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ID PMID Title PublicationDate abstract
23401699 An innovative method to identify autoantigens expressed on the endothelial cell surface: s 2013 Autoantibodies against integral membrane proteins are usually pathogenic. Although anti-endothelial cell antibodies (AECAs) are considered to be critical, especially for vascular lesions in collagen diseases, most molecules identified as autoantigens for AECAs are localized within the cell and not expressed on the cell surface. For identification of autoantigens, proteomics and expression library analyses have been performed for many years with some success. To specifically target cell-surface molecules in identification of autoantigens, we constructed a serological identification system for autoantigens using a retroviral vector and flow cytometry (SARF). Here, we present an overview of recent research in AECAs and their target molecules and discuss the principle and the application of SARF. Using SARF, we successfully identified three different membrane proteins: fibronectin leucine-rich transmembrane protein 2 (FLRT2) from patients with systemic lupus erythematosus (SLE), intercellular adhesion molecule 1 (ICAM-1) from a patient with rheumatoid arthritis, and Pk (Gb3/CD77) from an SLE patient with hemolytic anemia, as targets for AECAs. SARF is useful for specific identification of autoantigens expressed on the cell surface, and identification of such interactions of the cell-surface autoantigens and pathogenic autoantibodies may enable the development of more specific intervention strategies in autoimmune diseases.
25188388 Assessment of activity limitations with the health assessment questionnaire predicts the n 2014 OBJECTIVE: This study investigated whether the Health Assessment Questionnaire (HAQ) can be used as an instrument to assess the need for social support measures that address activity limitations and participation issues in patients with rheumatoid arthritis (RA). METHODS: This multicenter observational study included patients with RA and disease duration of at least one year, consulting their rheumatologist for routine evaluation of disease activity. In the single study visit data on demographics, disease history and current treatment were collected. DAS28 values were collected to evaluate current RA disease activity. Patients were asked to fill out the HAQ and SF-36 questionnaires. Receiver Operator Characteristics (ROC) curves were constructed to evaluate the performance of the HAQ, SF-36 and DAS28 in predicting the need for nine supporting measures available for chronically ill patients in the Belgian social security system. The expert opinion of the treating rheumatologist was used as a reference. RESULTS: The study included 316 patients with a mean age of 59.8 ± 12.6 years, disease duration of 11.4 ± 9.3 years, mean DAS28 values of 2.83 ± 1.17. Mean HAQ score was 0.95 ± 0.73, mean SF-36 score 56.5 ± 21.3. HAQ scores >1 were observed in 39.4% of patients. The area under the HAQ ROC curve was consistently >0.7 and higher for the HAQ than for SF-36 or DAS28 for all support measures. Rheumatologists on average recommended 3.67 support measures. CONCLUSION: The HAQ score was found to be a good predictor of the need for social support measures in patients with RA.
23613482 Thyroxin substitution and the risk of developing rheumatoid arthritis; results from the Sw 2014 Jun OBJECTIVES: Hypothyroidism in iodine-repleted areas is usually of autoimmune nature and leads to chronic thyroxin substitution. It shares some risk factors with anti-citrullinated peptide antibodies (ACPA)-positive rheumatoid arthritis (RA). We asked whether thyroxin substitution associated with risk of ACPA-positive or ACPA-negative RA, and whether interactions with established risk factors were present. METHODS: Data from a population-based case-control study with incident RA cases were analysed (1998 adult cases, 2252 controls). Individuals reporting thyroxin substitution were compared with those without thyroxin, by calculating OR with 95% CI, excluding participants reporting non-autoimmune causes for thyroxin substitution (thyroid cancer, iodine-containing drugs). Interaction was evaluated by attributable proportion (AP) with 95% CI. RESULTS: Thyroxin substitution was associated with a twofold risk of both ACPA-positive (OR=1.9, 95% CI 1.4 to 2.6) and ACPA-negative RA (OR=2.1, 95% CI 1.5 to 3.1). For ACPA-positive RA, the risk associated with the combination thyroxin+ HLA-DRB1 shared epitope alleles (SE) was much higher (OR=11.8, 95% CI 6.9 to 20.0) than for thyroxin (OR=1.4, 95% CI 0.7 to 3.0) or SE (OR=5.7, 95% CI 4.6 to 6.9) alone, indicating a strong interaction (AP=0.5, 95% CI 0.2 to 0.8). Thyroxin substitution interacted non-significantly with smoking (AP=0.4, 95% CI 0.0 to 0.7; OR thyroxin+smoking=3.6, thyroxin only=1.5, smoking only=1.8). Thyroxin did not interact with the PTPN22*R620W allele. CONCLUSIONS: Thyroxin users had a doubled risk of both ACPA-positive and ACPA-negative RA. The risk of ACPA-positive RA was manifold if they smoked or carried the SE. Furthermore, although joint symptoms can be a manifestation of hypothyroidism, physicians might consider whether it could be an early manifestation of RA.
