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ID PMID Title PublicationDate abstract
27325125 Ultrasound-detected subclinical inflammation was better reflected by the disease activity 2016 Oct Limited data are available about the ultrasound (US)-detected inflammatory features in patients with suspicion of inflammatory arthritis (S-IA) vs. established rheumatoid arthritis (RA). Our study aimed to assess if the presence of power Doppler (PD) can be predicted by a combination of clinical, laboratory and US parameters. We conducted a real-life, retrospective cohort study comparing clinical, laboratory and US parameters of 108 patients with established RA and 93 patients with S-IA. We propose a PD signal prediction model based on a beta-binomial distribution for PD variable using a mix of outcome measures. Patients with RA in clinical remission had significantly more active inflammation and erosions on US when compared with patients with S-IA with similar disease scores (p = 0.03 and p = 0.01, respectively); however, RA patients with different disease activity score (DAS-28) scores had similar PD scores (p = 0.058). The PD scores did not correlate with erosions (p = 0.38) or DAS-28 scores (p = 0.28) in RA patients, but they correlated with high disease activity in S-IA patients (p = 0.048). Subclinical inflammation is more common in patients with RA in clinical remission or with low disease activity than in patients with S-IA; therefore, US was more useful in assessing for true remission in RA rather than diagnosing IA in patients with low disease activity scores. This is the first study to propose a PD prediction model integrating several outcome measures in the two different groups of patients. Further research into validating this model can minimise the risk of underdiagnosing subclinical inflammation.
27043143 Increased Reactive Oxygen Species Formation and Oxidative Stress in Rheumatoid Arthritis. 2016 BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune inflammatory disorder. Highly reactive oxygen free radicals are believed to be involved in the pathogenesis of the disease. In this study, RA patients were sub-grouped depending upon the presence or absence of rheumatoid factor, disease activity score and disease duration. RA Patients (120) and healthy controls (53) were evaluated for the oxidant-antioxidant status by monitoring ROS production, biomarkers of lipid peroxidation, protein oxidation and DNA damage. The level of various enzymatic and non-enzymatic antioxidants was also monitored. Correlation analysis was also performed for analysing the association between ROS and various other parameters. METHODS: Intracellular ROS formation, lipid peroxidation (MDA level), protein oxidation (carbonyl level and thiol level) and DNA damage were detected in the blood of RA patients. Antioxidant status was evaluated by FRAP assay, DPPH reduction assay and enzymatic (SOD, catalase, GST, GR) and non-enzymatic (vitamin C and GSH) antioxidants. RESULTS: RA patients showed a higher ROS production, increased lipid peroxidation, protein oxidation and DNA damage. A significant decline in the ferric reducing ability, DPPH radical quenching ability and the levels of antioxidants has also been observed. Significant correlation has been found between ROS and various other parameters studied. CONCLUSION: RA patients showed a marked increase in ROS formation, lipid peroxidation, protein oxidation, DNA damage and decrease in the activity of antioxidant defence system leading to oxidative stress which may contribute to tissue damage and hence to the chronicity of the disease.
25990366 Ambulatory arterial stiffness index and carotid intima-media thickness in hypertensive rhe 2017 Dec AIM: Rheumatoid arthritis is associated with accelerated atherosclerosis. However, little is known about preclinical atherosclerosis in hypertensive rheumatoid arthritis patients. In this cross-sectional study we assessed the expression of preclinical atherosclerosis in hypertensive rheumatoid arthritis patients in comparison with matched hypertensive non-rheumatoid arthritis patients. METHODS: The study included 52 hypertensive rheumatoid arthritis patients and 42 hypertensive non-rheumatoid arthritis patients. The patients were extensively examined clinically and laboratory tested. The expression of preclinical atherosclerosis was estimated by assessing ambulatory arterial stiffness index and common carotid intima-media thickness. RESULTS: Arterial stiffness index and common carotid intima-media thickness were higher in hypertensive rheumatoid arthritis patients than in hypertensive non-rheumatoid arthritis patients. There was no correlation between arterial stiffness index and common carotid intima-media thickness with markers of inflammation and disease activity in hypertensive rheumatoid arthritis patients. CONCLUSION: The expression of subclinical atherosclerosis is more pronounced in hypertensive rheumatoid arthritis than in hypertensive non- rheumatoid arthritis patients.
