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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
23943546 Tofacitinib for treatment of rheumatoid arthritis. 2013 Aug The management of rheumatoid arthritis has seen a dramatic improvement with the introduction of a range of biological disease modifying anti-rheumatic drugs (DMARDs) in recent years. Nonetheless, a proportion of patients remain resistant or intolerant to multiple conventional and biological DMARDs, so innovative strategies are needed to offer patients new therapeutic options. Tofacitinib is the first of a new class of orally active DMARDs, with immunomodulating effects through inhibition of intracellular Janus kinase (JAK) pathways. It has been recently licensed for treatment of adults with moderate to severe RA in the US, Japan, and Russia. In this review the authors evaluate the efficacy and safety of tofacitinib in RA, focusing predominantly on the phase 3 study data.
24878860 Incidence of neoplasms in the most prevalent autoimmune rheumatic diseases: a systematic r 2014 Mar This article is a systematic review of the literature about the coexistence of cancer and autoimmune rheumatic diseases, their main associations, cancers and possible risk factors associated, with emphasis on existing population-based studies, besides checking the relation of this occur with the use of the drugs used in the treatment of autoimmune diseases. A search was conducted of scientific articles indexed in the Cochrane / BVS, Pubmed / Medline and Scielo / Lilacs in the period from 2002 to 2012. Also consulted was the IB-ICT (Brazilian digital library of theses and Masters), with descriptors in Portuguese and English for "Systemic sclerosis", "Rheumatoid Arthritis", " Systemic Lupus Erythematosus" and "Sjögren's syndrome", correlating each one with the descriptor AND "neoplasms". The results showed that in the database IBICT a thesis and a dissertation for the descriptor SLE met the inclusion criteria, none met RA one thesis to SS. Lilacs in the database/Scielo found two articles on "Rheumatoid Arthritis" AND "neoplasms". In Pubmed/Medline the inicial search resulted in 118 articles, and 41 were selected. The review noted the relationship between cancer and autoimmune rheumatic diseases, as well as a risk factor for protection, although the pathophysiological mechanisms are not known.
24346611 Use of health plan combined with registry data to predict clinical trial recruitment. 2014 Feb BACKGROUND: Large pragmatic clinical trials (PCTs) are increasingly used to conduct comparative effectiveness research. In the context of planning a safety PCT of the live herpes zoster vaccine in rheumatoid arthritis (RA) patients aged ≥ 50 years receiving anti-tumor necrosis factor (TNF) therapy, we evaluated the use of health plan combined with registry data to assess the feasibility of recruiting the 4000 patients needed for the trial and to facilitate site selection. METHODS: Using national US data from Medicare, we identified older RA patients who received anti-TNF therapy in the last quarter of 2009. Extrapolations were made from the Medicare patient population to younger patients and those with other types of insurance using the Consortium of Rheumatology Researchers of North America (CORRONA) disease registry. Patients' treating rheumatologists were grouped into practices and sorted by size from the greatest to the least number of eligible patients. RESULTS: Approximately 50,000 RA patients receiving anti-TNF therapy were identified in the Medicare data, distributed across 1980 physician practices. After augmenting Medicare data with information from CORRONA and extrapolating to younger patients and those with other types of insurance, more than 12,000 potentially eligible study subjects were identified from the 50 largest rheumatology practices. CONCLUSION: Health plan and registry databases appear useful to assess feasibility of large pragmatic trials and to assist in selection of recruitment sites with the greatest number of potentially eligible patients. This novel approach is applicable to trials with simple inclusion/exclusion criteria that can be readily assessed in these data sources.
