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ID PMID Title PublicationDate abstract
21422655 Frequency of HLA-DRB1 alleles in rheumatoid arthritis patients in Zahedan, southeast Iran. 2011 Mar BACKGROUND AND OBJECTIVES: Analysis of the role of different alleles of human leukocyte antigen (HLA) in rheumatoid arthritis (RA) patients is necessary in many populations and geographical areas. The aim of the present study was to investigate the frequency of HLA-DRB1 alleles in RA patients, comparing with that in control group in southeast Iran. DESIGN AND SETTING: Case-control study of rheumatoid arthritis patients referred to rheumatology clinic at university hospital. PATIENTS AND METHODS: The frequency of HLA-DRB1 alleles was determined in 79 RA patients and 93 healthy subjects in Zahedan, southeast Iran. HLA-DRB1 allele types were identified by polymerase chain reaction with sequence-specific primer (PCR-SSP). RESULTS: The HLA-DRB1FNx0110 allele showed a significantly higher frequency in patients with RA (OR=2.698, 95% CI=1.087-6.699, P=.045), while the frequency of DRB1FNx0103 allele in these subjects was significantly lower than that in the control group (OR=0.447, 95% CI=0.2285-0.8729, P=.021). The frequencies of DRB1FNx0101, DRB1FNx0104, DRB1FNx0107, DRB1FNx0109, DRB1FNx0111, DRB1FNx0113, DRB1FNx0114, DRB1FNx0115, DRB1FNx0116 were not significantly different between RA subjects and the control group. CONCLUSION: The data suggest that the DRB1FNx0110 allele is a risk factor and DRB1FNx0103 is protective for RA in this population.
24007828 [Assessment of the ability of first contact physicians in the treatment of rheumatoid arth 2011 Oct Rheumatic Diseases (RD) are part of the 20 most frequent reasons for consultation in family medicine, therefore, it is mandatory that family physicians perform an opportune recognizement and therapeutic approach of RD. The aim of this study was to measure the clinical competence for identification and therapeutic approach of rheumatoid arthritis (RA) of 144 from 450 family physicians by using a structured and validated instrument. The FP Sample was obtain from 5 randomly selected from 23 Family Medicine Units of the Instituto Mexicano del Seguro Social in the city of Guadalajara, Mexico. Main outcome measure was the clinical competence of FP, defined as the capacity to interpretate, to evaluate and proposals realized in its clinical practice. Competence levels were expressed in an ordinal scale and its association with other variables was assessed by using Kruskal-Wallis test or Chi square test. Clinical competence median value was 47.3, ranking from -6 to 90, and no statistical difference was found when comparing by Family Medicine Unit, neither when comparing by other variables. We conclude that 15.3 % of FP met clinical competence for identification and therapeutic approach of rheumatoid arthritis (RA).
21914398 [Assessment of synovitis in the knee of patients with newly-diagnosed rheumatoid arthritis 2011 Jun 21 OBJECTIVE: To investigate the value of high frequency and color Doppler ultrasonography in detection of synovitis and the intra-articular vascularization in the knee joint of patients with newly-diagnosed rheumatoid arthritis (RA). METHODS: Forty-one patients (30 women, 11 men) with newly-diagnosed RA were recruited to a cross sectional study (RA group). Forty-one age and gender-matched healthy volunteers were used as control group. The thickness of hydatid fluid, synovium hyperplasia, color flow imaging, peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), venous blood flow and intra-articular perfusion were evaluated by high frequency and color Doppler ultrasonography. RESULTS: Totally 91.46% knee joints with synovial hyperplasia (> 2 mm) were found in 41 patients with RA (75/82 knee joints), and the thickness of the synovial membrane was 2.2 - 19.7 mm (average 6.3 ± 3.4 mm). In aspect of blood flow, the percentage of 0 to 3 grade were 18.67% (14/75), 29.33% (22/75), 45.33% (34/75) and 6.67% (5/75), respectively; the results of arterial blood were indicated with PSV (10.82 ± 3.71 cm/s), EDV (3.86 ± 1.12 cm/s) and RI (0.61 ± 0.07), while the average of venous blood velocity was 2.72 ± 1.02 cm/s. Joint effusion was found in 69 joints (84.15%) with the anteroposterior diameter 2.4 - 16.1 mm (average 6.9 ± 3.2 mm). The thickness of synovial membrane was 1.2 - 1.8 mm (average 1.4 ± 0.4 mm) and no significant difference were observed in joint effusion, signal of blood flow and thickness of synovial membrane in the control group. CONCLUSIONS: High frequency and power Doppler ultrasonography may be a valuable and optimal clinical tool to accurately and objectively detect synovial hyperplasia, vascular pannus formation and joint effusion in the knee joint of patients with RA.
