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ID PMID Title PublicationDate abstract
26314337 FCGR2A, FCGR3A, FCGR3B polymorphisms and susceptibility to rheumatoid arthritis: a meta-an 2015 Sep OBJECTIVES: The aim of this study is to explore whether Fc gamma receptor (FCGR) polymorphisms are associated with the susceptibility to rheumatoid arthritis (RA). METHODS: We conducted a meta-analysis on the association between FCGR2A H131R (rs1801274), FCGR3A F158V (rs396991), and FCGR3B NA1/NA2 polymorphisms and RA susceptibility. RESULTS: A total of seventeen studies reported in fourteen articles (4,418 patients with RA and 3,560 controls) were considered in our meta-analysis. In all of the study subjects, meta-analysis indicated an association between RA and FCGR2A R allele (OR=0.877, 95% CI=0.792-0.971, p=0.011). Stratification by ethnicity indicated an association between FCGR2A R allele and RA in Europeans (OR=0.816, 95% CI=0.687-0.968, p=0.020), but not in East Asians (OR=0.900, 95% CI=0.778-1.040, p=0.154). Meta-analysis revealed an association between RA and FCGR3A VV vs. FF genotype in all the study subjects (OR=1.210, 95% CI=1.067-1.479, p=0.006). Stratification by ethnicity indicated an association between FCGR3A VV genotype and RA compared toFF genotype in Europeans (OR=1.350, 95% CI=1.107-1.646, p=0.003), but not in East Asians and South Asians. No association was observed between RA and FCGR3B polymorphisms on performing the meta-analysis. CONCLUSIONS: Although no relationship was found between the FCGR3B polymorphism and RA susceptibility, FCGR2A and FCGR3A polymorphisms were found to be associated with RA in Europeans, but not in Asians.
28049958 [Treatment strategy of elderly rheumatoid arthritis]. 2016 Since the general population is ageing, the number and the mean age of elderly patients of rheumatoid arthritis (RA) have increased. Elderly RA is classified into two clinical subsets, younger onset elderly RA (YORA) and elderly-onset RA (EORA). In the past literature, onset after 60 years of age is mainly adopted as the classical definition of EORA. Elderly-YORA patients, in addition to disease-modifying antirheumatic drugs, sometimes need analgestics, joint surgery and rehabilitation taking into account their bone destruction and their activities of daily living. Early phase EORA patients should be treated using the treat-to-target strategy, although low disease activity is the realistic goal due to their co-morbidities, patient factors and drug-related risks. Methotrexate (MTX) is the anchor drug in the treatment of EORA. It should be started at low dose (2-4 mg/day) and if tolerated, the dosage is carefully increased. In the case of renal dysfunction or dementia, and MTX is intolerable, biologics monotherapy could be a choice of treatment. Tapering of glucocorticoid, as far as possible, is needed because it is one of the risk factors of infection. Treatment of super-aged RA patients is a future agenda.
26202443 Individual variations in treatment decisions by Swedish rheumatologists regarding biologic 2015 OBJECTIVES: In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objectives were to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to patients with rheumatoid arthritis (RA) and to evaluate reasons for treatment choices. METHOD: Ten hypothetical patient cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the patients with a biological agent (Yes/No) and to explain their decisions. RESULTS: The response rate was 26/105 (25%). Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 patients and others to 2/10. In five of the 10 hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decisions to prescribe biologics and also not to prescribe biologics were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or the social function of the patient. CONCLUSIONS: The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical patient cases, and there were also disparities between rheumatologists practicing at the same clinic. Treatment choices were motivated primarily by medical reasons. This situation raises concerns about a lack of consensus in RA treatment strategies.