23817510 Pristane-induced lupus as a model of human lupus arthritis: evolvement of autoantibodies, 2013 Jul OBJECTIVE: Arthritis is frequently seen in human lupus, but rarely in lupus models. Pristane-induced lupus (PIL) can be induced in various mouse strains such as BALB/c and C57BL/6. We herein characterize clinical and histological features of arthritis in the context of systemic lupus and provide a prudent comparison with models of rheumatoid arthritis (RA). METHODS: A total of 57 BALB/c mice received pristane (PIL group) and were analyzed for serum autoantibodies (anti-chromatin-, -histone, -Sm, -dsDNA), as well as for clinical features and histopathology of joints, lungs and kidneys. Joint pathology was quantified by image analysis and tissue cytometry. Ten C57BL/6 mice (Bl/6-PIL) and historical groups of two different RA models were analyzed accordingly. RESULTS: In BALB/c PIL, clinical arthritis started at three months, occurred finally in 79% of PIL (but not in controls, p<0.001) and correlated with areas of inflammation, erosion, cartilage damage, osteoclast numbers and total severity score (for all: r>0.7, p<0.001). After eight months, 58% of PIL (but no controls, p<0.001) had mild-erosive arthritis. In contrast to RA, the most frequent inflammatory cell type of the pannus was granulocytes (17.7%), PIL had lower numbers of osteoclasts, erosions rarely affected both layers of the cortical bone and there was no progression to complete joint destruction (even after one year of observation). Serum autoantibodies (auto-abs) preceded arthritis and became significantly elevated in all PIL; affected joints showed increased deposits of IgG (and IgM) within the inflammatory tissue, indicative of an ab-mediated process. PIL mice with arthritis also showed signs of pulmonary (100%) and renal (46%) lupus. In contrast to BALB/c, Bl/6-PIL mice did not develop any signs of arthritis. CONCLUSION: PIL in BALB/c mice is characterized by severe organ involvement, typical autoabs and by a mild-erosive arthritis with similarities to, but also with distinct differences from, RA. PIL may help to study arthritis along with other key features of systemic lupus erythematosus after therapeutic interventions or in knock-out models based on a BALB/c but not on a C57BL/6 background.
24907147 Short-term efficacy of etanercept plus methotrexate vs combinations of disease-modifying a 2014 Nov OBJECTIVES: The aims of this study were to investigate the short-term benefit of etanercept (ETN) + MTX vs conventional synthetic DMARDs (csDMARDs; HCQ, LEF or SSZ) + MTX in subjects with established RA. The effect of disease duration (≤2 years vs >2 years) and severity (moderate vs severe) on treatment outcomes was also assessed. Methods. Data from Asian and Latin American subjects with inadequate response to MTX were pooled from the APPEAL (ETN 25 mg biweekly + MTX or csDMARD + MTX; NCT00422227) and Latin RA (ETN 50 mg/week + MTX or csDMARD + MTX; NCT00848354) studies. Endpoints included the 28-joint DAS with ESR (DAS28-ESR) low disease activity (LDA; ≤3.2), DAS28 remission (<2.6) and HAQ score ≤0.5. RESULTS: Four hundred seventy-eight subjects received ETN + MTX, 245 subjects received csDMARD + MTX [HCQ + MTX (n = 81), LEF + MTX (n = 69), SSZ + MTX (n = 95)]. At week 16, significantly more subjects receiving ETN + MTX vs subjects on csDMARDs + MTX achieved DAS28-ESR LDA (39% vs 18%, P < 0.001), remission (18% vs 7%, P < 0.001) and HAQ ≤0.5 (48% vs 34%, P < 0.001). For both treatment arms, these endpoints were achieved by a greater proportion of subjects with ≤2 years vs >2 years disease duration and with moderate vs severe disease activity. CONCLUSION: Overall, ETN + MTX was more effective in treating subjects with established RA than csDMARDs + MTX at 16 weeks. More subjects with shorter disease duration and moderate disease activity achieved optimal response regardless of treatment regimen. TRIAL REGISTRATION: clinicaltrials.gov, NCT00422227 and NCT00848354.
25078624 Genetic basis of rheumatoid arthritis: a current review. 2014 Sep 19 Rheumatoid arthritis (RA) is one of the most common autoimmune diseases. As with other complex traits, genome-wide association studies (GWASs) have tremendously enhanced our understanding of the complex etiology of RA. In this review, we describe the genetic architecture of RA as determined through GWASs and meta-analyses. In addition, we discuss the pathologic mechanism of the disease by examining the combined findings of genetic and functional studies of individual RA-associated genes, including HLA-DRB1, PADI4, PTPN22, TNFAIP3, STAT4, and CCR6. Moreover, we briefly examine the potential use of genetic data in clinical practice in RA treatment, which represents a challenge in medical genetics in the post-GWAS era.
