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Hadwen B, Yu R, Cairns E, Barra L. Presence of Autoantibodies in Males and Females With Rheumatoid Arthritis: A Systematic Review and Metaanalysis. J Rheumatol 2022; 49:663-671. [PMID: 35293336 DOI: 10.3899/jrheum.211020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is more common in females, and although the cause of RA is unknown, it is characterized by the production of autoantibodies. The aims of this study were to determine whether RA-associated autoantibodies are more often found in females than males and to identify factors that influence the relationship between sex and seropositivity. METHODS Databases were searched and studies of RA (N ≥ 100) were included if they reported proportion of seropositive patients with RA by sex. Metaanalyses and metaregression were conducted using the random-effects model. Covariates regressed were smoking, age, BMI, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Disease Activity Score in 28 joints (DAS28). RESULTS Eighty-four studies with a total of 141,381 subjects with rheumatoid factor (RF) seropositivity and 95,749 subjects with anticitrullinated protein antibody (ACPA) seropositivity met inclusion criteria. The mean age of participants ranged from 37 to 68 years and the proportion of female subjects ranged from 9% to 92%. Results indicated that females were less likely than males to be seropositive: odds ratio (OR) 0.84 [95% CI 0.77-0.91] for RF and OR 0.88 [95% CI 0.81-0.95] for ACPA. BMI, smoking, mean age, DAS28, and HAQ-DI did not affect the relationship between sex and seropositivity. CONCLUSION Although studies report that females have higher RA disease activity than males and that seropositivity predicts worse outcomes, females were less likely to be seropositive than males.
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Affiliation(s)
- Brook Hadwen
- B. Hadwen, BMSc, Department of Epidemiology and Biostatistics, Western University
| | - Richard Yu
- R. Yu, MD, Department of Medicine, Division of Rheumatology, Western University
| | - Ewa Cairns
- E. Cairns, PhD, Department of Medicine, Division of Rheumatology, and Department of Microbiology and Immunology, Western University
| | - Lillian Barra
- L. Barra, MD, Department of Epidemiology and Biostatistics, Department of Medicine, Division of Rheumatology, and Department of Microbiology and Immunology, Western University, London, Ontario, Canada.
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Lin D, Zhao M, Zhang Y, Xie Y, Cao J, Pan Y. Seronegative rheumatic arthritis has milder inflammation and bone erosion in an ultrasound study of disease-modifying anti-rheumatic drugs (DMARDs)-naïve Chinese cohort. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:661. [PMID: 35845489 PMCID: PMC9279788 DOI: 10.21037/atm-22-2171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 01/12/2023]
Abstract
Background Compared with the seropositive rheumatic arthritis (sp-RA), seronegative rheumatic arthritis (sn-RA) lacks ultrasound (US) research. It is unknown whether sn-RA patients had more severe synovitis than sp-RA ones at the same level of swollen joint counts (SJCs). We designed the US study to find out the answers. Methods All cases satisfied the 2010 classification criteria, first diagnosed and disease-modifying anti-rheumatic drugs (DMARDs) naïve with the characteristics of abnormal swelling or pain in the wrist, proximal interphalangeal (PIPs), and metacarpophalangeal (MCPs) joints. Demographic data was collected. US examinations, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale scores (VASs), patient global assessment (PGA), physician’s global assessment (PhGA), disease activity score of 28 joints (DAS28), and van der Heijde-modified Sharp score (vdHSS) were used to evaluate the disease activity among these groups. Anticitrullinated