25826632 Short stem total hip arthroplasty in patients with rheumatoid arthritis. 2015 Mar Total hip arthroplasty (THA) has proven successful in patients with rheumatoid arthritis (RA). Patients with RA often require multiple revisions, and bone conservation is mandatory. A variety of short stems is currently available with mid-term results for osteoarthritis. This retrospective study evaluated mid-term clinical results of short stem THA in a series of patients with RA. Between 2005 and 2009, a total of 105 cementless short stems were implanted in patients with RA. Average patient age at the time of the index THA was 44.2 years, and average length of follow-up was 5 years. Clinical evaluation included physical examination and documentation of potential adverse events during the postoperative period. No radiographic failures occurred. Femoral and cup components showed some minor radiolucencies with sclerotic lines, but none involved 100% of the bone-prosthesis interface. Complications included femoral component subsidence in 2 hips after initial full weight bearing; 1 case resolved after 3 months, and the other case was revised to a standard shaft. One intraoperative dorsolateral stem tip perforation occurred with revision to a conventional length stem. Migration in 1 cup led to revision without removal of the short stem implant. No infections or joint dislocations were observed. The transfer of the short stem concept to an additional treatment option for patients with RA proved successful in the early to mid-term postoperative period. Complications and revisions were limited to early migration and early loosening of the implants in line with the results reported in the literature of cementless conventional THA in patients with RA.
27889698 Major involvement of bacterial components in rheumatoid arthritis and its accompanying oxi 2017 Feb We review the evidence that infectious agents, including those that become dormant within the host, have a major role to play in much of the etiology of rheumatoid arthritis and the inflammation that is its hallmark. This occurs in particular because they can produce cross-reactive (auto-)antigens, as well as potent inflammagens such as lipopolysaccharide that can themselves catalyze further inflammagenesis, including via β-amyloid formation. A series of observables coexist in many chronic, inflammatory diseases as well as rheumatoid arthritis. They include iron dysregulation, hypercoagulability, anomalous morphologies of host erythrocytes, and microparticle formation. Iron dysregulation may be responsible for the periodic regrowth and resuscitation of the dormant bacteria, with concomitant inflammagen production. The present systems biology analysis benefits from the philosophical idea of "coherence," that reflects the principle that if a series of ostensibly unrelated findings are brought together into a self-consistent narrative, that narrative is thereby strengthened. As such, we provide a coherent and testable narrative for the major involvement of (often dormant) bacteria in rheumatoid arthritis.
25787143 Rheumatoid arthritis vaccine therapies: perspectives and lessons from therapeutic ligand e 2015 Jun The current status of therapeutic vaccines for autoimmune diseases is reviewed with rheumatoid arthritis as the focus. Therapeutic vaccines for autoimmune diseases must regulate or subdue responses to common self-antigens. Ideally, such a vaccine would initiate an antigen-specific modulation of the T-cell immune response that drives the inflammatory disease. Appropriate animal models and types of T helper cells and signature cytokine responses that drive autoimmune disease are also discussed. Interpretation of these animal models must be done cautiously because the means of initiation, autoantigens, and even the signature cytokine and T helper cell (Th1 or Th17) responses that are involved in the disease may differ significantly from those in humans. We describe ligand epitope antigen presentation system vaccine modulation of T-cell autoimmune responses as a strategy for the design of therapeutic vaccines for rheumatoid arthritis, which may also be effective in other autoimmune conditions.
25986276 Mycobacterium abscessus Pulmonary Infection under Treatment with Tocilizumab. 2015 Although biological agents are of considerable benefit to patients with rheumatoid arthritis (RA), the potential for opportunistic infections is a critical issue. It is therefore important to achieve a balance between treatment efficacy and controlling opportunistic infection. We herein report the successfully managed case of a 53-year-old patient with RA who developed pulmonary Mycobacterium abscessus infection during treatment with tocilizumab and methotrexate.
25940989 Diagnostic performance of anti-cyclic citrullinated peptide and rheumatoid factor in patie 2016 Sep AIM: To compare the diagnostic performance of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) in the diagnosis of patients with rheumatoid arthritis (RA) in Taiwan. METHODS: Serum concentrations of RF and anti-CCP were measured in 246 cases, including 39 patients with RA and 207 patients with other rheumatic diseases (non-RA). The age, sex, clinical presentation, RF, anti-CCP results and the final diagnoses were recorded and analyzed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated. RESULTS: Among all 246 patients, 39 (15.9%) were diagnosed with RA and 207 (84.1%) were diagnosed with other rheumatic diseases (non-RA). In the diagnosis of RA, the sensitivity, specificity, PPV, NPV, LR+ and LR- of the RF test were 67%, 79%, 37%, 93%, 3.12, and 0.42, respectively. The corresponding data for the anti-CCP test were 79%, 98%, 86%, 96%, 32.91 and 0.21, respectively. The presence of either anti-CCP or RF increased the sensitivity to 85%, and when they both were present, the specificity increased to 98%. Among the 39 RA patients, 26 (66.7%) tested positive for RF, and 31 (79.5%) tested positive for anti-CCP. RF was positive in two of eight anti-CCP-negative patients with RA, and anti-CCP was positive in seven of 13 RF-negative patients with RA. CONCLUSIONS: The RF and anti-CCP tests are complementary, and the co-detection of these antibodies can increase the detection rate and provide important clinical value in the diagnosis of RA. Both anti-CCP and RF positivity are useful for the diagnosis of RA, and use of both tests together improves the diagnostic sensitivity.
