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23125122 Perceptions of issues relating to exercise and joint health in rheumatoid arthritis: a UK- 2013 Sep OBJECTIVES: This questionnaire study investigated the perceptions of rheumatoid arthritis (RA) patients across the UK in relation to exercise and joint health. The validity of the measure was also assessed. METHODS: Members of the National Rheumatoid Arthritis Society (NRAS) with self-reported RA completed the questionnaire online. Items related to five factors that emerged from previous qualitative research. Participants responded using a five-point Likert-style scale (strongly disagree to strongly agree). The International Physical Activity Questionnaire (IPAQ) assessed physical activity. The model was tested using confirmatory factor analysis (LISREL 8.8); statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS). RESULTS: A total of 247 responses were collected over 47 days (88% females; age: 18-77 years; disease duration: <1-51 years). Acceptable factorial validity was revealed (Satorra-Bentler χ(2)  = 774.47, df = 454, p < 0.001, root mean squared error of approximation (RMSEA) = 0.05, 90% confidence interval RMSEA = 0.05-0.06, comparative fit index = 0.94, standardized root mean square residual = 0.09), with the following factor endorsements: 'Health professionals show exercise knowledge' (19%); 'Knowing what exercise should be done' (43%); 'Having to exercise because it is helpful' (72%); 'Worry about causing harm to joints' (44%); and 'Not wanting to exercise as joints hurt' (52%). Patient concerns about joint pain, joint harm and how to exercise were significantly associated with lower physical activity (p < 0.05). CONCLUSIONS: These results confirm that patients perceive exercise as beneficial. However, concerns about how to exercise, joint pain, causing harm to joints and a perceived lack of exercise knowledge among health professionals remain. Addressing these concerns may have implications for increasing physical activity within the RA population.
24215408 The case for measuring antibodies to specific citrullinated antigens. 2013 Dec Anti-citrullinated protein/peptide antibodies (ACPA) are the principal autoantibody system associated with rheumatoid arthritis (RA), with diagnostic sensitivity of 70% and specificity of 95%. Current testing for ACPA uses the anti-cyclic citrullinated peptide assay (anti-CCP) which measures a generalized reactivity with citrulline-containing peptides, thus giving no insight into reactivity to specific RA antigens. Of these, the best characterized are, α-enolase, fibrinogen/fibrin, vimentin, Type 2 collagen and filaggrin, antibodies to each of which are found in approximately 30-60% of RA cases. Given reports of cross-reactivity between citrullinated antigens, we discuss whether or not measuring these specific antibodies could aid: clinical diagnosis, identification of clinical subsets and drug responses, or provide insight into pathogenic mechanisms or etiology of RA.
23983173 Utility of the ultrasound examination of the hand and wrist joints in the management of es 2014 Feb OBJECTIVE: To investigate the usefulness of point-of-care hand and wrist joint ultrasound (US) examination in patients with established rheumatoid arthritis (RA). METHODS: Fifty-one RA patients were evaluated using clinical disease activity measures and gray-scale and power Doppler (PD) US. Agreement between US and clinical findings and its impact on physicians' confidence and clinical decision were assessed. RESULTS: Agreement between intraarticular PD signal and joint swelling (JS) was moderate (82%; κ = 0.44). Agreement between PD signal and joint tenderness to palpation (TTP) was fair (75%; κ = 0.24). The greatest agreement between PD signal and clinical findings was seen in the 5th metacarpophalangeal (MCP) joint (96% JS, 88% TTP) and the poorest agreement was seen in the wrist (69% JS, 65% TTP) and 2nd (75% JS, 72% TTP) and 3rd (82% JS, 72% TTP) MCP joints. The presence of PD signal in nonswollen and/or nontender joints accounted for most of the disagreement in the wrists, while the opposite was true for the 2nd/3rd MCP joints. Agreement between sonographic synovial thickening and clinical findings was poor. Total sonographic synovial hypertrophy or PD score correlated significantly with physician-recorded, but not patient-recorded, clinical outcomes. US increased both physicians' confidence in their clinical decision (P < 0.0005, irrespective of Clinical Disease Activity Index score) and patients' confidence in physicians' medical decisions (88.4% of the cases). US modified biologic agent and/or disease-modifying antirheumatic drug (DMARD) use in 7 individual cases, but it did not affect the overall treatment plan (P > 0.15) or DMARD (P < 0.062) or biologic agent (P > 1.0) use in this group of RA patients. CONCLUSION: PD examination of the wrist and 2nd/3rd MCP joints might be feasible and clinically meaningful in evaluation of disease activity in patients with established RA. US examination of the hand/wrist joints in RA increases physicians' confidence in their clinical decision and can help to individualize DMARD and biologic agent use.
