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ID PMID Title PublicationDate abstract
23053710 Dentofacial characteristics of patients with rheumatoid arthritis. 2013 Sep OBJECTIVES: The aims of this study are to evaluate the dentofacial morphology of patients with rheumatoid arthritis (RA) and to compare the morphological data with those of healthy age- and sex-matched control subjects. METHODS: Twenty-seven RA patients (mean age, 45.77 ± 8.64 years) and 25 healthy subjects (mean age, 44.80 ± 8.24 years) participated in this prospective study. Clinical and functional evaluations of the RA patients were assessed. The erythrocyte sedimentation rate, C-reactive protein level, rheumatoid factor level, and anti-citrullinated peptide antibodies (ACPA) titers of RA patients were determined, and DAS28 scores were calculated. Linear and angular measurements were performed on cephalometric tracings and condylar erosion was evaluated on lateral panoramic radiographs. Statistical comparison of the two groups was performed with an independent samples t test. Pearson correlation analysis was used to assess the relationship between the clinical and laboratory parameters. RESULTS: Based on DAS28 scores, no patient with RA was in the remission period, 3 patients had low, 23 had medium, and 1 had high disease activity. Sixteen (59.26 %) patients with RA had positive ACPA titers. Lateral cephalometric radiographs revealed statistically significant difference between the two groups for the measurement of U1-NA (millimeter; p = 0.047), U1-NA (degrees; p = 0.031), L1-NB (degrees; p = 0.030), IMPA (L1-MP; p = 0.001), interincisal angle (U1-L1; degrees; p = 0.022) and midface length (Co-A; millimeter; p = 0.033). A significant positive linear correlation was found between disease duration time and DAS28 scores (r = 0.066, p = 0.040). CONCLUSIONS: Dentoalveolar effects of RA on dentofacial morphology are more significant than the skeletal effects. Future studies with larger sample sizes are required to evaluate the exact effects of RA on dentofacial morphology. CLINICAL RELEVANCE: Clinicians should consider the fact that RA-associated dentoalveolar changes can be observed and may affect the orthodontic treatment process.
24836013 Contributions of ultrasound beyond clinical data in assessing inflammatory disease activit 2014 Dec Appropriate measures of disease activity need to be valid, reliable and sensitive to change for use in clinical studies while remaining at the same time feasible and practicable for utilization in daily clinical practice. Ultrasonography was shown to be a valid, sensitive and reliable imaging modality for the detection of synovitis in RA, however, it has so far failed to demonstrate superior sensitivity to change as compared with clinical examination. This review examines the current evidence for the use of established measures and/or US, either as an alternative or as a supplementary measure to clinical examination, as tools for monitoring synovitis in RA. It also includes a summary of results of recent studies evaluating clinical examination-based as well as clinical- and US-based multimodal disease activity indices. We review the rationale and limitations of incorporating US into composite disease activity indices and suggest a research roadmap for further studies in this field.
24285493 Time trends in disease activity, response and remission rates in rheumatoid arthritis duri 2015 Feb OBJECTIVES: To investigate whether baseline disease activity levels and responses in patients with rheumatoid arthritis (RA) changed during the period 2000-2010. METHODS: Data were provided by the Norwegian disease-modifying antirheumatic drug (NOR-DMARD) study. Patients with inflammatory joint diseases starting new treatment with disease-modifying antirheumatic drugs (DMARDs) were consecutively included and followed longitudinally. Time trend analyses were performed in methotrexate (MTX)-naïve RA patients starting MTX monotherapy (MTX mono) and biologic DMARD (bDMARD)-naïve RA patients starting tumour necrosis factor inhibitors+MTX (TNFi+MTX). RESULTS: A total of 2573 patients were included in the analyses: MTX mono n=1866 (69.9% female, 62.0% RF+, mean (SD) age 56.0 (13.7) years, median (25-75 percentile) time from diagnosis 0.2 (0.01-2.8) years); TNFi+MTX n=707 (70.3% female, 75.0% RF+, mean (SD) age 52.1 (13.2) years, median (25-75 percentile) time from diagnosis 5.7 (2.0-13.7) years). Significant time trends towards lower baseline disease activity score 28 (DAS28) as well as other disease activity measures were found in both groups (DAS28 from 5.17 to 4.75 in MTX mono and from 5.88 to 4.64 in TNFi+MTX), and disease duration became shorter. Six-month DAS28 remission rates increased significantly over the years (from 17.8 to 37.6 in MTX mono and from 16.9 to 46.3 in TNFi+MTX). CONCLUSIONS: During the last decade, baseline RA disease activity level at the time of starting MTX as well as TNFi+MTX decreased from high to moderate. A more than twofold increase in 6-month remission rates was observed in both groups. Our findings indicate that clinicians have implemented modern, more aggressive treatment strategies, which hopefully will lead to better long-term disease outcomes.