peptide antibody (ACPA), rheumatoid factor (RF) and SJCs were used to divide the patients into 3 groups, which were defined as follows: Group A, sp-RA (positive RF and/or ACPA) with SJC >10; Group B, sp-RA with SJC ≤10; and Group C, sn-RA (all negative RF and ACPA with SJC >10 due to the criteria). Results A total of 139 cases were recruited. Fifty-six were Group A, 54 were Group B, and 29 were Group C. All indexes above and the total US scores were significantly lower in Group C than Group A (both groups with SJC >10) (ESR, CRP, VASs, PGA, PhGA, DAS28, vdHSS, US total score respectively: 58.8 vs. 37.5, P=0.009; 37.5 vs. 17.8, P=0.008; 61.7 vs. 52.8, P=0.032; 62.2 vs. 53.9, P=0.031; 59.8 vs. 48.3, P=0.029; 6.92 vs. 5.56, P=0.000; 61.7 vs. 44.5, P=0.023; 31.4 vs. 20.9, P=0.000). The difference of the total US scores above was mostly contributed by the symptoms of synovitis. The total US scores were prominently lower in Group C with the duration over 2 years (2–5 years, >5 years, respectively compared to <2 years: 16.3 vs. 27.4, P=0.044; 16.5 vs. 27.4, P=0.048), and vdHSS were remarkably higher in almost all groups with a duration of over 5 years. For the patients with a duration over 2 years, bone erosions occurred earlier in sp-RA than in sn-RA patients. Conclusions Sn-RA patients had milder synovitis than sp-RA ones at the same extent of disease activity. In addition, sn-RA had delayed progress of bone erosion than the sp-RA group.
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Affiliation(s)
- Dongfang Lin
- Division of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minjing Zhao
- Division of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanli Zhang
- Division of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ya Xie
- Division of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junyan Cao
- Division of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunfeng Pan
- Division of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Lu CH, Chen LF, Huang YM, Cheng CF, Hsieh SC, Li KJ. Anti-Cyclic Citrullinated Peptide Antibodies Correlate to Ultrasound Synovitis in Rheumatoid Arthritis Better Than C-Reactive Protein. J Clin Rheumatol 2021; 27:e412-e417. [PMID: 32604244 PMCID: PMC8612904 DOI: 10.1097/rhu.0000000000001499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare ultrasound (US) grading and laboratory measures in patients with rheumatoid arthritis. METHODS Two-hundred four patients with rheumatoid arthritis who received US evaluation for synovitis were included after excluding those using tocilizumab. Ultrasound grading of synovial hypertrophy (SH) and power Doppler (PD) at the most severe site were recorded. An assessment of the correlation of laboratory measures and US grading was conducted by reviewing the electronic medical records. RESULTS High-titer anti-cyclic citrullinated peptide (anti-CCP) antibodies positivity was associated with SH grade ≥2 (odds ratio [OR], 6.00; 95% confidence interval [CI], 1.78-20.2) and PD grade ≥2 (OR, 5.56; 95% CI, 1.82-16.9). Recent C-reactive protein (CRP) levels ≥0.3 mg/dL were associated with SH grade ≥2 (OR, 3.13; 95% CI, 1.38-7.10) and PD grade ≥2 (OR, 2.38; 95% CI, 1.31-4.31). Anti-CCP antibody levels correlated with US scores better than the levels of CRP with higher Spearman ρ correlation coefficients. Most of the patients with recent CRP levels <0.3 mg/dL had US synovitis. In logistic regression, high levels of anti-CCP antibodies and CRP were both independently associated with SH grade ≥2 and PD grade ≥2. CONCLUSIONS Higher levels of anti-CCP antibodies and CRP may predict synovitis on US, whereas discrepancies existed between inflammatory markers and US grading. These findings suggest that US has a role in the comprehensive assessment of disease activity, especially for patients with high-titer positive anti-CCP antibodies.