26369319 Bone mineral density of postmenopausal women with rheumatoid arthritis depends on disease 2017 Jan The aim of this study was to determine the associations of disease activity and disease duration with the bone mineral density (BMD) in rheumatoid arthritis (RA) patients. We also evaluated the associations of biological drugs with bone loss. A total of 138 postmenopausal RA patients were retrospectively assessed to identify the associations of disease activity, disease duration, and biological drug use with BMD. We assessed the associations of disease duration, a C-reactive protein based disease activity score in 28 joints (DAS28), simplified disease activity index, clinical disease activity index, health assessment questionnaire scores, and the use of biological drugs with the lumbar spine, total hip, and femoral neck BMDs using univariate and multivariate linear regression analyses in bisphosphonate treatment and non-bisphosphonate treatment groups at 1 year of follow-up. The multivariate linear regression analyses showed that disease duration was significantly related to the BMD of the femoral neck and total hip regardless of bisphosphonate treatment. The use of biological drugs was not significantly associated with BMD. Hip BMD in postmenopausal women with RA depends on the disease duration regardless of bisphosphonate use. Biological drugs for RA treatment were not negatively associated with general bone loss.
27068100 Are depression and anxiety associated with disease activity in rheumatoid arthritis? A pro 2016 Apr 11 BACKGROUND: This study aimed to investigate the impact of depression and anxiety scores on disease activity at 1-year follow-up in people with Rheumatoid Arthritis (RA). METHODS: The Hospital Anxiety Depression Scale (HADS) was used to measure depression and anxiety in a cross-section of RA patients. The primary outcome of interest was disease activity (DAS28), measured one-year after baseline assessment. Secondary outcomes were: tender joint count, swollen joint count, erythrocyte sedimentation rate and patient global assessment, also measured one-year after baseline assessment. We also examined the impact of baseline depression and anxiety on odds of reaching clinical remission at 1-year follow-up. RESULTS: In total, 56 RA patients were eligible for inclusion in this analysis. Before adjusting for key demographic and disease variables, increased baseline depression and anxiety were associated with increased disease activity at one-year follow-up, although this was not sustained after adjusting for baseline disease activity. There was a strong association between depression and anxiety and the subjective components of the DAS28 at 12-month follow-up: tender joint count and patient global assessment. After adjusting for age, gender, disease duration and baseline tender joint count and patient global assessment respectively, higher levels of depression and anxiety at baseline were associated with increased tender joint count and patient global assessment scores at 1-year follow-up. CONCLUSIONS: Symptoms of depression and anxiety have implications for disease activity, as measured via the DAS28, primarily due to their influence on tender joints and patient global assessment. These findings have implications for treatment decision-making as inflated DAS28 despite well controlled inflammatory disease markers may indicate significant psychological morbidity and related non-inflammatory pain, rather than true disease activity.
25437270 Social support and quality of life in patients with rheumatoid arthritis in Greece. 2015 Jan OBJECTIVES: Previous research suggests that social support has beneficial effects for rheumatoid arthritis (RA) patients. Yet, recent studies suggest that sociocultural differences have implications for whether or not the individuals use social support to cope with stressful events. Given the stressful nature of a chronic disabling disease, the purpose of the present study was to investigate the association of structural and functional facets of social support with quality of life (QoL) in Greek RA patients. METHODS: In a cross-sectional study, 127 Greek RA patients completed the Rheumatoid Arthritis Quality of Life questionnaire (RAQoL), the Patient Activity Scale-II (PAS-II), the Quality of Social Support Scale (QSSS), the Social Network Index (measuring social network size and number of social roles) and a visual analogue scale measuring reciprocity. RESULTS: Patients' age, social network size and reciprocity had no significant correlation with QoL. Family income, education level and male gender were positively correlated with QoL. Number of social roles was positively correlated with QoL, but not significantly when disease activity and demographic factors were controlled. Quality of social support was positively correlated with QoL, and the correlation remained statistically significant after controlling for disease activity, demographic variables and number of social roles. CONCLUSIONS: In Greek RA patients, quality of social support predicts quality of life above and beyond disease activity, demographic factors and social integration. Structural aspects of social support were not significant predictors of QoL, in line with previous research on cultural differences in how people utilise their social networks.
