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ID PMID Title PublicationDate abstract
25315703 Barriers to achieving controlled rheumatoid arthritis in the United Arab Emirates: a cross 2015 Apr To better understand the factors that affect low disease activity (DAS28 ≤ 3.2, LDA) in rheumatoid arthritis (RA) and barriers within the UAE, demographic/treatment data and DAS28 scores were collected through chart reviews of 182 consecutive RA patients seen at a private clinic in Dubai over a 2-month period. Patients were separated into a LDA group and a group comprised of moderate (3.2 < DAS28 < 5.1) or high disease activity (DAS28 ≥ 5.1) (MHDA). We then examined variables that may be associated with LDA and re-examined the MHDA group for barriers. While 97 (53 %) of the 182 patients had achieved the treatment target of DAS28 ≤ 3.2, 85 (47 %) had MHDA. A significantly larger portion of LDA patients had been previously treated with sulfasalazine (36 in LDA vs. 14 in MHDA, P = 0.002) or was presently on biological treatments (24 vs. 9, P = 0.013). For the 85 MHDA patients, 40 (22 % of 182) exhibited resistant disease with 25 (13.7 % of 182) failing their current first tier disease-modifying anti-rheumatic drug (DMARD) treatment or combinations and 15 (8.2 % of 182) failing current anti-TNF or biologic treatment. Reasons listed were primarily socioeconomic with 40 % of the resistant disease group unable to afford biologicals and 52 % of the patient-driven preference group discontinuing DMARDs against professional advice. Going forward, emphasis on the agreement between patient and rheumatologist on treatment, specifically regarding how DMARDs help relieve symptoms and their proper use, could help reduce the percentage of MHDA patients in the UAE.
22872428 Detection of gene expression signatures related to underlying disease and treatment in rhe 2013 Jul OBJECTIVES: Gene expression signatures can provide an unbiased view into the molecular changes underlying biologically and medically interesting phenotypes. We therefore initiated this study to identify signatures that would be of utility in studying rheumatoid arthritis (RA). METHODS: We used microarray profiling of peripheral blood mononuclear cells (PBMCs) in 30 RA patients to assess the effect of different biologic agent (biologics) treatments and to quantify the degree of a type-I interferon (IFN) signature in these patients. A numeric score was derived for the quantification step and applied to patients with RA. To further characterize the IFN response in our cohort, we employed type-I IFN treatment of PBMCs in vitro and in reporter assays. RESULTS: Profiling identified a subset of RA patients with upregulation of type-I IFN-regulated transcripts, thereby corroborating previous reports showing RA to be heterogeneous for an IFN component. A comparison of individuals currently untreated with a biologic with those treated with infliximab, tocilizumab, or abatacept suggested that each biologic induces a specific gene signature in PBMCs. CONCLUSIONS: It is possible to observe signs of type-I IFN pathway activation in a subset of clinically active RA patients without C-reactive protein elevation. Furthermore, biologics-specific gene signatures in patients with RA indicate that looking for a biologic-specific response pattern may be a potential future tool for predicting individual patient response.
24686733 Higher prevalence of autoimmune diseases and longer spells of vertigo in patients affected 2014 Jun PURPOSE This study compared clinical features, predisposing factors, and concomitant diseases between sporadic and familial Ménière's disease (MD). METHOD Retrospective chart review and postal questionnaire were used. Participants were 250 definite patients with MD (sporadic, n =149; familial, n = 101) who fulfilled the American Academy of Otorhinolaryngology-Head and Neck Surgery (1995) criteria. RESULTS On average, familial patients were affected 5.6 years earlier than sporadic patients, and they suffered from significantly longer spells of vertigo (p = .007). The prevalence of rheumatoid arthritis (p = .002) and other autoimmune diseases (p = .046) was higher among the familial patients, who also had more migraine (p = .036) and hearing impairment (p = .002) in their families. CONCLUSION The clinical features of familial and sporadic MD are very similar in general, but some differences do exist. Familial MD patients are affected earlier and suffer from longer spells of vertigo.
