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ID PMID Title PublicationDate abstract
24871116 Diagnostic utility of oxidative damage markers for early rheumatoid arthritis in non-smoke 2014 Jan BACKGROUND: Besides the development of new markers and diagnostic criteria for rheumatoid arthritis (RA), many patients are still diagnosed after several years of symptoms. Oxidative stress markers are already increased at an early stage of RA. Our aim was to evaluate the additional diagnostic value of these markers. METHODS: A case-control study was performed. Patients met the 1987 RA ACR criteria, less than 2 years of symptoms and no previous treatment with disease-modifying anti-rheumatic drugs (DMARD), steroids or vitamin E. Controls were selected from patient's relatives and matched (1:1) by gender, age, and current smoking habit. Oxidative damage markers were malonyldialdehyde (MDA), Lipid hydroperoxides (LOOH) and Carbonyl proteins (CP). Statistical analysis was performed in agreement with the STARD initiative. RESULTS: Sixty-five RA patients without treatment and 65 healthy controls were included. LOOH, CP, antibodies against citrullinated peptides (anti-CCP) and rheumatoid factor (RF) were significantly higher in patients, and MDA higher in controls. The same results were obtained in the subgroups of patients who smoke or not, and in anti-CCP positive or negative. The diagnosis performance of traditional markers showed good specificity but low sensitivity. The addition of LOOH and CP increased the sensitivity and the area under the receiving operating characteristic (ROC) curve especially in non-smoking (66%) and negative anti-CCP (51%) patients. CONCLUSIONS: The separate or combined addition of LOOH or CP to the traditional disease markers improved the diagnosis of RA, especially in non-smoking or negative anti-CCP patients.
25086073 The role of depression, anxiety, fatigue, and fibromyalgia on the evaluation of the remiss 2014 Sep OBJECTIVE: To investigate the effect of depression, anxiety, fatigue, and fibromyalgia (FM) on the remission status in patients with rheumatoid arthritis (RA), defined according to the 28-joint count Disease Activity Score (DAS28)-erythrocyte sedimentation rate (ESR) and the Boolean-based new American College of Rheumatology/European League Against Rheumatism remission criteria. METHODS: The subjects were patients with RA who participated in a hospital-based observational cohort. Patients who met the DAS28-ESR remission criteria at their latest visit were invited to participate in our study. The patient groups fulfilling or not fulfilling the Boolean remission criteria were identified and compared with each other with regard to the presence of depression, anxiety, fatigue (0-50), and FM. The relationship between psychosocial factors and Simplified Disease Activity Index (SDAI) remission, which is the index-based definition of remission in RA, was also investigated. RESULTS: A total of 87 out of 428 patients (20%) with RA met the DAS28-ESR remission criteria and 32 (37%) of these also met the Boolean remission criteria, while 55 (63%) did not. Forty patients were also in SDAI remission. In the Boolean remission group, 2 patients had depression and 2 had anxiety (p = 0.004). In the Boolean nonremission group, 19 patients had depression and 13 had anxiety (p = 0.04). Continuous scales of anxiety (3.34 ± 3.76 vs 5.83 ± 4.70, p = 0.012) and depression (2.18 ± 2.75 vs 4.63 ± 4.10, p = 0.001) were also lower in the Boolean remission group in comparison with the nonremission group. Though FM syndrome was detected in only 1 patient of the Boolean remission group and in 7 patients of the Boolean nonremission group (p = 0.249), patients' polysymptomatic distress scores of FM in the Boolean remission group were significantly lower than those of the nonremission group (3.12 ± 3.25 vs 6.27 ± 5.19, p = 0.001). The mean fatigue scores were 9.5 ± 10.6 in the Boolean remission group and 16.8 ± 12.8 in the Boolean nonremission group (p = 0.006). In multivariate analysis, patient's global assessment (PtGA) and depression were found as the independent discriminators of Boolean-based definition. Similar relationships were also observed between psychosocial factors and SDAI remission. CONCLUSION: In patients with RA who do not fulfill the Boolean remission criteria, to avoid overtreatment, assessment of anxiety, fatigue, FM, and especially depression must be considered if PtGA scores and disease activity variables are significantly different.
