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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
25985702 [Disability due to traumas and diseases of a knee joint]. 2015 Feb The invalidism structure was analyzed for patients, suffering consequences of traumas and diseases of a knee joint (KJ). The primary invalidism level because of traumas and diseases of a KJ have constituted in 2013 yr 12.4%. The cause of invalidism in men is predominantly a one-side gonarthrosis, and in women--a bilateral one--due to concurrent aggravating causes (dishormonal changes, excessive body mass). The invalidism indices enhancement is caused by absence of a dispensary follow-up, insufficient treatment on various stages of the disease course, severity and irreversibility of pathological process in a KJ, socio-economic factors, low rehabilitational potential, prognosticated impossibility to conduct a professional-labour rehabilitation in a prepensionable and pensionable age.
27455560 [THE COMPARATIVE ANALYSIS OF LEVEL OF OLIGOMERIC MATRIX PROTEIN OF CARTILAGE IN BLOOD SERU 2016 Feb The osteoarthritis and rheumatoid arthritis are considered as the most prevalent diseases in the structure of diseases of musculoskeletal system. The higher social significance of these nosologies dictates necessity of searching reliable cartilage biomarkers having diagnostic validity both in discerning degenerative alterations at early stage of disease of joints and in monitoring of treatment effectiveness. The content of oligomeric matrix protein of cartilage using ELISA was evaluated in blood serum ofpatients with secondary osteoarthritis under rheumatoid arthritis (n=248). The comparison of derived results was carried out using control groups. Within the framework of study relationship was evaluated between level of oligomeric matrix protein of cartilage in patients with secondary osteoarthritis under rheumatoid arthritis with values offunctional KOOS index. The analysis of derived results established trend to increasing of level of oligomeric matrix protein of cartilage in blood serum ofpatients with secondary osteoarthritis under rheumatoid arthritis as compared with control groups. The moderate correlation interdependence between cartilage biomarker and KOOS index.
25327393 The impact of statins therapy on disease activity and inflammatory factor in patients with 2015 Jan OBJECTIVES: Statin is the most widely used as HMG-CoA reductase inhibitor, and contributes to clinically significant vascular risk reduction. However, the role of statins in the rheumatoid arthritis (RA) immunomodulation is debatable. This meta-analysis aimed to determine the efficacy of statins therapy in RA patients. METHODS: A structured literature search was undertaken to identify randomised controlled trials (RCTs) conducted in RA patients receiving either statins or control. A meta-analysis on standardised mean difference (SMD) with a 95% confidence interval (95%CI) was conducted. RESULTS: We included 15 studies with a total of 992 patients (487 patients allocated to statins therapy). Our data revealed statins can attenuate disease activity markedly. Overall, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) declined significantly during the treatment (n=12, SMD: -2.222, 95%CI: -2.404, -2.040, p=0.000; n=14, SMD: -3.014, 95%CI: -3.207, -2.821, p=0.000), among which ESR and CRP decreased obviously at 12 months (n=5, SMD: -2.874, 95%CI: -3.224, -2.523, p=0.000; n=7, SMD: -3.970, 95%CI: -4.300, -3.641, p=0.000; respectively). As expected, the tender joint count (TJC) and swollen joint count (SJC) also fell (n=9, SMD: -2.005, 95% CI: -2.216, -1.794; p=0.000; n=10, SMD: -1.76, 95%CI: -1.948, -1.577; p=0.000; respectively). Besides, morning stiffness was attenuated (n=5, SMD: -1.242, 95%CI: -1.474, -1.011, p=0.000), and showed no significant differences between 12 months and 24 months (p=0.205). Notably, statins indeed potently down-regulate inflammatory factors TNF-α (n=7, SMD: -4.290, 95%CI: -4.659, -3.922; p=0.000), IL-1 (n=4, SMD: -1.324, 95%CI: -1.646, -1.003; p=0.000), and IL-6 (n=10, SMD: -1.652, 95%CI: -1.822, -1.482; p=0.000). No publication bias was observed across all studies based on the Begg and Egger test. CONCLUSIONS: This meta-analysis demonstrates the pleiotropic effects of statins on ameliorating RA activity and mediating clinically apparent anti-inflammatory effects in the context of RA autoimmune inflammation, which make it recommended as a potent treatment for RA patients.