23711218 Clinical miscount of involved joints denotes the need for ultrasound complementation in us 2013 Jul OBJECTIVES: Ultrasound (US) examination can visualise and clarify involved joints anatomically in patients with rheumatoid arthritis (RA), and it enables physicians to verify the accuracy of clinical assessments of involved joints. Here, we studied the practical 'miscount'- calculated by subtracting US-determined involved joint count from clinically determined involved joint count - and analysed possible contributing factors for increased miscount. METHODS: The study population consisted of 137 patients with RA. Physical joint examination was performed by 3 assessors with different levels of experience in rheumatology, followed by US joint examination. Clinical and US examinations were performed on 28 joints (proximal interphalangeal, metacarpophalangeal, wrist, elbow, shoulder, and knee on both sides). Miscount was calculated for all patients, and multivariate analysis was conducted on possible contributing factors for miscount, including age, sex, body mass index, disease duration, Steinbrocker stage, erythrocyte sedimentation rate (ESR), C-reactive protein level, patient global assessment (GA), evaluator GA, matrix metalloproteinase-3 level, and power Doppler (PD) score. RESULTS: A high variability in concordance rate among the joint sites was observed among the 3 assessors. The average miscount was 1.07 (SD, 5.19; range, 18 to -11). ESR and patient GA were determined as significant contributing factors for false-positive miscount, whereas PD score and age were significant factors for false-negative miscount. CONCLUSIONS: In addition to the condition of the involved joint distribution and the assessor's clinical examination skills, the patients' background can also lead to increased miscount. Assessors should be blinded to patients' background information, and US complementation should be included in usual clinical joint examinations.
23574312 Tolerogenic dendritic cell therapy for rheumatoid arthritis: where are we now? 2013 May Dendritic cells with tolerogenic function (tolDC) have become a promising immunotherapeutic tool for reinstating immune tolerance in rheumatoid arthritis (RA) and other autoimmune diseases. The concept underpinning tolDC therapy is that it specifically targets the pathogenic autoimmune response while leaving protective immunity intact. Findings from human in-vitro and mouse in-vivo studies have been translated into the development of clinical grade tolDC for the treatment of autoimmune disorders. Recently, two tolDC trials in RA and type I diabetes have been carried out and other trials are in progress or are imminent. In this review, we provide an update on tolDC therapy, in particular in relation to the treatment of RA, and discuss the challenges and the future perspectives of this new experimental immunotherapy.
24336009 Concordance between inflammation at physical examination and on MRI in patients with early 2015 Mar BACKGROUND: MRI is increasingly used to measure inflammation in rheumatoid arthritis (RA) research, but the correlation to clinical assessment is unexplored. This study determined the association and concordance between inflammation of small joints measured with MRI and physical examination. METHODS: 179 patients with early arthritis underwent a 68 tender joint count and 66 swollen joint count and 1.5T MRI of MCP (2-5), wrist and MTP (1-5) joints at the most painful side. Two readers scored synovitis and bone marrow oedema (BME) according to the OMERACT RA MRI scoring method and assessed tenosynovitis. The MRI data were first analysed continuously and then dichotomised to analyse the concordance with inflammation at joint examination. RESULTS: 1790 joints of 179 patients were studied. Synovitis and tenosynovitis on MRI were independently associated with clinical swelling, in contrast to BME. In 86% of the swollen MCP joints and in 92% of the swollen wrist joints any inflammation on MRI was present. In 27% of the non-swollen MCP joints and in 66% of the non-swollen wrist joints any MRI inflammation was present. Vice versa, of all MCP, wrist and MTP joints with inflammation on MRI 64%, 61% and 77%, respectively, were not swollen. BME, also in case of severe lesions, occurred frequently in clinically non-swollen joints. Similar results were observed for joint tenderness. CONCLUSIONS: Inflammation on MRI is not only present in clinically swollen but also in non-swollen joints. In particular BME occurred in clinically non-inflamed joints. The relevance of subclinical inflammation for the disease course is a subject for further studies.