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Affiliation(s)
- Cheng-Hsun Lu
- From the Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University
| | - Lung-Fang Chen
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Yi-Min Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Chiao-Feng Cheng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan
| | - Song-Chou Hsieh
- From the Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital
| | - Ko-Jen Li
- From the Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital
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4
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Marques ML, Alunno A, Boonen A, Ter Wee MM, Falzon L, Ramiro S, Putrik P. Methodological aspects of design, analysis and reporting of studies with work participation as an outcome domain in patients with inflammatory arthritis: results of two systematic literature reviews informing EULAR points to consider. RMD Open 2021; 7:rmdopen-2020-001522. [PMID: 33542048 PMCID: PMC7868290 DOI: 10.1136/rmdopen-2020-001522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To summarise the methodological aspects in studies with work participation (WP) as outcome domain in inflammatory arthritis (IA) and other chronic diseases. Methods Two systematic literature reviews (SLRs) were conducted in key electronic databases (2014–2019): search 1 focused on longitudinal prospective studies in IA and search 2 on SLRs in other chronic diseases. Two reviewers independently identified eligible studies and extracted data covering pre-defined methodological areas. Results In total, 58 studies in IA (22 randomised controlled trials, 36 longitudinal observational studies) and 24 SLRs in other chronic diseases were included. WP was the primary outcome in 26/58 (45%) studies. The methodological aspects least accounted for in IA studies were as follows (proportions of studies positively adhering to the topic are shown): aligning the studied population (16/58 (28%)) and sample size calculation (8/58 (14%)) with the work-related study objective; attribution of WP to overall health (28/58 (48%)); accounting for skewness of presenteeism/sick leave (10/52 (19%)); accounting for work-related contextual factors (25/58 (43%)); reporting attrition and its reasons (1/58 (2%)); reporting both aggregated results and proportions of individuals reaching predefined meaningful change or state (11/58 (16%)). SLRs in other chronic diseases confirmed heterogeneity and methodological flaws identified in IA studies without identifying new issues. Conclusion High methodological heterogeneity was observed in studies with WP as outcome domain. Consensus around various methodological aspects specific to WP studies is needed to improve quality of future studies. This review informs the EULAR Points to Consider for conducting and reporting studies with WP as an outcome in IA.
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Affiliation(s)
- Mary Lucy Marques
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands .,Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Alessia Alunno
- Rheumatology Unit, University of Perugia Department of Medicine, Perugia, Umbria, Italy
| | - Annelies Boonen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
| | - Marieke M Ter Wee
- Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Rheumatology and immunology, AI&I, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Louise Falzon
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, New York, New York, USA
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Polina Putrik
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, The Netherlands.,Department of Health Services Research, Universiteit Maastricht Care and Public Health Research Institute, Maastricht, Limburg, The Netherlands
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Kim H, Cho SK, Choi S, Im SG, Jung SY, Jang EJ, Sung YK. Comparison of healthcare resource utilization and medical costs between patients with seropositive and seronegative rheumatoid arthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211024830. [PMID: 34262621 PMCID: PMC8252400 DOI: 10.1177/1759720x211024830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives: To compare healthcare utilization and medical costs between patients with seronegative (SN) and seropositive (SP) rheumatoid arthritis (RA). Methods: We conducted a nationwide population study using the Korean health insurance claims database in 2016. We divided patients with RA into SN and SP groups and compared healthcare utilization including medications, medical utilization, and direct medical costs for 1 year between the groups in a cross-sectional analysis. Differences in costs between patients with SPRA and SNRA were assessed using the quantile regression model. We performed longitudinal analysis using data from 2012 and 2016 to examine changes over time. Results: A total of 103,815 SPRA and 75,809 SNRA patients were included in the analyses. The SPRA group used significantly more methotrexate (73.2% versus 30.3%) and biologic agents (7.9% versus 2.9%) than the SNRA group. The number of RA-related outpatient visits [6.0 ± 3.7 versus 4.4 ± 4.0 times/year, standardized difference (SD) = 0.41] and annual medical costs per patient ($1027 versus $450/year, SD = 0.25) were higher in the SPRA group than the SNRA group. Quantile regression results indicated that the incremental cost of seropositivity on total medical costs of RA patients gradually increased as medical costs approached the upper quantile. The annual direct medical costs for each patient between 2012 and 2016 increased in both groups: by 25.1% in the SPRA group and 37.6% in the SNRA group. Conclusion: Annual RA-related direct medical costs and RA-related healthcare utilization per patient are higher in patients with SPRA than those with SNRA.