25824900 Animal models of rheumatoid arthritis: How informative are they? 2015 Jul 15 Animal models of arthritis are widely used to de-convolute disease pathways and to identify novel drug targets and therapeutic approaches. However, the high attrition rates of drugs in Phase II/III rates means that a relatively small number of drugs reach the market, despite showing efficacy in pre-clinical models. There is also increasing awareness of the ethical issues surrounding the use of animal models of disease and it is timely, therefore, to review the relevance and translatability of animal models of arthritis. In this paper we review the most commonly used animal models in terms of their pathological similarities to human rheumatoid arthritis as well as their response to drug therapy. In general, the ability of animal models to predict efficacy of biologics in man has been good. However, the predictive power of animal models for small molecules has been variable, probably because of differences in the levels of target knockdown achievable in vivo.
26711840 Have complementary therapies demonstrated effectiveness in rheumatoid arthritis? 2016 May In recent decades the treatment of rheumatoid arthritis (RA) has improved thanks to the use of highly effective drugs. However, patients usually require long term therapy, which is not free of side effects. Therefore RA patients often demand complementary medicine, they seek additional sources of relief and/or less side effects. In fact 30-60% of rheumatic patients use some form of complementary medicine. Therefore, from conventional medicine, if we want to optimally treat our patients facilitating communication with them we must know the most commonly used complementary medicines. The aim of this review is to assess, based on published scientific research, what complementary therapies commonly used by patients with RA are effective and safe.
26819061 [Alopecia areata secondary to the use of leflunomide in patients with rheumatoid arthritis 2015 Dec 30 Rheumatoid arthritis is a chronic, highly disabling autoimmune disease that requires aggressive pharmacological treatment using immunomodulatory drugs grouped under the name of Disease-Modifying Anti-rheumatic Drugs (DMARDs). Leflunomide is one of the most frequently prescribed. This drug, through its mechanism of action is able to suppress key factors in the disease process. However, its use is not without side effects. While there are series that report that the most prevalent adverse effects are diarrhea, nausea, rash and alopecia, there are few reported cases of alopecia universalis secondary to the use of leflunomide. We present a case in the Regional Hospital of Talca and a review of the use of leflunomide.
26414115 Asymptomatic Versus Symptomatic Ankle Joints in Rheumatoid Arthritis: A High-Resolution B- 2016 Jun OBJECTIVE: Ankle joints are frequently neglected in activity scoring systems, including the Disease Activity Score in 28 joints (DAS28). Only a few studies have assessed pathologies detected by ultrasonography of the ankles in symptomatic rheumatoid arthritis (RA) patients. We evaluated ankle joints in RA patients regardless of symptomatology, using musculoskeletal ultrasound (MSUS) as well as power Doppler ultrasound (PDUS). METHODS: A total of 160 ankle joints of 80 RA patients were examined using MSUS and PDUS, according to the European League Against Rheumatism MSUS guidelines. Additionally, the talonavicular joints (TNJs) and the medial and the lateral tendon compartments were examined. The visual analog scale (VAS) score was recorded for each patient. RESULTS: A total of 80 RA patients with a median age of 60 years and disease duration of 5 years were enrolled in our study. The median DAS28 score was 5. A total of 97 ankles were painful (VAS 1-10), whereas 63 ankles were asymptomatic (VAS 0). Overall, the predominant pathology was arthritis of the tibiotalar joint (TTJ) and/or TNJ in 124 ankles (77%), followed by tenosynovitis of the medial compartment tendons in 44 ankles (28%). Arthritis of the TTJ was present in 59% and synovitis of the TNJ in 35% of the symptomatic ankles. In asymptomatic ankles, TTJ synovitis was detected in 35%, whereas TNJ arthritis was observed in 18%. PDUS activity was higher in the subgroup of symptomatic ankles. CONCLUSION: The most frequent pathologies detected by MSUS were arthritis of the TTJ and TNJ, followed by tenosynovitis of the medial compartment tendons. Pathologic findings were more frequent in symptomatic but also common in asymptomatic patients, whereas PDUS activity was generally low and mainly observed in symptomatic patients.