25240769 Adding a "GRADE" to the quality appraisal of rheumatoid arthritis guidelines identifies li 2014 Nov OBJECTIVES: To assess how well treatment recommendations for rheumatoid arthritis (RA) address Grading of Recommendations Assessment, Development and Evaluation (GRADE) steps and determine whether these steps can be adequately appraised using Appraisal of Guidelines Research & Evaluation II (AGREE-II). STUDY DESIGN AND SETTING: We systematically reviewed English-language treatment recommendations for the pharmacologic management of RA since 2000, assessed how well GRADE steps were addressed, rated AGREE-II quality, and compared the findings. RESULTS: GRADE steps were poorly addressed by the 44 included guidelines. Few guidelines discussed study limitations and/or risk of bias (23%), inconsistency (50%), indirectness (39%), imprecision (23%), or potential for publication bias (0%). Observational evidence was cited in 96% but rarely evaluated systematically. Only one guideline considered evidence on patients' preferences for health outcomes, and few provided an explicit justification for the strength of evidence or recommendation. The five GRADE steps that overlapped with AGREE-II questions were addressed more frequently (by 54-100% of guidelines) than the 13 GRADE steps not directly assessed by AGREE-II (0-50%). Among the nine guidelines rated as "Recommended for use" by AGREE-II, 8 of 13 GRADE steps were not addressed consistently by any guideline. CONCLUSION: GRADE's steps are poorly addressed by RA recommendations. AGREE-II provides a broad assessment of quality but lacks sufficient granularity to assess how well a guideline addresses GRADE's steps.
23138614 Do anti-TNF-α drugs increase cancer risk in rheumatoid arthritis patients? 2013 Apr Concern has been raised about an increased risk of lymphoma and skin cancers in patients with rheumatoid arthritis due to administration of anti-TNF-α drugs. Meta-analysis of observational data from registries as well as from randomized controlled trials has failed to show a significant increase in the risk of lymphoma when the sample size has been sufficiently large; skin cancer risk may represent a valid concern. Issues relating to interpretation of these data are discussed.
23852763 Non-viral opportunistic infections in new users of tumour necrosis factor inhibitor therap 2014 Nov OBJECTIVES: To determine among patients with autoimmune diseases in the USA whether the risk of non-viral opportunistic infections (OI) was increased among new users of tumour necrosis factor α inhibitors (TNFI), when compared to users of non-biological agents used for active disease. METHODS: We identified new users of TNFI among cohorts of rheumatoid arthritis (RA), inflammatory bowel disease and psoriasis-psoriatic arthritis-ankylosing spondylitis patients during 1998-2007 using combined data from Kaiser Permanente Northern California, two pharmaceutical assistance programmes for the elderly, Tennessee Medicaid and US Medicaid/Medicare programmes. We compared incidence of non-viral OI among new TNFI users and patients initiating non-biological disease-modifying antirheumatic drugs (DMARD) overall and within each disease cohort. Cox regression models were used to compare propensity-score and steroid- adjusted OI incidence between new TNFI and non-biological DMARD users. RESULTS: Within a cohort of 33 324 new TNFI users we identified 80 non-viral OI, the most common of which was pneumocystosis (n=16). In the combined cohort, crude rates of non-viral OI among new users of TNFI compared to those initiating non-biological DMARD was 2.7 versus 1.7 per 1000-person-years (aHR 1.6, 95% CI 1.0 to 2.6). Baseline corticosteroid use was associated with non-viral OI (aHR 2.5, 95% CI 1.5 to 4.0). In the RA cohort, rates of non-viral OI among new users of infliximab were higher when compared to patients newly starting non-biological DMARD (aHR 2.6, 95% CI 1.2 to 5.6) or new etanercept users (aHR 2.9, 95% CI 1.5 to 5.4). CONCLUSIONS: In the USA, the rate of non-viral OI was higher among new users of TNFI with autoimmune diseases compared to non-biological DMARD users.