26107741 Rheumatoid Arthritis as a Therapeutic Challenge in a Patient with Lynch Syndrome. 2015 Jun 24 BACKGROUND: Lynch syndrome (LS) is an inherited colorectal cancer (CRC) syndrome accounting for about 3-5% of all cases and involves significantly higher risk of subsequent malignancies, colonic as well as extra-colonic. Increased risk of malignancies, especially lymphoid malignancies, have been described in patients with autoimmune diseases like rheumatoid arthritis (RA), systemic lupus erythematosus, and Sjögren's syndrome. Epidemiological studies demonstrated that hematopoietic, lung, skin, and prostate cancers are increased in RA, while breast and colon cancers are decreased, with an overall slight increase in all cancers. CASE REPORT: Our case demonstrates the development of CRC, endometrial cancer, and breast cancer as a presentation of LS in a patient with RA and presents a therapeutic challenge for RA treatment. CONCLUSIONS: We describe a patient with LS and RA presenting a therapeutic challenge because biologic agents commonly used to treat severe RA need to be used cautiously in patients with history of malignancy.
27603313 Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and 2016 OBJECTIVE: To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. METHODS: Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. RESULTS: The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5), moderate if >5 and <9 and high if ≥9. HUPI's AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28's AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. CONCLUSIONS: The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis.
28743354 Analysis of four serum biomarkers in rheumatoid arthritis: association with extra articula 2017 Jul OBJECTIVES: To evaluate the frequency of four serum biomarkers in RA patients and their relatives and identify possible associations with clinical findings of the disease. METHODS: This was a transversal analytical study. Anti-cyclic citrullinated peptide (anti-CCP), anti-mutated citrullinated vimentin (anti-MCV) and IgA-rheumatoid factor (RF) were determined by ELISA and IgM-RF by latex agglutination in 210 RA patients, 198 relatives and 92 healthy controls from Southern Brazil. Clinical and demographic data were obtained through charts review and questionnaires. RESULTS: A higher positivity for all antibodies was observed in RA patients when compared to relatives and controls (p<0.0001). IgA-RF was more frequent in relatives compared to controls (14.6% vs. 5.4%, p=0.03, OR=2.98; 95% CI=1.11-7.98) whereas anti-CCP was the most common biomarker among RA patients (75.6%). Concomitant positivity for the four biomarkers was more common in patients (46.2%, p<0.0001). Relatives and controls were mostly positive for just one biomarker (20.2%, p<0.0001 and 15.2%, p=0.016, respectively). No association was observed between the number of positive biomarkers and age of disease onset, functional class or tobacco exposure. In seronegative patients predominate absence of extra articular manifestations (EAMs) (p=0.01; OR=3.25; 95% CI=1.16-10.66). Arthralgia was present in positive relatives, regardless the type of biomarker. CONCLUSIONS: A higher number of biomarkers was present in RA patients with EAMs. Positivity of biomarkers was related to arthralgia in relatives. These findings reinforce the link between distinct biomarkers and the pathophysiologic mechanisms of AR.