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Affiliation(s)
- Hyoungyoung Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Seongmi Choi
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Seul Gi Im
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Andong, Gyeongsangbuk-do 36729, Republic of Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Wangshimni-ro 222-1, Seongdong-gu, Seoul 04763, Republic of Korea
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6
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Castillo-Cañón JC, Trujillo-Cáceres SJ, Bautista-Molano W, Valbuena-García AM, Fernández-Ávila DG, Acuña-Merchán L. Rheumatoid arthritis in Colombia: a clinical profile and prevalence from a national registry. Clin Rheumatol 2021; 40:3565-3573. [PMID: 33772350 DOI: 10.1007/s10067-021-05710-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/24/2021] [Accepted: 03/21/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a need to describe the demographic and clinical characteristics of people diagnosed with rheumatoid arthritis who are attended within the Colombian health system. This characterization allows prioritizing populations with specific risks, programming the use of health services, and planning the costs necessary to guarantee equitable care. OBJECTIVE To assess the demographic and clinical characteristics of a cohort of patients with rheumatoid arthritis using national data collected by the High-Cost Disease Fund (CAC in Spanish). METHODS A cross-sectional study from a secondary source. Data was gathered from a national administrative registry. A descriptive analysis was performed on sociodemographic and clinical characteristics. Age-standardized prevalence was estimated at national level and by geographical regions. Remission rates were also estimated for Colombian departments and regions. RESULTS By 2019, 81,386 patients with rheumatoid arthritis were reported in Colombia. The relation female-male was 5.2:1. The median age was 59 years (IQR: 50-67). Prevalence was higher in people aged 50-69 years. The most frequent comorbidities were high blood pressure (31.15%) and osteoporosis (19.46%). Age-standardized prevalence of rheumatoid arthritis was 0.24 per 100 population (95% CI: 0.23-0.24). In cases with complete information, 57.57% of departments had remission rates up to 30%. CONCLUSION Rheumatoid arthritis in Colombia was more frequent in females aged ≥50 year. Age-standardized prevalence was lower than reported by other studies performed in Colombia but similar to the estimated internationally for the country. Key Points • More than 80,000 rheumatoid arthritis patients were reported to this national registry in Colombia in 2019, finding an age-standardized prevalence of 0.24 per 100 population. • Hypertension was the most common comorbidity reported in people with rheumatoid arthritis. This finding is similar to the reports by similar studies such as the COMORA. • A major strength of this study is the large sample size since data come from a nationwide registry of people with rheumatoid arthritis, supported by the National Ministry of Health. Additionally, this registry has a rigorous data monitoring process that guarantees the internal validity of data and provides valuable information for decision-making based on local evidence. • Prevalence of rheumatoid arthritis was higher in females between 50 and 65 years. Age-standardized prevalence was lower than previously reported in Colombia, but similar to the world estimations.