23290690 Rheumatoid factor as predictor of response to abatacept, rituximab and tocilizumab in rheu 2013 Aug OBJECTIVE: To identify if rheumatoid factor (RF) is predictor of response to rituximab (RTX), abatacept (ABT), and tocilizumab (TCZ) in rheumatoid arthritis (RA). METHODS: Systematic review and meta-analysis of clinical trials and observational studies based on a sensitive search. Meta-regression was used to explore causes of heterogeneity. Unpublished data of clinical trials provided by the authors were also included. RESULTS: The electronic search captured 3221 references and 422 meeting abstracts. By hand search, four additional articles were also identified. A total of 23 studies meet the purpose of the study and were included in the review. RF positivity at starting predicts better ACR20 [OR, 1.95 (1.24, 3.08)], ACR50 [OR, 5.38 (2.50, 11.60)] and EULAR response [OR, 3.52 (1.66, 7.45)] in 14 studies with RTX, and better ACR20 [OR, 1.51 (1.21, 1.90)] in 6 studies with TCZ. In 3 studies with ABT, no association was found between response and RF [OR 1.36 (0.97, 1.90)]. No asymmetries in the funnel plots or significant variables were found in the meta-regression. CONCLUSION: In RA, RF positivity predicts better response to RTX and TCZ but not to ABT.
24798350 Good response to infliximab in rheumatoid arthritis following failure of interleukin-1 rec 2016 Apr AIM: To evaluate the efficacy of tumor necrosis factor inhibitor infliximab in patients with rheumatoid arthritis (RA) who were disease-resistant to recombinant human interleukin-1 receptor antagonist (IL-1Ra). METHODS: A total of 104 patients with active RA despite methotrexate (MTX) treatment were enrolled in the open trial. Among them, 27 IL-1Ra nonresponders 'Switchers' and 51 biologic-naive patients 'Naivers' received an infusion of 3 mg/kg infliximab at weeks 0, 2, 6 and 14, combined with concurrent MTX therapy, while the other 26 patients who had never received any biologics 'Controls' continued MTX monotherapy. Clinical outcomes and safety were assessed at weeks 0, 2 and every 4 weeks thereafter for 18 weeks with the American College of Rheumatology (ACR) core set criteria, the Disease Activity Score in 28 joints, and records of adverse events (AEs) and abnormal laboratory findings. RESULTS: At week 18, an ACR20 response was achieved in 56% of Switchers and 61% of Naivers, compared with 23% of Controls (P = 0.0013 and 0.0126, respectively). Compared with Controls, both Switchers and Naivers achieved a significant improvement in tender-joint count, swollen-joint count, patient's assessment of pain, patient's and physician's global assessment of disease activity, erythrocyte sedimentation rate and C-reactive protein. Switchers even achieved a greater benefit from health assessment questionnaire (HAQ) scores than Naivers. Infliximab was well tolerated, with a similar incidence of AEs across all study groups. CONCLUSION: Switching from IL-1Ra to infliximab is effective in improving disease activity and maintaining joint function.
23496879 Cryptococcosis of lumbar vertebra in a patient with rheumatoid arthritis and scleroderma: 2013 Mar 7 BACKGROUND: Although cryptococcosis mainly occurs in the central nervous system and lungs in immunocompromised hosts, it can involve any body site or structure. Here we report the first case of primary cryptococcosis of a lumbar vertebra without involvement of the central nervous system or lungs in a relatively immunocompromised individual with rheumatoid arthritis and scleroderma. CASE PRESENTATION: A 40-year-old Chinese woman with rheumatoid arthritis diagnosed 1 year beforehand and with a subsequent diagnosis of scleroderma was found to have an isolated cryptococcal infection of the fourth lumbar vertebra. Her main complaints were severe low back and left leg pain. Cryptococcosis was diagnosed by CT-guided needle biopsy and microbiological confirmation; however, serum cryptococcal antigen titer was negative. After 3 months of antifungal therapy with fluconazole the patient developed symptoms and signs of scleroderma, which was confirmed on laboratory tests. After taking fluconazole for 6 months, the progressive destruction of the lumbar vertebral body had halted and the size of an adjacent paravertebral mass had decreased substantially. On discharge symptoms had resolved and at an annual follow-up there was no evidence of recurrence on the basis of symptoms, signs or imaging investigations. CONCLUSION: Although cryptococcosis of the lumbar vertebra is extremely rare, it should be considered in the differential diagnosis for patients with lumbar vertebral masses to avoid missed diagnosis, misdiagnosis and diagnostic delay. Early treatment with antifungals proved to be a satisfactory alternative to surgery in this relatively immunocompromised patient. Any residual spinal instability can be treated later, once the infection has resolved.