24472261 Dose optimization of infliximab in patients with rheumatoid arthritis. 2014 Jan AIM: It is well established that tumor necrosis factor (TNF) inhibitors help control disease activity, limit radiographic progression and preserve function in patients with rheumatoid arthritis. However, not all patients respond adequately to initial anti-TNF treatment and some patients lose response over time. Possible treatment modifications include optimizing concomitant disease-modifying antirheumatic drugs, switching to another anti-TNF biologic or another class of agent, or optimizing the dose of the anti-TNF agent. Here we review data on dose optimization of infliximab, with emphasis on dose changes to address inadequate response, nonresponse and loss of response. METHOD: The authors conducted a literature review to identify studies that evaluated the effect of dose optimization on clinical response in infliximab-treated patients with rheumatoid arthritis. RESULTS: Few well-controlled studies of dose optimization of infliximab have been completed for patients with rheumatoid arthritis, and the evidence supporting efficacy and safety after dose adjustment can be difficult to interpret. Studies of dose optimization in infliximab-treated patients who fail to show initial response, have an inadequate response, or lose response over time are not entirely consistent, but tend to show a pattern of improvement after a dose increase. CONCLUSION: Dose optimization involves a balance of risks and benefits, and future research should seek to clarify which patients are most likely to benefit from dose optimization without undue increase in risk.
25270915 Further international adaptation and validation of the Rheumatoid Arthritis Quality of Lif 2015 Apr The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire was developed directly from rheumatoid arthritis (RA) patients in the United Kingdom and the Netherlands to measure quality of life (QoL). Since then, it has become widely used in clinical studies and trials and has been adapted for use in 24 languages. The objective was to develop and validate 11 additional language versions of the RAQoL in US English, Mexican Spanish, Argentinean Spanish, Belgian French, Belgian Flemish, French, Romanian, Czech, Slovakian, Polish and Russian. The language adaptation and validation required three stages: translation, cognitive debriefing interviews and validation survey. The translation process involved a dual-panel methodology (bilingual panel followed by a lay panel). The validation survey tested the psychometric properties of the new scales and included either the Nottingham Health Profile (NHP) or the Health Assessment Questionnaire (HAQ) as comparators. Internal consistency of the new language versions ranged from 0.90 to 0.97 and test-retest reliability from 0.85 to 0.99. RAQoL scores correlated as expected with the HAQ. Correlations with NHP sections were as expected: highest with energy level, pain and physical mobility and lowest with emotional reactions, sleep disturbance, and social isolation. The adaptations exhibited construct validity in their ability to distinguish subgroups of RA patients varying by perceived disease severity and general health. The new language versions of the RAQoL meet the high psychometric standards of the original UK English version. The new adaptations represent valid and reliable tools for measuring QoL in international clinical trials involving RA patients.