23213019 Study to determine the criterion validity of the SenseWear Armband as a measure of physica 2013 Jun OBJECTIVE: Measuring physical activity in people with rheumatoid arthritis (RA) is of great importance in light of the increased mortality in this population due to cardiovascular disease. Validation of activity monitors in specific populations is recommended to ensure the accuracy of physical activity measurement. Thus, the purpose of this study was to determine the validity of the SenseWear Pro3 Armband (SWA) as a measure of physical activity during activities of daily living (ADL) in people with RA. METHODS: Fourteen subjects (8 men and 6 women) with a diagnosis of RA were recruited from rheumatology clinics at the Mid-Western Regional Hospitals, Limerick, Ireland. Participants undertook a series of ADL of varying intensities. The SWA was compared to the criterion measures of the Oxycon Mobile indirect calorimetry system (energy expenditure in kJ) and of manual video observation (step count). Bland and Altman, intraclass correlation coefficient (ICC), and correlation analyses were done using SPSS, version 19.0. RESULTS: The SWA showed substantial agreement (ICC 0.717, P < 0.001) and a strong relationship (Pearson's correlation coefficient = 0.852) compared with the criterion measure when estimating energy expenditure during ADL. However, it was found that the SWA overestimated energy expenditure, particularly at higher intensity levels. The ability of the SWA to estimate step counts during ADL was poor (ICC 0.304, P = 0.038). CONCLUSION: The SWA can be considered a valid tool to estimate energy expenditure during ADL in the RA population; however, attention should be paid to its tendency to overestimate energy expenditure.
25241333 Efficacy and safety of tocilizumab in elderly patients with rheumatoid arthritis. 2015 Jan OBJECTIVE: To assess the safety and efficacy of tocilizumab (TCZ) in elderly (≥65 years) rheumatoid arthritis (RA) patients treated in daily practice. METHODS: We conducted a retrospective study of TCZ use in RA patients in five French university hospitals between 2009 and 2012. We considered two age groups, under 65 years (<65) and over 65 years (≥65). TCZ efficacy was evaluated at 24 weeks by the European League Against Rheumatism (EULAR) response and remission score. We also evaluated drug maintenance and safety, relative to adverse events discontinuation. A multivariate cumulative logit model for ordinal categories was performed to assess the relationship between age class and EULAR response (none, moderate and good) adjusted on possible confounders. TCZ retention (drug survival) over time was estimated with the Kaplan-Meier method. Treatment retention curves were compared according to age group with the log-rank test. RESULTS: Among 222 RA patients treated with TCZ, 61 (27.5%) were≥65 years at the initiation of treatment. After 6 months, this elderly patient group less often reached remission (27.8% versus 45.6%; P=0.02) or good EULAR response (40.7% versus 61.0%; P<0.01) compared to the younger patient group (<65). Multivariate analysis adjusted on baseline C-reactive protein and disease duration confirmed that elderly patients were more likely to have a lower EULAR response (none vs moderate-good or none-moderate vs good) (OR: 3.63; 95% CI [1.86-7.06], P<0.001) compared to younger patients. Drug maintenance for TCZ and adverse events discontinuation rates were similar between the two age groups. CONCLUSION: In daily practice, TCZ seems to be well tolerated in RA patients but is less efficient in elderly patients. A broader field of analysis to include an international register will be required to confirm these results.
25274898 Anticyclic citrullinated peptide antibodies in rheumatoid and nonrheumatoid rheumatic diso 2014 Dec OBJECTIVE: Anticyclic citrullinated peptide antibodies (anti-CCP) are considered specific markers of rheumatoid arthritis (RA) and have been included in the revised classification criteria for RA diagnosis. However, these antibodies have also been detected in patients with other types of chronic inflammatory rheumatism. Our objectives were to identify the prevalence of positive anti-CCP patients in non-RA diseases, to determine the diagnostic value of anti-CCP for the diagnosis of RA, to specify the clinical characteristics of non-RA patients positive for anti-CCP, and to determine the discriminatory value of the levels of anti-CCP in patients among the various diseases. METHODS: We carried out an observational and descriptive study. All the determinations of anti-CCP requested by the 2 rheumatology departments at Cochin Hospital over a period of 18 months were analyzed. Such determinations were requested for 1162 patients in total. Anti-CCP levels were determined with the Euro Diagnostica ELISA kit, with values ≥ 25 U for this test being considered positive. The diagnosis of rheumatic conditions was the responsibility of the treating physician. RESULTS: Anti-CCP antibodies were detected in 357 (30.7%) of the 1162 patients. The prevalence of anti-CCP was 292/417 (70.0%) in RA, 13/122 (10.6%) in patients with psoriatic arthritis, 13/62 (20.9%) in patients with unclassified rheumatism, 11/33 (33.3%) in patients with primary Sjögren syndrome, 5/30 (16.6%) in patients with systemic lupus erythematosus, 3/28 (10.7%) in patients with mixed connective tissue disorder, 3/36 (8.3%) in patients with systemic sclerosis, 7/44 (15.9%) in patients with juvenile arthritis, and 6/220 (2.7%) in patients with noninflammatory diseases. In the population of patients positive for anti-CCP, mean anti-CCP levels were 869.4 (± 978.4) U/ml, with no significant difference between RA [854.8 (± 959.8) U/ml] and any of the non-RA conditions [922.7 (± 1070.0) U/ml]. CONCLUSION: Anti-CCP are a hallmark of RA, but may be observed in other inflammatory, systemic, or mechanical diseases. In this large cohort of patients, the presence of second-generation anti-CCP (anti-CCP2) antibodies is useful in diagnosing RA (70% sensitivity, 91.3% specificity), but examining the levels of these antibodies does not appear to offer further discriminatory power among patients who are anti-CCP2-positive.