23427807 The role of the circadian clock in rheumatoid arthritis. 2013 Feb 21 Rheumatoid arthritis exhibits diurnal variation in symptoms, with patients suffering with increased painful joint stiffness in the early morning. This correlates with an early morning rise in circulating levels of pro-inflammatory cytokines, such as interleukin-6. This temporal variation in disease pathology is directed by the circadian clock, both at a systemic level, through signalling pathways derived in the central clock, and at a local level by autonomous clocks found within inflammatory organs and cells. Indeed, many cellular components of the immune system, which are involved in the pathogenesis of rheumatoid arthritis, possess independent clocks that facilitate temporal gating of their functions. Furthermore, the circadian clock regulates the expression and activity of several genes and proteins that have demonstrated roles in progression of this autoimmune disease. These include a number of nuclear receptors and also fat-derived adipokines. Employing the knowledge we have about how the inflammatory response is regulated by the clock will facilitate the development of chronotherapy regimens to improve the efficacy of current treatment strategies. Furthermore, a full understanding of the mechanisms by which the clock couples to the immune system may provide novel therapeutic targets for the treatment of this debilitating disease.
24066004 Decreased PERP expression on peripheral blood mononuclear cells from patient with rheumato 2013 BACKGROUND: PERP, p53 apoptosis effector related to PMP-22, is a p53-dependent apoptosis in diverse cell types and has cell type-specific roles in p53-mediated apoptosis. However, its role in PBMCs of RA patients has remained largely unclear. OBJECTIVES: The aim of this study was to detect the expression levels of PERP on PBMCs of RA patients and healthy controls and analyze the role of PERP in the pathogenesis of RA. Methods. The mRNA expression levels of PERP and IL-17 were detected by real-time PCR in PBMCs from patients with RA (n = 40) and healthy controls (n = 40). The correlations of PERP expression levels to IL-17 transcripts and disease activity parameters were analyzed. RESULTS: The PERP and IL-17 expression levels in the PBMCs were significantly decreased and increased in comparison of which in healthy controls. The mRNA expression levels of PERP in PBMCs from patients with RA were negatively correlated with IL-17 and disease activity parameters DAS28, RF, CRP, and ESR rather than Anti-CCP and ANA. CONCLUSIONS: These results demonstrated that PERP might be involved in the pathogenesis and a potential therapeutic target of RA by regulating the expression of IL-17.
23370377 Lessons to be learned from periodontitis. 2013 Mar PURPOSE OF REVIEW: This article reviews the link between periodontitis and rheumatoid arthritis (RA) with regard to similarities in genetic risk factors and immunopathogenesis. Emphasis is paid to the potential role of the periodontal pathogen Porphyromonas gingivalis in the etiopathogenesis of both periodontitis and RA, in particular by post-translational modification of arginine into citrulline. RECENT FINDINGS: P. gingivalis, a major periodontal pathogen, is presently known as the only bacterium in the oral flora which contains a peptidyl arginine deiminase enzyme (PAD). This enzyme is necessary for citrullination. As a result, citrullinated proteins and P. gingivalis PAD, PAD2 and PAD4 (expressed by infiltrating neutrophils) are found in periodontal tissues. Autoantibodies directed to citrullinated proteins, so-called anticitrullinated protein antibodies (ACPAs), are found to be present in gingival crevicular fluid originating from inflamed gingival tissue. Furthermore, treatment studies have revealed that nonsurgical periodontal treatment, that is removal of sub-gingival calculus and biofilm deposits, is accompanied by a reduction in the severity of RA. SUMMARY: In this study the similarities in immune response and tissue degradation between RA and periodontitis are reviewed. It is shown that the two diseases share the same environmental and genetic risk factors, apart from the fact that there is a link between both diseases via citrullination of proteins by human PAD and P. gingivalis PAD.