26715450 MDR-1 and MRP-1 activity in peripheral blood leukocytes of rheumatoid arthritis patients. 2015 Dec 30 BACKGROUND: Rheumatoid Arthritis is a chronic disease leading to decreased quality of life with a rather variable response rate to Disease Modifying Anti Rheumatic Drugs. Methotrexate (MTX) is the gold standard therapy in Rheumatoid Arthritis. The Multidrug resistance Related Protein and Multi Drug Resistance protein 1, also called P-glycoprotein-170 transporters can alter the intracellular concentration of different drugs. Methotrexate is an MRP1 substrate and thus the functional activity of MRP1 might have a clinical impact on the efficiency of the Methotrexate-therapy in Rheumatoid Arthritis. METHODS: We have compared the functional Multidrug Activity Factors (MAF) of the MDR1 and MRP1 transporters of Peripheral Blood Leukocytes of 59 Rheumatoid Arthritis patients with various response rate to MTX-therapy (MTX-responder, MTX-resistant and MTX-intolerant RA-groups) and 47 non-RA controls in six different leukocyte subpopulations (neutrophil leukocytes, monocytes, lymphocytes, CD4+, CD8+ and CD19+ cells). There was a decreased MAF of RA patients compared to non- Rheumatoid Arthritis patients and healthy controls in the leukocyte subpopulations. There was a significant difference between the MAF values of the MTX-responder and MTX intolerant groups. But we have not found significant differences between the MAF values of the MTX-responder and MTX-resistant Rheumatoid Arthritis -groups. RESULTS: Our results suggest that MDR1 and MRP1 functional activity does not seem to affect the response rate to MTX-therapy of Rheumatoid Arthritis-patients, but it might be useful in predicting MTX-side effects. We have demonstrated the decreased functional MDR-activity on almost 60 Rheumatoid Arthritis patients, which can be interpreted as a sign of the immune-suppressive effect of the MTX-treatment.
26424809 Factors affecting well-being in adults recently diagnosed with rheumatoid arthritis. 2017 Mar This article examines role stress, key psychosocial variables, and well-being in adults recently diagnosed with rheumatoid arthritis. Patients recently diagnosed with rheumatoid arthritis must often learn to balance disease and role-related responsibilities. This was cross-sectional, descriptive study ( N = 80). Data were analyzed using correlation coefficients and linear regression models. Participants were predominantly female (78%), married, and employed. Mean age and disease duration were 54.2 years and 24.2 months, respectively. The findings suggest that well-being is influenced by feelings of being self-efficacious and having balance in their roles and less to do with social support received from others.
27311180 [Articular cartilage MRI: Update]. 2016 Jun To evaluate the articular cartilage by MRI, there are two categories; delineating the cartilaginous morphology and estimating the cartilaginous internal content. The morphology delineation requires high spatial resolution with high contrast resolution between the cartilage surface and the surrounding synovial fluid. Precise section settings are mandatory. The quality assessment of the cartilage includes T2 mapping, T1 mapping (dGEMRIC), T2* mapping, T1ρ mapping, and the chemical exchange saturation transfer(CEST). T2 mapping is the most prevalent technique, however, it represents the collagen fibers and the internal water. T1ρ mapping and CEST techniques are seemed to detect the glycosaminoglycan content of the cartilage.
27592369 Increased serum levels of tumor necrosis factor receptor-associated factor 1 (TRAF1) corre 2016 Nov 1 BACKGROUND: In 2007 a genome wide association analyses revealed an additional risk-associated genetic region in rheumatoid arthritis (RA), the tumor necrosis factor receptor-associated factor 1-complement 5 (TRAF1-C5) containing locus on chromosome 9, comprehensive evaluation of the TRAF1 in RA patients remains necessary. METHODS: Serum was obtained from 79 RA patients and from 38 healthy individuals. Concentrations of TRAF1 were measured by enzyme-linked immune sorbent assay (ELISA). RESULTS: We found that the serum concentration of TRAF1 in RA patients was 35.9±51.2pg/ml, the serum concentration of TRAF1 in healthy controls was 12.5±8.6pg/ml. The difference between these 2 groups was significant (p=0.003). Patients with high disease activity had significantly higher TRAF1 concentration in comparison to patients with low and moderate disease activity (p<0.05). We also found that the numerical DAS28 had a significant positive correlation with TRAF1 concentration (r=0.419, p<0.001). We found that serum GPI and RF concentrations showed a significant positive correlation with TRAF1 concentrations respectively (r=0.767, p<0.001; r=0.365, p=0.001), while CCP concentration showed no significant correlation. CONCLUSIONS: TRAF1 plays a crucial role in the pathogenesis of autoantibodies and may serve as a serologic inflammatory marker of disease activity in RA patients.