23622099 Achieving remission in clinical practice: lessons from clinical trial data. 2013 Jul This review examines the literature on the frequency of remission associated with different treatment approaches in early rheumatoid arthritis (ERA). Trials reporting remission outcomes were identified through searches of the CINAHL, EMBASE, and Medline (PubMed) databases from 2000 through August 2012. Additional literature was identified through hand searching. The proportion of patients achieving remission and/or radiographic non-progression was extracted from each study. Evidence was examined in the context of unified remission criteria and practical considerations for achieving and maintaining remission are discussed. The literature highlights the benefits of early treatment with disease-modifying anti-rheumatic drug (DMARD) combination therapy, combination therapy with a biologic, and tight control with a pre-specified treatment target in achieving remission in ERA. The added stringency of the 2011 remission criteria may increase the proportion of patients achieving true remission, while identifying predictors of sustained remission may also help patients achieve better radiographic and functional outcomes.
23791462 Fibrosing interstitial pneumonia predicts survival in patients with rheumatoid arthritis-a 2013 Aug BACKGROUND: Rheumatoid arthritis (RA) is a systemic autoimmune disorder with a variety of extra-articular manifestations. The lung is a common target and diffuse parenchymal lung disease can appear as any of the patterns found with idiopathic interstitial pneumonia. Controversy exists as to the prognostic significance of these patterns among patients with RA-ILD. METHODS: We retrospectively identified 48 patients with a diagnosis of RA-ILD confirmed by surgical lung biopsy. The pathology was reviewed by four expert pulmonary pathologists. We examined survival after stratifying on the presence or absence of fibrotic ILD, and contrasted it with a matched idiopathic pulmonary fibrosis (IPF) population. The Cox proportional hazards model was used to identify independent predictors of survival. RESULTS: The majority of subjects were male smokers with physiologic restriction. A usual interstitial pneumonia (UIP)-pattern was identified in 31% of subjects. Median survival time for the entire cohort was 1360 days. Subjects with fibrotic ILD had worse survival than subjects with non-fibrotic ILD (log rank p = 0.02). There was no difference in survival between UIP-pattern RA-ILD subjects and IPF controls (log rank p = 0.94). Multivariable analysis revealed that age (hazard ratio [HR] = 1.04, p = 0.01) and fibrosis (HR = 2.1, p = 0.02) were independent predictors of mortality. CONCLUSIONS: Both cellular and fibrosing ILD patterns are common among RA-ILD patients who undergo surgical lung biopsy. These patients have a shortened survival when compared to the general population and all-comers with RA. Age and the presence of a fibrosing interstitial pneumonia predict shortened survival in these patients. Survival in UIP is similar to matched IPF patients.
24719251 Smokeless tobacco (moist snuff) use and the risk of developing rheumatoid arthritis: resul 2014 Oct OBJECTIVE: To investigate the association between snuff use (smokeless tobacco containing nicotine) and the risk of anti–citrullinated protein/peptide antibody (ACPA)–positive and ACPA-negative rheumatoid arthritis (RA). METHODS: Data from the Swedish Epidemiological Investigation of Rheumatoid Arthritis, a population-based case–control study including 1,998 incident cases and 2,252 randomly selected controls (matched on age, sex, and residential area) ages 18–70 years, were analyzed. Ever, current, and past moist snuff users were compared with never users. We calculated odds ratios (ORs) with 95% confidence intervals (95% CIs) by means of unconditional logistic regression models. All analyses were adjusted for cigarette smoking, alcohol consumption, and the matching variables. RESULTS: In total, 254 (13%) cases were ever moist snuff users compared with 290 (13%) controls, resulting in an OR of 1.0 (95% CI 0.8–1.2) of RA overall. When exposure to moist snuff was analyzed in relation to ACPA-positive and ACPA-negative disease, no associations were observed. Neither current nor past moist snuff use was related to the risk of any of the 2 RA subgroups. Analyses restricted to never smokers provided similar results. CONCLUSION: The use of moist snuff was not associated with the risk of either ACPA-positive or ACPA-negative RA. The increased risk of RA associated with smoking is most probably not due to nicotine.