24610538 Prevalence and incidence of rheumatoid arthritis in Italy. 2014 May Aim of the study was to estimate the prevalence and incidence of rheumatoid arthritis (RA) from an administrative cohort consisting of 2,268,514 males and 2,446,769 females, aged ≥ 18 years, from 32 Italian Health Districts. The diagnosis of RA was certified by a qualified specialist and confirmed by ≥3 prescriptions of "specific drugs" (corticosteroids, DMARDs or "biological" agents) during 2011. Patients on "specific drugs" qualified as "active RA"; those who never had more than 4 prescriptions in the past were classified as "unlikely RA," and those previously on chronic treatment but who discontinued therapy for >1 year were classified as "remission RA." The patients with a diagnosis of RA were 22,801 (0.48 %) with a prevalence of "active RA," "remission RA" and "confirmed RA" (Active + Remission RA) of 0.32, 0.09 and 0.41 % (95 % CI 0.38-0.44), respectively. The classification criteria tested in a fifth of the study population by direct analysis yielded >90 % accuracy and precision. The yearly incidence of "active RA" per 100,000 subjects was 48 (95 % CI 40-57) and 20 (95 % CI 10-30) for women and men, respectively. The peak for both prevalence and incidence was around the eighth decade of life. The female/male ratios for both prevalence and incidence were ca. 2.6 before the fifth decade of life, but approached unity in the ninth decade of life. The overall prevalence and incidence of RA in a large sample of the Italian population is only marginally lower than that reported from a similar administrative database of Sweden. With advancing age, the female/male ratio declines to about one.
24247116 When and where does inflammation begin in rheumatoid arthritis? 2014 Jan PURPOSE OF REVIEW: The cause of rheumatoid arthritis (RA), as well as the timing and anatomic site at which RA-related autoimmunity is initiated, is currently unknown. An improved understanding of the initial steps in the development of RA would provide insights into disease pathogenesis that could ultimately lead to more effective treatments and/or novel preventive strategies in RA. RECENT FINDINGS: Systemic inflammation and autoimmunity in RA begin long before the onset of detectable joint inflammation. Emerging data suggest that RA-related autoimmunity may be initiated at a mucosal site years before the onset of joint symptoms. The candidate sites of origin include the oral, lung and gastrointestinal mucosa, as data consistent with this hypothesis have been generated for each location. Individual patients may undergo initiation events at unique sites, but still converge on similar joint findings as the disease process evolves. SUMMARY: Investigations are needed to determine when and where RA begins, including comprehensive prospective studies of individuals in the preclinical period of RA that can provide insight into the relationship between mucosal inflammation, RA-related autoantibody generation and subsequent joint inflammation in RA.
24852650 The risk of serious infection in patients with rheumatoid arthritis treated with tumor nec 2014 Dec To investigate changes in the risk for serious infections (SIs) over time in Japanese rheumatoid arthritis (RA) patients treated with tumor necrosis factor inhibitors (TNFIs). This prospective cohort study included Japanese RA patients who began treatment with a TNFI from 2005 to 2007 (2005 group, n = 716, 634.2 patient years [PY]) and from 2008 to 2011 (2008 group, n = 352, 270.1 PY) at the time or after their enrollment in the registry of Japanese RA patients on biologics for long-term safety (REAL) database. Patients were observed for 12 months or until discontinuation of their initial TNFI in the REAL database. Drug discontinuation reasons and retention rates were analyzed. Incidence rates of serious adverse events (SAEs) were calculated with 95 % confidence intervals (CIs). The Cox proportional hazard model was applied to estimate the risk for SIs. The retention rate in the 2008 group was significantly lower than the 2005 group (p < 0.001). Discontinuation rates due to lack of efficacy or good control for the 2008 group were significantly higher than the 2005 group (p < 0.001). The crude incidence rate ratios comparing the 2008 group with the 2005 group for SAEs were 0.93 (95 % CI 0.65-1.34) and for SIs were 0.50 (0.24-1.03). The 2008 group had significantly lower risk for SIs than the 2005 group after adjusting for covariates (hazard ratio: 0.43 [0.20-0.93]). These results indicate significant decrease of the risk for SIs with TNFI treatment over time; this may be explained by evidence-based risk management of RA patients given TNFIs.