26026604 Interpreting the multi-biomarker disease activity score in the context of tocilizumab trea 2016 Feb The multi-biomarker disease activity (MBDA) score measures 12 proteins involved in the pathophysiology of rheumatoid arthritis (RA) to assess disease activity (DA). Previous studies demonstrated correlations between MBDA and clinical DA scores with some RA therapies. In this analysis, the relationship between DA and MBDA scores and changes in MBDA component biomarkers were evaluated in tocilizumab (TCZ)-treated patients. Patients from the ACT-RAY study were included in this analysis if they had DA measures and serum collected at pre-specified time points with sufficient serum for MBDA testing at ≥1 visit. Descriptive statistics, associations between outcomes, and percentage agreement between DA categories were calculated. Seventy-eight patients were included and were similar to the ACT-RAY population. Correlations between MBDA score and DAS28-CRP were ρ = 0.50 at baseline and ρ = 0.26 at week 24. Agreement between low/moderate/high categories of MBDA score and DAS28-CRP was observed for 77.1 % of patients at baseline and 23.7 % at week 24. Mean changes from baseline to weeks 4, 12, and 24 were proportionately smaller for MBDA score than DAS28-CRP. Unlike some other MBDA biomarkers, interleukin-6 (IL-6) concentrations increased in most patients during TCZ treatment. Correlations and agreement between MBDA and DAS28-CRP or CDAI scores were lower at week 24 versus baseline. The proportionately smaller magnitude of response observed for MBDA score versus DAS28-CRP may be due to the influence of the increase in IL-6 concentrations on MBDA score. Thus, MBDA scores obtained during TCZ treatment should be interpreted cautiously and in the context of available clinical information.
26347200 Relationship between Periodontitis and Rheumatoid Arthritis: Review of the Literature. 2015 Periodontitis (PD) and rheumatoid arthritis (RA) are immunoinflammatory diseases where leukocyte infiltration and inflammatory mediators induce alveolar bone loss, synovitis, and joint destruction, respectively. Thus, we reviewed the relationship between both diseases considering epidemiological aspects, mechanical periodontal treatment, inflammatory mediators, oral microbiota, and antibodies, using the keywords "periodontitis" and "rheumatoid arthritis" in PubMed database between January 2012 and March 2015, resulting in 162 articles. After critical reading based on titles and abstracts and following the inclusion and exclusion criteria, 26 articles were included. In the articles, women over 40 years old, smokers and nonsmokers, mainly constituted the analyzed groups. Eight studies broached the epidemiological relationship with PD and RA. Four trials demonstrated that the periodontal treatment influenced the severity of RA and periodontal clinical parameters. Nine studies were related with bacteria influence in the pathogenesis of RA and the presence of citrullinated proteins, autoantibodies, or rheumatoid factor in patients with PD and RA. Five studies investigated the presence of mediators of inflammation in PD and RA. In summary, the majority of the articles have confirmed that there is a correlation between PD and RA, since both disorders have characteristics in common and result from an imbalance in the immunoinflammatory response.
26997641 Anti-peptidyl-arginine deaminase 3 (PAD3) antibodies as a promising marker to measure join 2016 Jul BACKGROUND: Recently, antibodies directed against peptidyl arginine deiminase 3 and 4 (anti-PAD3/PAD4 antibodies), calcium-dependent enzymes that catalyze the conversion from arginine to citrulline, have been described. Furthermore, antibodies that cross-react between PAD3 and PAD4 cause increased PAD4 activity and consequently correlate with joint damage. This study analyzes the correlation of anti-PAD3 antibodies with joint damage. METHODS: To validate the novel chemiluminescent immunoassay (CIA) for the detection of anti-PAD3 antibodies, 20 samples were tested by CIA and by immunoprecipitation (IP). Next, 39 RA patients with available joint erosion score (JES), Total Sharp Score (TSS) and Joint Space Narrowing Score (JSNS) were tested for anti-CCP (using different methods) and anti-PAD3 antibodies by CIA. RESULTS: Excellent correlation was observed between the CIA and IP for the detection of anti-PAD3 antibodies (rho=0.85, p<0.0001). The median JES of our 39 patients was 14.1 with a standard deviation of 11.5. Anti-PAD3 antibody levels (rho=0.39, 95% CI=0.1-0.6; p=0.0149) were correlated with JES. No correlation was found with TSS and JSNS. In this cohort, ACPA measured using different anti-CCP assays did not correlate with the JES. CONCLUSION: In our cohort, anti-PAD3 antibodies correlate with joint erosion score. Therefore, anti-PAD3 antibodies might represent promising markers to predict joint damage in RA patients.