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Affiliation(s)
| | | | - Wilson Bautista-Molano
- University Hospital Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá D.C., Colombia
| | | | - Daniel G Fernández-Ávila
- Rheumatology Unit, Department of Internal Medicine, Hospital Universitario San Ignacio-School of Medicine, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
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7
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Tan YK, Li H, Allen JC, Thumboo J. Anti‐cyclic citrullinated peptide but not rheumatoid factor is associated with ultrasound‐detected bone erosion among rheumatoid arthritis patients with at least moderate disease activity. Int J Rheum Dis 2020; 23:1337-1343. [DOI: 10.1111/1756-185x.13933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- York Kiat Tan
- Department of Rheumatology and Immunology Singapore General Hospital Singapore
- Duke‐NUS Medical School Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - HuiHua Li
- Health Services Research Unit Singapore General Hospital Singapore
| | | | - Julian Thumboo
- Department of Rheumatology and Immunology Singapore General Hospital Singapore
- Duke‐NUS Medical School Singapore
- Yong Loo Lin School of Medicine National University of Singapore Singapore
- Health Services Research Unit Singapore General Hospital Singapore
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8
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Harrold LR, Shan Y, Connolly SE, Alemao E, Rebello S, Guo L, Kremer JM. Association among anti-citrullinated protein antibody status, erosive disease and healthcare resource utilization in patients with rheumatoid arthritis. Curr Med Res Opin 2020; 36:337-342. [PMID: 31612736 DOI: 10.1080/03007995.2019.1680354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To characterize the rate of healthcare resource utilization (HCRU) between anti-cyclic citrullinated peptide (CCP; a surrogate for anti-citrullinated protein antibodies [ACPAs]) positive (+) patients with rheumatoid arthritis (RA), either with or without erosions, who initiated biologic disease-modifying antirheumatic drug (bDMARD) treatment.Methods: Data from the Corrona RA registry, a prospective registry of adult patients with RA from 177 sites across 42 states in the US, were analyzed. Annual rates of HCRU (measured based on rates of all-cause hospitalization, joint surgery, imaging procedures and use of assistive devices) were estimated in anti-CCP + patients with and without erosions following bDMARD initiation using a Poisson regression model.Results: Among the 3333 patients with known anti-CCP and erosion status and 12-month post-bDMARD follow-up information in the Corrona registry, 2047 were anti-CCP + and included in this analysis; 868 with and 1179 without erosions. Baseline characteristics were generally well balanced between patients with and without erosions; however, those with erosions had a longer mean RA duration and a higher prior DMARD use. Over 12 months, among anti-CCP + patients, those with erosions had significantly higher rates of all HCRU, except joint surgery, than those without erosions. Age-adjusted risk ratios (95% confidence interval) were as follows: all-cause hospitalization, 1.47 (1.14, 1.90); all-cause imaging, 1.25 (1.03, 1.53); and assistive device use 1.12 (1.00, 1.25). The rate of joint surgery visits was also numerically higher in patients with versus without erosion.Conclusions: ACPA seropositivity with erosive disease was associated with higher rates of HCRU compared with seropositivity without erosions. These findings suggest that providers may want to manage anti-CCP + patients aggressively to achieve better disease control to prevent the development of erosions and the associated increase in HCRU.
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Affiliation(s)
| | | | | | - Evo Alemao
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Lin Guo
- Corrona, LLC, Waltham, MA, USA
| | - Joel M Kremer
- Albany Medical College and The Center for Rheumatology, Albany, NY, USA
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Autoantibodies as Diagnostic Markers and Mediator of Joint Inflammation in Arthritis. Mediators Inflamm 2019; 2019:6363086. [PMID: 31772505 PMCID: PMC6854956 DOI: 10.1155/2019/6363086] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/14/2019] [Indexed: 12/11/2022] Open
Abstract
Rheumatoid arthritis is a systemic, polygenic, and multifactorial syndrome characterized by erosive polyarthritis, damage to joint architecture, and presence of autoantibodies against several self-structures in the serum and synovial fluid. These autoantibodies (anticitrullinated protein/peptide antibodies (ACPAs), rheumatoid factors (RF), anticollagen type II antibodies, antiglucose-6 phosphate isomerase antibodies, anticarbamylated protein antibodies, and antiacetylated protein antibodies) have different characteristics, diagnostic/prognostic value, and pathological significance in RA patients. Some of these antibodies are present in the patients' serum several years before the onset of clinical disease. Various genetic and environmental factors are associated with autoantibody production against different autoantigenic targets. Both the activating and inhibitory FcγRs and the activation of different complement cascades contribute to the downstream effector functions in the antibody-mediated disease pathology. Interplay between several molecules (cytokines, chemokines, proteases, and inflammatory mediators) culminates in causing damage to the articular cartilage and bones. In addition, autoantibodies are proven to be useful disease markers for RA, and different diagnostic tools are being developed for early diagnosis of the clinical disease. Recently, a direct link was proposed between the presence of autoantibodies and bone erosion as well as in the induction of pain. In this review, the diagnostic value of autoantibodies, their synthesis and function as a mediator of joint inflammation, and the significance of IgG-Fc glycosylation are discussed.