22228465 Association between chronic periodontitis and rheumatoid arthritis: a hospital-based case- 2013 Jan Rheumatoid arthritis (RA) and chronic periodontitis are the most common chronic inflammatory diseases with remarkable pathological and clinical similarities. A lot of similarities exist between RA and periodontitis at cellular and molecular levels. The relationship between these two chronic inflammatory diseases is still unclear. This case-control study was undertaken to determine the possible association between chronic inflammatory diseases like RA and periodontitis. The case group consisted of 100 patients attending the Rheumatology clinic who have rheumatoid arthritis (RA group). Age- and gender-matched 112 patients without RA attending the Outpatient wing of Department of General Medicine formed the control group (NRA group). The number of missing teeth, gingival index (GI), oral hygiene index-simplified (OHI-S), probing pocket depth (PPD) and clinical attachment levels (CAL) were evaluated in both the groups. Rheumatoid disease activity was assessed by DAS-28 score system. Systemic markers of inflammation like erythrocytic sedimentation rate (ESR) and serum levels of C-reactive protein (CRP) were assessed. There was a statistically significant difference in GI, OHI-S, PPD, CAL, ESR and CRP levels between cases (RA group) and controls (NRA group) (P < 0.05). Among subjects with RA, there was no association between the rheumatoid disease activity and the severity of periodontal disease. The occurrence and severity of periodontitis was found to be higher in RA subjects as compared to subjects without RA, suggesting a positive relation between these two chronic inflammatory diseases.
23601344 Lack of association of IL-6 polymorphism with rheumatoid arthritis/type 1 diabetes: a meta 2013 Oct OBJECTIVE: The aim of this study was to determine whether the interleukin (IL)-6 -174 single nucleotide polymorphism confers susceptibility to rheumatoid arthritis (RA) and type 1 diabetes (T1D) in multiple ethnic populations. METHODS: A meta-analysis was conducted on the association between the IL-6 -174 polymorphism and RA/T1D susceptibility, using fixed and random effects models. RESULTS: Thirteen studies were included in the meta-analysis: RA: seven studies, including six European and one Asian population; T1D: six studies, including five European and one South American population. There was no significant association both in allele and genotype comparisons between the IL-6 -174 polymorphism and RA/T1D in all study subjects. Moreover, meta-analysis stratified by ethnicity indicated no significant association between the gene and RA/T1D. CONCLUSIONS: This meta-analysis suggests that the IL-6 -174 polymorphism might not confer susceptibility to RA/T1D.
23478596 Impact of fatigue on psychological outcomes in adults living with rheumatoid arthritis. 2013 May BACKGROUND: Fatigue has been shown to be a prevalent symptom in patients with rheumatoid arthritis, having a negative impact on health-related quality of life. However, aside from depression, related fatigue has not been linked to specific psychological outcomes and is not a common target in treatment programs. OBJECTIVES: The aim of the study was to examine the unique influence of rheumatoid arthritis-related fatigue on three psychological outcomes: depressive symptoms, perceived health impairment, and satisfaction with abilities. METHODS: In a large (n = 200) convenience sample of older adults who provided informed consent, multiple regression analyses were conducted to determine the direct and unique impact of demographic variables, functional impairment, pain, and fatigue on each of three psychological outcomes: depressive symptoms, perceived health impairment, and satisfaction with ability. RESULTS: Fatigue significantly and uniquely contributed to each of the psychological outcomes, above and beyond pain and functional impairment. The variances of depressive symptoms, perceived health impairment, and satisfaction with ability accounted for by fatigue were highly significant. DISCUSSION: The study indicates that rheumatoid arthritis-related fatigue contributes to diminished psychological well-being in older adults aging with rheumatoid arthritis and suggests the need for psychoeducational and management strategies that specifically target fatigue as part of an overall rheumatoid arthritis management program. Future research should attempt to obtain a larger sample of male and younger patients to determine if there are significant gender and age differences in the impact of fatigue on psychological outcomes.
