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Carvajal Alegria G, Milin M, Gandjbakhch F, Saraux A, Bailly F, Jousse-Joulin S, Schaeverbeke T, Lukas C, Foltz V, Fautrel B, Devauchelle-Pensec V. A simplified radiographic score effectively predicts radiographic progression of early arthritis in a large nationwide French cohort. Rheumatology (Oxford) 2020; 59:1566-1573. [PMID: 31628807 DOI: 10.1093/rheumatology/kez450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/01/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Evaluating radiographic progression is a key component of the follow-up of patients with RA. Existing scores are ill-suited to everyday clinical practice. The objective here was to validate a new simplified radiographic score (SRS) for evaluating radiographic progression in patients with early arthritis. METHODS Patients with arthritis of <6 months' duration were included in the large, prospective, nationwide, French ESPOIR cohort. Radiographs of the hands and feet were obtained at inclusion then 1 and 5 years later. The modified Sharp scores and SRS were determined by blinded readers. Interobserver reliability and intraobserver repeatability of each score, as well as agreement between the two scores, were assessed by computing the intraclass correlation coefficients. The rates of progression over the first year and the next 4 years were determined. RESULTS The 506 patients with complete data for the first 5 years were included. At inclusion, the intraclass correlation coefficient between the two scores was good for erosions (0.715, P < 0.001), joint space narrowing (0.892, P < 0.001) and the total score (0.896, P < 0.001). Agreement between the two scores was also good for radiographic progression after 1 year (0.781, P < 0.001). The SRS had good positive and negative predictive values for slow and for rapid progression. SRS determination was less time consuming. CONCLUSION The SRS is effective for monitoring radiographic progression in early arthritis and is easier to use and less time-consuming than the Sharp score. The usefulness of the SRS in clinical practice deserves further evaluation.
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Affiliation(s)
- Guillermo Carvajal Alegria
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | - Morgane Milin
- Rheumatology Department, Hôpital Yves Le Foll, Saint-Brieuc
| | - Frédérique Gandjbakhch
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Alain Saraux
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | - Florian Bailly
- Sorbonne University, Paris.,Pitié Salpêtrière Hospital, APHP, Pain Unit, Paris
| | - Sandrine Jousse-Joulin
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | | | - Cédric Lukas
- Rheumatology Department, Montpellier University, Montpellier Hospital and EA2415, Montpellier, France
| | - Violaine Foltz
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Bruno Fautrel
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Valérie Devauchelle-Pensec
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
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Abdelzaher MG, Tharwat S, AbdElkhalek A, Abdelsalam A. Ultrasound versus magnetic resonance imaging in the evaluation of shoulder joint pathologies in a cohort of rheumatoid arthritis patients. Int J Rheum Dis 2019; 22:2158-2164. [PMID: 31670481 DOI: 10.1111/1756-185x.13728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/22/2019] [Accepted: 09/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic autoimmune disease that has a great impact on different joints, may result in their destruction and loss of function. Although the shoulder is affected in a large portion of patients with RA, it does not receive much attention during the follow up of RA. The precise diagnosis of shoulder pain in RA is a clinical challenge and benefits from a reliable imaging modality to detect its exact origin. AIM To determine the diagnostic accuracy of ultrasound (US) in detecting shoulder joint pathologies in RA, considering magnetic resonance imaging (MRI) as the gold standard. MATERIALS AND METHODS This cross-sectional, observational study was carried out on 30 RA patients complaining of unilateral or bilateral shoulder pain. Patients were subjected to history taking, clinical shoulder examination, plain X-ray, US examination following a standardized protocol, and MRI. The results were correlated with each other. RESULTS In comparison with the MRI findings, US showed high accuracy in terms of sensitivity (Sn) and specificity (Sp) in supraspinatus tendinopathy (Sn 96.6%; Sp 93.3%), biceps tenosynovitis (Sn 87.5%; Sp 97.6%), subacromial-subdeltoid bursitis (Sn 72.7%; Sp 95.7%), humeral erosions (Sn 90.5%; Sp 97.3%), and acromioclavicular osteoarthritis (Sn 85.7%; Sp 95.7%). In terms of reliability, the agreement between US and MRI was almost perfect (κ = .9, P < .001). CONCLUSION US may have a role as the initial imaging modality in RA patients with shoulder pain, as it is highly sensitive and specific in detecting different pathological abnormalities of the shoulder.