24340926 [Body structure and serum concentration of adiponectin and cytokines (IL-6, -10 and TNF-al 2013 In the study the comparative assessment of the main markers of body structure and serum concentrations of adiponectin and cytokines (IL-6, TNF-alpha, IL-10) has been carried out in 26 rheumatoid arthritis patients at a normal body mass index (BMI) [Me; 25; 75 percentile = 24,1 (23,5; 28,6)] and in 15 obese patients [BMI = 33,4 (31,3; 42,7)]. The control group consisted of 25 apparently healthy individuals [BMI = 23,5 (21,8; 24,4)] randomized by sex and age with the main group. The expressed increase of production of pro-inflammatory cytokines--TNF-alpha and IL-6 in both groups has been established, in the group of patients with obesity serum concentration of these cytokines 1,8-2,4 fold exceeded similar in group with a normal BMI and amounted 245,3 (89,3; 302,3) and 54,4 (18,4; 72,3) microg/ml correspondingly. Anti-inflammatory cytokine IL-10 increased more significantly at normal BMI [227,2 (143,4; 282,3) pg/ml)] in comparison with group of rheumatoid arthritis patients with obesity [122,2 (89,3; 164,3) pg/ml] while in control group its content was 60,8 (24,3; 75,4) pg/ml. It has been shown that serum concentration of adiponectin was higher in group with normal BMI [9,2 (6,3; 15,3) mcg/ml] and was lower in patients with obesity [3,2 (2,3; 8,3) mcg/ml] than in healthy subjects [7,4 (4,4; 9,2) mcg/ml]. The analysis of the body structure markers demonstrate that fatty tissue content increase both in patients with normal BMI (1,7 fold) and at obesity (2,6 fold).
25178316 E-health to improve work functioning in employees with rheumatoid arthritis in rheumatolog 2014 OBJECTIVES: To evaluate the feasibility of an e-health intervention in rheumatology practice for employees with rheumatoid arthritis (RA) who experience problems with work functioning. METHOD: Twenty-three out of 90 patients with RA from a hospital rheumatology department, invited by letter, participated in a feasibility study. The 3-month internet e-health programme consisted of a self-management programme using a three-step problem-solving strategy: (step 1) analyse your work problems and opportunities; (step 3) identify solutions; and (step 3) work out a strategy (action plan). Support and personal feedback was provided by a rheumatology nurse. Patients completed assignments, received information, and actively worked on their goals. The main feasibility outcome included satisfaction with the programme. Other feasibility outcomes included usefulness, suitability, website use, and work functioning measured at baseline and/or 3 months using questionnaires, semi-structured interviews, and website data. RESULTS: In total, 95% of the participants were satisfied with the programme, and 96% thought the programme was useful for working RA patients and would recommend the programme to other working RA patients (91%). On the website, all patients at least partially completed the assignments in step 1 and 12 patients completed at least one assignment in step 3. Patients judged the website as well arranged with clear tasks. Patients worked on a range of (individual) goals, resolving work challenges using different strategies and actions. CONCLUSIONS: The e-health intervention is a feasible intervention for rheumatology practice justifying further effectiveness evaluation while allowing for further improvements in the selection of RA patients and shaping the intervention.