24991562 Treatment of rheumatoid arthritis with traditional chinese medicine. 2014 Rheumatoid arthritis (RA) is a chronic inflammatory disease that will affect quality of life and, working efficiency, and produce negative thoughts for patients. Current therapy of RA is treated with disease-modifying antirheumatic drugs (DMARDs). Although most of these treatment methods are effective, most patients still have a pleasant experience either due to poor efficacy or side effects or both. Interleukin-6 receptor (IL6R) is important in the pathogenesis of RA. In this study, we would like to detect the potential candidates which inhibit IL6R against RA from traditional Chinese medicine (TCM). We use TCM compounds from the TCM Database@Taiwan for virtually screening the potential IL6R inhibitors. The TCM candidate compound, calycosin, has potent binding affinity with IL6R protein. The molecular dynamics simulation was employed to validate the stability of interaction in the protein complex with calycosin. The analysis indicates that protein complex with calycosin is more stable. In addition, calycosin is known to be one of the components of Angelica sinensis, which has been indicated to have an important role in the treatment of rheumatoid arthritis. Therefore, calycosin is a potential candidate as lead compounds for further study in drug development process with IL6R protein against rheumatoid arthritis.
25365087 14-3-3η: a novel biomarker platform for rheumatoid arthritis. 2014 Sep 14-3-3 proteins are a conserved family of 7 isoforms with diverse cellular functions found predominantly intracellularly. The 14-3-3η isoform is expressed extracellularly in the joints of patients with rheumatoid arthritis (RA) and expression in both serum and joint fluid correlates strongly with expression of metalloproteinases. 14-3-3η activates proinflammatory signalling cascades and inflammatory mediators relevant to the pathogenesis of RA. A new ELISA based assay has diagnostic utility for RA with sensitivity of 63.6% and specificity of 92.6% using the optimal cut-off from ROC analysis of 0.19ng/ml. Adding 14-3-3η to anti-cyclic citrullinated peptide antibodies (ACPA) resulted in an identification rate of 72% compared to 59% for ACPA alone. Adding rheumatoid factor (RF) to ACPA increased diagnostic capture from 59% to 72% and this increased further to 78% when 14-3-3η was added. Positive 14-3-3η status is also significantly associated with radiographic progression in early RA at years 1, 3 and 5 indicating prognostic utility. Extracellular 14-3-3η elicits the production of autoantibodies to the native protein, which also possess diagnostic utility. These do not correlate with expression of the protein and have complementary diagnostic utility. The presence of either the protein or its autoantibodies is observed in 90% of patients with early RA. Together with RF and/or ACPA this may result in identification of 95% of patients with early RA.
22899659 Relationship between perceived cognitive dysfunction and objective neuropsychological perf 2013 Mar OBJECTIVE: Research shows a gap between perceived cognitive dysfunction and objective neuropsychological performance in persons with chronic diseases. We explored this relationship in persons with rheumatoid arthritis (RA). METHODS: Individuals from a longitudinal cohort study of RA participated in a study visit that included physical, psychosocial, cognitive, and biologic metrics. Subjective cognitive dysfunction was assessed using the Perceived Deficits Questionnaire (PDQ; range 0-20, where higher scores = greater perceived impairment). Objective cognitive impairment was assessed using a battery of 12 standardized neuropsychological measures yielding 16 indices. On each test, subjects were classified as impaired if they performed 1 SD below the age-based population norms. Total cognitive function scores were calculated by summing the transformed scores (range 0-16, where higher scores = greater impairment). Multiple linear regression analyses determined the relationship of the total cognitive function score with the PDQ score, controlling for sex, race, marital status, income, education, disease duration, disease severity, depression, and fatigue. RESULTS: One hundred twenty subjects (mean ± SD age 58.5 ± 11.0 years) were included. Mean ± SD scores of total cognitive function and the PDQ were 2.5 ± 2.2 (range 0-10) and 5.8 ± 3.8 (range 0-16), respectively. In multivariate analysis, there was no significant relationship between the total cognitive function score and the PDQ score. However, depression and fatigue (β = 0.32, P < 0.001 and β = 0.31, P = 0.001, respectively) were significantly associated with the PDQ score. CONCLUSION: The findings emphasize the gap between subjective and objective measures of cognitive impairment and the importance of considering psychological factors within the context of cognitive symptoms in clinical settings.