25529905 Disability intervention model for older adults with arthritis: an integration of theory of 2014 Dec To evolve a management plan for rheumatoid arthritis, it is necessary to understand the patient's symptom experience and disablement process. This paper aims to introduce and critique two models as a conceptual foundation from which to construct a new model for arthritis care. A Disability Intervention Model for Older Adults with Arthritis includes three interrelated concepts of symptom experience, symptom management strategies, and symptom outcomes that correspond to the Theory of Symptom Management. These main concepts influence or are influenced by contextual factors that are situated within the domains of person, environment, and health/illness. It accepts the bidirectional, complex, dynamic interactions among all components within the model representing the comprehensive aspects of the disablement process and its interventions in older adults with rheumatoid arthritis. In spite of some limitations such as confusion or complexity within the model, the Disability Intervention Model for Older Adults with Arthritis has strengths in that it encompasses the majority of the concepts of the two models, attempts to compensate for the limitations of the two models, and aims to understand the impact of rheumatoid arthritis on a patient's physical, cognitive, and emotional health status, socioeconomic status, and well-being. Therefore, it can be utilized as a guiding theoretical framework for arthritis care and research to improve the functional status of older adults with rheumatoid arthritis.
23596784 [Effects of leflunomide in treating patients with rheumatoid arthritis of different Chines 2013 Jan OBJECTIVE: To study whether the effects of Leflunomide were different in treating patients with rheumatoid arthritis (RA) of different Chinese medical syndrome patterns. METHODS: Totally 150 RA patients were recruited and assigned to 5 Chinese medical syndrome types, i.e., the heat-dampness blocking collateral type, cold-dampness blocking collateral type, Shen-qi deficiency cold type, Gan-Shen yin deficiency type, and stagnant blood blocking collateral type according to Chinese medical syndrome typing standards. They were treated with Leflunomide, 3 months as one therapeutic course. The parameters including numbers of joint tenderness and swelling, morning stiffness time, scores estimated by Visual Analog Scale (VAS), as well as laboratory indices involving rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American College of Rheumatology 20% improvement (ACR20), and American College of Rheumatology 50% improvement (ACR50) were observed before and after treatment, and statistically analyzed. RESULTS: After treatment the numbers of joint tenderness, numbers of joint swelling, VAS scores, ESR, CRP, and RF all decreased, showing statistical difference when compared with those before treatment (P < 0.05). The morning stiffness time was shortened in the heat-dampness blocking collateral type, cold-dampness blocking collateral type, and stagnant blood blocking collateral type, showing statistical difference (P < 0.05). Of them, the numbers of joint tenderness, the numbers of joint swelling, the morning stiffness time, RF, VAS scores, and the improvement of the total effective rate were obviously better in the heat-dampness blocking collateral type, cold-dampness blocking collateral type, and stagnant blood blocking collateral type than in the Shen-qi deficiency cold type and Gan-Shen yin deficiency type, showing statistical difference (P < 0.05). CONCLUSIONS: Leflunomide showed significant effects in treating RA. Of them, its effects were obviously better in the heat-dampness blocking collateral type, cold-dampness blocking collateral type, and stagnant blood blocking collateral type than in the Shen-qi deficiency cold type and Gan-Shen yin deficiency type.
23926094 High disease activity may not be sufficient to escalate care. 2014 Feb OBJECTIVE: Rheumatoid arthritis (RA) treatment regimens are not adjusted in response to active disease as frequently as indicated. The objective of this study was to examine how disease activity and patients' illness beliefs combine to predict future treatment changes in patients who are currently under the care of a rheumatologist. METHODS: We interviewed RA patients at baseline and at 2, 4, and 6 months. We examined the association of disease activity (Routine Assessment of Patient Index Data 4) and 5 specific illness beliefs (consequences, treatment control, symptom burden, concern, and emotional impact) with future escalation of treatment using logistic regression. Analyses were adjusted for age, current biologic agent use, and disease duration. Disease activity and illness beliefs were dichotomized at the median to create 4 dummy variables (e.g., low disease activity + high illness belief) in order to examine the combined impact of disease activity and illness beliefs on escalation. RESULTS: Twenty-nine percent of the participants (n = 41 of 142) had an escalation of treatment during the followup period. When examined separately, disease activity and 4 of the illness beliefs (consequences, symptom burden, concern, and emotional impact) were associated with future escalation. High disease activity was predictive of future escalation only when combined with high levels of consequences, concern, and emotional impact. The combinations of high disease activity and high consequences, concern, and emotional impact were much stronger predictors of future escalation than either factor in isolation. CONCLUSION: The findings suggest that patients' illness beliefs are an important determinant of treatment decisions, which are not fully captured by disease activity measures alone.