21965129 Longitudinal predictors of progression of carotid atherosclerosis in rheumatoid arthritis. 2011 Nov OBJECTIVE: To explore predictors of change in measures of carotid atherosclerosis among rheumatoid arthritis (RA) patients without known cardiovascular disease (CVD) at baseline. METHODS: RA patients underwent carotid ultrasonography at 2 time points separated by a mean ± SD of 3.2 ± 0.3 years. The associations of baseline and average patient characteristics with the average yearly change in the mean maximal intima-media thickness (IMT) of the common carotid artery (CCA) and the internal carotid artery (ICAs) and with incident or progressive plaque in the ICA/carotid bulb, were explored. RESULTS: Among the 158 RA patients, the maximal CCA-IMT increased in 82% (median 16 μm/year; P < 0.001) and the maximal ICA-IMT increased in 70% (median 25 μm/year; P < 0.001). Incident plaque was observed in 14% of those without plaque at baseline (incidence rate 4.2 per 100 person-years [95% confidence interval 1.6, 6.8]). Plaque progression was observed in 5% of those with plaque at baseline. Among RA predictors, the adjusted average yearly change in the maximal CCA-IMT was significantly greater in patients with earlier RA than in those with disease of longer duration. Those taking tumor necrosis factor (TNF) inhibitors at baseline had a 37% lower adjusted rate of progression in the maximal CCA-IMT compared with nonusers (14 μm/year versus 22 μm/year; P = 0.026). For the maximal ICA-IMT, cumulative prednisone exposure was associated with progression after adjustment (1.2 μm/year per gm [95% confidence interval 0.1, 2.4]) and was lower in patients who were prescribed statins concomitant with prednisone. Higher swollen joint counts and higher average C-reactive protein levels were both associated with incident or progressive plaque, primarily in patients with elevated CVD risk at baseline based on the Framingham Risk Score. CONCLUSION: These prospective data provide evidence that inflammation is a contributor to the progression of subclinical atherosclerosis in RA and that it is potentially modified favorably by TNF inhibitors and detrimentally by glucocorticoids.
22709491 Increased frequency of osteoporosis and BMD below the expected range for age among South K 2012 Jun OBJECTIVE: To compare the frequency of osteoporosis and bone mineral density (BMD) below the expected range for age between female patients with rheumatoid arthritis (RA) and healthy subjects and to determine risk factors for bone loss in female patients with RA. METHOD: Two hundred and ninety-nine patients with RA and 246 age-matched healthy subjects were included in this study. BMD in the lumbar spine, femoral neck and total hip were measured with dual-energy X-ray absorptiometry. A T-score of -2.5 or lower in postmenopausal women was defined as osteoporosis, and a Z-score -2.0 or lower in females prior to menopause was defined as below the expected range for age. RESULT: The frequency of osteoporosis in the RA patients (22.1%) was significantly higher than in healthy subjects (11.4%) at either the spine or hip (P = 0.014). The occurrence of BMD below the expected range for age in RA patients (7.8%) was also significantly higher than in healthy subjects (1.0%, P = 0.015). In 299 female patients with RA, higher age, lower body mass index and postmenopausal status were significantly associated with the lumbar spine and hip BMD reduction. Of disease-related variables, glucocorticoid use was independently associated with reduction of hip BMD. CONCLUSION: The prevalence of osteoporosis in the RA patients was 1.9 times higher than in healthy subjects. Glucocorticoid use was a risk factor for generalized bone loss in female RA patients.