23774109 Rheumatic manifestations in inflammatory bowel disease. 2014 Jan Musculoskeletal symptoms (articular, periarticular and muscular involvement, osteoporosis and related fractures, and fibromyalgia) are the most common frequent extra-intestinal manifestations of inflammatory bowel disease (IBD) and affect 6-46% of patients. IBD-related arthropathy is one of a group of inflammatory arthritides known as seronegative spondyloarthropathies (SpA), which also includes idiopathic ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, and undifferentiated SpA. The articular involvement in IBD significantly affects the patients' quality of the life. Although magnetic resonance imaging (MRI) is still the gold standard for assessing entheseal involvement, ultrasonography (US) is a non-invasive and easily reproducible means of detecting early pathological changes in SpA patients. It can identify characteristic features of SpA such as enthesitis, bone erosions, synovitis, bursitis, and tenosynovitis and is therefore helpful for diagnostic purposes. Anti-TNF drugs should be used to treat AS patients with axial and peripheral symptoms (arthritis and enthesitis) who have persistently high levels of disease activity despite conventional treatment, and adalimumab and infliximab can also be beneficially used in patients with IBD.
24124063 Who makes it to the base? Selection procedure for a physical activity trial targeting peop 2014 May OBJECTIVE: To compare those who were finally included in a large well-defined sample of individuals with rheumatoid arthritis (RA) at target for a physical activity (PA) trial with those who were not. METHODS: In total, 3,152 individuals answered questionnaires on sociodemographic, disease-related, and psychosocial factors and PA levels. The differences between individuals making it to the baseline assessments and those who did not were analyzed in 3 steps. RESULTS: In a first step, 1,932 individuals were eligible for the trial if they were interested in participating, not physically active enough, and fluent in Swedish and if they were not participating in any other study. The participants were mainly younger women, had higher education and income, were more likely to live with children, and had better support for exercise and had higher outcome expectations of PA than the 1,208 ineligible individuals. In a second step, the 286 individuals accepting participation had higher income and education, more support for exercise, less fear-avoidance beliefs, and higher outcome expectations of PA than the 1,646 individuals declining participation. In a third step, the 244 individuals assessed at baseline reported less fatigue than the 42 withdrawing before assessment. CONCLUSION: To our knowledge, this is the first study describing the entire selection procedure, from a target sample for a PA trial to the sample assessed at baseline, in individuals with RA. Factors other than those related to the disease seemed to mainly determine participation and largely resembled determinants in the general population. Sociodemographic and psychosocial factors should be recognized as important for PA in people with RA.
24164840 A multi-center, observational study shows high proportion of Australian rheumatoid arthrit 2013 Oct OBJECTIVES: To evaluate the disease activity and current pharmacological interventions used to achieve remission in rheumatoid arthritis (RA) patients in Australia. METHODS: Rheumatoid arthritis patients treated in participating Australian clinics were included in the study. Patient demographics, disease onset, medications and disease measures were analyzed. Data, de-identified to the patient, clinic and clinician were captured using an electronic clinical management program. The disease activity score (DAS28) was used to classify patients into the disease activity states of remission, low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA). Choice of therapy was at the discretion of the treating clinician. RESULTS: A total of 5686 patients, 72.9% female, 26.9% male, with mean age 61.1 (SD 13.6) years and mean disease duration of 11.5 (SD 10.5) years were analyzed. DAS28 ESR (erythrocyte sedimentation rate) scores were recorded for 2973 patients, with 41.6% in remission, 18.6% LDA, 31.6% MDA and 8.2% HDA. Of those in remission, 17% received a biological disease modifying anti-rheumatic drug (bDMARD), 73% methotrexate (MTX), 19% leflunomide (LEF) and 28% prednisolone. Of the patients with MDA, 20% received a bDMARD, 76% MTX, 24% LEF and 39% prednisolone. Of the patients in HDA, 27% received a bDMARD, 78% MTX, 31% LEF and 60% with prednisolone. CONCLUSIONS: Cross-sectional assessment of this large cohort of Australian RA patients found a large proportion remain in moderate or high disease activity; suggesting a considerable evidence-practice gap. Improvement in disease control in this group may reduce future health burdens.