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Affiliation(s)
- Mohamed Gamal Abdelzaher
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samar Tharwat
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed AbdElkhalek
- Radiodiagnosis Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Abdelsalam
- Rheumatology and Immunology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Pincus T, Chua JR, Gibson KA. Evidence from a Multidimensional Health Assessment Questionnaire (MDHAQ) of the Value of a Biopsychosocial Model to Complement a Traditional Biomedical Model in Care of Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.4.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jacquelin R Chua
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kathryn A Gibson
- Rheumatology Department, Liverpool Hospital, University of New South Wales, and Ingham Research Institute, Liverpool, NSW, Australia
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Scott DL, Ibrahim F, Farewell V, O'Keeffe AG, Ma M, Walker D, Heslin M, Patel A, Kingsley G. Randomised controlled trial of tumour necrosis factor inhibitors against combination intensive therapy with conventional disease-modifying antirheumatic drugs in established rheumatoid arthritis: the TACIT trial and associated systematic reviews. Health Technol Assess 2015; 18:i-xxiv, 1-164. [PMID: 25351370 DOI: 10.3310/hta18660] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is initially treated with methotrexate and other disease-modifying antirheumatic drugs (DMARDs). Active RA patients who fail such treatments can receive tumour necrosis factor inhibitors (TNFis), which are effective but expensive. OBJECTIVE We assessed whether or not combination DMARDs (cDMARDs) give equivalent clinical benefits at lower costs in RA patients eligible for TNFis. DESIGN An open-label, 12-month, pragmatic, randomised, multicentre, two-arm trial [Tumour necrosis factor inhibitors Against Combination Intensive Therapy (TACIT)] compared these treatment strategies. We then systematically reviewed all comparable published trials. SETTING The TACIT trial involved 24 English rheumatology clinics. PARTICIPANTS Active RA patients eligible for TNFis. INTERVENTIONS The TACIT trial compared cDMARDs with TNFis plus methotrexate or another DMARD; 6-month non-responders received (a) TNFis if in the cDMARD group; and (b) a second TNFi if in the TNFi group. MAIN OUTCOME MEASURES The Heath Assessment Questionnaire (HAQ) was the primary outcome measure. The European Quality of Life-5 Dimensions (EQ-5D), joint damage, Disease Activity Score for 28 Joints (DAS28), withdrawals and adverse effects were secondary outcome measures. Economic evaluation linked costs, HAQ changes and quality-adjusted life-years (QALYs). RESULTS In total, 432 patients were screened; 104 started on cDMARDs and 101 started on TNFis. The initial demographic and disease assessments were similar between the groups. In total, 16 patients were lost to follow-up (nine in the cDMARD group, seven in the TNFi group) and 42 discontinued their intervention but were followed up (23 in the cDMARD group and 19 in the TNFi group). Intention-to-treat analysis with multiple imputation methods used for missing data showed greater 12-month HAQ score reductions with initial cDMARDs than with initial TNFis [adjusted linear regression coefficient 0.15, 95% confidence interval (CI) -0.003 to 0.31; p = 0.046]. Increases in 12-month EQ-5D scores were greater with initial cDMARDs (adjusted linear regression coefficient -0.11, 95% CI -0.18 to -0.03; p = 0.009) whereas 6-month changes in HAQ and EQ-5D scores and 6- and 12-month changes in joint damage were similar between the initial cDMARD group and the initial TNFi group. Longitudinal analyses (adjusted general estimating equations) showed that the DAS28 was lower in the initial TNFi group in the first 6 months (coefficient -0.63, 95% CI -0.93 to -0.34; p < 0.001) but there were no differences between the groups in months 6-12. In total, 36 patients in the initial cDMARD group and 44 in the initial TNFi group achieved DAS28 remission. The onset of remission did not differ between groups (p = 0.085 on log-rank test). In total, 10 patients in the initial cDMARD group and 18 in the initial TNFi group experienced serious adverse events; stopping therapy because of toxicity occurred in 10 and six patients respectively. Economic evaluation showed that the cDMARD group had similar or better QALY