22426123 Capillaroscopic pattern in inflammatory arthritis. 2012 May BACKGROUND: There are limited data about the role of nailfold capillaroscopy in inflammatory arthritis. OBJECTIVES: To study the role of capillaroscopy in inflammatory arthritis-rheumatoid arthritis (RA), psoriatic arthritis (PsA) and early arthritis. METHODS: Patients from the following groups were included in the study: 62 patients with RA; 34 patients with PsA with involvement of the joints of the hands; 9 women with early arthritis. Nailfold capillaroscopy was performed with videocapillaroscope. RESULTS: Raynaud's phenomenon (RP) was found in 30.6% (19/62) of RA patients, in 32.4% (11/34) of PsA patients and 44.4%, (4/9) of cases with early arthritis. The most frequent found capillaroscopic changes in RA patients were presence of elongated capillaries in 58% of cases (36/62) and prominent subpapillary plexus in 69% (43/62). Dilated capillaries were found in 78.9% (15/19) of patients with secondary RP and in 62.8% (27/43) of those without RP. "Scleroderma-like" capillaroscopic pattern was observed with low frequency in RA patients (14.5%/9/62). "Scleroderma-like" capillaroscopic pattern was also found in 11.1% (1/9) in the group of patients with early arthritis. The low frequency of the last type of capillaroscopic pattern in RA requires patients with such changes to be observed during regular follow-up for the development of systemic rheumatic disease different from inflammatory arthritis. In patients with PsA capillaries with specific morphology (tight terminal convolutions) were found in 58.8% (20/34) of cases. CONCLUSIONS: Results from the present study confirm the necessity for inclusion of the nailfold capillaroscopy in the diagnostic algorithm in patients with inflammatory arthritis.
23021595 Short time administration of antirheumatic drugs - methotrexate as a strong inhibitor of o 2012 Sep 29 INTRODUCTION: Due to increasing use of disease modifying antirheumatic drugs (DMARDs) as first line therapy in rheumatic diseases, dental and maxillofacial practitioner should be aware of drug related adverse events. Especially effects on bone-metabolism and its cells are discussed controversially. Therefore we investigate the in vitro effect of short time administration of low dose methotrexate (MTX) on osteoblasts as essential part of bone remodelling cells. METHODS: Primary bovine osteoblasts (OBs) were incubated with various concentrations of MTX, related to tissue concentrations, over a period of fourteen days by using a previously established standard protocol. The effect on cell proliferation as well as mitochondrial activity was assessed by using 3-(4, 5-dimethylthiazol-2-yl) 2, 5-diphenyltetrazolium bromide (MTT) assay, imaging and counting of living cells. Additionally, immunostaining of extracellular matrix proteins was used to survey osteogenic differentiation. RESULTS: All methods indicate a strong inhibition of osteoblast`s proliferation by short time administration of low dose MTX within therapeutically relevant concentrations of 1 to 1000 nM, without affecting cell differentiation of middle-stage differentiated OBs in general. More over a significant decrease of cell numbers and mitochondrial activity was found at these MTX concentrations. The most sensitive method seems to be the MTT-assay. MTX-concentration of 0,01 nM and concentrations below had no inhibitory effects anymore. CONCLUSION: Even low dose methotrexate acts as a potent inhibitor of osteoblast's proliferation and mitochondrial metabolism in vitro, without affecting main differentiation of pre-differentiated osteoblasts. These results suggest possible negative effects of DMARDs concerning bone healing and for example osseointegration of dental implants. Especially the specifics of the jaw bone with its high vascularisation and physiological high tissue metabolism, suggests possible negative effects of DMARD therapy concerning oral and cranio-maxillofacial bone surgery as could be seen in a similar way in bisphosphonate related osteonecrosis of the jaw.