24756903 Use of whole-blood transcriptomic profiling to highlight several pathophysiologic pathways 2014 Aug OBJECTIVE: To identify a molecular signature that could be predictive of the clinical response to rituximab (RTX) and elucidate the transcriptomic changes after RTX therapy in patients with rheumatoid arthritis (RA), with the use of whole-blood transcriptomic profiling. METHODS: A microarray assay of the whole human genome was performed using RNA from peripheral blood samples obtained before the first cycle of RTX from 68 patients with RA in the SMART study. The transcriptomic profile was also assessed 24 weeks after the first administration of RTX (among 24 nonresponders and 44 responders, according to the European League Against Rheumatism response criteria at week 24). Ingenuity Interactive Pathways Analysis was used to identify molecular pathways that were modified by RTX therapy according to the clinical response. Quantitative polymerase chain reaction was performed to confirm the microarray results. RESULTS: In total, 198 genes showed significant baseline differential expression between patient groups according to their subsequent response to RTX (good or moderate responder versus nonresponder). This molecular signature could be reduced to 143 genes, which allowed for correctly classifying 89% of the patients by their EULAR response status at week 24, with 93% identification of responders and 100% identification of nonresponders. The signature for response featured up-regulation of inflammatory genes centered on NF-κB, including IL33 and STAT5A, and down-regulation of the interferon pathway. As expected, at week 24 post-RTX therapy, genes involved in the development and functions of B cells were the genes most strongly down-regulated, without any difference between the 2 groups. CONCLUSION: Whole-blood transcriptomic analyses may accurately identify patients with RA who will not respond to RTX therapy. These findings could open new perspectives on the clinical management of RA.
24670133 Current prevalence and characteristics of cervical spine instability in patients with rheu 2014 Nov OBJECTIVES: Cervical spine instability (CSI) is commonly involved in patients with rheumatoid arthritis (RA). Although the treatment for RA has dramatically changed due to methotrexate and biologics, it is unclear whether this change contributes to the prevalence of CSI or not. Our objectives were to update the current prevalence of CSI and to investigate the factors associated with CSI. METHODS: A cross-sectional study of patients with RA was conducted in our outpatient clinic. Clinical information and symptoms related to CSI were obtained. Plain radiography and magnetic resonance imaging were performed. CSI included atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS). RESULTS: Two hundred and twenty patients were analyzed, 93 (42%) of whom had CSI. A ≥ 10-year disease duration, Steinbrocker stage III, and three or more narrowed disc spaces from C2/3 to C6/7 were significantly associated with CSI. A neck pain VAS was associated with VS, but not with AAS and SAS. In contrast, methotrexate and biologics had no effect on CSI. CONCLUSION: The prevalence of CSI in this study was lower compared to previous reports before the approval of biologic, although we failed to detect the effect of biologics. Further prospective studies are needed to elucidate the efficacy.
23352514 Performance of the American College of Rheumatology/European League Against Rheumatism 201 2013 Oct OBJECTIVES: To evaluate the ability of American College of Rheumatology (ACR) 2010 classification criteria to diagnose rheumatoid arthritis (RA) compared to the widely used ACR 1987 criteria in Chinese patients. METHODS: Four hundred and four patients suffering from arthritis were included in the study. Two hundred and twenty-one of them were classified as RA patients and 183 had alternative diagnoses. The patients were further subdivided into three groups according to their disease duration of within one year, one to two years or more than two years. The diagnostic value of ACR/EULAR 2010 criteria for RA was evaluated by comparing the sensitivity and specificity with those of ACR 1987 criteria in these patients. RESULTS: The sensitivity and specificity of ACR/EULAR 2010 criteria for diagnosing RA were 95% and 92.9%, respectively. In contrast, the sensitivity and specificity of ACR 1987 criteria were 81.4% and 92.9%, respectively. The efficacy of ACR/EULAR 2010 criteria was superior to the ACR 1987 criteria by comparing their area under the curves (AUC) (0.940, 95% CI [0.912, 0.967] vs. 0.872, 95% CI [0.835, 0.909]). The recognition accuracy of ACR/EULAR 2010 criteria was higher than that of ACR 1987 criteria (94.5% vs. 86.6%, P<0.05). Inter-rater analysis showed that agreement of the two criteria was substantial (Kappa=0.744, P<0.001). For patients with disease duration within one year, one to two years and over two years, the sensitivities of ACR 1987 criteria were 69.2%, 81.3% and 89.9%, while the specificities were 94.4%, 90.6% and 92%, respectively. The corresponding sensitivities of ACR/EULAR 2010 criteria in these patients were 91%, 93.8% and 98.2%, while the corresponding specificities were 94.4%, 96.6% and 89.3%, respectively. The advantage of ACR/EULAR 2010 criteria over 1987 criteria in higher sensitivity was remarkable particularly in patients with disease duration within one year (P<0.001). CONCLUSIONS: The ACR/EULAR 2010 criteria is more accurate in RA diagnosis compared to the ACR 1987 criteria by elevating the sensitivity while preserving the specificity, especially in patients with disease duration within one year. The ACR/EULAR 2010 criteria may serve as new diagnostic tools in daily clinical practice.