26485681 Association of Cardiovascular Risk Factors with Carotid Intima Media Thickness in Patients 2015 OBJECTIVES: Rheumatoid arthritis (RA) has been identified as an independent cardiovascular risk factor. The importance of risk factors such as hypertension and hyperlipidemia in the generation of atherosclerosis in RA patients is unclear. This study analyzed clinical parameters associated with carotid intima media thickness (cIMT) in patients with RA. METHODS: Subjects with RA and healthy controls without RA, both without known cardiovascular disease, were included. Participants underwent a standard physical examination and laboratory measurements including a lipid profile. cIMT was measured semi-automatically by ultrasound. RESULTS: In total 243 RA patients and 117 controls were included. The median RA disease duration was 7 years (IQR 2-14 years). The median DAS28 was 2.4 (IQR 1.6-3.2) and 114 (50.4%) of the RA patients were in remission. The presence of RA and cIMT were not associated (univariate analysis). Multivariable regression analysis showed that cIMT in RA patients was associated with age (B = 0.006, P<0.001) and systolic blood pressure (B = 0.003, P = 0.003). In controls, cIMT was associated with age (B = 0.006, P<0.001) and smoking (B = 0.097, P = 0.001). CONCLUSION: cIMT values were similar between RA patients and controls. Hypertension was strongly associated with cIMT in RA patients. After adjustment, no association between cIMT and specific RA disease characteristics was found in this well treated RA cohort.
28026732 [Spontaneous Tendon Ruptures in the Rheumatoid Hand]. 2016 A spontaneous tendon rupture is a direct consequence of rheumatoid inflammation and can appear without any noticeable impact, often during sleep. The patient then presents with inability to flex or extend metacarpophalageal or interphalangeal joints. Multiple ruptures resulting in impaired function of several fingers can also occur and markedly limit the hand's grip strength. A tear may arise from either mechanical injury to the tendon along its course over bone or connective tissues, or by biochemical action of lysosomal enzymes, released during the inflammation process, on the connective tissue of the tendon. Ischaemic damage to a part of the tendon due to constriction of vessels supplying the peritenonium is found in hypertrophic peri-tenosynovitis. Spontaneous ruptures can be prevented, in the first place, by early synovectomy and then by a number of prophylactic procedures on soft tissues and carpal bones, which can stop or at least slow down the development of severe axial deformities of the wrist and hand. Simple end-to-end suture of the stumps is usually not possible; tendon repair surgery using free grafts or, more often, intact tendon transfer is necessary. In the flexor part, transfer of the superficial flexor tendon to a stump of the deep flexor tendon is frequently performed; a free graft can also be used at a two-stage tendon reconstruction. The repair of flexor tendons is technically more demanding and the results are less satisfactory compared to repair surgery on the extensor tendon. Key words: rheumatoid arthritis, metacarpophalageal joint, interphalangeal joint, tendon rupture.
27149868 Update on Therapeutic Approaches for Rheumatoid Arthritis. 2016 Rheumatoid arthritis is a common chronic inflammatory and destructive arthropathy that consumes considerable personal, social and economic costs. It consists of a syndrome of pain, stiffness and symmetrical inflammation of the synovial membrane (synovitis) of freely moveable joints such as the knee (diarthrodial joints). Although the etiology of rheumatoid arthritis is unclear, the disease is characterized by inflammation of the synovial lining of diarthrodial joints, high synovial proliferation and an influx of inflammatory cells, macrophages and lymphocytes through angiogenic blood vessels. Diseasemodifying antirheumatic drugs slow disease progression and can induce disease remission in some patients. Methotrexate is the first line therapy, but if patients become intolerant to this drug, biologic agents should be used. The development of biological substances for the treatment of rheumatic conditions has been accompanied by ongoing health economic discussions regarding the implementation of these highly effective, but accordingly, highly priced drugs are the standard treatment guidelines of rheumatic diseases. In this way, more efficient strategies have to be identified. Despite numerous reviews in rheumatoid arthritis in the last years, this area is in constant development and updates are an urgent need to incorporate new advances in rheumatoid arthritis research. This review highlights the immunopathogenesis rationale for the current therapeutic strategies in rheumatoid arthritis.