21342003 Antibody responses to periodontopathic bacteria in relation to rheumatoid arthritis in Jap 2011 Oct BACKGROUND: Periodontopathic bacteria have been implicated as contributory to the etiology of rheumatoid arthritis (RA). Anticyclic citrullinated peptide (CCP) antibodies and rheumatoid factor (RF) were shown to be associated with RA. This study examines whether serum levels of antibodies to periodontopathic bacteria may affect clinical and laboratory profiles of RA. METHODS: The study participants consisted of 80 patients with RA, and 38 age-, sex-, smoking status-, and periodontal condition-balanced healthy controls. After periodontal and rheumatologic examination, serum levels of immunoglobulin G (IgG) antibodies to Porphyromonas gingivalis (Pg), Prevotella intermedia, Aggregatibacter actinomycetemcomitans (Aa) (previously Actinobacillus actinomycetemcomitans), and Eikenella corrodens (Ec) and those of anti-CCP antibodies and RF were determined by an enzyme-linked immunosorbent assay. RESULTS: Patients with RA showed significantly higher levels of anti-Pg and anti-CCP antibodies than controls (P = 0.04 and P <0.0001). In contrast, IgG responses to Aa and Ec in patients with RA were significantly lower than those in controls (P <0.0001 and P = 0.0001). Multiple logistic regression analysis revealed a significant association of anti-Pg and anti-Aa IgG responses with RA, after adjustment for age, sex, and smoking (P = 0.005 and P = 0.02). Anti-Pg titer displayed a significant correlation with RF levels, probing depth, and clinical attachment level (P = 0.03, P = 0.03, and P = 0.02). CONCLUSION: These results suggest that serum levels of anti-Pg IgG antibodies were associated with RA, and might affect serum levels of RF and periodontal condition in patients with RA.
22182481 Presentation of the candidate rheumatoid arthritis autoantigen aggrecan by antigen-specifi 2012 Apr Effective immune responses require antigen uptake by antigen-presenting cells (APC), followed by controlled endocytic proteolysis resulting in the generation of antigen-derived peptide fragments that associate with intracellular MHC class II molecules. The resultant peptide-MHC class II complexes then move to the APC surface where they activate CD4(+) T cells. Dendritic cells (DC), macrophages and B cells act as efficient APC. In many settings, including the T helper type 1 (Th1) -dependent, proteoglycan-induced arthritis model of rheumatoid arthritis, accumulating evidence demonstrates that antigen presentation by B cells is required for optimal CD4(+) T cell activation. The reasons behind this however, remain unclear. In this study we have compared the activation of CD4(+) T cells specific for the proteoglycan aggrecan following antigen presentation by DC, macrophages and B cells. We show that aggrecan-specific B cells are equally efficient APC as DC and macrophages and use similar intracellular antigen-processing pathways. Importantly, we also show that antigen presentation by aggrecan-specific B cells to TCR transgenic CD4(+) T cells results in enhanced CD4(+) T cell interferon-γ production and Th1 effector sub-set differentiation compared with that seen with DC. We conclude that preferential CD4(+) Th1 differentiation may define the requirement for B cell APC function in both proteoglycan-induced arthritis and rheumatoid arthritis.
23218424 An update on the measurement of productivity losses due to rheumatoid diseases. 2012 Oct Many health systems are interested in the impact of disease and interventions on non-health outcomes. Over the last 10 years, work productivity has become one of the most important topics. This study was conducted to review guidelines for economic evaluations worldwide to identify how views on the types of productivity costs to be included differ across jurisdictions and to review recent trials that have measured productivity losses to identify trends and compare consistency with guidelines from different jurisdictions. The guidelines from 28 countries were evaluated and only 12 required productivity costs to be included in the main analysis or the base case analysis. Little specific guidance was provided around the types of productivity costs to be included. Correspondingly, we identified only 10 trials that explicitly measured productivity outcomes and all were conducted after the year 2001. While there was a growth in the proportion of trials evaluating biologics to measure this outcome, it showed that fewer than 50% of even recent studies failed to measure or report productivity. Furthermore, most trials did not use a standard and validated questionnaire to measure all productivity loss components. In conclusion, whether the rationale for the exclusion of productivity impacts is that healthcare budgets should only be concerned with health impacts and ignore general social welfare impacts or whether productivity impacts should be ignored to maintain generational equity or whether the methodology of productivity measurement leads to imprecise estimates, the reality is that productivity impacts are real and to ignore them is tantamount to not being fully accountable to our citizenry.
