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ID PMID Title PublicationDate abstract
27537849 Anti-Carbamylated Protein Antibodies as a Reproducible Independent Type of Rheumatoid Arth 2016 A large fraction of the patients with rheumatoid arthritis (RA) develop specific autoantibodies, which until recently were only of two types, rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA). We aimed to replicate important findings about a recently described third type of specific autoantibodies, anti-carbamylated protein (anti-CarP) antibodies, because they have been described based only in the homemade ELISA from a single laboratory. Our study included 520 patients with established RA and 278 healthy controls of Spanish ancestry and it was done with an independently performed ELISA. The prevalence and pattern of environmental, clinical and genetic associations of the anti-CarP antibodies were similar to the previously described. Notably, the presence and titers of anti-CarP correlated with the presence and titers of ACPA, but the anti-CarP antibodies did not share the known genetic and exposure risk factors of the ACPA. In addition, anti-CarP antibodies were independently associated with a higher (10.5%) prevalence of bone erosions. The reproducibility of these characteristics across laboratories and European subpopulations, indicates the wide validity of the results and suggests that determination of anti-CarP antibodies could contribute to explain RA pathogenesis and identify clinically relevant patient subgroups.
26774261 DAS steered therapy in clinical practice; cross-sectional results from the METEOR database 2016 Jan 16 BACKGROUND: Little is known on how well targeted treatment, for instance targeting towards low DAS, is implemented in clinical practice. Our aim was to evaluate treatment adjustments in response to DAS in RA patients in clinical practice. METHODS: We used data from one referral centre, multiple rheumatologists, from the METEOR database. Generalized Estimating Equations (GEE) were used to assess whether in case of non-low disease activity (DAS > 2.4) treatment intensifications in DMARD therapy occurred ((change or increase in dose or number of DMARDs, including synthetic (s)DMARDs, biologic (b)DMARDs and corticosteroids compared to the visit before)). Determinants of not intensifying the treatment when DAS > 2.4 were investigated using GEE. RESULTS: Five thousand one hundred fifty-seven registered visits of 1202 patients were available for the analyses. A DAS > 2.4 was weakly (OR: 1.19; 95% CI 1.07-1.33) associated with a treatment intensification. In 69% (n = 3577) of the visits patients were in low disease activity. In 66% (n = 1028) of the visits with DAS > 2.4 treatment was not intensified. These patients had a higher tender joint count and received more often methotrexate plus a bDMARD, or csDMARD monotherapy, as compared to patients that received treatment intensification. CONCLUSION: In the majority of visits in the METEOR database patients were already in a state of low disease activity, reflecting appropriate treatment intensity. When DAS was greater than 2.4, treatment was often not intensified due to high tender joint count or specific treatment combinations. This data suggest that while aiming for low DAS, physicians per patient weigh whether all DAS elements indicate disease activity or will respond to DMARD adjustment or not, and make treatment decisions accordingly.
27106351 Interleukin 6/Wnt interactions in rheumatoid arthritis: interleukin 6 inhibits Wnt signali 2016 Apr 23 AIM: To evaluate the impact of previously unrecognized negative interaction between the Wnt and interleukin (IL) 6 signaling pathways in skeletal tissues as a possible major mechanism leading to age- and inflammation-related destruction of bone and joints. METHODS: Luciferase reporter assays were performed to monitor Wnt pathway activation upon IL-6 and tumor necrosis factor-α (TNFα) treatment. Functional contribution of IL-6 and TNFα interaction to inhibition of bone formation was evaluated in vitro using small hairpin RNAs (shRNA) in mouse mesenchymal precursor cells (MPC) of C2C12 and KS483 lines induced to differentiate into osteoblasts by bone morphogenetic proteins (BMP). RESULTS: IL-6 inhibited the activation of Wnt signaling in primary human synoviocytes, and, together with TNFα and Dickkopf-1, inhibited the activation of Wnt response. ShRNA-mediated knockdown of IL-6 mRNA significantly increased early BMP2/7-induced osteogenesis and rescued it from the negative effect of TNFα in C2C12 cells, as well as intensified bone matrix mineralization in KS483 cells. CONCLUSION: IL-6 is an important mediator in the inhibition of osteoblast differentiation by TNFα, and knockdown of IL-6 partially rescues osteogenesis from the negative control of inflammation. The anti-osteoblastic effects of IL-6 are most likely mediated by its negative interaction with Wnt signaling pathway.