25036855 Predictors of severe self-reported disability in RA in a long-term follow-up study. 2015 PURPOSE: Identify factors predictive for severe self-reported disability in patients with rheumatoid arthritis. METHODS: Patients (n = 1910) were sent a questionnaire 5-18 years after disease onset. Outcomes were the Health Assessment Questionnaire (HAQ), Rheumatoid Arthritis Outcome Score (RAOS) and physical activity. The tertile of patients most affected by the disease were compared to those less affected. Proposed predictive factors were function, pain, general health, radiographic joint damage, swollen/tender joints and disease activity measures at baseline. Age, gender and disease duration were controlled for in logistic regression analyses. RESULTS: Seventy-three percent (n = 1387) responded to the questionnaire, mean age 65 years (SD 15) and 70% were women. Worse scores in function, pain, general health and tender joints at baseline increased the risk of being in the most affected group, as measured by HAQ and RAOS 5-18 years after disease onset (p < 0.000). CONCLUSION: High levels of pain and worse reports of function at disease onset were risk factors for being in the most disabled tertile of patients after 5-18 years. Pain and function proved to be predictors of the outcome while some measures of inflammation were not. It is important to recognize these patients who may be in need of multidisciplinary treatments already at disease onset. IMPLICATIONS FOR REHABILITATION: Health care providers should be aware of the subgroup of patients with more severe symptoms of pain and impaired function at disease onset since they have an increased risk of being in the most disabled tertile of rheumatoid arthritis patients several years later. Health care providers should assess pain and function and act on high pain and impaired function already at disease onset as they proved to be predictors of patient-reported outcomes controlled for inflammatory parameters. These findings support European guidelines and research findings that patients with high pain and impaired function despite of well-managed inflammatory parameters should early in the disease course be referred to multidisciplinary treatment for supplementary regime.
27209051 Interleukin-17A expression in human synovial mast cells in rheumatoid arthritis and osteoa 2016 Sep BACKGROUND: Interleukin (IL)-17A plays a pivotal role in the pathogenesis of rheumatoid arthritis (RA). The expression of IL-17A in synovial mast cells (MCs) in RA and osteoarthritis (OA) has been reported, but the frequencies of IL-17A expression in synovial MCs have varied. The aim of this study was to investigate whether IL-17A expression is upregulated in human synovial MCs in RA and to elucidate the mechanism of IL-17A expression in synovial MCs. METHODS: Synovial tissues were obtained from patients with RA or OA undergoing joint replacement surgery, and synovial MCs were enzymatically dispersed. Synovium-derived cultured MCs were generated by culturing synovial cells with stem cell factor. IL-17A expression was investigated using immunofluorescence in synovial tissues. IL-17A mRNA expression and its production from MCs were examined using RT-PCR and ELISA, respectively. RESULTS: The number of IL-17A-positive ((+)) synovial MCs and the percentage of IL-17A(+) MCs among all the IL-17A(+) cells from RA patients were not significantly increased compared with those from OA subjects. The synovium-derived cultured MCs spontaneously released small amounts of IL-17A. Neither IgE- nor IgG-dependent stimulation increased IL-17A production from the MCs. IL-33, tumor necrosis factor-α, C5a, lipopolysaccharide or IL-23 plus IL-1β did not affect IL-17A production in MCs. CONCLUSIONS: The synovial MCs are not a main source of IL-17A in RA.
26912585 Translating patient reported outcome measures: methodological issues explored using cognit 2016 Jun OBJECTIVE: Cross-cultural translation of patient-reported outcome measures (PROMs) is a lengthy process, often performed professionally. Cognitive interviewing assesses patient comprehension of PROMs. The objective was to evaluate the usefulness of cognitive interviewing to assess translations and compare professional (full) with non-professional (simplified) translation processes. METHODS: A full protocol used for the Bristol RA Fatigue Multi-dimensional Questionnaire and Numerical Rating Scale (BRAF-MDQ, BRAF-NRS) was compared with a simplified protocol used for the RA Impact of Disease scale (RAID). RA patients in the UK, France, the Netherlands, Germany, Spain and Sweden completed the PROMs during cognitive interviewing (BRAFs in the UK were omitted as these were performed during development). Transcripts were deductively analysed for understanding, information retrieval, judgement and response options. Usefulness of cognitive interviewing was assessed by the nature of problems identified, and translation processes by percentage of consistently problematic items (⩾40% patients per country with similar concerns). RESULTS: Sixty patients participated (72% women). For the BRAFs (full protocol) one problematic item was identified (of 23 items × 5 languages, 1/115 = 0.9%). For the RAID (simplified protocol) two problematic items were identified (of 7 items × 6 languages, 2/42 = 4.8%), of which one was revised (Dutch). Coping questions were problematic in both PROMs. CONCLUSION: Conceptual and cultural challenges though rare were important, as identified by formal evaluation, demonstrating that cognitive interviewing is crucial in PROM translations. Proportionately fewer problematic items were found for the full than for the simplified translation procedure, suggesting that while both are acceptable, professional PROM translation might be preferable. Coping may be a particularly challenging notion cross-culturally.