outcomes than TNFi with significantly lower costs at 6 and 12 months. In the systematic reviews we identified 32 trials (including 20-1049 patients) on early RA and 19 trials (including 40-982 patients) on established RA that compared (1) cDMARDs with DMARD monotherapy; (2) TNFis/methotrexate with methotrexate monotherapy; and (3) cDMARDs with TNFis/methotrexate. They showed that cDMARDs and TNFis had similar efficacies and toxicities. CONCLUSIONS Active RA patients who have failed methotrexate and another DMARD achieve equivalent clinical benefits at a lower cost from starting cDMARDs or from starting TNFis (reserving TNFis for non-responders). Only a minority of patients achieve sustained remission with cDMARDs or TNFis; new strategies are needed to maximise the frequency of remission. TRIAL REGISTRATION Current Control Trials ISRCTN37438295. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David L Scott
- Department of Rheumatology, King's College London School of Medicine, London, UK
| | - Fowzia Ibrahim
- Department of Rheumatology, King's College London School of Medicine, London, UK
| | - Vern Farewell
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Aidan G O'Keeffe
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Margaret Ma
- Department of Rheumatology, King's College London School of Medicine, London, UK
| | - David Walker
- Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Margaret Heslin
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| | - Anita Patel
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| | - Gabrielle Kingsley
- Department of Rheumatology, King's College London School of Medicine, London, UK
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Rouster-Stevens KA, Ardoin SP, Cooper AM, Becker ML, Dragone LL, Huttenlocher A, Jones KB, Kolba KS, Moorthy LN, Nigrovic PA, Stinson JN, Ferguson PJ. Choosing Wisely: The American College of Rheumatology's Top 5 for Pediatric Rheumatology. Arthritis Care Res (Hoboken) 2014; 66:649-57. [DOI: 10.1002/acr.22238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 11/14/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Ashley M. Cooper
- University of Texas Southwestern Medical School, Dallas, and Children's Mercy Hospitals and Clinics; Kansas City Missouri
| | - Mara L. Becker
- Children's Mercy Hospitals and Clinics; Kansas City Missouri
| | | | | | | | - Karen S. Kolba
- Pacific Arthritis Center Medical Group; Santa Maria California
| | | | - Peter A. Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital; Boston Massachusetts
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Tobón G, Saraux A, Lukas C, Gandjbakhch F, Gottenberg JE, Mariette X, Combe B, Devauchelle-Pensec V. First-year radiographic progression as a predictor of further progression in early arthritis: results of a large national French cohort. Arthritis Care Res (Hoboken) 2014; 65:1907-15. [PMID: 23861163 DOI: 10.1002/acr.22078] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/04/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE A major goal in the treatment of recent arthritis is the prevention of joint destruction. The value of radiographic progression in the first year for predicting further radiographic progression has not been evaluated comparatively with conventional predictive factors. METHODS Patients with arthritis of <6 months' duration were included in the prospective French ESPOIR cohort. Radiographs were obtained and modified Sharp scores were determined by a blinded reader. The rate of progression was determined over the first year, then over the second and third years. Rapid progression was defined as a >5-point annual increase in the total Sharp score. RESULTS In total, 500 patients had complete data available after 3 years and were included. The total Sharp score indicated rapid progression in 123 patients (25%) in year 1 and 92 patients (18%) in years 2/3. By logistic regression, the variables independently associated with rapid progression in years 2/3 were year 1 rapid progression of the erosion and total Sharp scores, baseline erosion Sharp score, the serologic American College of Rheumatology/European League Against Rheumatism criterion, and interleukin-6 level. When these variables were combined, year 1 rapid progression made the largest contribution to predicting years 2/3 rapid progression. CONCLUSION First-year radiologic progression is the best independent predictor of further rapid progression in early arthritis.
