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ID PMID Title PublicationDate abstract
28623526 Benefit-risk trade-offs for treatment decisions in moderate-to-severe rheumatoid arthritis 2017 Sep Given the increasing number of available treatments for rheumatoid arthritis (RA) with varying efficacy and safety profiles, it is critical to understand the level of trade-offs that patients are willing to make between benefits and risks. Adult patients with moderate to severe RA were invited to participate in a discrete choice experiment that solicited their preferences for hypothetical RA treatments. Each participant was presented with 14 choice cards asking about their preference between two hypothetical RA treatments with varying levels of efficacy, adverse events, and process-related attributes. A multivariable logistic regression model assessed the association between the attributes and the patient's decision and risk-increases were calculated. 510 eligible patients with moderate to severe RA completed the study. The average age of the participants was 56.4 years, 64.7% were female, and 45.1% received biologic agents. To achieve a 50% improvement in physical function, patients were willing to accept risk-increases of 91.1, 4.7, and 18.4% for abnormal laboratory results, cancer, and serious infection, respectively. Similarly, to achieve a 50% reduction in RA-related pain, patients were willing to accept risk-increases of 70.6, 3.7, and 14.2% for each AE. Moreover, patients were willing to trade risk-increases of 42.0, 2.2, and 8.5% for each AE to obtain a 50% reduction in the number of swollen joints. Patients with moderate to severe RA are willing to accept increased treatment risks to achieve improved physical function and disease control. These attributes are helpful to clinicians to make informed treatment choices.
28316139 Changes in body composition and metabolic profile during interleukin 6 inhibition in rheum 2017 Aug BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by increased mortality associated with cardiometabolic disorders including dyslipidaemia, insulin resistance, and cachectic obesity. Tumour necrosis factor inhibitors and interleukin 6 receptor blocker licensed for the treatment of RA decrease inflammation and could thus improve cardiovascular risk, but their effects on body composition and metabolic profile need to be clarified. We investigated the effects of tocilizumab (TCZ), a humanized anti-interleukin 6 receptor antibody, on body composition and metabolic profile in patients treated for RA. METHODS: Twenty-one active RA patients treated with TCZ were included in a 1 year open follow-up study. Waist circumference, body mass index, blood pressure, lipid profile, fasting glucose, insulin, serum levels of adipokines and pancreatic/gastrointestinal hormones, and body composition (dual-energy X-ray absorptiometry) were measured at baseline and 6 and 12 months of treatment. At baseline, RA patients were compared with 21 non-RA controls matched for age, sex, body mass index, and metabolic syndrome. RESULTS: Compared with controls, body composition was altered in RA with a decrease in total and appendicular lean mass, whereas fat composition was not modified. Among RA patients, 28.6% had a skeletal muscle mass index below the cut-off point for sarcopaenia (4.8% of controls). After 1 year of treatment with TCZ, there was a significant weight gain without changes for fat mass. In contrast, an increase in lean mass was observed with a significant gain in appendicular lean mass and skeletal muscle mass index between 6 and 12 months. Distribution of the fat was modified with a decrease in trunk/peripheral fat ratio and an increase in subcutaneous adipose tissue. No changes for waist circumference, blood pressure, fasting glucose, and atherogenic index were observed. CONCLUSIONS: Despite weight gain during treatment with TCZ, no increase in fat but a modification in fat distribution was observed. In contrast, muscle gain suggests that blocking IL-6 might be efficient in treating sarcopaenia associated with RA.
28500368 Advanced myocardial tissue characterisation by a multi-component CMR protocol in patients 2017 Nov OBJECTIVES: Rheumatoid arthritis (RA) patients are at increased risk of suffering from adverse cardiovascular events. Cardiovascular magnetic resonance (CMR) mapping techniques might be appropriate tools to complement late gadolinium enhancement (LGE) for the assessment of myocardial involvement. This study aimed to perform advanced myocardial tissue characterisation in RA patients by a multicomponent CMR protocol. METHODS: 22 RA patients were prospectively enrolled and underwent CMR, including LGE and T1/T2 mapping sequences; 20 volunteers served as controls. RESULTS: Mean LV-EF was 66%; prevalence of LGE was 18%. RA patients had increased native T1 (985 vs. 959 ms, p = 0.03), expanded extracellular volume (ECV) (27 vs. 25%, p = 0.02) and higher T2 values (52 vs. 49 ms, p < 0.001) compared to controls irrespective of the presence of LGE. T2 mapping showed the highest prevalence of values beyond the 95% percentile of controls. CONCLUSION: RA patients demonstrated higher T1, ECV and T2 values compared to controls, with most significant differences for T2. Since these results seem to be independent of the presence of LGE, advanced myocardial tissue characterisation including CMR mapping techniques in addition to LGE-CMR might be useful in the evaluation of myocardial involvement in RA patients. KEY POINTS: • RA patients had higher T1, ECV and T2 values compared to controls. • Most significant differences were observed for T2. • Our results seem to be independent of the presence of LGE. • Mapping might be useful in the evaluation of myocardial involvement in RA.