27330161 Self-reported comorbidity is common in early inflammatory arthritis and associated with po 2016 Oct OBJECTIVE: Comorbid medical conditions may influence treatment and contribute to poor outcomes in early RA. We aimed to assess the association of baseline comorbidity with outcomes in early inflammatory arthritis using data from the Canadian Early Arthritis Cohort. METHODS: Patients (n = 2090) with early inflammatory arthritis (symptom duration of < 1 year) reported comorbid medical conditions at baseline. Functional status (HAQ), detailed clinical assessments and treatment were assessed. Treatment is not protocolized but participating rheumatologists aim for remission. The influence of comorbidity on clinical outcomes was determined using multivariate models. RESULTS: At least one comorbid condition was reported by 76% of patients. Patients with comorbidity were older (mean age 56 vs 44 years, P < 0.0001) and had worse baseline function [median (interquartile range, IQR) HAQ score (0.88 (1) vs 0.75(1), P < 0.0001] compared with those without comorbidity even after controlling for age, sex and symptom duration. At 1 year, patients with baseline comorbidity were less likely to achieve remission (odds ratio, OR = 0.67; 95% CI: 0.51, 0.88, P = 0.004) and had higher HAQ [median (IQR) 0.25 (1) vs 0 (0), P < 0.0001] and pain scores [median (IQR) 2.85 (4) (out of 10) vs 1 (4), P < 0.0001] than patients without comorbidity after adjusting for age, sex, symptom duration, baseline disease activity and arthritis treatment. CONCLUSION: Comorbidity is common in early inflammatory arthritis and associated with higher disease activity, worse functional status and greater pain scores during the first year of follow-up. While the mechanisms for this association require investigation, addressing comorbidity may improve clinical outcomes in early RA.
26316393 Circulating Interferon-Inducible Protein IFI16 Correlates With Clinical and Serological Fe 2016 Apr OBJECTIVE: The interferon-inducible protein 16 (IFI16) has been detected in sera from patients with autoimmune/inflammatory diseases, but not in healthy subjects. This leaking leads to loss of tolerance toward this self-protein and the development of autoantibodies. In this study, clinical significance of both IFI16 protein and anti-IFI16 antibodies in rheumatoid arthritis (RA) was investigated. METHODS: IFI16 protein and anti-IFI16 antibody levels were assessed by enzyme-linked immunosorbent assay in serum samples from 154 RA patients and 182 healthy controls, and in synovial fluid (SF) samples from 21 RA patients and 25 patients with osteoarthritis (OA). RESULTS: Mean serum levels for both IFI16 and anti-IFI16 antibodies were higher in RA patients than in healthy controls, with a direct correlation between IFI16 concentration and anti-IFI16 antibody titer. The majority of RA patients with detectable circulating IFI16 protein were also positive for rheumatoid factor (RF)/anti-cyclic citrullinated peptide antibody (anti-CCP). The latter group was found to be positive for anti-IFI16 antibodies as well. The mean SF concentrations of both IFI16 protein and anti-IFI16 antibodies were higher in RA patients when compared with control OA patients. Interestingly, the presence of circulating IFI16 protein, but not anti-IFI16 antibodies, significantly correlated with RA-associated pulmonary disease. This correlation was not dependent on the presence of anti-IFI16 antibodies, sex, and smoking habit. CONCLUSION: Our data demonstrate that the high levels of circulating IFI16 in RA are more frequent in RF/anti-CCP-positive RA patients and significantly associated with pulmonary involvement. The relevance of circulating IFI16 protein as a new clinical biomarker of RA should be verified with additional studies.