24144456 Associations between TRAF1-C5 gene polymorphisms and rheumatoid arthritis: a meta-analysis 2014 OBJECTIVE: The aim of this study is to determine whether tumor necrosis factor receptor-associated factor 1-complement 5 (TRAF1-C5) polymorphisms are associated with susceptibility to rheumatoid arthritis (RA) in different populations. METHODS: We conducted a meta-analysis of associations between the TRAF1-C5 polymorphisms and RA susceptibility. RESULTS: A total of 24 comparative studies were included in this meta-analysis, including 22,682 patients with RA and 23,493 controls. The meta-analysis showed an association between the second allele of rs10818488 and RA in Europeans, but not in Asians (OR 1.229, 95% CI 1.094-1.381, p = 0.001; OR 1.060, 95% CI 0.930-1.335, p = 0.092). The meta-analysis also indicated an association between the second allele of rs3761847 and RA in Europeans, but not in Asians (OR 1.156, 95% CI 1.006-1.327, p = 0.041; OR 1.049, 95% CI 0.952-1.156, p = 0.333). The meta-analysis revealed an association between the second allele of the rs2900180 and rs10760130 polymorphisms and RA risk in Europeans (OR 1.224, 95% CI 1.065-1.405, p = 0.004; OR 1.072, 95% CI 1.002-1.147, p = 0.042). CONCLUSIONS: This meta-analysis confirms that the TRAF1-C5 rs10818488, rs3761847, rs2900180 and rs10760130 polymorphisms are associated with RA susceptibility in Europeans.
23547732 Myopericarditis, as the first sign of rheumatoid arthritis relapse, evaluated by cardiac m 2013 Jun INTRODUCTION: Rheumatoid arthritis (RA) affects many organs, including the heart. Cardiac magnetic resonance (CMR) can assess heart pathophysiology in RA. AIM: To evaluate, using CMR, RA patients under remission with recent onset of cardiac symptoms. PATIENTS AND METHODS: Twenty RA under remission (15F/5M), aged 60±5 yrs, with recent onset of cardiac symptoms (RAH), were prospectively evaluated by CMR. The CMR included left ventricular ejection fraction (LVEF), T2-weighted (T2-W), early (EGE) and late gadolinium enhanced (LGE) images evaluation. Their results were compared with those of 20 RA under remission without cardiac symptoms (RAC) and 18 with systemic lupus erythematosus (SLE) with clinically overt myocarditis. RESULTS: Cardiac enzymes were abnormal in 5/20 RAH. CMR revealed inferior wall myocardial infarction in 2/20 (1M, 1F) and myocarditis in 13/20 (8M/5F) RAH. The T2 ratio of myocardium to skeletal muscle was increased in RAH and SLE compared to RAC (2.5 ± 0.05 and 3.4±0.7 vs 1.8 ± 0.5, p<0.001). EGE was increased in RAH and SLE compared to RAC (15 ± 3 and 12±4.7 vs 2.7±0.8, p<0.001). Epicardial LGEs were identified in 10/13 and pericarditis in 6/13 RAH. Coronary angiography, performed in 5 RAH with increased cardiac enzymes, proved a right coronary artery obstruction in 2/5. In 3/5 with CMR positive for myocarditis, coronary arteries were normal, but endomyocardial biopsy revealed inflammation with normal PCR. An RA relapse was observed after 7-40 days in 10/13 RAH with myopericarditis. The one year follow up showed that a) RAH with myocarditis had more disease relapses and b) CHF was developed in 4 RAH with myocarditis. CONCLUSIONS: Myopericarditis with atypical presentation, diagnosed by CMR in RA under remission, may precede the development of RA relapse. In 1 year follow up, RA patients with history of myocarditis have a higher frequency of disease relapse and may develop CHF.