28190151 Oral health-related quality of life depending on oral health in patients with rheumatoid a 2017 Dec BACKGROUND: The aim of this study was to evaluate the oral health-related quality of life (OHRQoL) in patients with rheumatoid arthritis (RA) depending on their oral health in comparison with healthy controls (HCs). METHODS: One hundred three RA patients (55.5 years, female 58) were included. A healthy control group (HC n = 104; 56.7 years, female 68) was matched according to age, gender, and smoking habits. The OHRQoL was determined by Oral Health Impact Profile (OHIP)-G14 questionnaire. Oral examination included dental findings (DMF-T), gingival inflammation (PBI), periodontal probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP). Based on CAL and/or PPD, periodontitis was categorized as healthy/mild, moderate, or severe. STATISTICAL ANALYSIS: trend test (Cochran-Armitage) and Wilcoxon rank-sum test (α = 5%). RESULTS: For DMF-T (RA 17.6 ± 6.1, HC 16.0 ± 6.5) and PBI (RA 0.10 ± 0.18, HC 0.08 ± 0.18), no significant differences between both groups were found (p > 0.05). Approximately 65% of RA group and 79% of HC group showed moderate to severe periodontitis (p = 0.02); RA patients showed significantly higher BOP values (p < 0.01). OHRQoL was significantly worse in RA group compared to HC group (mean OHIP value RA = 7.3 ± 7.2, HC = 1.6 ± 2.1; p < 0.001). In the HC group, a significant effect of DMF-T, M-T, and PD on OHRQoL was detected (p < 0.01), whereas in the RA group, no influence was determined (p > 0.05). CONCLUSION: RA patients showed a worse OHRQoL than HC patients, which was independent of dental and periodontal conditions. RA patients require a more intensive care in consideration of dental, medical, and psychological factors. CLINICAL RELEVANCE: Interdisciplinary collaboration between dentists and rheumatologists is necessary, whereby psychological factors should be considered.
28477897 Tocilizumab treatment leads to improvement in disease activity regardless of CCP status in 2017 Oct OBJECTIVE: Autoantibodies can be useful in predicting response to certain treatments in rheumatoid arthritis (RA). We aimed to evaluate initial response to tocilizumab (TCZ) by change in physician and patient-reported outcomes and laboratory parameters in a real-world cohort of patients with RA. We analyzed the data by autoantibody status to determine whether patients with seronegative RA had improved response to tocilizumab when compared to their seropositive counterparts. METHODS: Data from the CORRONA RA registry were analyzed. Patients were included if they were started on TCZ and had data from a follow-up visit 4-8 months after initiation, as well as having information on serologic status. Serologic status was determined by presence of anti-cyclic citrullinated peptide (CCP) antibodies. Changes in disease activity measures from baseline to follow-up visit were evaluated. RESULTS: Both CCP-negative and -positive groups had statistically significant improvement in physician-reported measurements (physician rating of disease activity and joint counts), patient-reported measures (disease activity, pain, and fatigue), and acute phase reactants after 4-8 months of treatment with tocilizumab. The magnitude of improvement, however, did not differ significantly by CCP status. CONCLUSION: Tocilizumab led to statistically significant improvement in all patient- and physician-reported measures of disease activity evaluated in this cohort of patient with RA. The response to tocilizumab did not differ by CCP status.