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7
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Steinhoff K, Pierer M, Siegert J, Pigla U, Laub R, Hesse S, Seidel W, Sorger D, Seese A, Kuenstler JU, Pietzsch HJ, Lincke T, Rullmann M, Emmrich F, Sabri O. Visualizing inflammation activity in rheumatoid arthritis with Tc-99 m anti-CD4-mAb fragment scintigraphy. Nucl Med Biol 2014; 41:350-4. [PMID: 24503329 DOI: 10.1016/j.nucmedbio.2013.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 11/27/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE T-cell-located CD4 antigen represents one of the therapeutic targets in rheumatoid arthritis (RA). However, up to now there is no established imaging tool to visualize this target in vivo. The aim of our study was to assess the safety and tolerability of a technetium-99m labelled murine anti-human CD4 IgG1-Fab fragment ([(99m)Tc]-anti-CD4-Fab, [(99m)Tc]-EP1645) in patients with active synovitis due to RA, and to evaluate its potential as a marker of disease activity. METHODS In the present phase I proof of principle study five patients with RA were examined. Planar scans of the whole body, hands, and feet were taken 30 min up to 24h after application of 550 ± 150 MBq [(99m)Tc]-anti-CD4-Fab, followed by visual analyses, comparison with clinical data in 68 joints per patient and semiquantitative analysis of hand and wrist joints. RESULTS Neither infusion related adverse events nor adverse events during follow up were observed. No increase in human anti-murine antibody titres was seen. All patients had positive scans in almost 70% of clinically affected joints. Positive scans were also found in 8% of joints without evidence of swelling or tenderness. CONCLUSION Scintigraphy with [(99m)Tc]-anti-CD4-Fab is a promising technique for evaluation of inflammatory activity in patients with RA, pre-therapeutical evaluation of CD4 status and therapy control. Tracer uptake in clinically inconspicuous joints strongly indicates diagnostic potential of [(99m)Tc]-anti-CD4-Fab. Whether this technique is eligible as a prognostic factor in RA needs to be analysed in further studies as well as the pathophysiological background of clinically affected joints lacking tracer uptake.
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Affiliation(s)
- K Steinhoff
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany.
| | - M Pierer
- Department of Rheumatology, Medical Department II, University of Leipzig, Germany
| | - J Siegert
- Institute of Clinical Pharmacology, Medical Faculty, Technical University Dresden, Germany
| | - U Pigla
- Biotectid GmbH, Leipzig, Germany
| | - R Laub
- Biotectid GmbH, Leipzig, Germany
| | - S Hesse
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
| | - W Seidel
- St. Georg Hospital, Department of Rheumatology, Leipzig, Germany
| | - D Sorger
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
| | - A Seese
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
| | - J U Kuenstler
- Biotectid GmbH, Leipzig, Germany; Institute of Radiopharmacy, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - H J Pietzsch
- Institute of Radiopharmacy, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - T Lincke
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
| | - M Rullmann
- LIFE - Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
| | - F Emmrich
- Institute for Clinical Immunology and Transfusion Medicine, University of Leipzig, Leipzig, Germany; Translational Centre for Regenerative Medicine, Leipzig, Germany
| | - O Sabri
- Department or Nuclear Medicine, University Hospital, Leipzig, Germany
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8
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Waljee JF, Chung KC. Objective functional outcomes and patient satisfaction after silicone metacarpophalangeal arthroplasty for rheumatoid arthritis. J Hand Surg Am 2012; 37:47-54. [PMID: 22196292 DOI: 10.1016/j.jhsa.2011.09.042] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 09/28/2011] [Accepted: 09/29/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Patient satisfaction is an essential measure of quality of care for rheumatoid arthritis. Prior research demonstrates that patient satisfaction improves after silicone metacarpophalangeal arthroplasty (SMPA) despite minimal change in hand function. The purpose of this study was to identify the level of objective functional recovery that yields satisfaction after SMPA. We hypothesized that measurable gains in objective hand function after SMPA will discriminate between satisfied and dissatisfied patients. METHODS In this prospective, multicenter, cohort study, we observed 46 patients with rheumatoid arthritis and metacarpophalangeal (MCP) joint subluxation for 2 years after reconstructive surgery. We derived satisfaction scores from the Michigan Hand Outcomes Questionnaire, ranging from 0 (least satisfied) to 100 (most satisfied), and dichotomized them using the Cohen large effect size. We measured hand function at baseline and follow-up including strength (grip strength and pinch strength), finger position (extensor lag and ulnar drift), and MCP arc of motion. We constructed receiver operating characteristic curves to identify optimal cutoffs in hand function that correspond with satisfaction. RESULTS At 2 years of follow-up, patients who achieved an extension lag of 30° or less were considered satisfied, which represented a 52% improvement (preoperative lag = 63°). Similarly, patients who gained improvement in ulnar drift from an average of preoperatively 62° to 9° postoperatively were satisfied. Finally, patients who achieved an improvement in MCP arc of motion from an average of 21° to 31° postoperatively were satisfied. No improvements in grip or pinch strength corresponded with postoperative patient satisfaction. CONCLUSIONS Patients were satisfied with only modest gains in grip and pinch strength after silicone metacarpophalangeal arthroplasty. However, maintaining finger position, without recurrence of ulnar drift or extensor lag, and MCP arc of motion corresponded with patient satisfaction in the postoperative period. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Jennifer F Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI 48109-5340, USA
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9
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Abstract
Rheumatoid arthritis (RA) remains a major clinical problem, but treatments involving biologics have revolutionized its management. They target pathogenically relevant cytokines such as tumor necrosis factor and immune cells such as B cells. In RA, biologics reduce joint inflammation, limit erosive damage, decrease disability, and improve quality of life. Infections are the main risk associated with their use. Because of the high prices of biologics, their cost-effectiveness is a matter of debate. They are mainly coadministered with disease-modifying drugs such as methotrexate when the latter are found to achieve insufficient disease control on their own.
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Affiliation(s)
- D L Scott
- Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, London, UK.
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10
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Thompson MK, Axford JS, Sofat N. Rheumatoid arthritis in 2011: an editorial. Best Pract Res Clin Rheumatol 2011; 25:435-46. [PMID: 22137916 DOI: 10.1016/j.berh.2011.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 10/14/2022]
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Abstract
BACKGROUND The Michigan Hand Questionnaire is one of the most widely used hand-specific surveys that measure health status relevant to patients with acute and chronic hand disorders. However, item redundancy exists in the original version, and an abbreviated survey could minimize responder burden and offer broader applicability. METHODS Patients (n = 422) with four specific hand conditions--rheumatoid arthritis (n = 162), thumb carpometacarpal osteoarthritis (n = 31), carpal tunnel syndrome (n = 97), and distal radius fracture (n = 132)--completed the Michigan Hand Questionnaire at two time points. Correlation analysis identified two items from each of six domains (i.e., function, activities of daily living, work, pain, aesthetics, and satisfaction). The Brief Michigan Hand Questionnaire score was calculated as the sum of the responses to the 12 items. Psychometric analysis was performed to describe the reliability, validity, and responsiveness of the Brief Michigan Hand Questionnaire. RESULTS The Brief Michigan Hand Questionnaire includes 12 items that were highly correlated with the summary Michigan Hand Questionnaire score (r = 0.99, p < 0.001). The Brief Michigan Hand Questionnaire scores were highly correlated between the two time periods (r = 0.78, p < 0.001) and by disease type. Responsiveness of the Brief Michigan Hand Questionnaire was high for all diseases and similar to that of the original Michigan Hand Questionnaire. CONCLUSIONS The 12-item Brief Michigan Hand Questionnaire is an efficient and versatile outcomes instrument specific to hand disability that retains the psychometric properties of the original Michigan Hand Questionnaire. The Brief Michigan Hand Questionnaire is an important tool with which to measure patient outcomes and the quality of care in hand surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, I.(Figure is included in full-text article.).
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12
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Wells AF, Haddad RH. Emerging role of ultrasonography in rheumatoid arthritis: optimizing diagnosis, measuring disease activity and identifying prognostic factors. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1173-1184. [PMID: 21645962 DOI: 10.1016/j.ultrasmedbio.2011.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 04/06/2011] [Accepted: 04/17/2011] [Indexed: 05/30/2023]
Abstract
Ultrasonography is a sensitive imaging modality that provides valuable information regarding early inflammatory changes that are not detected by clinical examination or X-rays, such as subclinical synovitis and erosions. This information may improve the management of rheumatoid arthritis by providing a more timely and accurate diagnosis, identifying poor prognostic factors, more accurately monitoring response to therapeutic intervention, improving treatment decisions and more accurately assessing remission. Ultrasonography could play a critical role in minimizing disease activity through strict monitoring and aggressive therapeutic adjustment, which has emerged as an approach to improve long-term outcomes for patients with rheumatoid arthritis.