26344819 Limited extension after linked total elbow arthroplasty in patients with rheumatoid arthri 2016 OBJECTIVE: Total elbow arthroplasty (TEA) has become an established procedure to relieve pain and to increase the range of motion of the destructed elbow in patients with rheumatoid arthritis (RA). However, some patients still have limited extension after TEA, and the causes of limited extension after TEA have yet to be elucidated. METHODS: To examine whether widening of the joint space can cause such limited extension, we retrospectively analyzed 55 cases of linked TEA in patients with RA. There were seven male and 40 female with a mean age of 63.8 years (range, 30-80 years) and a mean follow-up of 7.5 ± 4.2 years (range, 2.5-15.6 years). The Mayo Elbow Performance Score (MEPS) and radiological measurements were recorded. Widening of the joint space was calculated by subtracting the length measured on postoperative radiograph from preoperative radiograph. RESULTS: MEPS and range of motion were significantly improved after surgery except for extension. The degree of extension was significantly correlated with radiological widening of the joint space in the limited extension group. Correlation analyses showed that postoperative limited extension was correlated with lower MEPS daily function. CONCLUSIONS: Limited extension after linked TEA is partly derived from perioperative widening of the joint space and potentially limits daily function in patients with RA.
27762194 Information technology concerning SDAI and CDAI. 2016 Sep Disease activity assessment of rheumatoid arthritis has never been trivial. Composite indices like the Disease Activity Score using 28 joint counts 28 (DAS28) and the Clinical Disease Activity Index (CDAI) and the Simplified Disease Activity Index (SDAI) attempted to integrate several core set variables into one readout, which eventually laid the grounds for implementation strategies that targeted disease activity levels, like remission. While CDAI and SDAI were clearly simpler at times when a calculator was needed, this has likely become less relevant in the era of digital records, where core set variables are entered into a computed device after measurement. However, DAS28 has faced new challenges, which are derived from its lack of specificity when it comes to assessing remission. Digital technology has advanced the management of patients with RA in clinical practice, since the disease activity levels can now be followed for each patient over adjustable time periods interesting for the clinician, such as since start of the last treatment. Also for research purposes, the digital records have allowed a more rapid course of projects from the scientific hypothesis to publication, simply by allowing to go to the digital database and select the items and observation needed. This has made clinical research much more efficient. In the digital era, the CDAI and SDAI can still be used on a piece of paper without the necessity of any electronic device, and it is exactly this flexibility and versatility of these two scores that account for their continued success.
27094362 Is there a role of synovial biopsy in drug development? 2016 Apr 19 Rheumatoid arthritis (RA) is an autoimmune disease which causes significant pain, joint deformity, functional disability. The pathological hallmark of RA is inflammation of the synovium characterized by involvement of inflammatory and resident stromal cells, soluble mediators and signalling pathways leading to irreversible joint destruction. The treatment goal in RA has evolved over the last decade towards a target of disease remission that is achieved in less than a third of patients in clinical trials. The lack of therapeutic response to current treatments is suggestive of alternative drivers of RA pathogenesis that might serve as promising therapeutic targets. There are data to justify the use of synovial tissue in early drug development. Synovial tissue represents an appropriate compartment to be studied in patients with inflammatory arthritis and provides information that is distinct from peripheral blood. Modern techniques have made the procedure much more accessible and ultrasound guided biopsies represent a safe and acceptable option. Advances in analytic technologies allowing transcriptomic level of analysis can provide unique inside to target organ/tissue following the exposure to investigational medicinal product. However, there are still caveats with regard to both the choice of technique and analytical methods. Therefore the significance of synovial biopsy remains to be determined in future clinical trials. The aim of the current debate is to explore the potential for accessing and evaluating synovial tissue in early drug development, to summarize lessons we have learned from clinical trials and to discuss the challenges that have arisen so far.