23890495 Clinical and radiological results of radiolunate arthrodesis for rheumatoid arthritis: 22 2013 Aug PURPOSE: To evaluate the clinical and radiological results of radiolunate (RL) arthrodesis for rheumatoid arthritis (RA) patients treated with disease-modifying antirheumatic drugs and/or biologicals with an average of 7 years of follow-up. In addition, we compared the results in advanced stages with those in less advanced stages in patients with comparatively low disease activity of RA. METHODS: This study included RL arthrodesis for 22 wrists in 19 patients with comparatively low disease activity of RA. The mean follow-up period was 7 years (range, 2-16 y). Fourteen wrists with Larsen classification grade III and 8 wrists with grade IV were included in this study. The range of motion was calculated, and clinical scores were graded using the Mayo wrist score and the Stanley classification. The carpal height ratio (CHR) and ulnar translation (UT) were determined from the radiographs. RESULTS: All wrists achieved radiographic fusion. Clinical scores were markedly improved, although there was a decrease in flexion. The Larsen grade did not deteriorate during follow-up. CHR and UT improved immediately after operation and remained good through the final follow-up. Although the flexion/extension range of motion of the grade IV wrists was smaller than that of the grade III wrists at follow-up, both groups obtained good clinical results. CONCLUSIONS: Our results for RL arthrodesis were clinically and radiologically better than those of previous reports. Control of the disease activity of RA could theoretically be a factor in obtaining good long-term clinical and radiographic outcomes. RL arthrodesis is our recommended procedure for the RA wrist even in the advanced stage. LEVEL OF EVIDENCE: Therapeutic IV.
25060487 The good EULAR response at the first year is strongly predictive of clinical remission in 2015 Jan The purpose of this study was to identify the prevalence and prognostic factors of clinical remission in patients with rheumatoid arthritis (RA). The Thai Army Rheumatoid Arthritis Cohort (TARAC) patients were included if baseline data were available. Clinical remission was defined as 28-joint count disease activity scores (DAS28) <2.6 in the last two consecutive visits, at least 3 months apart. Three hundred and thirty-five patients were enrolled, and 89.9 % were female. Mean (SD) age was 61 years (11.4), and mean disease duration was 145.9 months (93.7). Rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) were positive in 69.9 and 67.8 %, respectively. Eighty-nine percent of patients were treated with synthetic DMARDs, of which 29 % received monotherapy. The combination of biologic and synthetic DMARDs was used in 10.4 % of the patients. Clinical remission was observed in 49 patients (14.6 %). Early diagnosis and treatment within 12 months of onset (odds ratio (OR) 1.95, 95 % confidence interval (CI) 1.02-3.74, p = 0.04), rheumatoid factor negativity (OR 2.10, 95 % CI 1.04-4.21, p = 0.04) and good EULAR response at the end of the first year of treatment (OR 2.75, 95 % CI 1.08-6.99, p = 0.03) were associated with clinical remission in univariate analysis. In multivariate regression analysis, only a good EULAR response at the first year was significantly correlated with clinical remission in this study (OR 3.1, 95 % CI 1.15-8.36, p = 0.03). Although remission is currently a treatment goal in patients with RA, only one-seventh of patients have achieved sustained clinical remission in clinical practice. The good EULAR response at the end of the first year was an independent predictive factor of clinical remission.
23053684 The effect of the Arthritis Self-Management Program on outcome in African Americans with r 2013 Jan The purpose of the study was to determine the effect of the Arthritis Self-Management Program (ASMP) on a cohort of patients, primarily African American (90 %), with rheumatoid arthritis (RA) served by a public hospital. One hundred four patients were randomly assigned to the ASMP group or the usual care group and followed for 18 months. The primary endpoint was clinical improvement indicated by the American College of Rheumatology (ACR20). Focus groups were conducted to provide contextual data. The percentages of patients achieving ACR20 were similar in the ASMP (14 % at 18 months) and usual care (17 %) groups (p = 0.3). However, 28 % of the 25 ASMP patients that attended four or more classes achieved ACR 20 after 18 months of follow-up, but only 5 % of the 27 ASMP patients that attended less than four classes achieved ACR20 (P = 0.1). There was a reduction in the tender and swollen joints in both groups over time (P = 0.02), and those aged 60 and over had fewer joints involved. Half of the cohort fell at or below the poverty level. The percentages of patients achieving ACR20 were similar in the ASMP and usual care groups. Patients who attended four or more ASMP classes improved the most, but included only half of those assigned to ASMP. This suggests a need for innovative participant retention strategies or a different type of self-management program for this population.