25244989 Singapore Chapter of Rheumatologists Consensus Statement on the Eligibility for Government 2014 Aug INTRODUCTION: Up to 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional non-biologic disease modifying antirheumatic drugs (nbDMARDs), and may benefit from therapy with biologic DMARDs (bDMARDs). However, the high cost of bDMARDs limits their widespread use. The Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore aims to define clinical eligibility for government-assisted funding of bDMARDs for local RA patients. MATERIALS AND METHODS: Evidence synthesis was performed by reviewing 7 published guidelines on use of biologics for RA. Using the modified RAND/UCLA Appropriateness Method (RAM), rheumatologists rated indications for therapies for different clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate the practice recommendations. RESULTS: Ten recommendations including diagnosis of RA, choice of disease activity measure, initiation and continuation of bDMARD and option of first and second-line therapies were formulated. The panellists agreed that a bDMARD is indicated if a patient has (1) active RA with a Disease Activity Score in 28 joints (DAS28) score of ≥3.2, (2) a minimum of 6 swollen and tender joints, and (3) has failed a minimum of 2 nbDMARD combinations of adequate dose regimen for at least 3 months each. To qualify for continued biologic therapy, a patient must have (1) documentation of DAS28 every 3 months and (2) at least a European League Against Rheumatism (EULAR) moderate response by 6 months after commencement of therapy. CONCLUSION: The recommendations developed by a formal group consensus method may be useful for clinical practice and guiding funding decisions by relevant authorities in making bDMARDs usage accessible and equitable to eligible patients in Singapore.
23306035 Cytokine measurements and possible interference from heterophilic antibodies--problems and 2013 May 15 Cytokines are important in the understanding of the immune process in health and disease and are valuable indicators in diagnostics. Measurements of cytokines are based on immunometric methods, and it is important to understand possible pitfalls in these methods to produce reliable cytokine data. This paper focuses on obtaining optimal measurements when applying enzyme-linked immunosorbent assay (ELISA) or multiplex immunoassays (MIA). Cytokines are measured in serum or plasma, as well as in various other body fluids, all containing a series of antibodies and the possibility of interference from these. Some antibodies, such as heterophilic and human anti-animal antibodies, are able to interfere with all immunoassays, but the immunometric techniques are most prone to serious interference from this source. Another type, rheumatoid factor (RF) is a composite of different autoimmune antibodies which can be present in both blood and synovial fluid. RF is present in some arthritic diseases as well as in some other medical conditions. When present, especially RF IgM is known to interfere with the immunometric measurements. A possible and affordable solution to diminish this interference is PEG precipitation, but other efficient, but more expensive, methods, such as precipitation using Protein L or commercially available blocking agents, are also available. Interference of RF is at present not tested in all cytokine assays, but degree of interference from RF, human anti-animal and heterophilic antibodies, as well as from other possible disease-specific antibodies, must always be considered when developing and applying new assays for cytokine measurements.
24495819 The rising burden of rheumatoid arthritis surpasses rheumatology supply in Ontario. 2013 Oct 31 OBJECTIVES: Accurate data on the burden of rheumatoid arthritis (RA) are scarce, but critical in helping health care providers and decision makers to optimize clinical and public health strategies for disease management. We quantified the burden of RA in Ontario from 1996 to 2010 by age, sex and health planning region. METHODS: We used the Ontario Rheumatoid Arthritis administrative Database (ORAD), a validated population-based cohort of all Ontarians with RA, to estimate the crude prevalence and incidence of RA among men and women, and by age group from 1996 to 2010. Burden by area of patient residence and rheumatology supply also were determined. RESULTS: The number of RA patients increased over time, from 42,734 Ontarians (0.5%) in 1996 to 97,499 (0.9%) in 2010. On average 5,830 new RA patients were diagnosed each year. In 2010, the burden was higher among females (1.3%) than males (0.5%) and increased with age, with almost half of all RA patients aged 65 years and older. The burden was higher in northern communities (1.0%) than in southern urban areas (0.7%). During the study period, the number of rheumatologists practicing in Ontario remained unchanged (approximately 160). CONCLUSION: Over a 15-year period, the number of RA patients more than doubled with no concomitant increase in the number of practicing rheumatologists. We observed considerable regional variation in burden, with the highest rates observed in the north. Our findings highlight the need for regional approaches to the planning and delivery of RA care in order to manage the growing burden.