29027497 Comparative evaluation of treatment patterns and healthcare utilization of newly-diagnosed 2018 Mar BACKGROUND: Anti-cyclic citrullinated peptide (CCP) antibody positivity is an established diagnostic factor for severe disease activity and joint damage and a prognostic factor for aggressive disease in rheumatoid arthritis (RA). OBJECTIVE: To compare RA-related treatment, healthcare utilization, and joint erosion between anti-CCP-positive and anti-CCP-negative RA patients. METHODS: Newly-diagnosed RA patients were identified from the Henry Ford Health System database between January 1, 2009 and December 31, 2014; the date of the first RA diagnosis within the study period was the index date. Baseline anti-CCP test was used to categorize patients as anti-CCP-positive or anti-CCP-negative, and outcomes were evaluated in the 6 months post-index. RESULTS: There were 217 anti-CCP-positive and 191 anti-CCP-negative RA patients included in the study. A higher proportion of anti-CCP-positive patients were initiated on RA treatment than anti-CCP-negative patients (70.5% vs 23.0%; p < .0001). More anti-CCP-positive patients received methotrexate (73.2% vs 56.8%; p = .0374), while more anti-CCP-negative patients received hydroxychloroquine (31.8% vs 13.1%; p = .0037) in first-line therapy. A higher proportion of anti-CCP-negative patients were tested for rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR). Of those tested, there were more positive test results in the anti-CCP-positive cohort compared to the anti-CCP-negative cohort (RF: 84.4% vs 18.2%, p < .0001; C-reactive protein [CRP]: 69.7% vs 48.3%, p = .0008; and ESR: 89.5% vs 53.9%, p < .0001). Outpatient utilization predominated, with more anti-CCP-positive patients having any outpatient physician office visit (96.3% vs 77.5%, p < .0001) and a higher mean number of visits (5.3 vs 2.5, p < .0001) than anti-CCP-negative patients. Among anti-CCP-positive (n = 113) and anti-CCP-negative (n = 58) patients with imaging results, more anti-CCP-positive patients had joint erosion compared to anti-CCP-negative patients (18.6% vs 8.6%; p = .0858); however, statistical significance was not reached. CONCLUSION: RA patients with positive anti-CCP antibodies had higher degrees of inflammation and disease activity as indicated by laboratory results, which likely contributed to their higher rates of healthcare utilization, joint erosion, and proportions of RA treatment.
26586235 Preserved cardiorespiratory function and NT-proBNP levels before and during exercise in pa 2017 Jan Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction and congestive heart failure. In RA patients, elevated NT-proBNP levels have been reported to be a prognostic marker of left ventricular dysfunction. In this study, we evaluated cardiorespiratory functional capacity and NT-proBNP levels before and during cardiopulmonary exercise test in early RA (ERA) patients. Twenty ERA patients and 10 healthy controls were studied by color Doppler echocardiography to evaluate ventricular systolic and diastolic function. Arterial stiffness and wave reflections were quantified non-invasively using applanation tonometry of the radial artery. Cardiopulmonary treadmill test was performed to measure peak VO(2) and VE/VCO(2) parameters. NT-proBNP plasma levels were measured before and at the exercise peak during cardiopulmonary exercise. The peak oxygen uptake [VO(2) (ml/min/kg)], the ventilatory equivalents for carbon dioxide (EqCO(2)), respiratory exchange ratio and arterial stiffness were similar between patients and controls during cardiopulmonary exercise test. Basal and peak cardiopulmonary exercise NT-proBNP plasma levels were comparable in ERA patients with respect to healthy controls. When we analyzed patients according to disease characteristics and cardiovascular risk factors, ERA patients with high disease activity, BMI > 25 kg/m(2) and ACPA positivity presented significantly higher baseline and exercise peak NT-proBNP levels. Cardiorespiratory function is preserved in patients with recent onset of rheumatoid arthritis. The increased basal and exercise peak NT-proBNP plasma levels in patients with negative disease prognostic factors represent a possible marker to stratify the cardiovascular risk in patients with early rheumatoid arthritis.