26852313 Recently diagnosed rheumatoid arthritis patients benefit from a treat-to-target strategy: 2016 Mar Despite considerable evidence on the efficacy and safety of early aggressive treat-to-target (T2T) strategies in early rheumatoid arthritis (RA), a proportion of patients still fail to reach remission. The goal of this study is to examine remission rates and predictors of remission in a real life T2T cohort of consecutive patients with a recent diagnosis of RA. Baseline demographics, clinical, laboratory and patient-reported variables and 1-year follow-up disease activity data were used from patients with early RA included in the DREAM remission induction cohort II study. Survival analyses and simple and multivariable logistic regression analyses were used to examine remission rates and significant predictors of achieving remission. A total of 137 recently diagnosed consecutive RA patients were available for this study. During the first year after inclusion, DAS28 remission was achieved at least once in 77.2 % of the patients and the median time to first remission was 17 weeks. None of the examined baseline variables were robustly associated with achieving remission within 1 year and in the multivariable analysis only lower ESR (p = 0.005) remained significantly associated with achieving fast remission within 17 weeks. During the first year of their disease a high proportion of recently diagnosed RA patient achieved remission, with only a small percentage of patients needing bDMARD therapy. Combined with the absence of baseline predictors of remission, this suggests that clinicians in daily clinical practice may focus on DAS28 scores only, without needing to take other patients characteristics into account.
26456433 Outcome after total elbow arthroplasty: a retrospective study of 167 procedures performed 2015 Dec BACKGROUND: Total elbow arthroplasties (TEAs) are traditionally grouped into linked and unlinked design. The aim was to analyze the difference in clinical outcomes after TEA based on implant design and indication for surgery and to evaluate primary and revision TEAs. METHODS: A total of 167 TEAs (126 primary and 41 revision TEAs) in 141 patients were evaluated with patient-reported outcome measure by the Oxford Elbow Score (OES) and clinically assessed with the Mayo Elbow Performance Score (MEPS), range of motion (ROM), and standard radiographs. RESULTS: The mean follow-up was 10.5 years for primary and 7.5 years for revision TEAs. There was no difference in OES or MEPS between linked and unlinked primary TEAs. The OES score in the social-psychological domain was significantly lower in TEAs performed due to fracture (67) compared with rheumatoid arthritis (81; P = .025). ROM in extension-flexion was 116° for primary linked TEAs compared with 110° for primary unlinked TEAs (P = .02). Revision TEAs were associated with a poorer outcome in OES, MEPS, and ROM compared with primary TEAs. Radiographic signs of loosening were seen in 15 primary and 7 revision TEAs at follow-up. CONCLUSIONS: We found no clinically significant differences in outcomes after linked or unlinked TEAs. Patients with TEAs due to fracture had poorer social-psychological results than rheumatoid arthritis patients. The results after revision surgery were significantly inferior compared with primary procedures. The OES contributes to the evaluations of the outcome after TEA surgery with a nuanced picture of the patient's perception.
24252054 Confirmation of effectiveness of tocilizumab by ultrasonography and magnetic resonance ima 2015 Efficacy of tocilizumab in active early-stage RA patients despite methotrexate was evaluated for 12 months. One out of 5 patients was quitted by infusion reaction whereas tocilizumab continued for 12 months in the remaining 4 patients. Power Doppler articular synovitis was reduced in every patient and disappeared in 2 patients. Marked MRI osteitis, found in 1 patient, had disappeared at 12 months. Present results confirm the efficacy of tocilizumab by ultrasonography and MRI.
26903239 Effects of synthetic and biological disease modifying antirheumatic drugs on lipid and lip 2016 Jun BACKGROUND: Dyslipidemia in rheumatoid arthritis (RA) patients is frequently observed, and treatment with anti-rheumatic drugs has an impact on lipid profiles. Pathophysiologically, inflammation leads to decreased blood lipids and lipoproteins; RA treatment reduces inflammation and therefore may increase lipids and lipoproteins. Whether the lipid changes with RA treatment confer an increased risk of cardiovascular disease or just reflect their potentially atheroprotective anti-inflammatory effect is currently unclear due to limited and conflicting data. OBJECTIVE: The aim of this review is to summarize the current knowledge on the effects of synthetic and biological disease modifying antirheumatic drugs for the treatment of RA on lipid and lipoprotein parameters. RESULTS: Recent studies on methotrexate emphasize its anti-atherogenic effect. Golimumab combined with methotrexate revealed a trend towards an anti-atherogenic potential. The known pro-atherogenic lipid-spectrum alterations caused by tofacitinib can be effectively treated with atorvastatin. Tocilizumab signals a favorable impact on the extent of lipid modifications when combined with methotrexate. Abatacept indicated a trend towards an anti-atherogenic lipid profile demonstrated by favorable effects on HDL-C and on the TC/HDL-C ratio. Rituximab has beneficial effects on HDL-C and ApoA1, as well as on the ApoB/ApoA1 ratio. CLINICAL IMPLICATIONS: Anti-rheumatic drugs have various effects on lipid parameters, which in part appear pro-atherogenic. However, because many of these lipid changes may well reflect their potentially atheroprotective anti-inflammatory action the cardiovascular impact of these changes remains unclear. Whatsoever, cardiovascular safety trials for antirheumatic drugs would be valuable.