23176063 Impact of a multi-biomarker disease activity test on rheumatoid arthritis treatment decisi 2013 Jan OBJECTIVE: To assess how use of a multi-biomarker disease activity (MBDA) blood test for rheumatoid arthritis (RA) affects treatment decisions made by health care providers (HCPs) in clinical practice. RESEARCH DESIGN AND METHODS: At routine office visits, 101 patients with RA were assessed by their HCPs (N = 6), and they provided blood samples for MBDA testing. HCPs completed surveys before and after viewing the MBDA test result, recording dosage and frequency for all planned RA medications and physician global assessment of disease activity. Frequency and types of change in treatment plan that resulted from viewing the MBDA test result were determined. MAIN OUTCOME MEASURE: Percentage of cases in which the HCP changed the planned treatment after viewing the MBDA test result. RESULTS: Prior to HCP review of the MBDA test, disease modifying anti-rheumatic drug (DMARD) use by the 101 patients included methotrexate in 62% of patients; hydroxychloroquine 29%; TNF inhibitor 42%; non-TNF inhibitor biologic agent 19%; and other drugs at lower frequencies. Review of MBDA test results changed HCP treatment decisions in 38 cases (38%), of which 18 involved starting, discontinuing or switching a biologic or non-biologic DMARD. Other changes involved drug dosage, frequency or route of administration. The total frequency of use of the major classes of drug therapy changed by <5%. Treatment plans changed 63% of the time when the MBDA test result was perceived as being not consistent or somewhat consistent with the HCP assessment of disease activity. STUDY LIMITATIONS: Limited sample size; lack of control group; no longitudinal follow-up. CONCLUSIONS: The addition of the MBDA test to clinical assessment led to meaningful changes in the treatment plans of 38% of RA patients being cared for by HCPs in office practice. Even though treatment was potentially improved, the overall quantity of drug use was minimally affected.
24371446 Efficacy and safety of iguratimod for the treatment of rheumatoid arthritis. 2013 All randomized controlled trials (RCTs) of iguratimod for rheumatoid arthritis (RA) to assess its efficacy and safety are included in this paper. The Review Manager software was used for meta-analysis to assess risk bias of the studies included, and GRADE profiler software was used for the evidence quality of the studies included. Four RCTs involving 1407 patients with RA were included. Meta-analyses showed that, after 24-week therapy, ACR20, tender joint count, swollen joint count, rest pain, physician and patient global assessment of disease activity, HAQ score, ESR, and CRP in iguratimod group were better than those in placebo group and that the difference between those of iguratimod group and those of other DMARDs (MTX and SASP) group was not significant. GRADE evidence classification of the studies included was moderate. Iguratimod for RA had few adverse events, and its efficacy and safety were the same as those of MTX and SASP for RA. The results of this systematic review suggest that more high-quality and large-scaled RCTs were needed to determine the efficacy of iguratimod for RA and whether iguratimod is as effective as other DMARDs besides MTX and SASP.
23995733 Serum level of osteopontin as an inflammatory marker does not indicate disease activity or 2014 Mar Osteopontin (OPN) is known to be significantly involved in the pathogenesis of rheumatoid arthritis (RA). This study aimed to evaluate if the serum concentration of OPN in patients with RA before and after therapeutic treatments was correlated to disease activity and response to therapy. Blood samples from 40 patients with RA were collected at baseline and six months after starting treatment with disease-modifying antirheumatic drugs (DMARDs) and/or tumor necrosis factor (TNF)-α blockers. Serum levels of OPN were measured by ELISA. At baseline, the serum OPN level in RA patients was significantly higher than that of the healthy group. The OPN level at baseline in RA patients with severe disease activity as evaluated by DAS28 was slightly higher than that of those with moderate disease activity. The serum OPN level in RA patients was not significantly correlated with the DAS28 level. The serum OPN level in both responders and non-responders after therapy was significantly decreased regardless of responsiveness to therapy. Also, the OPN level at baseline did not affect the responsiveness to therapeutic treatments. In conclusion, serum OPN level was not correlated with disease activity or responsiveness of RA patients to therapeutic treatments.