25575064 [Elevated levels of Th17/regulatory T cells in peripheral blood are associated with diseas 2015 Jan OBJECTIVE: To detect the relative quantity of Th17 cells and regulatory T cell (Tregs) in peripheral blood of patients with rheumatoid arthritis (RA) and explore its clinical significance. METHODS: The study enrolled 60 patients who met the diagnostic criteria of RA and 15 healthy subjects as control group. Using flow cytometry, we tested the percentage of Th17 cells/Tregs in the total CD4⁺ cells in peripheral blood and contrasted the difference between the RA patients and healthy subjects. Then we analyzed the relationships of the Th17 cells/Tregs expression with the numbers of swollen and tender joints, DAS28 scores, pain intensity on a visual analogue scale (VAS), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). RESULTS: Compared with the controls, the RA patients presented with significantly increased Th17 cell number and decreased Tregs. There was a positive correlation between the number of Th17 cells in peripheral blood of the RA patients and the numbers of swollen and tender joints, DAS28 scores and CRP, and no correlation between the number of Tregs and the indices of the disease activity like the numbers of swollen and tender joints, DAS28 scores, pain on the VAS, ESR and CRP. CONCLUSION: The relative quantity of Th17 cells rises and that of Tregs drops in peripheral blood of RA patients, and the increase of Th17 cells is related to the disease activity of RA.
25687985 Sociodemographic factors associated with functional disability in outpatients with rheumat 2015 May With the rising number of patients with rheumatoid arthritis (RA), there is a limited understanding about sociodemographic factors that influence functional disability in Chinese patients. In order to provide more targeted interventions to improve health-related quality of life (HRQoL) for patients with RA, we conducted a cross-sectional study to investigate the level and influencing factors of functional disability. Convenient samples were collected in outpatients with RA from a rheumatological center in southwest China from September to December 2013. Data were collected by printed questionnaires, and functional disability was measured by the Health Assessment Questionnaire Disability Index (HAQ-DI). The results showed that 58.48 % of 607 outpatients had functional disability. Patients from rural residents, with lower household income and lower education level, were significantly associated with worse functional disability. Multivariate regression findings showed that pain, age, disease duration, total cost for treatment, and frequency of hospitalization were positively associated with functional disability. Meanwhile, subjective and available social support was the protective predictors for functional disability. The results suggested that systematic intervention and therapies should be provided as early as possible. Patients and health care providers should promote the awareness of the importance of accessible health education in early intervention of RA. Besides, pain management and social support are encouraged to postpone the process of disability of patients and improve the HRQoL. Lastly, but not least, prevention and intervention of RA should be incorporated into public health education.
27479367 Rheumatoid arthritis: previously untreated early disease. 2016 Aug 1 INTRODUCTION: Rheumatoid arthritis is a chronic autoimmune disease, which most often presents as a symmetrical polyarthritis of the hands and feet. Pharmacological treatments include non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs) and other disease-modifying anti-rheumatoid drugs (DMARDs), which may be synthetic (either conventional [csDMARDs] or targeted [tsDMARDs]) or biological (bDMARDs). METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of methotrexate in combination with other csDMARDs versus methotrexate monotherapy in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs as monotherapy versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs in combination with methotrexate versus methotrexate monotherapy or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of glucocorticoids in combination with methotrexate or with other csDMARDs versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 2058 studies. Of the full articles evaluated, 10 systematic reviews, 22 RCTs, and one follow-up report were added at this update. We performed a GRADE evaluation for 18 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for 22 comparisons based on information about the effectiveness and safety of bDMARDs (monotherapy or combined with csDMARDs), csDMARDs (monotherapy or combined with other csDMARDs), glucocorticoids combined with methotrexate or other csDMARDs, and methotrexate (monotherapy or combined with other csDMARDs), identifying interventions which were likely or unlikely to be beneficial.