21802972 Does brachydactyly have a protective effect on the erosive changes in rheumatoid arthritis 2012 May OBJECTIVE: Brachydactyly (BD) is a general term for inappropriately short fingers and/or toes. The author previously reported that a short metacarpal bone had a protective effect on the metacarpophalangeal joint of the same finger in rheumatoid arthritis (RA). The objective was to investigate the prevalence of BD in patients with RA and its potential effect on the phenotype, especially erosive changes. METHODS: A total of 1524 Korean patients with RA were recruited. The presence of BD on hand radiographs, rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP), HLA-DRB1 shared epitopes (SE), risk haplotypes of peptidyl deiminase type IV (PADI4) and erosive joint stage, and smoking status, were determined. RESULTS: The prevalence of BD was 7.9% (n=120) in our RA cohort. The types of BD were type A3 (79.2%), type D (15.0%), Kirner deformity (14.2%), and type E (6.7%). RA patients with BD had reduced erosion on hand radiographs (OR=0.57, 95% CI: 0.34-0.95, p=0.029) adjusted for age, sex, disease duration, smoking, RF, anti-CCP, SE, and PADI4. CONCLUSION: BD is more common in RA patients than might be expected. BD may have a protective effect on erosive changes in RA independent of previously well-established risk factors such as seropositivity, SE, PADI4, and smoking.
22922792 Fragments of SLIT3 inhibit cellular migration. 2012 Nov The repellent factor family of Slit molecules has been described as having a repulsive function in the developing nervous system on growing axons expressing the Roundabout (Robo) receptors. Recent studies determined the effects of Slit molecules on the migratory and invasive potential of several types of tumor cells but also on synovial fibroblasts (SFs) derived from rheumatoid arthritis (RA) patients. To optimize a potential therapeutic application we aimed at generatingfragments of Slit3 showing the same functional ability as the full-length molecule but having the advantage of a smaller size. Recombinant Slit3 proteins were expressed and analyzed by western blotting. Their activity was defined by functional assays such as migration assays with RASF and melanoma cells. Recombinant Slit3 containing only leucine rich repeat domain 2 (D2), the domain important for Robo binding and the minimal functional unit D2 dNC were both able to inhibit migration of RASFs as effectively as Slit3 with all 4 repeats. Collectively, our data showed that the ability of Slit3 to reduce the migratory activity of synovial cells from patients with RA and melanoma cells can be mimicked by small protein fragments derived from Slit3. Slit3 fragments may be helpful in therapeutic attempts; however, further studies are necessary in order to elucidate their activity in vivo.
23094973 Mavrilimumab, a human monoclonal GM-CSF receptor-α antibody for the management of rheumat 2012 Dec INTRODUCTION: Mavrilimumab , formerly known as CAM-3001, a GM-CSF receptor-α antibody, is the first human monoclonal antibody to be used in Phase II studies (2011) to modulate the innate immunity pathway targeting GM-CSF signaling in moderate rheumatoid arthritis (RA). AREAS COVERED: Analysis of available clinical trial data on GM-CSF receptor-α antibody and medical literature search using MEDLINE for molecular mechanisms of pathogenesis of RA and its treatment forms the basis of this expert opinion review. The mavrilimumab Phase II double blind, randomized, placebo-controlled ascending dose trial demonstrated statistically significant achievement of primary and secondary end points in patients with moderate RA. The trial demonstrated significant clinical benefit in the 100 mg mavrilimumab cohort compared to the placebo group. EXPERT OPINION: The novel molecular targeting mechanism of mavrilimumab together with its demonstrated clinical efficacy, tolerability and safety profile in Phase II clinical trials in moderate RA, suggests significant potential utility for this drug to induce clinical remission, reduce flares and improve morbidity and mortality in patients with RA.