29354971 [Flipping moxibustion of Hui medicine combined with western medication for rheumatoid arth 2017 Oct 12 OBJECTIVE: To compare the effects of flipping moxibustion of Hui medicine combined with western medication and simple western medication for rheumatoid arthritis with cold dampness bi syndrome. METHODS: Eighty patients were randomly assigned into an observation group and a control group, 40 cases in each group. Oral methotrexate (1 time a week) and sulfasalazine (twice a day except the day for methotrexate) were used in the two groups. Patients in the observation group were treated with flipping moxibustion of Hui medicine, twice a week. The main acupoints were Shenshu (BL 23), Guanyuan (CV 4), Zusanli (ST 36), Yinlingquan (SP 9), and the matching acupoints were in the meridians related to the disease location. All the treatment was given for continuous 4 weeks. The TCM symptom score, visual analogue scale (VAS) score, blood sedimentation (ESR), rheumatoid factor (RF) and C-reactive protein (CRP) were observed before and after treatment. The effect was evaluated. RESULTS: The total effect rate in the observation group was 95.0% (38/40), which was better than 77.5% (31/40) in the control group (P<0.05). After treatment, the VAS score, TCM symptom score, RF, ESR, CRP levels decreased in the two groups (all P<0.05), with better effects in the observation group (all P<0.05). The adverse reactions in the observation group were lower than those in the control group. CONCLUSION: Flipping moxibustion of Hui medicine combined with western medication for rheumatoid arthritis with cold dampness bi syndrome are better than simple western medication, which are safer and more effective.
27030253 Distribution of Podoplanin in Synovial Tissues in Rheumatoid Arthritis Patients Using Biol 2017 OBJECTIVE: Podoplanin (PDPN) mediates tumor cell migration and invasion, which phenomena might also play a role in severe rheumatoid arthritis (RA). Therefore, the precise cellular distribution of PDPN and it's relationships with inflammation was studied in RA treated with biologic disease-modifying anti-rheumatic drugs (DMARD) or conventional DMARDs (cDMARD). METHODS: PDPN+ cells were immunostained by NZ-1 mAb, and scored (3+; >50%/ area, 2+; 20%- 50%, 1+; 5%-20%, 0: <5%) in synovial tissues from RA treated with biologic DMARDs (BIO, n=20) or cDMARD (n=20) for comparison with osteoarthritis (OA, n=5), followed by cell grading of inflammation and cell-typing. RESULTS: Inflammatory synovitis score was 1.4 in both BIO and cDMARD, compared to only 0.2 in OA. PDPN+ cells were found in the lining layer (BIO 1.6, cDMARD 1.3, OA 0.2) and lymphoid aggregates (BIO 0.6, cDMRD 0.7, OA 0.2), and correlated with RA-inflammation in BIO- and cDMARD-groups in both area (r=0.7/0.9, r=0.6/0.7, respectively p<0.05). PDPN was expressed in CD68+ type A macrophage-like and 5B5+ type B fibroblast-like cells in the lining layer, and in IL- 17+ cells in lymphoid aggregates in RA. CONCLUSION: PDPN was markedly increased in the immunologically inflamed RA synovitis, which was surgically treated due to BIO- and cDMARD-resistant RA. PDPN may have potential of a new marker of residual arthritis in local joints for inflammation-associated severe RA.
28198156 Prevalence of secondary Sjögren's syndrome in Indian patients with rheumatoid arthritis: 2017 Jul AIM: To assess the prevalence of secondary Sjögren's syndrome (sSS) and its association with joint damage in patients with rheumatoid arthritis (RA) from northern India. METHODS: Patients included had RA, fulfilling the 1987 American College of Rheumatology criteria, with disease duration of more than 1 year. They were administered a sicca questionnaire that included six questions from subjective criteria of American European Consensus Group (AECG) criteria. Those who answered affirmatively to at least one question underwent Schirmer I test (ocular function) and salivary scintigraphy (salivary gland involvement). Patients with involvement of both were classified as having sSS as per AECG criteria. A damaged joint count was done using Norfolk Arthritis Register Damaged Joint Count (NOAR-DJC). RESULTS: This study included 199 patients with RA, with mean (SD) age and disease duration of 44 (9.9) and 6.8 (5.5) years, respectively. The prevalence of sicca symptoms and sSS was 14.6% and 5.5%, respectively. Those having sSS had a longer (mean ± SD) disease duration (9.2 ± 4.0, 6.8 ± 5.5 years, P = 0.07) and were significantly older in age (50.8 ± 6.8, 43.6 ± 9.9 years, P = 0.005) than those without sSS. There was no significant difference in the median (interquartile range) damaged joint count (0 (0-2), 0 (0-2), P = 0.75). CONCLUSIONS: The prevalence of sSS in northern Indian RA patients was 5.5%, and it was significantly associated with older age but not damaged joint count.