27699656 Dichotomous versus semi-quantitative scoring of ultrasound joint inflammation in rheumatoi 2017 May The aim of the study is to compare the responsiveness of two joint inflammation scoring systems (dichotomous scoring (DS) versus semi-quantitative scoring (SQS)) using novel individualized ultrasound joint selection methods and existing ultrasound joint selection methods. Responsiveness measured by the standardized response means (SRMs) using the DS and the SQS system (for both the novel and existing ultrasound joint selection methods) was derived using the baseline and the 3-month total inflammatory scores from 20 rheumatoid arthritis patients. The relative SRM gain ratios (SRM-Gains) for both scoring system (DS and SQS) comparing the novel to the existing methods were computed. Both scoring systems (DS and SQS) demonstrated substantial SRM-Gains (ranged from 3.31 to 5.67 for the DS system and ranged from 1.82 to 3.26 for the SQS system). The SRMs using the novel methods ranged from 0.94 to 1.36 for the DS system and ranged from 0.89 to 1.11 for the SQS system. The SRMs using the existing methods ranged from 0.24 to 0.32 for the DS system and ranged from 0.34 to 0.49 for the SQS system. The DS system appears to achieve high responsiveness comparable to SQS for the novel individualized ultrasound joint selection methods.
26962704 Rediscovering the therapeutic use of glucocorticoids in rheumatoid arthritis. 2016 May PURPOSE OF REVIEW: This review will focus on new information obtained on how to apply glucocorticoids in the treatment of rheumatoid arthritis, aiming at an optimal risk-benefit ratio. Moreover, advances in the development of new preparations such as liposomal glucocorticoids will be discussed. RECENT FINDINGS: In early rheumatoid arthritis, treatment regimens with a disease-modifying drug and initially medium-dose glucocorticoids (>7.5 but ≤30 mg prednisone equivalent) are noninferior compared with regimens with disease-modifying drugs and initially high-dose glucocorticoids (>30 mg prednisone equivalent) and have repeatedly been proven to be more effective than methotrexate monotherapy. Use of glucocorticoids following such a scheme during a period of 6 months to 2 years was not associated with increased mortality, nor with substantial bone loss if bone protective measures had been taken. New drug delivery systems, and in particular long-circulating liposomes, aiming at enhancing the biodistribution and the target site accumulation of glucocorticoids and thereby improving the balance between their efficacy and toxicity, are promising; more results on the effects in rheumatoid arthritis patients are expected to be reported during the years to come. SUMMARY: Combination therapy including methotrexate and glucocorticoids should be the initial treatment in patients with early rheumatoid arthritis. Treatment regimens including medium-dose glucocorticoids are noninferior compared with regimens with initially high-dose glucocorticoids. Studies on new glucocorticoid preparations and new drug delivery systems improving the balance between efficacy and toxicity of glucocorticoid therapy are ongoing.
27762200 Primary and secondary patient data in contrast: the use of observational studies like RABB 2016 Sep The study of secondary patient data, particularly represented by claims data, has increased in recent years. The strength of this approach involves easy access to data that have been generated for administrative purposes. By contrast, collection of primary data for research is time-consuming and may therefore appear outdated. Both administrative data and data collected prospectively in clinical care can address similar research questions concerning effectiveness and safety of treatments. Therefore, why should we invest the precious time of rheumatologists to generate primary patient data? This article will outline some features of primary patient data collection illustrated by the German biologics register RABBIT (Rheumatoid arthritis: observation of biologic therapy). RABBIT is a long-term observational cohort study that was initiated more than 15 years ago. We will discuss as quality indicators: (i) study design, (ii) type of documentation, standardisation of (iii) clinical and (iv) safety data, (v) monitoring of the longitudinal follow-up, (vi) losses to follow-up as well as (vii) the possibilities to link the data base. The impact of these features on interpretation and validity of results is illustrated using recent publications. We conclude that high quality and completeness of data prospectively-collected offers many advantages over large quantities of non-standardised data collected in an unsupervised manner. We expect the enthusiasm about the use of secondary patient data to decline with more awareness of their methodological limitations while studies with primary patient data like RABBIT will maintain and broaden their impact on daily clinical practice.