21051173 Unmet information needs about the delivery of rheumatology health care services: a survey 2011 Nov OBJECTIVE: To measure patient-perceived knowledge and information need regarding regional health care services and their determinants among 400 patients with rheumatoid arthritis (RA) and to identify the preferred method of information provision. METHODS: Postal survey on knowledge and information need (content and accessibility) of 18 regional health care services and preferences for the mode of delivery of information. Logistic regression analyses determined which factors were associated with insufficient knowledge and information need. RESULTS: Two-hundred and thirty-seven (94%) patients reported insufficient knowledge about the contents and 235 (94%) about the accessibility of at least one health care services, whereas 172 patients (69%) reported an information need about the content and 154 (61%) on the accessibility. Age was significantly associated with knowledge whereas both age and physical functioning were significantly associated with information need. Seventy-nine percent of the patients mentioned written information, 21% the Internet and 12% personal contact with a professional as a preferred method of information delivery. CONCLUSION: Many RA patients reported a lack of knowledge or information need concerning the contents and accessibility of regional health care services. PRACTICE IMPLICATIONS: Active strategies to provide practical information about health care services are needed for RA patients.
21624184 Advances in rheumatology: new targeted therapeutics. 2011 May 25 Treatment of inflammatory arthritides - including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis - has seen much progress in recent years, partially due to increased understanding of the pathogenesis of these diseases at the cellular and molecular levels. These conditions share some common mechanisms. Biologic therapies have provided a clear advance in the treatment of rheumatological conditions. Currently available TNF-targeting biologic agents that are licensed for at east one of the above-named diseases are etanercept, infliximab, adalimumab, golimumab, and certolizumab. Biologic agents with a different mechanism of action have also been approved in rheumatoid arthritis (rituximab, abatacept, and tocilizumab). Although these biologic agents are highly effective, there is a need for improved management strategies. There is also a need for education of family physicians and other healthcare professionals in the identification of early symptoms of inflammatory arthritides and the importance of early referral to rheumatologists for diagnosis and treatment. Also, researchers are developing molecules - for example, the Janus kinase inhibitor CP-690550 (tofacitinib) and the spleen tyrosine kinase inhibitor R788 (fostamatinib) - to target other aspects of the inflammatory cascade. Initial trial results with new agents are promising, and, in time, head-to-head trials will establish the best treatment options for patients. The key challenge is identifying how best to integrate these new, advanced therapies into daily practice.
22608255 Autoimmune arthritis: the interface between the immune system and joints. 2012 Rheumatoid arthritis (RA) is an autoimmune disease, characterized by chronic inflammation and synovial hyperplasia in the joints that ultimately lead to cartilage and bone destruction. A wealth of research has shown that CD4(+) T cells, especially IL-17 producing helper T (Th17) cells, play an important role in RA development. However, it still remains to be clarified how the systemic immune response results in the local joint disorders. Studies on animal models of RA have shed light on the importance of the interaction between immune cells and joint-specific mesenchymal cells. In particular, joint-specific mesenchymal cells contribute to the Th17-mediated augmentation of the inflammatory phase in RA by promoting the migration of Th17 cells to the inflammatory joint and then homeostatic proliferation with increase in IL-17 production. In addition, recent progress in osteoimmunology has provided new insights into the pathogenesis of the bone destruction phase in RA. Of note, Th17 cells have been shown to enhance the differentiation of osteoclasts via joint-specific mesenchymal cells. Thus, the interaction of CD4(+) T cells and nonhematopoietic mesenchymal cells in joints plays a key role in RA pathogenesis during both the inflammatory and bone destruction phases. Focusing on this interaction will lead to a better understanding of the mechanism by which the systemic immune response results in local joint disorders and also helps provide a molecular basis for novel therapeutic strategies.
21354921 [Expression of miR-146a and miR-16 in peripheral blood mononuclear cells of patients with 2011 Feb OBJECTIVE: To investigate the expression levels of miR-146a and miR -16 in the peripheral blood mononuclear cells (PBMCs) of patients with rheumatoid arthritis (RA) and their correlation to the disease activity. METHODS: The expression levels of miR-146a and miR-16 in the in PBMCs were measured using real-time RT-PCR in 40 RA patients and 16 healthy individuals. The correlations of miR-146a and miR-16 expressions to the disease activity of RA were analyzed. RESULTS: The expression levels of miR-146a and miR-16 in the PBMCs of RA patients increased significantly compared to those in the healthy individuals (P<0.05). Their expression levels was significantly higher in active RA patients than in patients with disease remission (P<0.05) and healthy individuals (P<0.01). The expression levels of miR-146a and miR-16 were positively correlated to ESR, CRP and the disease activity scores in 28 joints (DAS28) (P<0.01), but not to RF (P>0.05). CONCLUSION: The elevated expression levels of miR-146a and miR-16 are correlated to RA disease activity, suggesting their value in assessment of the clinical disease activity of RA.
