis. 2011 Apr Rheumatoid arthritis (RA) and antisynthetase syndrome (ASS) are distinct clinical syndromes, and their co-occurrence is rarely encountered. The authors report the case of a 56-year-old female patient with RA of 3 years duration who suddenly developed ASS, and include a review of the literature. The patient was diagnosed with ASS based on; positivity for anti-histidyl-tRNA synthetase (Jo-1) antibody, interstitial lung disease, polyarthritis, and mechanic's hands. High-dose corticosteroid and pulse intravenous cyclophosphamide were used to control the ASS. This case demonstrates that ASS should be considered during clinical presentations due to its potential overlap with RA.