25365093 Scores for all seasons: SDAI and CDAI. 2014 Sep Disease activity assessment is one of the most pivotal aspects in the care of RA patients. Composite measures of disease activity are superior to individual measures, since they capture the multiple facets of the disease. Since swollen joint counts correlate with joint damage progression and tender joint counts with physical function, composite scores that include joint counts are preferable. The simplified and clinical disease activity indices (SDAI, CDAI) are easy to calculate and correlate well with joint damage and physical function. Cutpoints for disease activity states have been established and improvement criteria likewise. The SDAI and CDAI remission criteria (ACR-EULAR index-based remission) are stringent, usually associated with a halt of progression of damage and optimisation of physical function and can still be achieved in 1 of 4 clinic patients and up to one third of patients in trials of early arthritis.
23223890 [Biomarkers and personalized medicine]. 2013 Feb Biomarkers form the basis for patient stratification and the development of individualized treatment strategies. As the understanding of the pathophysiological processes underlying rheumatic diseases increases, novel biomarkers will become available and established markers can be used more efficiently. Autoantibodies in rheumatoid arthritis (RA), for example, define a subgroup of patients with a specific risk profile and response to therapy. For this reason they have been added to the classification criteria for RA and are part of current treatment guidelines. In addition, novel markers are being evaluated and validated. For the concept of personalized medicine this indicates that the use of future therapeutic substances will be more frequently coupled to the detection of specific biomarkers. While this will decrease the number of patients who become eligible for certain treatments, it will increase efficacy and safety for patients and potentially the cost-effectiveness.
25361815 A Q-methodology study of flare help-seeking behaviours and different experiences of daily 2014 Nov 1 BACKGROUND: Previous studies have not addressed rheumatoid arthritis (RA) patients' help-seeking behaviours for RA flares, and only one small qualitative study has addressed how patients experience daily life on current treatment regimes. Thus, this study aims to identify clusters of opinion related to RA patients' experiences of daily life on current treatments, and their help-seeking behaviours for RA flares. METHODS: Using Q-methodology (a methodology using qualitative and quantitative methods to sort people according to subjective experience), two separate studies were conducted with the same sample of RA patients (mean age 55, 73% female). Thirty participants sorted 39 statements about daily life (Q-study 1) and 29 participants separately sorted 23 statements about flare help-seeking (Q-study 2). Data were examined using Q-factor analysis. RESULTS: Daily life with RA (Q-study 1): Three factors relating to the experience of living with RA were extracted and explained. Patients belonging to Factor A (mean age 62, 86% female) use effective self-management techniques to control the daily impact of RA. Those in Factor B (mean age 55, 75% male) struggle to self-manage and cope. Whilst patients in Factor C (mean age 42, 100% female) prioritise life responsibilities over their RA, reporting less impact.Flare help-seeking (Q-study 2): Two factors explaining the experience of flare help-seeking (unrelated to the factors from Q-study 1) were extracted and explained. Factor X (68.8% on biologics) reported seeking help quickly, believing the medical team is there to help. Factor Y (0% on biologics) delay help-seeking, concerned about wasting the rheumatologist's time, believing they should manage alone. All participants agreed they sought help due to intense pain and persistent, unmanageable symptoms. CONCLUSIONS: Patients with different characteristics appear to manage RA life in different ways and men may struggle more than women. Whilst all patients are prompted to seek help by persistent, unmanageable symptoms, some delay help-seeking. Further research is needed to quantify the severity of daily symptoms, the level of symptoms needed for patients to define themselves as in flare and to understand the support needs of RA men.
25488711 Diagnostic value of the anti-Sa antibody compared with the anti-cyclic citrullinated pepti 2015 Jan AIM: To evaluate the prevalence and diagnostic significance of the autoantibody against citrullinated vimentin (anti-Sa) compared with the widely used anti-cyclic citrullinated peptide autoantibody (anti-CCP) in patients with rheumatoid arthritis (RA). METHOD: One hundred and sixty-nine patients hospitalized at the Department of Rheumatology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland, were enrolled in a cross-sectional study and divided into two groups. The RA group comprised 41 patients diagnosed as having RA. The non-RA control group included 128 individuals with a variety of rheumatic disorders. Serum anti-Sa and anti-CCP measurements were performed by enzyme-linked immunosorbent assay. RESULTS: The sensitivity and specificity of anti-Sa for the diagnosis of RA was 36.6% and 96.9%, respectively. For the anti-CCP test, the sensitivity was 65.9% and the specificity was 95.3%. Concomitant presence of anti-Sa and anti-CCP was determined in 36.6% of the patients with RA, whereas isolated positivity of anti-Sa was not observed. Anti-Sa positive RA patients had significantly higher anti-CCP levels compared to anti-Sa negative subjects (P < 0.05). CONCLUSION: With regard to the relatively low diagnostic sensitivity and the lack of cases identified by anti-Sa alone, we were unable to demonstrate any additional diagnostic value of the anti-Sa autoantibody in comparison to the anti-CCP autoantibody. To the authors' best knowledge, this is the first study among Polish patients verifying the clinical utility of anti-Sa in the diagnosis of RA.