23370854 Joint-protective effects of compound K, a major ginsenoside metabolite, in rheumatoid arth 2013 Aug Regulatory expression of matrix metalloproteinases (MMPs) and osteoclastogenesis is implicated in the process of joint destruction in rheumatoid arthritis (RA). Although several reports suggested the anti-arthritic effects of ginseng saponins, it has not been investigated whether the most absorbable ginsenoside, compound K (CK), has a joint-protective action. We here investigated the effect of CK (0-5 μM) on TNF-α-induced MMP-1, MMP-3, and MMP-13 and TIMP-1 production from RA fibroblast-like synoviocytes (FLS) and determined the inhibitory effect of CK on osteoclastogenesis from RAW264.7 cells co-cultured with RA-FLS and from human CD14+ monocytes. The effect of CK on NF-κB, nuclear factor of activated T cells c1 (NFATc1), and mitogen-activated protein kinases pathways were evaluated using immunoblotting or specific inhibitors. CK significantly inhibited MMP-1 and MMP-3 productions from RA-FLS in a concentration-dependent manner through suppressing the JNK and ERK pathways. In the co-culture system of TNF-α-stimulated RA-FLS and RAW264.7 cells, CK dose-dependently reduced receptor activator of NF-κB ligand (RANKL) expression in the RA-FLS and inhibited the formation of tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells. Furthermore, CK significantly inhibited soluble RANKL-induced osteoclastogenesis or osteoclast activity in RAW264.7 cells and human CD14+ monocytes through inhibition of RANKL-induced IκBα degradation and NFATc1 expression. In conclusion, our results increase the understanding of the molecular mechanisms of the joint-protective effects of CK in RA. The characteristic actions of CK provide in vitro evidence for its potential utility in RA therapy.
24254038 Recent clinical applications of Japanese oriental (Kampo) medicine for rheumatoid arthriti 2013 Nov Rheumatoid arthritis (RA) is a heterogeneous disease. In rheumatology, researchers have not identified useful clinical markers to predict the effects of biological agents or of nonbiological, antirheumatic drugs before administration. Since the advent of biological agents, therapeutic strategies for RA have focused on early detection and early intensive treatment. Although responders to Japanese Oriental (Kampo) medicine exist, physicians first have had to diagnose RA using the practices of conventional medicine. They could identify those patients who would benefit from administration of Kampo medicine only by administering the treatment. Only the presence of a positive response could confirm the benefits for a particular individual. In this article, the author discusses the clinical importance of Kampo medicine within the context of the present RA classification criteria and therapeutic treatment and discusses the use of the basal value of anti-CCP antibody (aCCP) titer as a prognostic factor for use of Kampo medicine for RA. The author then defines a methodology for determining who should receive the treatment.