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Affiliation(s)
- Alvin F Wells
- Rheumatology and Immunotherapy Center, Oak Creek, WI 53154, USA.
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13
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KARSH JACOB, KEYSTONE EDWARDC, HARAOUI BOULOS, THORNE JCARTER, POPE JANETE, BYKERK VIVIANP, MAKSYMOWYCH WALTERP, ZUMMER MICHEL, BENSEN WILLIAMG, KRAISHI MAJEDM. Canadian Recommendations for Clinical Trials of Pharmacologic Interventions in Rheumatoid Arthritis: Inclusion Criteria and Study Design: Table 1. J Rheumatol 2011; 38:2095-104. [DOI: 10.3899/jrheum.110188] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective.Current clinical trial designs for pharmacologic interventions in rheumatoid arthritis (RA) do not reflect the innovations in RA diagnosis, treatment, and care in countries where new drugs are most often used. The objective of this project was to recommend revised entry criteria and other study design features for RA clinical trials.Methods.Recommendations were developed using a modified nominal group consensus method. Canadian Rheumatology Research Consortium (CRRC) members were polled to rank the greatest challenges to clinical trial recruitment in their practices. Initial recommendations were developed by an expert panel of rheumatology trialists and other experts. A scoping study methodology was then used to examine the evidence available to support or refute each initial recommendation. The potential influence of CRRC recommendations on primary outcomes in future trials was examined. Recommendations were finalized using a consensus process.Results.Recommendations for clinical trial inclusion criteria addressed measures of disease activity [Disease Activity Score 28 using erythrocyte sedimentation rate (DAS28-ESR) > 3.2 PLUS ≥ 3 tender joints using 28-joint count (TJC28) PLUS ≥ 3 swollen joint (SJC28) OR C-reactive protein (CRP) or ESR > upper limit of normal PLUS ≥ 3 TJC28 PLUS ≥ 3 SJC28], functional classification, disease classification and duration, and concomitant RA treatments. Additional recommendations regarding study design addressed rescue strategies and longterm extension.Conclusion.There is an urgent need to modify clinical trial inclusion criteria and other study design features to better reflect the current characteristics of people living with RA in the countries where the new drugs will be used.
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14
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Lories RJU, de Vlam K, Luyten FP. Are current available therapies disease-modifying in spondyloarthritis? Best Pract Res Clin Rheumatol 2011; 24:625-35. [PMID: 21035084 DOI: 10.1016/j.berh.2010.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Disease modification in spondyloarthritis should target the improvement of symptoms and preservation of function. Therefore, inhibition of structural damage caused by the disease processes appears essential. In spondyloarthritis, structural damage results mainly in progressive ankylosis of the spine and peripheral joint destruction. Currently available therapies for the treatment of spondyloarthritis appear effective at inhibiting tissue destruction but, with the exception of celecoxib, do not appear to affect new tissue formation leading to ankylosis. In this article, we discuss clinical and pathophysiological concepts of disease modification in spondyloarthritis, challenges in its evaluation, recent clinical data and new concepts that may help explain structural damage as well as the onset and progression of disease.
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Affiliation(s)
- Rik J U Lories
- Laboratory for Skeletal Development and Joint Disorders, Division of Rheumatology, Department of Musculoskeletal Sciences, Katholieke Universiteit Leuven, Belgium.
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15
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Bird P, Joshua F. New applications of imaging techniques for monitoring progression of rheumatoid arthritis and predicting outcome. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.10.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Although rheumatoid arthritis causes significant disability for more than 1 million individuals in the United States, prior research regarding surgical treatment options has been limited by study sample size, study design, and methods of comparison. Furthermore, there is wide variation in the referral pattern for hand surgery consideration and type of surgical treatment of rheumatoid hand disease, yet the reasons for these differences are unclear. This review describes the role of outcomes research in rheumatoid hand disease by summarizing variations in surgical treatment, detailing current outcome assessment strategies, and offering potential strategies for designing future studies for rheumatoid hand disease.