27618678 Rheumatoid nodule presenting as a buccal submucosal nodule: A rare presentation of a commo 2017 Jan BACKGROUND: Rheumatoid nodules are a common manifestation of rheumatoid arthritis but buccal rheumatoid nodules are extremely rare. The purpose of this study was to report a rare case of a rheumatoid buccal nodule and a review of the literature. METHODS AND RESULTS: This case is about a 79-year-old woman with rheumatoid arthritis who was taking methotrexate and hydroxychloroquine, presenting with an enlarging left buccal submucosal mass. An incisional biopsy showed features consistent with that of a rheumatoid nodule. The mass was managed expectantly and the patient was taken off methotrexate with a marked reduction in the size of the nodule. CONCLUSION: Submucosal rheumatoid nodules of the oral cavity are an extremely rare manifestation of rheumatoid arthritis but should be considered in the differential diagnosis in patients with a history of rheumatoid arthritis presenting with submucosal masses. © 2016 Wiley Periodicals, Head Neck 39: E12-E14, 2017.
27926914 Comorbidities in Turkish patients with rheumatoid arthritis: association with the health-r 2016 Oct AIMS: The aim of our study was to investigate the comorbidities in Turkish RA patients and evaluate the impact of comorbidities on health-related quality of life (HRQoL) in terms of disease activity, functional and radiological status, severity of pain, and social and emotional functioning. METHODS: In a cross-sectional setting, a total of 160 RA patients who were admitted to our outpatient clinic between December 2013 and February 2014 were consecutively enrolled in the study. Comorbidities were recorded. Disease activity was measured by using Disease Activity Score-28 (DAS28). Stanford Health Assessment Questionnaire (HAQ) was used for determining functional status, Nottingham Health Profile (NHP) for HRQoL, and modified Sharp Score for radiological damage. MAJOR RESULTS: Comorbidities were reported in 107 patients (66.88 %). The most common was peptic ulcer (31.25%). This was followed by osteoporosis (21.25%), dyslipidemia (15.63%), depression (15%), hypertension (13.75%), diabetes mellitus (13.13%), thyroid disorders (%8.13), lung diseases (%6.88), cardiovascular diseases (6.25%), and cancers [(1 breast cancer, 1 malign melanoma, 3 lung carcinoma), 3.13%], respectively. Patients with comorbidities scored significantly higher in DAS28, HAQ, pain, energy and physical mobility subgroups of NHP (p<0.05). It was not recorded any statistical significant difference in modified Sharp scores and sleep, social isolation and emotional reactions subgroups of NHP between the patient groups with and without comorbidities (p>0.05). CONCLUSIONS: Comorbid conditions of RA are common and associated with more active and severe disease and functional impairment. Comorbidities should be detected and treated earlier to reduce its negative impact on outcome in RA.
25728224 Social interactions at the onset of rheumatoid arthritis and their influence on help-seeki 2015 Sep OBJECTIVES: To explore how social interactions at the onset of rheumatoid arthritis (RA) influence help-seeking behaviour from the perspectives of those with RA and their significant others (family and friends). METHODS: Nineteen semi-structured qualitative interviews were undertaken with people recently diagnosed with RA and their significant others. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Significant others' initial appraisals of symptoms led them to provide practical support with daily activities rather than advice to seek help. People with RA described difficulties in communicating the severity of their symptoms and often attempted to hide their symptoms from others. Significant others also reacted negatively, expressing disbelief and dismissing symptoms. On occasion, early symptoms were even described as the catalyst for the breakdown of relationships. On reflection, significant others expressed guilt about their initial reactions and wished that they had recognized the need for intervention earlier. When symptoms had advanced and were more obvious, significant others often strongly advised that help should be sought and, in some cases, physically escorted the patient to their medical appointment. In many instances, people with RA described significant others as the catalyst for eventually seeking help. CONCLUSIONS: Significant others play an important role in influencing help-seeking behaviour; this has implications for theoretical models of help-seeking and the development of help-seeking interventions. A negative consequence of social interactions resulted from a lack of understanding and knowledge about RA among significant others, highlighting the need for greater public awareness about the early symptoms of RA.