25781999 The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systemati 2015 BACKGROUND AND OBJECTIVES: Economic evaluations provide information to aid the optimal utilization of limited healthcare resources. Costs of biologics for Rheumatoid arthritis (RA) are remarkably high, which makes these agents an important target for economic evaluations. This systematic review aims to identify existing studies examining the cost-effectiveness of biologics for RA, assess their quality and report their results systematically. METHODS: A literature search covering Medline, Scopus, Cochrane library, ACP Journal club and Web of Science was performed in March 2013. The cost-utility analyses (CUAs) of one or more available biological drugs for the treatment of RA in adults were included. Two independent investigators systematically collected information and assessed the quality of the studies. To enable the comparison of the results, all costs were converted to 2013 euro. RESULTS: Of the 4890 references found in the literature search, 41 CUAs were included in the current systematic review. While considering only direct costs, the incremental cost-effectiveness ratio (ICER) of the tumor necrosis factor inhibitors (TNFi) ranged from 39,000 to 1,273,000 €/quality adjusted life year (QALY) gained in comparison to conventional disease-modifying antirheumatic drugs (cDMARDs) in cDMARD naïve patients. Among patients with an insufficient response to cDMARDs, biologics were associated with ICERs ranging from 12,000 to 708,000 €/QALY. Rituximab was found to be the most cost-effective alternative compared to other biologics among the patients with an insufficient response to TNFi. CONCLUSIONS: When 35,000 €/QALY is considered as a threshold for the ICER, TNFis do not seem to be cost-effective among cDMARD naïve patients and patients with an insufficient response to cDMARDs. With thresholds of 50,000 to 100,000 €/QALY biologics might be cost-effective among patients with an inadequate response to cDMARDs. Standardization of multiattribute utility instruments and a validated standard conversion method for missing utility measures would enable better comparison between CUAs.
26418481 Association between trabecular bone score and risk factors for fractures in Korean female 2016 Jul OBJECTIVE: To identify the association between trabecular bone score (TBS) and other known risk factors for fractures in rheumatoid arthritis (RA) patients. METHODS: One hundred female RA patients aged ≥50 years were enrolled. The following risk factors for fracture were selected: prevalent vertebral fracture (VF), bone mineral density (BMD), TBS, and 10-year probability of major osteoporotic fracture by FRAX® (MOF-FRAX scores). The associations between risk factors were identified, and accuracy of TBS, BMD, and FRAX scores to detect the prevalent VF, the strongest risk factor for future fracture, were assessed. RESULTS: Twenty-six patients were revealed to have moderate to severe VFs. There was a modest negative correlation between MOF-FRAX score and TBS (r =  -0.367, p < 0.01), while there was no correlation between MOF-FRAX score and L-spine BMD (r =  -0.050, p = 0.62). The areas under curves (AUCs) were 0.818, 0.683, and 0.518 for the MOF-FRAX score, TBS, and L-spine BMD, respectively. Among patients with glucocorticoids (GC) use (n = 57), AUCs were 0.762, 0.758, and 0.448 for their MOF-FRAX score, TBS, and L-spine BMD, respectively. CONCLUSIONS: TBS showed better correlation with MOF-FRAX score than BMD, and it was superior to BMD in identifying prevalent VFs in RA patients, especially who are in use of GCs.