29021442 The Relationship between the Serum Oxytocin Levels, Disease Activity, the ADLs and the QOL 2017 Dec 1 Objective To investigate the factors associated with depression, including the serum oxytocin (OXT) levels, disease activity, activities of daily living (ADLs) and quality of life (QOL), and their effects on rheumatoid arthritis (RA). Methods This study included 42-RA-patients. We measured the following variables before and after 6 months of treatment with biological disease-modifying antirheumatic drugs (bDMARDs): the baseline characteristics (including age, sex, disease duration, smoking, and body mass index), the doses of prednisolone and methotrexate, the serum level of matrix metalloprotease-3, the erythrocyte sedimentation rate and the C-reactive protein level. The disease activity of RA was assessed using the Simplified Disease Activity Index (SDAI), depression was assessed using the Hamilton Depression Rating Scale (HAM-D), the ADLs were assessed using the Health Assessment Questionnaire disability index and the QOL was assessed using the Short Form (SF)-36. The serum OXT levels were determined using an enzyme-linked immunosorbent assay. Results The HAM-D score was significantly correlated with the SDAI, and the mental component summary score of the SF-36. However, the serum OXT levels were not correlated with the HAM-D score. The serum OXT levels before and after bDMARDs treatment did not differ to a statistically significant extent, regardless of the presence of depression. Although the differences in the serum levels of OXT were observed prior to the initiation of treatment, there was no gender difference after treatment. Conclusion Although RA complicated by depression may be related to the following high disease activity, a poor QOL and poor ADLs, the serum OXT levels were not directly correlated.
29246875 Proteomics analysis reveals differential pattern of widespread protein expression and nove 2018 Apr 1 Rheumatoid factor (RF) is an auto-antibody against antigen-antibody immune complexes. RF is valuable as a biomarker for the screening of autoimmune and infectious diseases. However, it is suggested that RF would be a more powerful biomarker when used complementarily with RF-correlated proteins. In this study, we utilized a proteomic approach to analyze global protein expression in RF-low and RF-high subjects using high-performance liquid chromatography tandem mass spectrometry. Histidine-rich glycoprotein (HRG) and lipopolysaccharide-binding protein (LBP) were found to be differentially expressed between RF-low and RF-high subjects (cut-off > 2-fold, p < 0.05), which was validated by enzyme-linked immunosorbent assay. To evaluate whether both proteins allow discriminating rheumatoid arthritis patients from healthy controls, receiver-operating characteristic (ROC) curves were analyzed. Areas under the ROC curves of HRG and LBP were 0.861 and 0.888, respectively. The correlation between RF and HRG was statistically significant (p = 0.003), and LBP was also correlated with RF (p = 0.044), as indicated by correlation analysis. HRG and LBP are reportedly involved in RF-producing and RF-correlated diseases. Thus, we propose that HRG and LBP could be useful screening markers for RF-correlated diseases.
29101674 Human microbiome, infections, and rheumatic disease. 2017 Dec Microbes have coevolved with their human hosts for millions of years and are vital to their normal development and homoeostasis. It is now clear that there is direct and indirect cross talk between the microbiome and host immune responses. However, the exact mechanisms for this microbial influence in disease pathogenesis remain elusive and are now a major research focus.
27696750 Mediating Effect of Changes in Hand Impairments on Hand Function in Patients With Rheumato 2017 Jul OBJECTIVE: To determine whether the effect of the Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) exercise program on hand function was mediated by changes in the proposed active ingredients: strength, dexterity, and/or range of motion. METHODS: The SARAH intervention included exercises hypothesized to improve potential mediators of grip strength, pinch strength, wrist flexion, wrist extension, finger flexion, finger extension, thumb opposition, and dexterity, which would theoretically improve self-reported hand function. All variables were measured at baseline and at 4 and 12 months. Structural equation modeling was used to assess mediation on change in hand function via change in potential mediators. RESULTS: Change in grip strength partially mediated change in hand function. Grip strength mediated 19.4% (95% confidence interval 0.9%, 37.8%) of the treatment effect. CONCLUSION: Improvements in grip strength at 4 months are likely to mediate improved hand function at 12 months. The role of joint mobility exercises is less clear and is likely influenced by the choice of measurement tools for both mobility and function outcomes. More robust measurements of wrist and hand mobility for patients with rheumatoid arthritis may be necessary to determine the relationship between this variable and self-reported hand function. Using a large trial data set, we have demonstrated that techniques used to target grip strength are key active ingredients of the SARAH exercise program and mediate its effect.