23900576 A meta-analysis of the role of p38 mitogen-activated protein kinase inhibitors in patients 2013 Dec The role of p38 mitogen-activated protein kinase (MAPK) inhibitors for treating rheumatoid arthritis (RA) is debated. Therefore, we performed a meta-analysis of all published randomized controlled trials (RCTs) to evaluate the efficacy and safety of p38 MAPK inhibitors in patients with active RA. Searches were conducted in the databases PubMed, EMBASE, and Cochrane Library. We identified three articles including four RCTs with analysis on the efficacy and safety of p38 inhibitors for the treatment of RA. Our meta-analysis showed that a better American College of Rheumatology 20% improvement (ACR20) was observed in the p38 inhibitors group compared with the placebo group, but there were no meaningful differences in ACR50, Disease Activity Score in 28 joints response, and CRP levels between two groups past week 12. The overall adverse events were similar between placebo and treatment groups. In conclusion, p38 MAPK inhibitors showed modest efficacy in patients with RA. However, this conclusion is based on the small number of available studies and inadequate sample size, and more well-designed RCTs will be necessary to determine the role of p38 MAPK inhibitors in RA.
25028372 Association of anticyclic citrullinated peptide antibodies and/or rheumatoid factor status 2014 Aug OBJECTIVE: To compare the initial clinical, biological, and radiographic findings of early arthritis by positivity for rheumatoid factor (RF) and/or anticyclic citrullinated peptide antibodies (anti-CCP), and to validate a patient profile based on this serologic information. METHODS: The ESPOIR cohort comprises patients presenting synovitis of at least 2 joints for 6 weeks to 6 months. Patients underwent testing for IgM rheumatoid factor (IgM-RF) and anti-CCP2 antibodies and were divided into 4 groups: RF- and anti-CCP- (group 1), RF+ and anti-CCP- (group 2), RF- and anti-CCP+ (group 3), RF+ and anti-CCP+ (group 4). We compared the groups in terms of clinical, biological, and radiographic features (baseline scores and 6-month and 12-month progression). RESULTS: Of the 813 recruited patients, 406 (50%) were in group 1, 91 (11.2%) in group 2, 34 (4.1%) in group 3, and 281 (34.6%) in group 4. Mean baseline erythrocyte sedimentation rate and C-reactive protein were higher for anti-CCP+ groups (groups 3 and 4) than for other groups (p < 0.001), and van der Heijde-modified Sharp score for radiographs was higher for group 4 than for other groups (p < 0.001). Clinical presentation was not consistently associated with serologic profile. Radiographic progression at 1 year was higher for anti-CCP+ groups than other groups (p < 0.001). CONCLUSION: The phenotype of patients with early arthritis with or without anti-CCP and/or RF positivity did not correspond to a particular clinical presentation. However, baseline acute-phase reactants and short-term radiographic progression were high in patients with anti-CCP positivity, which may be associated with the inflammatory process and progressive disease in patients with early arthritis.
23981363 Drug survival of the first course of anti-TNF agents in patients with rheumatoid arthritis 2013 Nov OBJECTIVES: To compare drug survival of different anti-TNF drugs (infliximab, INF, etanercept, ETA, and adalimumab, ADA) in rheumatoid arthritis (RA) and spondyloarthritis (SpA) by analysing data collected from an Italian multicenter observational cohort study. METHODS: All patients with RA or SpA registered in the MonitorNet database who started their first course of anti-TNF therapy were included. Overall drug survival was measured, along with specific reasons of discontinuation (inefficacy or adverse events). A first set of analyses using RA as reference category assessed the relationship between diagnosis and drug survival. A second set of analyses stratified by diagnosis (RA and SpA) used INF as reference drug. Adjustment for confounders was performed. The results are presented as adjusted hazard ratios (adjHR) and 95% confidence intervals (95%CI). RESULTS: 2640 RA patients and 1220 SpA patients with a median follow-up of 17 months (IQR 7.2-33.4) were included in the analyses. Patients with a diagnosis of SpA showed a lower risk of drug discontinuation with an adjHR (95%CI) of 0.81 (0.73, 0.90). In SpA, the subset of patients with ankylosing spondylitis (AS) showed the best survival on treatment. In RA, both ETA and ADA showed a significantly lower probability of withdrawal when compared to INF [adjHR (95%CI) 0.46 (0.38, 0.56) and 0.68 (0.57, 0.81), respectively]. Similar results were found in SpA. CONCLUSIONS: Drug survival for SpA is longer than that in RA mainly due to the AS subgroup. In both RA and SpA, ETA and ADA showed a better retention on treatment when compared to INF.