23552059 A chronic model of arthritis supported by a strain-specific periarticular lymph node in BA 2013 Current animal models of arthritis only partially reflect the complexity of rheumatoid arthritis and typically lack either chronicity or autoantibody formation. Here we describe a model that combines features of antigen-induced arthritis and collagen-induced arthritis, which can be efficiently induced in BALB/c and C57BL/6 mice. However, BALB/c mice generate significantly higher titres of anticollagen and anticitrullinated peptide antibodies, show a stronger progressive joint destruction, and in the chronic phase the disease spreads between joints. Concomitant to the observation of a more severe pathology, we discovered a previously undescribed small periarticular lymph node in close proximity to the knee joint of BALB/c mice, which acts as the primary draining lymph node for the synovial cavity. Our model more closely reflects the pathology of rheumatoid arthritis than classical models of arthritis and is hence particularly suitable for further studies of disease pathogenesis.
25047643 GILZ: a new link between the hypothalamic pituitary adrenal axis and rheumatoid arthritis? 2014 Oct The hypothalamic-pituitary-adrenal (HPA) axis is an important regulator of the stress response. In healthy individuals, the HPA axis maintains an equilibrium, ensuring that endogenous glucocorticoid (GC) levels remain within the normal range. However, hypofunction of the HPA axis may have a role in the development of inflammatory diseases, such as rheumatoid arthritis (RA). Glucocorticoid-induced leucine zipper (GILZ) is an anti-inflammatory protein, the expression of which is upregulated by GC. Although GILZ mediates the anti-inflammatory effects of GC, it may not be associated with the adverse effects that are frequently caused by exogenous GC administration. This has raised interest in GILZ potentiation as a therapeutic approach in diseases such as RA, which may mimic the anti-inflammatory effects of GC without causing harmful side effects. This review will outline the involvement of the HPA axis in RA, as a prelude to highlighting emerging evidence regarding the role of GILZ in inflammation control and RA.
22623274 HLA-DRβ1*04 typing by simple in-house PCR-SSP technique for rheumatoid arthritis patients 2013 Apr A strong association between rheumatoid arthritis (RA) and human leukocyte antigen (HLA) has been observed in many different populations and that accounts for approximately one-third of the genetic component of RA susceptibility. The greatest effect comes from DRβ1 gene where the strongest association has been found with DRβ1*04 (DR4) allele. As serology has some disadvantages over polymerase chain reaction (PCR)-based techniques and commercially available PCR-based kits are expensive, this study was aimed to standardize simple in-house PCR-SSP technique. Accuracy of this test was further checked with standard PCR-SSOP (RLS) results. The frequency HLA-DRβ1*04 was significantly increased among RA patients when compared with normal controls. In this study, a very simple, convenient and more cost-effective in-house PCR-SSP technique was standardized for HLA-DRβ1*04 typing that is helpful to RA diagnosis in developing countries like India, which can be used as a good screening test.
23845805 Strategies for active TNF-α vaccination in rheumatoid arthritis treatment. 2013 Aug 28 Local overexpression of tumor necrosis factors alpha (TNF-α) is critically involved in the inflammatory response and tissue destruction of rheumatoid arthritis (RA). Currently, the blockade of TNF-α by passive immunotherapy is indeed efficacious in the treatment of RA, but it still present some disadvantages. Induction of high level of anti-TNF-α neutralizing autoantibodies by TNF-α autovaccine has been developed to avoid these shortcomings. This review is to briefly introduce several vaccination approaches that have been used to induce a B cell response, including coupled TNF-α (entire/peptide) with a carrier protein, modified TNF-α with foreign Th cell epitopes, and engineered DNA vaccine. These methods showed remarkable therapeutic efficiency in experimental animals which indicated that active TNF-α immunization would be a promising and cost-effective new treatment option for RA.