26890537 The impact of introducing biologics to patients with rheumatoid arthritis in Taiwan: a pop 2016 Nov AIM: The biologics used to treat rheumatoid arthritis (RA) patients with a catastrophic illness certificate have been free without co-payment since 2003 in Taiwan. The purpose of this study was to explore the trend of health care expenditures and the cost of biologics for the treatment of RA patients between 1999 and 2009. METHODS: This study used a specially requested nation-wide RA patient claim dataset from National Health Insurance program. We identified all patients by both the primary diagnosis code ICD-9-CM 714.0 and the catastrophic illness certificate for RA. A total of 30 013 patients were recorded in the treated RA cohort from 1999 to 2009.The growth rates before and after introducing biologics were compared and tested. RESULTS: We found that from 1999 to 2009 the adjusted incidence rate for RA stably increased. Drug costs accounted for 53.2-70.3% of the total medical cost during the study period. There was a significant increase in biologics cost, climbing rapidly from 2.8% in 2003 to 60.4% of the total drug cost in 2009. The growth rate of outpatient drug costs was much higher after the introduction of biologics (2003-2009), which was 207.8% versus 42.0% as compared to the earlier period (1999-2002). Biologics such as etanercept, adalimumab and rituximab, were the crucial factors responsible for this increase in drug cost. CONCLUSIONS: The financial impact of adopting new biologics on healthcare costs is a critical issue that needs to be addressed by the National Health Insurance.
27323078 Correlation between IL-3 and IL-13 gene polymorphisms in Chinese patients and rheumatoid a 2016 May 23 The aim of this study was to examine the association between polymorphisms in the interleukin-3 and -13 (IL-3 and IL-13) genes and rheumatoid arthritis (RA). In this hospital-based case-control study, we analyzed the IL-3 rs2073506 G/A, IL-3 rs40401 C/T, and IL-13 rs1800925 C/T polymorphisms in 615 RA patients and 839 controls from a Chinese Han population. Genotyping was performed using a custom-by-design 48-Plex single nucleotide polymorphism scanTM kit. Our results indicated that the IL-3 rs2073506 G/A, IL-3 rs40401 C/T, and IL-13 rs1800925 C/T polymorphisms were not associated with RA. However, stratification analyses suggested that the IL-13 rs1800925 CT and CT/CC genotypes increased the risk of RA in patients with erythrocyte sedimentation rate (ESR) <25.00. To sum up, these findings suggest that the IL-13 rs1800925 C/T polymorphism may be associated with increased risk of RA in ESR <25.00 patients. Future studies with larger sample sizes and inclusion of other ethnic populations must be conducted to confirm the findings of this study.
26742756 Arterial stiffness is associated with left ventricular dysfunction in patients with rheuma 2016 Nov Arterial stiffness (AS) has a detrimental effect on cardiovascular system particularly on left ventricle (LV). The aim of the study was to evaluate the impact of AS on LV functions in patients with rheumatoid arthritis (RA). Forty patients with RA and 25 age-sex matched control subjects (mean age 48.5 ± 6.3 vs. 45.1 ± 6.9 years, respectively, p = 0.06) were enrolled in study. AS was assessed by carotid-femoral pulse wave velocity (CF-PWV) and heart rate corrected augmentation index (AIx@75) measured by applanation tonometry (SphygmoCor). LV function was evaluated using tissue Doppler-derived myocardial performance index (MPI) from lateral mitral annulus. CF-PWV (28.3 ± 10.3 vs. 21.8 ± 9.3 m/s, p = 0.03), AIx@75 (10.2 ± 2.3 vs. 9.2 ± 1, %, p = 0.01) and MPI (0.46 ± 0.12 vs. 0.36 ± 0.1, p < 0.001) were significantly higher in patients with RA than in controls. LV MPI was found to be significantly positive correlated with CF-PWV, AIx@75, and ESR (r = 0.360, p = 0.005; r = 0.334, p = 0.009; r = 0.293, p = 0.023, respectively). Arterial stiffness parameters including CF-PWV and AIx@75 are associated with subclinical left ventricular dysfunction in patients with RA.