24996676 Total joint arthroplasty of the distal radioulnar joint for rheumatoid arthritis. 2014 Sep PURPOSE: To evaluate the clinical and radiological results of primary total distal radioulnar joint (DRUJ) replacement as well as reconstruction following ulnar head excision in patients with rheumatoid arthritis (RA). METHODS: Seventeen patients with RA underwent 19 total DRUJ replacement between 2005 and 2011. Mean age at the time of the surgery was 57 years. Mean follow-up was 39 months (range, 12-79 mo). Pain level was evaluated using a visual analog scale (VAS). Pronation and supination were recorded before and after surgery. A patient satisfaction survey was used, as well as postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Related Wrist Evaluation (PRWE) scores. Ulnar translocation of the carpus was assessed radiographically, and the presence or absence of radiolucent zones around the implant were recorded. RESULTS: The preoperative average VAS score for the 19 joints was 7.3. Pain decreased after surgery to 2.2. Pronation improved from 56° before surgery to 78° afterward, a 39% improvement. Supination improved from 57° before surgery to 71° afterward, a 27% improvement. Final scores were 24 for the DASH and 24 for the PRWE. Fifteen patients reported substantial pain relief. All patients were satisfied with their surgical result. CONCLUSIONS: The results of this study suggest that total replacement of the DRUJ is of benefit to the patient with RA. Pronation was significantly increased and supination was increased but did not approach significance. Improvement in VAS score suggests that pain was decreased. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
25126750 Inhibition of HMGB1-induced angiogenesis by cilostazol via SIRT1 activation in synovial fi 2014 High mobility group box chromosomal protein 1 (HMGB-1) released from injured cells plays an important role in the development of arthritis. This study investigated the anti-angiogenic effects of cilostazol in collagen-induced arthritis (CIA) of mice, and the underlying mechanisms involved. The expressions of HIF-1α, VEGF, NF-κB p65 and SIRT1 in synovial fibroblasts obtained from rheumatoid arthritis (RA) patients were assessed by Western blotting, and in vitro and in vivo angiogenesis were analyzed. Tube formations by human microvascular endothelial cells (HMVECs) were significantly increased by direct exposure to HMGB1 or to conditioned medium derived from HMGB1-stimulated RA fibroblasts, and these increases were attenuated by cilostazol, the latter of which was blocked by sirtinol. HMGB1 increased the expression of HIF-1α and VEGF and concomitantly increased nuclear NF-κB p65 and DNA binding activity, but these effects of HMGB1 were inhibited by cilostazol. SIRT1 protein expression was time-dependently decreased (3-24 hr) by HMGB1, which was recovered by pretreatment with cilostazol (1-30 µM) or resveratrol, accompanying with increased SIRT1 deacetylase activity. In the tibiotarsal joint tissues of CIA mice treated with vehicle, HIF-1α- and VEGF-positive spots and CD31 staining were markedly exaggerated, whereas SIRT1 immunofluorescence was diminished. These variables were wholly reversed in cilostazol (30 mg/kg/day)-treated mice. Furthermore, number of blood vessels stained by von Willebrand factor antibody was significantly lower in cilostazol-treated CIA mice. Summarizing, cilostazol activated SIRT1 and inhibited NF-κB-mediated transcription, thereby suppressing the expression of HIF-1α and VEGF. In addition, cilostazol caused HIF-1α deacetylation by enhancing SIRT1 activity and reduced VEGF production, thereby had an anti-angiogenic effect in vitro studies and in CIA murine model.
24334647 Determining a magnetic resonance imaging inflammatory activity acceptable state without su 2014 Feb OBJECTIVE: To assess the predictive value of magnetic resonance imaging (MRI)-detected subclinical inflammation for subsequent radiographic progression in a longitudinal study of patients with rheumatoid arthritis (RA) in clinical remission or low disease activity (LDA), and to determine cutoffs for an MRI inflammatory activity acceptable state in RA in which radiographic progression rarely occurs. METHODS: Patients with RA in clinical remission [28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6, n = 185] or LDA state (2.6 ≤ DAS28-CRP < 3.2, n = 69) with longitudinal MRI and radiographic data were included from 5 cohorts (4 international centers). MRI were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS). Statistical analyses included an underlying conditional logistic regression model stratified per cohort, with radiographic progression as dependent variable. RESULTS: A total of 254 patients were included in the multivariate analyses. At baseline, synovitis was observed in 95% and osteitis in 49% of patients. Radiographic progression was observed in 60 patients (24%). RAMRIS synovitis was the only independent predictive factor in multivariate analysis. ROC analysis identified a cutoff value for baseline RAMRIS synovitis score of 5 (maximum possible score 21). Rheumatoid factor (RF) status yielded a significant interaction with synovitis (p value = 0.044). RF-positive patients with a RAMRIS synovitis score of > 5 vs ≤ 5, had an OR of 4.4 (95% CI 1.72-11.4) for radiographic progression. CONCLUSION: High MRI synovitis score predicts radiographic progression in patients in clinical remission/LDA. A cutoff point for determining an MRI inflammatory activity acceptable state based on the RAMRIS synovitis score was established. Incorporating MRI in future remission criteria should be considered.