25515746 The use of citrullinated peptides for the diagnosis and prognosis of rheumatoid arthritis. 2014 Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes joint inflammation and extra-articular manifestations. To prevent progressive and irreversible structural damage, early diagnosis of RA is of paramount importance. Antibodies directed against citrullinated proteins and peptides (ACPAs) are the most specific serological markers available for diagnosing RA. ACPAs may be detected several years before symptoms appear, and their presence at disease onset is a good predictor of the development of erosive joint lesions. Synthetic peptides can replace cognate proteins in solid-phase assays for specific autoantibody recognition in RA patients. The use of synthetic peptides instead of proteins represents an advantage in terms of the reproducibility of such immunoassays. They give absolute control over the exact epitopes presented. Furthermore, it is difficult to prepare sufficient amounts of high-quality antigenic proteins with a well-defined degree of citrullination. Synthetic citrullinated peptides, in contrast, are easily obtained in a pure form with a well-defined chemical structure and the epitopes can be precisely oriented in the plate by covalent binding of the peptides. We have recently obtained and highlighted the application of chimeric peptides bearing different citrullinated protein domains for the design of RA diagnosis systems. Our results indicate that more than one serological test is required to classify RA patients based on the presence or absence of ACPAs. Each of the target molecules reported (fibrin, vimentin and filaggrin) helps to identify a particular subset of RA patients.
23171316 Associations of the IL-1F7 gene polymorphisms with rheumatoid arthritis in Chinese Han pop 2013 Jun Our aim was to investigate whether genetic polymorphism of IL-1F7 (rs3811047) was involved in the susceptibility to rheumatoid arthritis (RA) in Chinese Han population. Single nucleotide polymorphism (SNP) of IL-1F7 gene (rs3811047) was analyzed in 184 unrelated Chinese Han patients with RA and 184 healthy controls by ligase detection reaction based on high temperature ligase detection reactions polymerase chain reaction (LDR-PCR). There were no statistically significant differences in the genetic polymorphism (genotypes and allele frequencies) of IL-1F7 (rs3811047) in the patients with RA compared with control. Although all of the clinical and laboratory measures were similar to each other among patients with different genotypes, RA patients carrying AA or AG genotypes had lower swollen joint count, swollen joint index, rest pain and health assessment questionnaire (HAQ) score than that in patients having GG genotype (P < 0.05). These findings show that no evidence for the involvement of a pro-inflammatory polymorphism in the IL-1F7 in the susceptibility to RA in China. Patients carrying A allele had less severe disease activity than those not carrying this allele, suggesting that the A allele of IL-1F7 gene (rs3811047) may have a protective effect on RA.
24746382 The importance of evolution in the development and course of rheumatoid arthritis. 2014 Jun Rheumatoid arthritis (RA) is a complex autoimmune disease of recent evolutionary origin. Genetic drift determines diverse polymorphisms implicated in the susceptibility to RA including the major histocompatibility complex (MHC) class II genes in the so-called shared epitope. These genes originated after the divergence between Homo and Pan from their common ancestry Ardipithecus ramidus about 5 million years ago. Natural selection determined the particular changes in the legs (bipedal position), hands, neck, brain and eusociality in humans which influence the clinical presentation of RA. In this article, we hypothesized that the origin and course of RA may be explainable in the light of evolution.
23918169 Development of an algorithm for identifying rheumatoid arthritis in the Korean National He 2013 Dec This study aimed to develop an identification algorithm for validating the International Classification of Diseases-Tenth diagnostic codes for rheumatoid arthritis (RA) in the Korean National Health Insurance (NHI) claims database. An individual copayment beneficiaries program for rare and intractable diseases, including seropositive RA (M05), began in South Korea in July 2009. Patients registered in this system pay only 10 % of their total medical costs, but registration requires an official report from a doctor documenting that the patient fulfills the 1987 ACR criteria. We regarded patients registered in this system as gold standard RA and examined the validity of several algorithms to define RA diagnosis using diagnostic codes and prescription data. We constructed nine algorithms using two highly specific prescriptions (positive predictive value >90 % and specificity >90 %) and one prescription with high sensitivity (>80 %) and accuracy (>75 %). A total of 59,823 RA patients were included in this validation study. Among them, 50,082 (83.7 %) were registered in the individual copayment beneficiaries program and considered true RA. We tested nine algorithms that incorporated two specific regimens [biologics and leflunomide alone, methotrexate plus leflunomide, or more than 3 disease-modifying anti-rheumatic drugs (DMARDs)] and one sensitive drug (any non-steroidal anti-inflammatory drug (NSAID), any DMARD, or any NSAID plus any DMARD). The algorithm that included biologics, more than 3 DMARDs, and any DMARD yielded the highest accuracy (91.4 %). Patients with RA diagnostic codes with prescription of biologics or any DMARD can be considered as accurate cases of RA in Korean NHI claims database.