23149217 Nocturnal sleep, daytime sleepiness and fatigue in fibromyalgia patients compared to rheum 2013 Jan OBJECTIVE: Fibromyalgia (FM) and rheumatoid arthritis (RA) are pain disorders, both of which are associated with complaints of sleep disturbance, non-refreshing sleep, and daytime sleepiness and fatigue. Given the putative differential central versus peripheral nervous system involvement in these disorders, subjective and objective measures of nocturnal sleep, daytime sleepiness, fatigue and pain were compared between patient groups and to healthy controls (HC). METHODS: Fifty women (18 with FM, 16 with RA, and 16 HC) completed an 8h nocturnal polysomnogram (NPSG), Multiple Sleep Latency Test (MSLT) the following day, and self-reports of sleepiness, fatigue, and pain. RESULTS: FM and RA patients were similar to each other and had less total sleep time than HC, primarily due to more wake after sleep onset. In an analysis of sleep and wake bouts, both patient groups had longer duration of wake bouts than HC. Nocturnal sleep was judged to be non-restorative for both patient groups. Although reporting the greatest subjective sleepiness and fatigue, FM patients had less objective (MSLT) daytime sleepiness than HC, whereas RA patients were intermediate in objective sleepiness. Unlike the RA and HC, FM patients also showed no association between their subjective and objective sleepiness. CONCLUSIONS: Women with FM have similar nocturnal sleep disturbance as those with RA, but FM patients report greater self-rated daytime sleepiness and fatigue than RA and HC, which did not correspond to the relatively low level of objectively determined daytime sleepiness of FM patients. These findings suggest a generalized hyperarousal state in FM.
22051047 The contribution of pain and depression to self-reported sleep disturbance in patients wit 2012 Jan The objective of this article is to assess the contribution of disease activity, pain, and psychological factors to self-reported sleep disturbance in patients with rheumatoid arthritis (RA), and to evaluate whether depression mediates the effects of pain on sleep disturbance. The sample included 106 patients with confirmed RA who participated in an assessment of their disease activity, pain, psychological functioning, and sleep disturbance during a baseline evaluation prior to participating in a prospective study to help them manage their RA. Self-measures included the Rapid Assessment of Disease Activity in Rheumatology, the SF-36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index, the Active and Passive Pain Coping Scales of the Pain Management Inventory, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Quality Index. Hierarchical multiple regression analysis confirmed that higher income, pain, internality, and depression contributed independently to higher sleep disturbance. A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance among patients with RA. The data suggest the importance of interventions that target pain and depression to improve sleep in this medical condition.
22023483 Assistive devices, home adjustments and external help in rheumatoid arthritis. 2012 PURPOSE: To explain the determinants of adaptation with disease and self-management of patients with rheumatoid arthritis (RA) in Estonia, focusing on the use of assistive devices, home adjustments and the need for external help. METHOD: A random sample (n = 1259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, the costs of care, quality of life, use of assistive devices, home adjustments and the need for external help. Regression analysis was used to analyse the predictors of patient's adaptation with disease and self-management. RESULTS: Twenty-six percent of the respondents used assistive devices, 20% had made home adjustments and 37% needed external help. Disabilities and physical impairments predicted the use of assistive devices, home adjustments and the need for external help. The use of medical rehabilitation services predicted the less frequent use of assistive devices, while female gender and single status predicted a more expressed need for external help. CONCLUSIONS: Disability and physical impairment are the most important determinants of the use of various technical aids and home adjustments. These factors, along with the female gender and single status of the patient, predict help-dependence.