25065917 Efficacy of the clinical use of iguratimod therapy in patients with rheumatoid arthritis. 2015 Mar OBJECTIVE: Iguratimod (IGU) is a new synthetic disease-modifying antirheumatic drug intended to treat patients with rheumatoid arthritis (RA). We conducted a 24-week study on the efficacy of IGU in RA patients with daily clinical use. METHODS: Forty-one patients were enrolled in this study, and the improvement in RA was evaluated every 4 weeks during the 24 weeks. RESULTS: The patient's global assessment of the disease activity with a scale (Pt VAS) was significantly decreased beginning at week 4. The disease activity score (DAS) 28-erythrocyte sedimentation rate, DAS28-C-reactive protein (CRP), simplified disease activity index and clinical disease activity index all significantly decreased at week 24. The matrix metalloproteinase-3 level was significantly decreased by the combination treatment with methotrexate at week 24. According to a logistic regression analysis, the factor which was most associated with the achievement of low disease activity (DAS28-CRP < 2.7) at week 24 was the DAS28-CRP at week 0. CONCLUSIONS: IGU had significant clinical effects on the RA patients within 24 weeks. IGU might therefore represent a new practical choice to treat RA patients.
25304188 Validation of the 2010-ACR/EULAR -classification criteria using newly EULAR-defined erosio 2015 Jan OBJECTIVE: To validate the 2010-ACR/EULAR criteria for rheumatoid arthritis (RA), taking into account the recent EULAR definition of "erosive disease", on the 310 patients comprising the very early arthritis cohort (VErA). METHODS: 2010-criteria performances were tested by first strictly applying its three items successively: ≥ 1 clinical synovitis/another disease(s)/score ≥ 6/10), then the typical erosion grid without obtaining a score of ≥ 6 to diagnose RA. We tested successively: no erosion (S1), ≥ 1 erosion(s) (S2), EULAR-defined erosive disease (S3). Two gold standards were used: expert diagnosis at six years and EULAR erosive disease at two years. RESULTS: At inclusion, median age was 52 years; median RA duration 4.2 months. 2010-ACR/EULAR criteria, including EULAR-defined erosive disease applied at baseline, classified comparable numbers of patients as the 1987 criteria (P=0.27). Using expert diagnosis at six years, more patients were classified as RA with S2 than 1987-ACR criteria (P<0.04). In contrast, sensitivity and specificity indicated that 2010-ACR/EULAR-S3 criteria performed slightly but not significantly better than 1987-ACR criteria. On ROC curves, a score ≥ 6 correctly classified RA. When EULAR-defined erosion at two years was the gold standard, the 1987-ACR, the 2010-S1, -S2 and -S3 criteria performed comparably. CONCLUSIONS: Using the very early community-based, conservatively treated VErA cohort, the strict application of 2010-ACR/EULAR criteria using the new EULAR definition of erosive disease or not performed slightly but not significantly better than the 1987-ACR criteria.