27450487 Medical ozone increases methotrexate clinical response and improves cellular redox balance 2016 Oct 15 Medical ozone reduced inflammation, IL-1β, TNF-α mRNA levels and oxidative stress in PG/PS-induced arthritis in rats. The aim of this study was to investigate the medical ozone effects in patients with rheumatoid arthritis treated with methotrexate and methotrexate+ozone, and to compare between them. A randomized clinical study with 60 patients was performed, who were divided into two groups: one (n=30) treated with methotrexate (MTX), folic acid and Ibuprophen (MTX group) and the second group (n=30) received the same as the MTX group+medical ozone by rectal insufflation of the gas (MTX+ozone group). The clinical response of the patients was evaluated by comparing Disease Activity Score 28 (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), Anti-Cyclic Citrullinated (Anti-CCP) levels, reactants of acute phase and biochemical markers of oxidative stress before and after 20 days of treatment. MTX+ozone reduced the activity of the disease while MTX merely showed a tendency to decrease the variables. Reactants of acute phase displayed a similar picture. MTX+ozone reduced Anti-CCP levels as well as increased antioxidant system, and decreased oxidative damage whereas MTX did not change. Glutathione correlated with all clinical variables just after MTX+ozone. MTX+ozone increased the MTX clinical response in patients with rheumatoid arthritis. No side effects were observed. These results suggest that ozone can increase the efficacy of MTX probably because both share common therapeutic targets. Medical ozone treatment is capable of being a complementary therapy in the treatment of rheumatoid arthritis.
25948362 Fatal complication of Legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid 2015 We herein report a fatal case of Legionella pneumophila pneumonia in a tocilizumab-treated rheumatoid arthritis patient who was in a state of shock on admission but remained afebrile even during severe pneumonia. Legionella antigen was detected in the urine and neutrophil CD64 expression was highly elevated. Despite undergoing intensive treatment, the patient developed sepsis and died 12 days after admission. An autopsy indicated that while the Legionella infection had almost been controlled, a subarachnoid hemorrhage was the ultimate cause of death.
25384758 Evaluation of serum interleukin-6 level as a surrogate marker of synovial inflammation and 2015 Jul OBJECTIVE: Interleukin-6 (IL-6) is a key cytokine in rheumatoid arthritis pathogenesis. We aimed to analyze the association between IL-6 serum levels and joint inflammation at baseline and the correlation of time-integrated IL-6 values with structural damage during the first 36 months of early arthritis. METHODS: IL-6 was assessed by 2 different methods in 813 patients of the French early arthritis cohort ESPOIR (Etude et Suivi des Polyarthrites Indifférenciées Récentes) over 36 months. IL-6 and C-reactive protein (CRP) changes were correlated to radiographic progression assessed by the total Sharp/van der Heijde score (SHS). Synovium inflammation was assessed in a subgroup of 126 patients by ultrasonography (US). The relationship between SHS change and IL-6 or CRP levels at baseline was investigated by a univariate regression and a multivariable analysis. A longitudinal model nested by visit and patient was conducted to assess the role of IL-6 on SHS at each visit. RESULTS: At baseline, IL-6 was more strongly correlated with the swollen joint count than CRP level. In the univariate analysis, the time-integrated value of IL-6 was more strongly correlated with the swollen joint count and the variation of SHS than time-integrated CRP level. Baseline IL-6 was not independently associated with SHS change. Longitudinal models nested by patient showed that IL-6 levels were associated with structural damage independently from the Disease Activity Score in 28 joints, smoking status, rheumatoid factor, and anti-citrullinated protein peptide antibody serology, treatments, and CRP levels. CONCLUSION: IL-6 level was a marker of US synovitis at baseline. Repeated measurements of IL-6 are associated with structural damage.