24046468 Patient self-assessment and physician's assessment of rheumatoid arthritis activity: which 2013 Dec OBJECTIVE: The objective of this study was to compare disease activity assessed by the patient, the physician and musculoskeletal US in patients with RA in clinical remission. METHODS: We evaluated 69 patients with RA in clinical remission according to their attending rheumatologist. Tenderness and swelling in 28 joints were blindly assessed by patients and physicians. The presence of B-mode and Doppler synovitis was blindly investigated in the above joints. The DAS28 and Simplified Disease Activity Index (SDAI) were calculated. RESULTS: The percentage of patients in remission according to the self-derived DAS28 (26.1%) was significantly less than that according to the physician-derived DAS28 (52.2%) (P < 0.0005). There was no significant difference in the percentage of patients in remission according to the self-derived SDAI (14.5%) and the physician-derived SDAI (11.6%) (P = 0.172). We found moderate agreement between the patient-derived and physician-derived DAS28 and SDAI [intraclass correlation coefficient (ICC) = 0.620 and ICC = 0.678, respectively]. Agreement between patient and physician was better for the tender joint count (TJC; ICC = 0.509) than for the swollen joint count (SJC; ICC = 0.279). The mean (S.D.) count for B-mode synovitis [4.09 (3.25)] was significantly greater than the SJC assessed by both the patient and physician [2 (3.71) and 1.42 (2.03), respectively] (P < 0.0005 and P = 0.033, respectively). We found moderate agreement between the physician-assessed SJC and the joint count for Doppler synovitis (ICC = 0.528). CONCLUSION: Patient-assessed and physician-assessed overall RA activity showed acceptable agreement. Patient self-assessment overestimated disease activity determined by the DAS28. At the patient level, physician-assessed joint swelling showed an acceptable concordance with Doppler US synovitis.
24924725 [Technological orthopedic treatment of feet destroyed by rheumatism. Update]. 2014 Jun BACKGROUND: The course of rheumatoid arthritis often leads to afflictions of the feet with typical deformities and complaints. In addition to the basis medication, physical therapy, physiotherapy and local infiltration techniques, technological orthopedic shoe treatment is an important component of conservative therapy. MATERIAL AND METHODS: This review article presents the foundations of the pathomechanics of rheumatic feet and the principles of treatment. RESULTS AND CONCLUSION: Through a sensible implementation of a foot disorder orthosis it is possible to mitigate deformities due to rheumatoid arthritis and also positively influence the further course. The aim of a foot disorder orthosis is ultimately to delay or even avoid surgical measures for rheumatic feet and also to stabilize the results after surgical interventions.