23481417 Do biologic drugs affect the need for and outcome of joint replacements in patients with r 2013 Aug OBJECTIVES: The aim was to study the incidence of joint replacements among biologic drug and disease-modifying anti-rheumatic drug (DMARD) users as well as to investigate the plausible effect of biologic treatment on survival of prostheses in patients with Rheumatoid arthritis (RA). METHODS: The study population comprised 2 cohorts of patients [Register of biologic treatment in Finland (ROB-FIN) and the Central Finland RA database] from 1999 to 2010. Records of joint replacements performed in the study population between 1980 and 2010 were retrieved from the Finnish Arthroplasty Register. Propensity score matching was used to equalize patient characteristics between biologics and DMARD users. The incidence rates of primary and revision operations were compared between the 2 treatment groups. Kaplan-Meier survival analysis was used to analyze prosthesis survival. RESULTS: Of the 2102 biologics and 2710 DMARD users identified from the registries, 1587 were included in both groups after the matching. Median follow-up times were 3.1 and 8.0 years, respectively. There were more primary operations per 100 patient years in the biologics (3.89, CI 95% 3.41-4.41) vs. DMARD (2.63, 2.35-2.94) group but slightly fewer revisions (0.65, 0.46-0.88 vs. 0.83, 0.68-1.01). Biologics users were more likely to receive a joint replacement to small joints (p < 0.001). The survival of the prostheses installed during or prior to follow-up was similar in both treatment groups. CONCLUSIONS: The use of biologic drugs did not reduce the need for joint replacement surgery in patients with a similar on-medication disease activity. Despite possibly lower rate of revisions among biologic users, the durability of prostheses was not improved.
24260991 Nurse management of cardiovascular risk factors in rheumatoid arthritis. 2013 Jul 25 Rheumatoid arthritis (RA) is a chronic, multi-system inflammatory disease. The incidence and prevalence of RA varies considerably between geographic areas and over time; the prevalence of RA in adults aged > 20 years in Spain is around 0.5% (Carmona et al, 2002). People with RA also have extra-articular manifestations, presenting an increased cardiovascular morbidity and mortality risk; therefore, cardiovascular risk screening and management strategies are necessary in individuals with RA. The importance of interventions in the management of people with RA and cardiovascular risk factors is recognised by the European League Against Rheumatism (EULAR) recommendations (Peters et al, 2010). Rheumatology specialist nurses are well placed to include routine cardiovascular risk assessment for people with RA attending clinic, and to provide educational interventions to reduce cardiovascular risk, such as smoking cessation, weight loss, eating a balanced, low-fat diet and exercising regularly.
24825074 Circulating plasma levels of cathepsin S and L are not associated with disease severity in 2014 BACKGROUND: Rheumatoid arthritis (RA) is characterized by chronic synovitis and articular cartilage destruction. Increased activities of cathepsin S and cathepsin L, two potent cysteine proteases, are thought to play a role in the pathogenesis of the irreversible articular cartilage destruction. Nevertheless, data regarding the potential importance of the cathepsins as circulating biomarkers in RA patients are limited. METHOD: Subjects enrolled in this study are part of a larger study where patients from the three northern counties of Sweden diagnosed with early RA are followed in an ongoing prospective study. In total, 71 patients were included, along with 44 age- and sex-matched control subjects. Plasma levels of cathepsin S and L were analysed. Disease severity was assessed using the 28-joint count Disease Activity Score (DAS28). RESULTS: Plasma levels of cathepsin S and L were significantly increased in patients with RA compared to healthy controls (p < 0.05 for both). However, in the patients with RA, no association between the cathepsins and the severity of the disease, as characterized by DAS28, was observed (p > 0.51). CONCLUSIONS: Although circulating levels of cathepsin S and L were significantly increased in patients with recently diagnosed RA, our data do not support the notion that circulating levels of cathepsins are relevant biomarkers for disease severity.