24656623 Inflammatory markers in patients with rheumatoid arthritis. 2015 Jan BACKGROUND: Autoimmune diseases such as rheumatoid arthritis (RA) are the consequence of a persistent imbalance between pro- and anti-inflammatory immune mechanisms, leading to chronic inflammation. The objective of this study was to determine whether the high sensitive C-reactive protein (hs-CRP) and cytokines are elevated in RA patients and to investigate the relationship between these markers and disease activity in RA, measured by disease activity score 28 (DAS28). METHODS: We studied 110 RA patients according to American College of Rheumatology revised criteria for RA, and 55 controls matched by age and sex. Serum levels of hs-CRP and cytokines interleukin (IL)-6, IL-10 and tumour necrosis factor-α (TNF-α) were estimated and correlated with the DAS28. Serum hs-CRP was assayed immunoturbidimetrically and cytokines were analysed by commercially available ELISA kit. RESULTS: We found that RA patients had significantly higher levels of serum hs-CRP (p<0.001), IL-6 (p<0.001), TNF-α (p<0.001), and IL-10 (p<0.01) as compared to healthy controls. hs-CRP, IL-6 and TNF-α correlated positively (p<0.001) and IL-10 correlated negatively (p<0.01) with DAS28. CONCLUSIONS: These results demonstrate that RA patients have high levels of inflammatory markers, and these levels are correlated with the DAS28. These findings suggest a possible role of these markers in the pathogenesis of RA. Moreover, these biomarkers can be used as markers of disease activity in the diagnosis and treatment of RA.
24369410 Influence of disease activity on the physical activity of rheumatoid arthritis patients. 2014 Apr OBJECTIVES: The aims of this study were to study physical activity (PA) in patients with RA by accelerometry and to determine to what degree their mobility is affected by disease activity. METHODS: A group of 50 RA patients, without lower limb clinical disease, and 50 age- and sex-matched healthy controls were included in this cross-sectional study. PA was assessed by accelerometry and with the International Physical Activity Questionnaire (IPAQ). We performed multiple regression analysis not only to compare PA between groups, but also to explore the relation between RA features, including disease activity and cardiovascular risk parameters, and PA. In a randomized group of 30 RA patients a test-retest study was carried out in order to determine the correlation between variations in disease activity and PA. RESULTS: The number of minutes of moderate and vigorous activity per day, as evaluated by accelerometry, was significantly lower in RA patients than in healthy controls. In RA patients, accelerometry and IPAQ demonstrated concordance to a moderate degree [quadratic weighed kappa index 0.27 (0.06-0.48), P = 0.02]. HAQ negatively correlated with both IPAQ and accelerometry data. The 28-joint DAS using CRP (DAS28-CRP) was also inversely related with IPAQ. Framingham score and metabolic syndrome were inversely associated with PA in RA patients. Interestingly, variations in PA by accelerometry inversely correlated with changes in RA disease activity (r = -0.42, P = 0.02). CONCLUSION: In RA patients, accelerometry is a reliable technique to evaluate PA. This study not only showed that RA patients spend less time doing moderate and vigorous PA than healthy controls, but also PA, as assessed by accelerometry, was sensitive to any changes in disease activity.
24233123 The limited effects of anti-tumor necrosis factor blockade on bone health in patients with 2014 Sep We investigated the effects of biologics for rheumatoid arthritis (RA) patients on bone mineral density (BMD) and bone metabolic markers (BMM), retrospectively, and also clarified the effects of bisphosphonates (alendronate or risedronate 35 mg/week) and glucocorticoids. Participants in this study comprised 219 patients with RA, including 117 patients treated with biologics (infliximab, n = 90; etanercept, n = 27) and 102 patients with conventional disease-modifying anti-rheumatic drugs (DMARDs) for 1 year. Changes in BMD at the lumbar spine and total hip and BMMs [urinary type I collagen cross-linked N-telopeptide (NTX) and bone-specific alkaline phosphatase] were measured. BMD of the lumbar spine in both groups and total hip BMD in the biologics group were unchanged during treatment with biologics. However, BMD of the total hip was significantly decreased in the DMARDs group (from 0.731 ± 0.135 to 0.706 ± 0.135 g/cm2). Patients receiving glucocorticoids without bisphosphonates showed significant decrease in BMD of the total hip compared with patients not receiving glucocorticoids or receiving glucocorticoids with bisphosphonates in both biologics and DMARDs groups. Furthermore, BMD of the lumbar spine increased (p < 0.05) for patients in the biologics group who received bisphosphonates. NTX was significantly decreased only in the biologics group. Multiple regression analysis showed that BMD and bone metabolic marker levels correlated positively with bisphosphonate and biologics use and negatively with glucocorticoid use. BMD of the total hip was maintained in the patients using biologics without glucocorticoids or with bisphosphonates, but it was not maintained in the DMARDs patients, even without glucocorticoids or with bisphosphonates. Even if biologics have protective effect against bone loss of RA patients, we should consider reducing the dose of glucocorticoids and adding bisphosphonates for the treatment of osteoporosis.