24283757 Increased risk for bone loss in women with systemic sclerosis: a comparative study with rh 2016 Apr AIM: To assess bone mass in women with systemic sclerosis (SSc) in comparison to age and sex-matched patients with rheumatoid arthritis (RA), and to evaluate factors influencing bone mineral density (BMD). METHODS: Patients were consecutively recruited and assessed for BMD at the lumbar spine and hip by dual-energy X-ray absorptiometry (DEXA) using a densitometer. In SSc, the extent of skin involvement, modified Rodnan skin thickness score (mRSS) and Medsger disease severity index were assessed. RESULTS: Forty-three patients with SSc and 38 age-matched patients with RA were included. There was no difference in BMD measurements between patients with diffuse or limited SSc. Patients with SSc had similar risk factors associated with osteoporosis (OP) or low bone mass except for low body mass index (BMI) and low vitamin D levels compared to patients with RA. Lumbar spinal BMD and T score were similar between groups. Total hip and femoral neck BMD and T score at femoral neck and total hip were significantly lower in patient with SSc versus RA. There was significant association between mRSS, Medsger severity score (peripheral vascular involvement and skin) and femoral BMD. CONCLUSION: There is an increased risk for bone loss in patients with SSc and the risk of OP is associated with disease severity, prolonged menopause and disease duration. The complex pathophysiology of bone metabolism as well as complex pathogenesis of the SSc pose some difficulty reaching clear-cut conclusions on the causal relationship between SSc and bone loss.
27264825 [Association of AIRE gene polymorphisms with susceptibility to rheumatoid arthritis among 2016 Jun OBJECTIVE: To assess the association of AIRE gene polymorphisms with rheumatoid arthritis (RA) among ethnic Han Chinese from Shaan'xi Province. METHODS: Genomic DNA was prepared from 384 individuals with RA and 576 healthy controls. Four tag single nucleotide polymorphisms (SNP) in the AIRE gene (rs2075876, rs760426, rs1800520, and rs878081) were genotyped with a SNaPshot method. The genotypic and allelic frequencies were evaluated using a Chi square test. Genotyping data was corrected by Logistic regression for age and gender. The linkage disequilibrium (LD) block structure was examined using Hapview 4.2 software. RESULTS: All 4 SNPs have conformed to Hardy-Weinberg equilibrium (P > 0.05). Two SNPs were significantly associated with RA, which included G allele of rs2075876 (OR=1.41, 95% CI: 1.17-1.71, P=3.7 × 10(-4)); Dominant model (OR=1.79, 95% CI: 1.21-2.63, P=0.002), Recessive model (OR=1.48, 95% CI: 1.14-1.93, P=0.003). rs760426 A risk allele (OR=1.26, 95% CI: 1.04-1.52, P=0.01); Recessive model (OR=1.33, 95% CI: 1.02-1.73, P=0.03). In addition, rs878081 and rs1800520 SNPs were not allele and genotyped polymorphisms were significantly associated with RA susceptibility. CONCLUSION: The rs2075876 and rs760426 loci of the AIRE gene are associated with increased risk for rheumatoid arthritis among ethnic Han Chinese from ShaanXi.
26188617 Access to an optimal treatment. Current situation. 2015 Mar Access to an optimal treatment is determined by several factors, like availability, pricing/funding, and acceptability. In Latin America (LA), one of the regions with more disparities particularly on healthcare in the world, access is affected by other factors, including socio-demographic factors like poverty, living in rural regions, and/or health coverage. Regarding rheumatoid arthritis (RA), an inadequate access to specialists leads to diagnosis and treatment delays diminishing the probability of remission or control. Unfortunately, in almost every LA country, there are cities with more than 100,000 inhabitants without rheumatologists; furthermore, a primary care reference system is present in only about half the countries. In the public health system, coverage of biologic disease-modifying antirheumatic drugs occurs for less than 10 % of the patients in about half of the countries. Also, as healthcare providers based their funding decisions mainly in direct costs instead of on patient-centered healthcare quality indicators, access to new drugs is more complicated in this region than in high-income countries. More accurate epidemiological data from LA need to be obtained in order to improve the management of patients with rheumatic diseases in general and RA in particular.