23681393 Introduction to statistical modelling 2: categorical variables and interactions in linear 2015 Jul In the first article in this series we explored the use of linear regression to predict an outcome variable from a number of predictive factors. It assumed that the predictive factors were measured on an interval scale. However, this article shows how categorical variables can also be included in a linear regression model, enabling predictions to be made separately for different groups and allowing for testing the hypothesis that the outcome differs between groups. The use of interaction terms to measure whether the effect of a particular predictor variable differs between groups is also explained. An alternative approach to testing the difference between groups of the effect of a given predictor, which consists of measuring the effect in each group separately and seeing whether the statistical significance differs between the groups, is shown to be misleading.
24645724 Subclinical atherosclerosis among rheumatoid arthritis patients without overt cardiovascul 2014 Nov OBJECTIVE: To determine the associated factors of subclinical atherosclerosis measured with carotid intima media thickness (CIMT) among rheumatoid arthritis (RA) patients without any overt traditional cardiovascular (CV) risk factors. METHODS: Forty RA patients with matched age and gender healthy controls were recruited. Carotid ultrasound was performed to all subjects. CIMT was considered to be abnormally thickened if it was more than the 75th percentile matched for age and sex reference values. Univariate and multivariate analyses were performed to determine the association between the sociodemographics and disease characteristics of RA with thickened CIMT. RESULTS: Abnormally thickened CIMT were observed in 11 RA patients (27.5%) and in 4 control subjects (10%), p = 0.04. It was highly prevalent among RA patients with active disease (54.5% vs 17.2%), p = 0.02. Patients with thickened CIMT also tend to have erosive disease, p = 0.06. Seropositive rheumatoid factor (RF) patients also had significantly higher CIMT values as compared with sero-negative patients, p = 0.03. Multivariable logistic regression analysis revealed that active disease was independently associated with thickened CIMT. CONCLUSIONS: RA patients are at risk for subclinical atherosclerosis despite absence of traditional CV risk co morbidities and active disease was the independent factor associated with it.
24913966 Rheumatoid arthritis-associated interstitial lung disease: lung inflammation evaluated wit 2015 Jan OBJECTIVE: To describe the association between rheumatoid arthritis disease activity (RA) and interstitial lung damage (inflammation and fibrosis), in a group of patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). METHODS: A retrospective study of RA patients with interstitial lung disease (restrictive pattern in lung function tests and evidence of interstitial lung disease in high resolution computed tomography (HRCT)). Patients were evaluated to exclude other causes of pulmonary disease. RA disease activity was measured with the CDAI index. Interstitial lung inflammation and fibrosis were determined by Kazerooni scale. We compared Kazerooni ground-glass score with the nearest CDAI score to HRCT date scan of the first medical evaluation at our institution. In nine patients, we compared the first ground-glass score with a second one after treatment with DMARDs and corticosteroids. Spearman's rank correlation coefficient was used to evaluate association between RA disease activity and the Kazerooni ground-glass and fibrosis scores. RESULTS: Thirty-four patients were included. A positive correlation between CDAI and ground-glass scores was found (rs=0.3767, P<0.028). Fibrosis and CDAI scores were not associated (rs=-0.0747, P<0.6745). After treatment, a downward tendency in the ground-glass score was observed (median [IQR]): (2.33 [2,3] vs. 2 [1.33-2.16]), P<0.056, along with a lesser CDAI score (27 [8-43] vs. 9 [5-12]), P<0.063. CONCLUSION: There is a correlation between RA disease activity and ground-glass appearance in the HRCT of RA-ILD patients. These results suggest a positive association between RA disease activity and lung inflammation in RA-ILD.