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Abstract
Rheumatoid arthritis is characterised by persistent synovitis, systemic inflammation, and autoantibodies (particularly to rheumatoid factor and citrullinated peptide). 50% of the risk for development of rheumatoid arthritis is attributable to genetic factors. Smoking is the main environmental risk. In industrialised countries, rheumatoid arthritis affects 0·5-1·0% of adults, with 5-50 per 100 000 new cases annually. The disorder is most typical in women and elderly people. Uncontrolled active rheumatoid arthritis causes joint damage, disability, decreased quality of life, and cardiovascular and other comorbidities. Disease-modifying antirheumatic drugs (DMARDs), the key therapeutic agents, reduce synovitis and systemic inflammation and improve function. The leading DMARD is methotrexate, which can be combined with other drugs of this type. Biological agents are used when arthritis is uncontrolled or toxic effects arise with DMARDs. Tumour necrosis factor inhibitors were the first biological agents, followed by abatacept, rituximab, and tocilizumab. Infections and high costs restrict prescription of biological agents. Long-term remission induced by intensive, short-term treatment selected by biomarker profiles is the ultimate goal.
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MESH Headings
- Antirheumatic Agents/therapeutic use
- Arthritis, Juvenile
- Arthritis, Rheumatoid/classification
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/genetics
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/pathology
- Arthritis, Rheumatoid/physiopathology
- Arthritis, Rheumatoid/therapy
- Autoantibodies/blood
- Biomarkers/blood
- Cartilage/pathology
- Cost-Benefit Analysis
- Critical Pathways
- Fibroblasts/pathology
- Glucocorticoids/therapeutic use
- Humans
- Incidence
- Inflammation/physiopathology
- Rheumatoid Factor/blood
- Risk Factors
- Still's Disease, Adult-Onset
- Synovial Membrane/pathology
- Treatment Outcome
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
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Affiliation(s)
- David L Scott
- Department of Rheumatology, King's College London School of Medicine, London, UK.
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Waljee JF, Chung KC, Kim HM, Burns PB, Burke FD, Wilgis EFS, Fox DA. Validity and responsiveness of the Michigan Hand Questionnaire in patients with rheumatoid arthritis: a multicenter, international study. Arthritis Care Res (Hoboken) 2010; 62:1569-77. [PMID: 20521331 DOI: 10.1002/acr.20274] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 05/24/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Millions of patients experience the disabling hand manifestations of rheumatoid arthritis (RA), yet few hand-specific instruments are validated in this population. Our objective was to assess the reliability, validity, and responsiveness of the Michigan Hand Questionnaire (MHQ) in patients with RA. METHODS At enrollment and at 6 months, 128 RA patients with severe subluxation of the metacarpophalangeal joints completed the MHQ, a 37-item questionnaire with 6 domains: function, activities of daily living (ADL), pain, work, aesthetics, and satisfaction. Reliability was measured using Spearman's correlation coefficients between time periods. Internal consistency was measured using Cronbach's alpha. Construct validity was measured by correlating MHQ responses with the Arthritis Impact Measurement Scales 2 (AIMS2). Responsiveness was measured by calculating standardized response means (SRMs) between time periods. RESULTS The MHQ demonstrated good test-retest reliability (r = 0.66, P < 0.001). Cronbach's alpha scores were high for ADL (α = 0.90), function (α = 0.87), aesthetics (α = 0.79), and satisfaction (α = 0.89), indicating redundancy. The MHQ correlated well with AIMS2 responses. Function (r = -0.63), ADL (r = -0.77), work (r = -0.64), pain (r = 0.59), and summary score (r = -0.74) were correlated with the physical domain. Affect was correlated with ADL (r = -0.47), work (r = -0.47), pain (r = 0.48), and summary score (r = -0.53). Responsiveness was excellent among arthroplasty patients in function (SRM 1.42), ADL (SRM 0.89), aesthetics (SRM 1.23), satisfaction (SRM 1.76), and summary score (SRM 1.61). CONCLUSION The MHQ is easily administered, reliable, and valid to measure rheumatoid hand function, and can be used to measure outcomes in rheumatic hand disease.
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