24399184 Systematic review of 2008-2012 literature and update of recommendations for the use of met 2013 Dec 18 The objective of this review is to update the recommendations of the 2010 Italian Consensus on the use of methotrexate (MTX) in rheumatoid arthritis (RA) and other rheumatic diseases. The literature published between 2008 and 2012 was systematically reviewed and updated recommendations on MTX use in rheumatic diseases, particularly RA, were formulated. These recommendations were approved by a panel of expert Italian Rheumatologists. A total of 10,238 references were identified, among which 70 studies were selected for critical evaluation. Sufficient evidence had accumulated to warrant changes to several of the recommendations in the new version. A new recommendation for patients with RA who are in MTX-induced clinical remission was also proposed and approved by the panel. Updated recommendations for the use of MTX in patients with RA or other rheumatologic disease are proposed.
23271131 Polymorphism in vitamin D receptor and osteoprotegerin genes in Egyptian rheumatoid arthri 2013 May 1α,25-Dihydroxyvitamin D3 upregulates the expression of the receptor activator of nuclear factor kB ligand (RANKL), and downregulates osteoprotegerin (OPG) expression. We tested the effects of polymorphisms in the vitamin D receptor gene (VDR), and OPG gene in rheumatoid arthritis (RA) patients and healthy controls and their relationship to bone mineral density (BMD) and development of osteoporosis. Three hundred and fifty women were evaluated, 200 women having RA and 150 healthy control. The subjects were genotyped for polymorphism at BsmI in VDR and A163G in OPG genes by polymerase chain reaction followed by restriction fragment length polymorphism analysis. BMD was also measured. In A163G, the G allele increased the risk for RA and for the development of osteoporosis. We found a significant association between lower hip (BMD-h) and genotype variants of VDR (BsmI) and OPG A163G in RA patients with osteoporosis. Our results suggested that OPG A163G polymorphism was associated with RA susceptibility and with the development of osteoporosis in these patients. Also, VDR and OPG genes are important candidates for osteoporosis in RA patients.
24241481 Repeated anticitrullinated protein antibody and rheumatoid factor assessment is not necess 2014 Jan OBJECTIVE: Presence and levels of anticyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) contribute to the classification and prognosis of rheumatoid arthritis (RA). The objective was to determine the usefulness of repeating anti-CCP/RF measurements during the first 2 years of followup in patients with early arthritis. METHODS: In patients with early undifferentiated arthritis, serial anti-CCP and RF were measured using automated second-generation assays every 6 months for 2 years. Frequencies of seroconversions (from negative to positive or the reverse) and changes in antibody levels during followup were determined. RESULTS: In all, 775 patients, mean (SD) age 48.2 (12.5) years, mean symptom duration 3.4 (1.7) months, 76.6% female, were analyzed; 614 (79.2%) satisfied the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria for RA at baseline. At baseline, respectively for anti-CCP and RF, 318 (41.0%) and 181 (23.4%) patients were positive, of whom 298 (93.7% of the positive) and 111 (61.3% of the positive) were highly positive (above 3 × upper limit of the norm). There were only 12 anti-CCP seroconversions toward the positive (i.e., 2.6% of the anti-CCP-negative), 21 seroconversions toward the negative (6.6% of the anti-CCP-positive), and 8 (1.0%) changes to a higher anti-CCP level category during the 2-year followup; respectively for RF, 27 (4.6%), 95 (52.5%), and 13 (1.7%). CONCLUSION: In this cohort of patients with early arthritis, including in the subset of patients who did not fulfill the RA criteria, antibody status showed little increase over a 2-year period. Repeated measurements of anti-CCP/RF very infrequently offer significant additional information.