24978393 Interleukin-6-receptor polymorphisms rs12083537, rs2228145, and rs4329505 as predictors of 2014 Aug Tocilizumab (TCZ), a monoclonal antibody targeting the human interleukin-6-receptor (IL-6R), is indicated for the treatment of rheumatoid arthritis (RA). We examined whether three IL6R single-nucleotide polymorphisms rs12083537, rs2228145 (formerly rs8192284), and rs4329505 with previously reported functional effects were associated with clinical response to TCZ in a retrospective study cohort consisting of 79 RA patients. Three months after initiation of TCZ therapy, changes in swollen joint count (SJC) and, subordinately, tender joint count (TJC), serum-CRP, DAS28-CRP, and EULAR-response were tested for association with the IL6R-haplotype or genotype. The major allele (A) of rs12083537 and the minor allele (C) of rs4329505 were associated with a poor SJC response (P=0.02 and 0.02, respectively). Moreover, the AAC-haplotype (for rs12083537, rs2228145, and rs4329505, respectively) was associated with a poor SJC response (P=0.00004) and, with borderline significance, EULAR-response (P=0.05). These data suggest that genetic variation in IL6R may aid in predicting TCZ therapy outcome in RA patients.
24261761 Rheumatoid arthritis of the hand: a five-year longitudinal analysis of clinical and radiog 2014 Jan OBJECTIVES: Treatments for rheumatoid arthritis (RA) have improved since methotrexate and biological agents were approved; however, few longitudinal analyses have tracked joint destruction, deformity progression, or functional impairments that directly affect the activities of daily living. Due to the consequences of functional impairments, we conducted this study to glean more information regarding deformity progression over time. METHODS: This study enrolled 134 hands in 67 RA patients with hand deformities in 2004. After 5 years, 100 hands in 52 patients were eligible for the final assessment. Analyses consisted of morphological and radiographical evaluations of deformities, functional evaluations by questionnaires and the modified Kapandji index, and activity evaluations. RESULTS: In this period, the type I deformity (Nalebuff and Millender, Orthop Clin North Am 6(3):753-63, 1975) was the most common thumb deformity. Swan-neck and boutonnière finger deformities also progressed. At the 5-year follow-up, questionnaire score worsened, when disease activity was high. CONCLUSIONS: Our study showed that there was a marked progression in hand deformities in RA patients over a 5-year period. In order to assist RA patients in performing the activities of daily living, medical and rehabilitative interventions should target the restoration of functional loss through joint destruction as well as the prevention of disease progression.
23900577 Additive hindfoot arthrodesis for rheumatoid hindfoot disease: a clinical study of patient 2013 Dec Advanced rheumatoid hindfoot disease causes significant pain and disability. Hindfoot arthrodesis is a useful procedure but is often overlooked as a treatment option. The objective of this study was to report the improvements in patients' health, pain, functional ability and satisfaction following this procedure. Thirty-seven patients with rheumatoid arthritis (RA) were recruited from the outpatient clinic and underwent 42 hindfoot arthrodesis procedures by a single surgeon. Outcome measures were SF12 score, Manchester-Oxford Foot Questionnaire index score, visual analogue pain score and satisfaction scores, as well as radiographic assessment. Assessment was undertaken at the pre-admission clinic and at 6 and 12 months post-operatively. Statistically significant improvements were seen at 6 and 12 months in all measured outcomes. The union rate was 97.6%. The satisfaction rate was 92.5%. The complication rate was 7.1%. The functional benefit and outcome scores are comparable to those reported following hip and knee replacement in patients with RA. The findings of this study provide evidence that hindfoot arthrodesis should be considered a worthwhile surgical treatment in the rheumatoid patient with advanced hindfoot disease. Healthcare professionals involved in the management of these patients should be aware of the potential benefits of this procedure and refer early to a foot and ankle surgeon specialist when conservative treatment modalities have failed.