25935347 Intraarticular gene transfer of SPRY2 suppresses adjuvant-induced arthritis in rats. 2015 Aug AKT and ERK pathways have been implicated as therapeutic targets for human rheumatoid arthritis (RA), fibroblast-like synoviocytes (FLS) inhibition, and thus RA treatment. Sprouty2 (SPRY2) has been known as a tumor suppressor by blocking both ERK and AKT signaling cascades. Whether SPRY2 can function as a suppressor of tumor-like inflammatory FLS and RA through negatively regulating AKT and ERK activation has not been reported. The purpose of this study was to determine whether SPRY2 might have antiarthritic effects in experimental animal model of RA. We first determined that expression of SPRY2 mRNA was decreased in FLS from patients with RA compared with patients with osteoarthritis (OA). Further studies demonstrated that intraarticular gene transfer with AdSPRY2, the recombinant adenovirus containing SPRY2 complementary DNA, resulted in a significant suppression of rat adjuvant-induced arthritis (AIA) compared with the control AdGFP, the adenoviral vector encoding green fluorescent protein, as reflected in both clinical and histological observations. AdSPRY2 suppressed the production of proinflammatory cytokines and matrix metalloproteinases (MMPs), and the activation of ERK and AKT signals in AIA ankle joints. These results suggest that using SPRY2 to block the AKT and ERK pathways effectively reduces the inflammatory responses and arthritic progression in AIA. Thus, the development of an immunoregulatory strategy based on SPRY2 may therefore have therapeutic potential in the treatment of RA.
26457726 Recent insight in the pathophysiology of coeliac disease: relevance to rheumatoid arthriti 2015 Jul Coeliac disease (CD) is a T cell mediated inflammatory disorder of the small intestine that affects approximately 1% of the population (1, 2). CD is triggered by gluten ingestion, proteins found in wheat, barley and rye. CD4(+) T cells specific for post-translationally modified gluten peptides bound to the disease-predisposing HLA-DQ2 or HLADQ8 molecules are typically found in patients with CD, explaining the strong association between these HLA-alleles and the occurrence of CD (1, 2). In addition, antibodies specific for modified gluten are also present in patients with CD, implying a role for B to T cell presentation (1). Recent studies have determined the T cell repertoire (TCR) that is utilised by gluten-specific T cells in HLA-DQ2(+) and HLA-DQ8(+) patients and structures between such TCR and HLA-DQ-gluten peptide complexes have been solved (3-7). In HLA-DQ2 patients the TCR repertoire specific for an immunodominant gluten peptide is dominated by the expression of TRAV26 and TRBV7-2 (3-5) while in HLA-DQ8(+) patients such T cells frequently express TRAV26 and TRBV9 (6, 7). Moreover, in the TCR-HLADQ-gluten complexes a non-germline encoded arginine is positioned in the interface between the TCR and HLADQ-gluten which makes critical interactions with both HLA-DQ and the bound peptide (5-7). Collectively, these observations point to stringent selection of a high affinity TCR repertoire in patients with CD. Similar mechanisms are likely to play a role in rheumatoid arthritis (RA).
26172858 Integrating patient reported outcome measures and computerized adaptive test estimates on 2017 Oct AIM: This study aimed to explore the potential of an inclusive and fully integrated measurement system for the Activities component of the International Classification of Functioning, Disability and Health (ICF), incorporating four classical scales, including the Health Assessment Questionnaire (HAQ), and a Computerized Adaptive Testing (CAT). METHODS: Three hundred patients with rheumatoid arthritis (RA) answered relevant questions from four questionnaires. Rasch analysis was performed to create an item bank using this item pool. A further 100 RA patients were recruited for a CAT application. Both real and simulated CATs were applied and the agreement between these CAT-based scores and 'paper-pencil' scores was evaluated with intraclass correlation coefficient (ICC). Anchoring strategies were used to obtain a direct translation from the item bank common metric to the HAQ score. RESULTS: Mean age of 300 patients was 52.3 ± 11.7 years; disease duration was 11.3 ± 8.0 years; 74.7% were women. After testing for the assumptions of Rasch analysis, a 28-item Activities item bank was created. The agreement between CAT-based scores and paper-pencil scores were high (ICC = 0.993). Using those HAQ items in the item bank as anchoring items, another Rasch analysis was performed with HAQ-8 scores as separate items together with anchoring items. Finally a conversion table of the item bank common metric to the HAQ scores was created. CONCLUSION: A fully integrated and inclusive health assessment system, illustrating the Activities component of the ICF, was built to assess RA patients. Raw score to metric conversions and vice versa were available, giving access to the metric by a simple look-up table.