26344671 Fatigue in rheumatoid arthritis: quantitative findings on the efficacy of tocilizumab and 2015 Sep OBJECTIVES: Fatigue is an important aspect of rheumatoid arthritis (RA). The objective was to assess fatigue levels and its determinants over the first 4 months of tocilizumab (TCZ) treatment in RA patients. METHODS: We performed a multicentre prospective study of RA patients treated with intravenous TCZ in open-label prescription conditions. The first 5 infusions (4 months) were assessed. The primary endpoint was the percentage of patients with variation of the FACIT fatigue scale from inclusion to 4 months, above the minimal clinically important difference (MCID) of 4 points. Fatigue was also assessed by the patient acceptable symptom state for fatigue (PASS) question. Variables related with fatigue and with fatigue improvement including other patient reported outcomes, depression and anxiety, and disease activity, were assessed before and after treatment. ANALYSES: univariate and multivariate logistic regressions. RESULTS: Of 719 patients, 610 had evaluable data: mean age 56±13 years, disease duration 12±10 years, 490 (81%) women. At baseline, fatigue levels were high: 73% patients had unacceptable fatigue. At 4 months, 378 patients (62%) reached MCID improvement for fatigue. Fatigue reduction was rapid, seen as early as after 2 weeks. Fatigue was mainly related to functional status (HAQ score), depression and anxiety, both before and after TCZ treatment. Moderate predictors of fatigue improvement were evidenced. CONCLUSIONS: In these long-standing RA patients, fatigue levels were high and mainly explained by HAQ and psychological distress but improved with treatment indicating a link with disease activity. The pathophysiological basis of RA fatigue should be further explored.
26843177 Decreased expression of methylene tetrahydrofolate reductase (MTHFR) gene in patients with 2016 Jan OBJECTIVES: Impairment of methylene tetrahydrofolate reductase (MTHFR), a key enzyme in the folate metabolism, results in an elevated plasma level of homocysteine, considered an independent risk factor for cardiovascular (CV) disease. Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increased risk of CV death. Polymorphisms in the MTHFR gene increase the frequency of CV disease in RA. The aim of this study was to determine the expression of MTHFR gene in patients with RA, with and without ischaemic heart disease (IHD). METHODS: Relative expression of MTHFR gene and beta-actin and GAPDH as housekeeping genes was quantified by quantitative real-time polymerase chain reaction. It was analysed by the comparative Ct (threshold cycle) method in peripheral blood from 26 Spanish patients with RA (12 with IHD and 14 without IHD) and 10 healthy controls. MTHFR expression level in RA patients was also assessed according to disease activity, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies status. RESULTS: MTHFR expression was significantly reduced in patients with RA compared to controls (fold change = 0.85, p=0.029). It was especially true for RA patients with IHD (fold change= 0.79, p=0.021). However, no statistically significant relationship between MTHFR expression level in patients with RA and DAS28 CRP, DAS28 ESR, RF and anti-CCP status was observed. CONCLUSIONS: Patients with RA, in particular those with IHD, show a decreased expression of the MTHFR gene. This may support a potential implication of the transcriptional regulation of MTHFR in the pathogenesis of RA.
26007151 Influence of rheumatoid arthritis-related morning stiffness on productivity at work: resul 2015 Nov The objective of this study was to evaluate the influence of morning stiffness on productivity at work and to estimate the work-related economic consequences of morning stiffness among patients with RA-related morning stiffness in 11 European countries. The original sample comprised 1061 RA patients from 11 European countries (Belgium, Denmark, Finland, France, Germany, Italy, Norway, Poland, Spain, Sweden and UK). They had been diagnosed with RA and experience morning stiffness three or more times per week. Data were collected by interviews. Women comprised 77.9 % of the sample, the average age was 50.4 years, and 84.3 % had RA diagnosed for more than 2 years. Overall costs of RA-related morning stiffness was calculated to be 27,712€ per patient per year, varying from 4965€ in Spain to 66,706€ in Norway. On average, 96 % of the overall production losses were attributed to early retirement, with a markedly lower level (77 %) in Italy than in other countries (p < 0.0001). The proportion of patients who reported retirement due to morning stiffness and productivity losses due to late work arrivals and working while sick showed considerable variation across the countries represented in the study. Overall, the average annual cost of late arrivals (0.8 % of the total costs) was approximately half of the costs attributed to sick leave (1.7 %) and working while sick (1.5 %). Morning stiffness due to RA causes significant production losses and is a significant cost burden throughout Europe. There seem to be notable differences in the impact of morning stiffness on productivity between European countries.