24731866 Age at onset determines severity and choice of treatment in early rheumatoid arthritis: a 2014 Apr 14 INTRODUCTION: Disease activity, severity and comorbidity contribute to increased mortality in patients with rheumatoid arthritis (RA). We evaluated the impact of age at disease onset on prognostic risk factors and treatment in patients with early disease. METHODS: In this study, 950 RA patients were followed regularly from the time of inclusion (<12 months from symptom onset) for disease activity (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tender and/or swollen joints, Visual Analogue Scale pain and global scores, and Disease Activity Score in 28 joints (DAS28)) and function (Health Assessment Questionnaire (HAQ)). Disease severity, measured on the basis of radiographs of the hands and feet (erosions based on Larsen score), extraarticular disease, nodules, and comorbidities and treatment (disease-modifying antirheumatic drugs (DMARDs), corticosteroids, biologics and nonsteroidal anti-inflammatory drugs) were recorded at the time of inclusion and at 5 years. Autoantibodies (rheumatoid factor, antinuclear antibodies and antibodies against cyclic citrullinated peptides (ACPAs)) and genetic markers (human leucocyte antibody (HLA) shared epitope and protein tyrosine phosphatase nonreceptor type 22 (PTPN22)) were analysed at the time of inclusion. Data were stratified as young-onset RA (YORA) and late-onset RA (LORA), which were defined as being below or above the median age at the time of onset of RA (58 years). RESULTS: LORA was associated with lower frequency of ACPA (P < 0.05) and carriage of PTPN22-T variant (P < 0.01), but with greater disease activity at the time of inclusion measured on the basis of ESR (P < 0.001), CRP (P < 0.01) and accumulated disease activity (area under the curve for DAS28 score) at 6 months (P < 0.01), 12 months (P < 0.01) and 24 months (P < 0.05), as well as a higher HAQ score (P < 0.01) compared with YORA patients. At baseline and 24 months, LORA was more often associated with erosions (P < 0.01 for both) and higher Larsen scores (P < 0.001 for both). LORA was more often treated with corticosteroids (P < 0.01) and less often with methotrexate (P < 0.001) and biologics (P < 0.001). YORA was more often associated with early DMARD treatment (P < 0.001). The results of multiple regression analyses supported our findings regarding the impact of age on chosen treatment. CONCLUSION: YORA patients were more frequently ACPA-positive than LORA patients. LORA was more often associated with erosions, higher Larsen scores, higher disease activity and higher HAQ scores at baseline. Nevertheless, YORA was treated earlier with DMARDs, whilst LORA was more often treated with corticosteroids and less often with DMARDs in early-stage disease. These findings could have implications for the development of comorbidities.
25189095 Disease activity affects all domains of quality of life in patients with rheumatoid arthri 2014 Nov OBJECTIVES: This study was conducted to determine how disease activity affects quality of life (QOL) and its interaction with functional impairments, and disease duration in patients with rheumatoid arthritis (RA). METHODS: This cross-sectional study enrolled 230 patients with RA from a rheumatology clinic in Taiwan and 227 healthy controls matched according to age, sex, marital status, and education. QOL was measured using the Taiwan version of the short form of the World Health Organisation Quality of Life (WHOQOL-BREF) questionnaire. Activity of RA was assessed by the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28). Functional disability was assessed by the Health Assessment Questionnaire (HAQ). Multiple regression analyses were performed to explore independent effects and interactions among DAS28, HAQ, and duration after controlling demographic factors. RESULTS: A higher HAQ score, longer duration of disease, and higher DAS28 score were independently associated with lower QOL scores. DAS28 score affected most items in all physical, psychological, environment, and social domains after controlling other factors. Besides, patients with longer disease duration showed aggravated scores on many facets of the physical and psychological domains, if their disease activity was elevated. CONCLUSIONS: Disease activity affects QOL of RA patients in all domains. It also aggravates scores in physical and physiological domains among those with a longer duration.
22740431 Prospective study of posttraumatic stress disorder and disease activity outcomes in US vet 2013 Feb OBJECTIVE: To examine the relationship between posttraumatic stress disorder (PTSD) and disease activity in US veterans with rheumatoid arthritis (RA). METHODS: US veterans with RA were enrolled in a longitudinal observational study and were categorized as having PTSD, other anxiety/depression disorders, or neither of these psychiatric diagnoses using administrative codes. Generalized linear mixed-effects models were used to examine the associations of the diagnostic groups with outcomes measured over a mean followup period of 3.0 years. RESULTS: At enrollment, 1,522 patients had a mean age of 63 years, they were primarily men (91%), and a majority (78%) reported white race. A diagnosis of PTSD was observed in 178 patients (11.7%), and other anxiety/depression diagnoses (excluding PTSD) were found in 360 patients (23.7%). The presence of a PTSD diagnosis was independently associated with higher values of self-reported pain, physical impairment, tender joint count, and worse patient global well-being scores compared to patients with no psychiatric diagnosis. There were no significant group differences in swollen joint count, erythrocyte sedimentation rate, or Disease Activity Score in 28 joints. There were no differences between any outcomes comparing those with PTSD and those with other anxiety/depression diagnoses. CONCLUSION: In this RA cohort, the diagnosis of PTSD was associated with worse patient-reported outcomes and tender joint counts, but not with other physician- or laboratory-based measures of disease activity. These results suggest that PTSD, along with other anxiety/depression disorders, may affect RA disease activity assessments that rely on patient-reported outcomes and the resulting treatment decisions.