28215986 The β4GalT1 affects the fibroblast-like synoviocytes invasion in rheumatoid arthritis by 2017 Mar OBJECTIVE: The level of β-1,4-galactosyltransferase 1 (β4GalT1) is up-regulated in collagen-induced arthritis (CIA) mice. It is reported that CXC chemokine receptor 3 (CXCR3) can enhance the invasiveness of fibroblast-like synoviocytes (FLS) in rheumatoid arthritis (RA). This study aims to investigate the specific mechanism of β4GalT1 and relationship between β4GalT1 and CXCR3 in RA. METHODS: The model of CIA mice was established to explore the role of β4GalT1. The N-glycosylation of CXCR3 was detected by mass spectrometry and western-blot. The interaction between β4GalT1 and CXCR3 was tested by immunoprecipitation. The truncted MMP-1 was detected by ELISA. Flow cytometry analysis was applied to measure ligand-receptor interaction between CXCR3 and CXCL10. RESULTS: β4GalT1 can promote the inflammatory process of arthritis. CXCR3 was N-glycosylated and its glycosylation regulated by β4GalT1. β4GalT1 can enhance the invasiveness of FLS by modifying CXCR3. N-glycosylation of CXCR3 influences the ligand-receptor interaction between CXCR3 and CXCL10. CONCLUSIONS: β4GalT1 can regulate N-glycans of CXCR3 in RA. N-glycans of CXCR3 affects CXCL10/CXCR3 ligand-binding which enhancing FLS invasion.
28817199 Exposure-Response Modeling and Power Analysis of Components of ACR Response Criteria in Rh 2017 Sep American College of Rheumatology (ACR) response criteria is used to assess improvement in tender and swollen joint counts and in 3 of the 5 core measures (acute-phase reactant, physician global assessment, patient global assessment, pain, and physical function). From the clinical trial data on 5 approved biological products for the treatment of rheumatoid arthritis, population pharmacokinetic/pharmacodynamic models were developed to quantitatively describe the relationship between exposure and response rates of 3 individual components of ACR response criteria. The models were then used to simulate the clinical outcomes at various time points following different treatment regimens. The relative sensitivity of these criteria components was assessed using power analysis. As compared to the composite endpoints (ACR20/ACR50/ACR70), the individual ACR criteria components had adequate power and higher sensitivity in distinguishing treatment effects over placebo/methotrexate control. The 3 individual ACR criteria components appeared to have similar powers at different dose levels after long-term treatment. This research provides a unique approach to assess the relative sensitivity of the 3 binary components of ACR response criteria which would be useful to support future dose selection and trial design in the treatment of rheumatoid arthritis.
29190608 Seropositivity of Rheumatoid Arthritis Specific Tests in a Patient With Nephrotic Syndrome 2017 Nov Presentation of rheumatoid arthritis (RA) with renal complications is very rare without articular symptoms. We here report a case of a 23-year-old woman, presenting with the edema of the extremities, no relevant previous medical history, and the features of acute tubular injury in her percutaneous kidney biopsy. Following the incidental notification of a positive rheumatoid factor test, other immunologic tests including anticyclic citrullinated peptide and antimutated citrullinated vimentin were performed, the positive results of which favored the diagnosis of RA. Administration of rituximab led to the complete remission of the disease. Six weeks later, along with steroid dose reduction, the symptoms of arthralgia was observed, which was managed with methotrexate. Nephrotic syndrome could be rarely the first manifestation of RA, and screening of specific RA autoantibodies might be considered as part of diagnostic evaluations in nephrotic syndrome workup.