25224416 Psychological distress over time in early rheumatoid arthritis: results from a longitudina 2015 Mar OBJECTIVE: RA is a chronic disease with frequent psychological co-morbidities, of which depression and anxiety are two common manifestations. We aimed to identify predictive factors of psychological distress in a large prospective cohort of very early RA patients. METHODS: ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) is a multicentre, longitudinal and prospective cohort study of patients with early arthritis (<6 months disease duration). The study sample comprised 641 patients with very early RA according to the 2010 ACR/European League Against Rheumatism RA criteria from the ESPOIR cohort. Psychological distress was assessed over 3 years by the five-item Mental Health Inventory questionnaire at various time points (baseline, 6, 12, 18, 24 and 36 months). Logistic regression with a generalized estimating equation model was used to analyse the association of disease variables and risk of psychological distress. RESULTS: At baseline, 46.9% of RA patients were screened as positive for psychological distress. Over 3 years, psychological distress decreased significantly, with a prevalence of 25.8% at 36 months. The HAQ Disability Index (HAQ-DI) score was the most important factor predicting psychological distress over 3 years [odds ratio 2.10 (95% CI 1.41, 3.14)-3.59 (2.29, 5.63)]. Baseline biological and radiological variables and treatment regimens were not associated with distress. CONCLUSION: Psychological distress in very early RA is frequent and the HAQ-DI score is a predictor of depression and anxiety in these patients. A psychological evaluation in patients with early RA is important for further individual psychiatric diagnosis and management.
24106167 Radiologic patterning of joint damage to the foot in rheumatoid arthritis. 2014 Apr OBJECTIVE: Foot and ankle deformities greatly affect the quality of life of rheumatoid arthritis (RA) patients. The aim of this study was to elucidate the pattern of destruction of the RA foot and its impact on patients. METHODS: We cross-sectionally investigated RA patients (274 patients and 542 feet) using radiographs. The grade of joint destruction was assigned using Larsen's grading system for 12 joints in the foot and ankle. Cluster analysis was performed using the K-means method to classify the pattern of joint destruction. Of the 274 patients evaluated radiographically, 212 were assessed for functional disability using questionnaires. RESULTS: Cluster analysis revealed that 542 feet were divided into 5 clusters, named according to the characteristic distribution of joint destruction: cluster I (normal type), cluster II (forefoot type), cluster III (midfoot type), cluster IV (mid-hindfoot type), and cluster V (combined type). Radiographic measurements revealed the characteristic deformities of each cluster: splay foot for cluster II, flat foot for cluster III, hindfoot malalignment for cluster IV, and mixtures of these characteristics for cluster V. A distribution map of each cluster based on disease duration revealed that cluster III peaked in cases of 5-10-year disease duration and subsequently decreased, followed by a gradual increase of cluster IV and cluster V. Cluster IV and cluster V showed significant changes in functional disability compared to cluster III. CONCLUSION: This report is the first to reveal the pattern of RA foot deformities and their impact on patients using statistical measures in a large series.
24097135 Kinematic, kinetic and electromyographic response to customized foot orthoses in patients 2014 Jan OBJECTIVE: To describe the effect of customized foot orthoses (FOs) on the kinematic, kinetic and EMG features in patients with RA, tibialis posterior (TP) tenosynovitis and associated pes plano valgus. METHODS: Patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including three-dimensional (3D) kinematics, kinetics, intramuscular EMG of TP and surface EMG of tibialis anterior, peroneus longus, soleus and medial gastrocnemius. Findings were compared between barefoot and shod with customized FO conditions. RESULTS: Ten patients with RA with a median (range) disease duration of 3 (1-18) years were recruited. Moderate levels of foot pain and foot-related impairment and disability were present with moderately active disease states. Altered timing of the soleus (P = 0.05) and medial gastrocnemius (P = 0.02) and increased magnitude of tibialis anterior (P = 0.03) were noted when barefoot was compared with shod with FO. Trends were noted for reduced TP activity in the contact period (P = 0.09), but this did not achieve statistical significance. Differences in foot motion characteristics were recorded for peak rearfoot eversion (P = 0.01), peak rearfoot plantarflexion (P < 0.001) and peak forefoot abduction (P = 0.02) in the shod with FOs compared with barefoot conditions. No differences in kinetic variables were recorded. CONCLUSION: This study has demonstrated, for the first time, alterations in muscle activation profiles and foot motion characteristics in patients with RA, pes plano valgus and US-confirmed TP tenosynovitis in response to customized FOs. Complex adaptations were evident in this cohort and further work is required to determine whether these functional alterations lead to improvements in patient symptoms.