23380896 Assessing rheumatologists and radiologists agreement rate regarding the diagnosis of focal 2013 Aug In rheumatoid arthritis, diagnosis of bone erosions and osteopenic changes in earlier stages is extremely important to the initiation of specific and more aggressive treatment to subsidize the disease, decrease morbidities, and increase patients' quality of life. In the present study, we assessed consensus rate of rheumatologists and radiologists regarding the detection of radiographic changes of hand in rheumatoid arthritis. Ninety-six adult patients with documented rheumatoid arthritis referring to our outpatient rheumatology clinic during March 2009-2010, enrolled into this cross-sectional study. Hands and wrists X-ray obtained for all patients. The films were observed by a rheumatologist and a radiologist separately, to detect focal bone erosions, periarticular osteopenic changes, and joint space losses. Agreement rates between the two specialists were assessed using the kappa test ratio. A total of 96 patients comprising 86 (89.5%) female and 10 (10.41%) male with a mean age of 48.5 ± 1.2 years (range 22-76 years old) were studied. The proportion agreement between the radiologist and rheumatologist regarding bone erosions and juxta-articular osteopenic changes was 69.7 and 84.3%, respectively. The kappa agreement coefficient for the diagnosis of bone erosions was 36% which showed significant poor agreement between two specialist (p < 0.001, proportion agreement = 69.7%). As well, the kappa of 20% for the detection of juxta-articular osteopenic changes revealed significant poor agreement between the two specialist (p < 0.047, proportion agreement = 84.3%). The results of the present study demonstrate that there is a minimal agreement between the two radiology and rheumatology specialists regarding simultaneous diagnosis of bone erosions and periarticular osteopenic changes in rheumatoid arthritis patients that emphasis requiring both specialists' X-ray report at the time of diagnosis.
23974221 Palisaded neutrophilic and granulomatous dermatitis associated with ankylosing spondylitis 2013 Dec Palisaded neutrophilic granulomatous dermatitis (PNGD) is a rare neutrophilic dermatosis that shows a broad clinical and histopathological spectrum. The clinical presentation of PNGD varies from asymptomatic papules, to nodules, to annular plaques. The most common clinical presentation is erythematous papules on the extensor surface of extremities, especially fingers and elbows. Histopathological findings demonstrate a spectrum of changes that reflect the evolution of the lesions, from only sparse mixed perivascular infiltrates to interstitial or palisaded granuloma formation with dermal fibrosis. The cause of PNGD is unknown, but there is a prominent association with systemic conditions, particularly with autoimmune diseases, representing rheumatoid arthritis and systemic lupus erythematosus, the most common associations. It has also been described associated to systemic sclerosis, sarcoidosis, systemic vasculitis, inflammatory bowel disease, and lymphoproliferative disorders, and also drugs have been implicated. Recently, it has been described the potential association with tumor necrosis factor alpha inhibitors. This dermatosis should be considered as a marker of systemic disease and particularly it should be considered in patients with history of autoimmune disorders who present with papular eruptions on the extremities.
24330489 Treating to the target of remission in early rheumatoid arthritis is cost-effective: resul 2013 Dec 13 BACKGROUND: Where health economic studies are frequently performed using modelling, with input from randomized controlled trials and best guesses, we used real-life data to analyse the cost-effectiveness and cost-utility of a treatment strategy aiming to the target of remission compared to usual care in early rheumatoid arthritis (RA). METHODS: We used real-life data from comparable cohorts in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry: the DREAM remission induction cohort (treat-to-target, T2T) and the Nijmegen early RA inception cohort (usual care, UC). Both cohorts were followed prospectively using the DREAM registry methodology. All patients fulfilled the American College of Rheumatology criteria for RA and were included in the cohort at the time of diagnosis. The T2T cohort was treated according to a protocolised strategy aiming at remission (Disease Activity Score in 28 joints (DAS28) < 2.6). The UC cohort was treated without DAS28-guided treatment decisions. EuroQol-5D utility scores were estimated from the Health Assessment Questionnaire. A health care perspective was adopted and direct medical costs were collected. The incremental cost effectiveness ratio (ICER) per patient in remission and incremental cost utility ratio (ICUR) per quality-adjusted life year (QALY) gained were calculated over two and three years of follow-up. RESULTS: Two year data were available for 261 T2T patients and 213 UC patients; an extended follow-up of three years was available for 127 and 180 patients, respectively. T2T produced higher remission percentages and a larger gain in QALYs than UC. The ICER was € 3,591 per patient in remission after two years and T2T was dominant after three years. The ICUR was € 19,410 per QALY after two years and T2T was dominant after three years. CONCLUSIONS: We can conclude that treating to the target of remission in early RA is cost-effective compared with UC. The data suggest that in the third year, T2T becomes cost-saving.