28217867 Effects of 25-hydroxyvitamin D and vitamin D-binding protein on bone mineral density and d 2018 May AIM: Vitamin D3 [25(OH)D] has been shown to be important in bone health and can influence rheumatoid arthritis (RA) disease activity. Vitamin D-binding protein (VDBP) levels vary with race and may modulate 'bioavailable' levels of 25(OH)D. The aim of this study was to explore the relationships between 25(OH)D, VDBP and clinical factors on bone mineral density (BMD) in a group of multi-ethnic Malaysian RA patients and healthy controls. METHODS: A cross-sectional study of 77 female RA patients and 29 controls was performed. Serum 25(OH)D was measured using the Elecsys(®) Vitamin D total assay. Serum VDBP was measured using a Quantikine(®) enzyme-linked immunosorbent assay kit. BMD was assessed using dual-energy X-ray absorptiometry (DXA). RESULTS: Overall, mean 25(OH)D levels were 42.66 ± 21.75 nmol/L with no significant difference between RA patients and controls. 25(OH)D levels were significantly higher in Chinese, compared to Malay/Indian subjects. In RA patients, menopausal status and body mass index (BMI) were significantly associated with BMD but not 25(OH)D or RA Disease Activity Score of 28 joints (DAS28). There was no significant correlation between 25(OH)D and DAS28, even after correction for menopausal status and BMI. VDBP levels were not significantly different between the races and did not significantly correlate with BMD, 25(OH)D overall, or DAS28 in RA patients. CONCLUSIONS: In Malaysian RA patients, menopausal status and BMI were more important influences on BMD than 25(OH)D or RA disease activity. The utility of measuring VDBP levels in this population remains uncertain.
27143194 What factors affect discordance between physicians and patients in the global assessment o 2017 Jan OBJECTIVE: To identify the level of agreement between patients with rheumatoid arthritis (RA) and physicians in the global assessment of disease activity and to explore factors influencing their discordance. METHODS: A total of 4368 patients with RA were analyzed from the KORean Observational study Network for Arthritis (KORONA) database. Patients were divided into four subgroups according to difference from their physicians in the assessment of disease activity by substracting physician's visual analog scale (VAS) from patient's VAS as follows: positive discordance group I (10 mm ≤ discordance <25 mm), positive discordance group II (≥25 mm), concordance (<|10| mm), and negative discordance (≤ -10mm). Multinomial logistic regression analysis was performed to identify factors associated with discordance. RESULTS: Only 1350 (29.2%) patients were classified in the concordance group. Positive discordance was found in 52.3% of the patients (n = 2425), with 33.7% (n = 1563) showing marked discordance (≥25 mm). The high disease activity (OR =1.41), gastrointestinal (GI) disease (OR =1.28), pain (OR =1.12), fatigue (OR =1.07) were consistently associated with positive discordance. CONCLUSION: More than half of patients with RA thought their disease more severe than their physicians. In addition to high disease activity, pain, fatigue, and sleep disturbance or GI disease were associated with the discordance between physicians and patients with RA.
28516236 Identification of patients at risk of non-adherence to oral antirheumatic drugs in rheumat 2017 Jul The ARCO study (Study on Adherence of Rheumatoid Arthritis patients to SubCutaneous and Oral Drugs), a multicenter, non-interventional retrospective study, was primarily designed to assess the percentage of patients [aged ≥18 years with an established rheumatoid arthritis (RA) diagnosis] with non-adherence to prescribed subcutaneous biologicals. This paper reports data for the secondary objective from a subset of patients, namely to evaluate non-adherence to prescribed oral antirheumatic drugs in RA patients in Spain using the validated Compliance Questionnaire Rheumatology (CQR). Patients also completed the Morisky-Green Medication Adherence Questionnaire, Beliefs about Medicines Questionnaire, and a questionnaire (developed and validated in Spain) on patient satisfaction with RA treatment and preferences. A total of 271 patients (76.7% females; mean age 55.6 years) were being treated with oral drugs for RA, of which 234 completed the CQR questionnaire. Non-adherence was reported in 49/234 (20.9%) patients. The proportion of non-adherence in younger patients (aged ≤48 years; 37.5%) was double that recorded in patients aged >48 years (p = 0.006). Patients with a perception of lower efficacy also had a higher risk of non-adherence (p = 0.012). Multivariable analysis showed that younger age and male gender were independently associated with risk of non-adherence. There was only slight agreement between the CQR and Morisky-Green assessment tools (kappa coefficient = 0.186), possibly reflecting the fact that both questionnaires measure slightly different aspects of medication adherence. In conclusion, one out of five RA patients was identified as at risk for non-adherence with the CQR, and this was more frequent in younger patients and in males.