23936829 Joint involvement in primary Sjögren's syndrome: an ultrasound "target area approach to a 2013 OBJECTIVE: To characterize the ultrasound (US) pattern of joint involvement in primary Sjögren's syndrome (pSS). METHODS: Seventeen patients with pSS, 18 with secondary Sjögren's syndrome (sSS), and 17 healthy controls underwent US examinations of various articular regions. Synovitis (synovial hypertrophy/joint effusion), power Doppler (PD) signals, and erosions were assessed. RESULTS: In patients with pSS, synovitis was found in the metacarpophalangeal joints (MCP, 76%), wrists (76%), and knees (76%), while the proximal interphalangeal joints, elbows, and ankles were mostly unscathed. Intra-articular PD signals were occasionally detected in wrists (12%), elbows (6%), and knees (6%). Erosions were evident in the wrists of three (18%) patients with pSS, one of these also having anti-cyclic citrullinated peptide (anti-CCP) antibodies. While US synovitis does not discriminate between sSS and pSS, demonstration of bone erosions in the 2nd MCP joints showed 28.8% sensitivity and 100% specificity for diagnosing sSS; in comparison, these figures were 72.2 and 94.1% for circulating anti-CCP antibodies. CONCLUSIONS: In pSS, the pattern of joint involvement by US is polyarticular, bilateral, and symmetrical. Synovitis is the US sign most commonly found in patients with pSS, especially in MCP joints, wrists, and knees, and bone erosions also may occur.
22215043 Early diagnosis of rheumatoid arthritis: an introduction to the newly designed Iran Criter 2013 Jan More than 14 years of clinical practice in rheumatology led the author to discover the prognostic role of anti-citrullinated protein antibody (ACPA) as well as the erosions found by MRI, in detecting the RA patients resulting in establishing a new set of criteria by revising the 1987 ACR classification-Iran Criteria for Rheumatoid Arthritis. Medical records of 243 patients at the outpatient Rheumatology Clinic of the author (private sector) were reviewed for the data on the criteria of the 1987 ACR, 2010 ACR/European League against Rheumatism (EULAR), and Iran Criteria for RA. In addition to modifying the 1987 ACR classification, Iran Criteria for RA adds some additional information to the ACR criteria (including ACPA and bony erosions detected by MRI), and any patient who satisfies 6 out of 12 points is considered as a definite RA patient. Sensitivity of the three classifications was calculated considering the clinical diagnosis by a single rheumatologist as the gold standard. A total of 63 male and 180 female patients with a mean follow-up duration of 28.24 ± 50.19 months were considered. Mean age at diagnosis and mean disease duration were 49.16 ± 15.38 years and 7.04 ± 6.87 months, respectively. The sensitivity for Iran Criteria for RA, 1987 ACR classification, and 2010 ACR/EULAR criteria were calculated as 98.4, 59.7, and 66.3%, respectively. Comparing Iran Criteria for RA with ACR and ACR/EULAR criteria, it was concluded that our newly introduced criteria is a more sensitive instrument in determining RA patients in the early stages of the disease.
23415074 Similar clinical outcomes in rheumatoid arthritis with more versus less expensive treatmen 2013 May OBJECTIVES: Selection of efficacious medications for rheumatoid arthritis (RA) has tremendously increased over a decade including new costly biologic agents and inexpensive conventional anti-rheumatic drugs, used in combinations for more efficacy. Treatments aim at remission or at least low disease activity. Our objective was to study whether treatment target is reached and to what cost, in patients with RA in two Nordic rheumatology clinics. METHODS: Cross sectional observational clinical data of all patients with RA seen in 2010 in two Nordic county hospital rheumatology units: Kristiansand, Norway and Jyväskylä, Finland, which both serve a population of about 275,000. Measures included patient demographic measures, clinical characteristics, disease activity, functional status, and treatments. Annual costs of medications to the society were calculated per 100 patients, using an assumption that a patient is taking current medications for one year. RESULTS: Patient populations from Kristiansand and Jyväskylä were similar according to age, gender, disease duration, and prevalence of RF and CCP. Disease activity was low and patients' functional status well reserved in both clinics. Almost twice as many patients in Kristiansand than in Jyväskylä (33% vs. 17%) used biologic agents. A combination of conventional anti-rheumatic drugs was currently used by <1% of patients in Kristiansand and by 37% of patients in Jyväskylä. Estimated annual costs of medications per 100 patients were €508,000 in Kristiansand and €280,000 in Jyväskylä. CONCLUSIONS: Treatment target of remission/low disease activity and good functional status can be reached in RA using expensive and less-expensive anti-rheumatic drugs.