25641884 Clinical and serological analysis of patients with positive anticyclic citrullinated Pepti 2015 May OBJECTIVE: Anticitrullinated protein antibodies (ACPA) are a highly specific and sensitive biomarker for the diagnosis of rheumatoid arthritis (RA). Some patients who were found to have a positive ACPA test were referred to our Rheumatology Central Triage (CT; Calgary, Alberta, Canada) for assessment by a rheumatologist. The objectives of our study were to determine the clinical accuracy of ACPA in establishing a diagnosis of RA in a real-time clinical setting. METHODS: Cases that met 3 criteria were included in the study: (1) referred to the CT over 3 calendar years (n = 20,389), (2) reason for referral was a positive ACPA test (n = 568), and (3) evaluated by a certified rheumatologist (n = 314). An administrative serological database was used to retrieve specific ACPA results. RESULTS: Of patients referred through our CT for evaluation of a positive ACPA test, 57.6% received a diagnosis of RA; the remainder had a variety of other diagnoses, some of which might be considered early RA (9%). The predictive values of ACPA for the diagnosis of RA were increased when rheumatoid factor (RF) results were included in the analysis. When definite and possible RA were combined and the prevalence of moderate/high ACPA was compared to all other individuals, the positive and negative predictive values for moderate/high ACPA for RA were 74.3% and 68.4%, respectively. CONCLUSION: About 58% of patients with a positive ACPA referred through a triage system for a rheumatologist opinion received a diagnosis of RA at their first visit. RF provides additional useful information to guide the diagnosis and urgency of referral.
27585858 Ultrasound disease activity of bilateral wrist and finger joints at three months reflects 2017 Mar OBJECTIVE: We evaluated whether the early responsiveness of ultrasound synovitis can predict the clinical response in rheumatoid arthritis (RA) patients treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs). METHODS: Articular synovitis was assessed by ultrasound at 22 bilateral wrist and finger joints in 39 RA patients treated with bDMARDs. Each joint was assigned a gray-scale (GS) and power Doppler (PD) score from 0 to 3, and the sum of the GS or PD scores was considered to represent the ultrasound disease activity. We investigated the correlation of the change in ultrasound disease activity at three months with the EULAR response criteria at six months. RESULTS: GS and PD scores were significantly decreased at three months (p < 0.0001). The % changes of the GS and PD scores at three months were significantly higher at six months in moderate and good responders compared with non-responders (p < 0.05). These tendencies were numerically more prominent if clinical response was set as good responder or Disease Activity Score 28 remission. Poor improvement of ultrasound synovitis scores had good predictive value for non-responders at six months. CONCLUSIONS: The responsiveness of ultrasound disease activity is considered to predict further clinical response in RA patients treated with bDMARDs.
26493688 High-resolution computed tomography and rheumatoid arthritis: semi-quantitative evaluation 2016 Mar BACKGROUND: We aimed to establish risk factors for radiological lung damage associated with rheumatoid arthritis (RA) and determine whether clinical findings and pulmonary function test were correlated with Warrick score calculated on the basis of high-resolution computed tomography or not. METHODS: One hundred thirty RA patients who were followed at rheumatology outpatient clinic were included through retrospective screening. To evaluate radiological involvement, the semi-quantitative evaluation proposed by Warrick was used to assign a score for each lesion based on the severity and extent of the pulmonary damage. In addition to the total score, indices for alveolitis and fibrosis were created. The correlations between each score and clinical and functional parameters were tested for all patients. RESULTS: We showed that age was an independent explanatory variable of radiological lung damage. Percentage of predicted lung diffusion capacity for carbon monoxide (DLco) below 75 % and presence of respiratory symptoms were found to contribute more to radiological lung damage. Warrick score was positively correlated with age at study onset (r = 0.43, p < 0.001). In addition, a negative correlation was found between Warrick score and DLco % predicted (r = -0.357, p = 0.001). Alveolitis index was negatively correlated with DLco % predicted (r = -0.321, p = 0.003). CONCLUSIONS: It is considered that this semi-quantitative method may have added value in early diagnosis, appropriate treatment decisions and follow-up when taken into account together with risk factors associated with pulmonary damage in RA.