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10
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Cho SK, Sung YK. A paradigm shift in studies based on rheumatoid arthritis clinical registries. Korean J Intern Med 2019; 34:974-981. [PMID: 30759964 PMCID: PMC6718765 DOI: 10.3904/kjim.2018.440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/02/2019] [Indexed: 12/18/2022] Open
Abstract
Clinical research is the study of aspects of patient health or illness that are closely related to clinical practice. In the late 20th and early 21th century, outcomes for patients with rheumatoid arthritis (RA) improved dramatically due to breakthroughs in new drugs. Patient-reported outcome measures now play a significant role in the drug development process as study endpoints in clinical trials of new therapies, and this has led to increased interest in the patient's perspective, drug safety and treatment outcomes in clinical practice. In accordance with these needs, many prospective cohorts for RA patients and registries of biologic disease modifying anti-rheumatic drugs have been actively conducted in the United States and European and Asian countries. A gradual shift is taking place in the major outcomes of clinical research using these prospective cohorts and registries. This article will introduce representative registries for RA in each country set up in the early 2000s and will discuss future perspectives in clinical research on RA patients using such clinical registries.
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Affiliation(s)
- Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Correspondence to Yoon-Kyoung Sung, M.D. Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-9250 Fax: +82-2-2298-8231 E-mail:
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Luo Q, Li X, Zhang L, Yao F, Deng Z, Qing C, Su R, Xu J, Guo Y, Huang Z, Li J. Serum PGLYRP‑1 is a highly discriminatory biomarker for the diagnosis of rheumatoid arthritis. Mol Med Rep 2018; 19:589-594. [PMID: 30431075 DOI: 10.3892/mmr.2018.9632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/12/2018] [Indexed: 11/06/2022] Open
Abstract
Peptidoglycan recognition protein‑1 (PGLYRP‑1) is a part of the innate immune system. It is well‑known that dysregulation of innate immune responses is present in patients with rheumatoid arthritis (RA). However, the role of Pglyrp1/PGLYPR‑1 in RA is poorly understood. Reverse transcription‑quantitative polymerase chain reaction was used to detect the level of Pglyrp1 in peripheral blood mononuclear cells. An ELISA was used to measure the level of PGLYPR‑1 in the serum, and correlation analysis was performed to analyze the association between the level of PGLYPR‑1 in the serum and clinical characteristics. A receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic value of PGLYPR‑1 in serum. The expression of PGLYPR‑1 in the serum of healthy controls compared with PGLYPR‑1 in the serum from patients with RA was significantly increased compared with patients with systemic lupus erythematosus (SLE). The level of PGLYPR‑1 in serum was correlated with rheumatoid factor and anti‑cyclic citrullinated peptide. ROC curve analysis suggested that PGLYPR‑1 in the serum may have significant value for RA diagnosis. In addition, the risk score based on PGLYPR‑1 in the serum also significantly discriminated the patients with RA from the disease controls (SLE). The present study suggested that increased expression of PGLYPR‑1 in the serum from patients with RA may serve as a potential biomarker for RA diagnosis.
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Affiliation(s)
- Qing Luo
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Xue Li
- Department of Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Lu Zhang
- Department of Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Fangyi Yao
- Clinical Laboratory Department, Jiangxi Province Blood Center, Nanchang, Jiangxi 330006, P.R. China
| | - Zhen Deng
- Department of Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Cheng Qing
- Intensive Care Unit, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Rigu Su
- Department of Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Jianqing Xu
- Department of Medical College, Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Yang Guo
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zikun Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Junming Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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Alemao E, Al MJ, Boonen AA, Stevenson MD, Verstappen SMM, Michaud K, Weinblatt ME, Rutten-van Mölken MPMH. Conceptual model for the health technology assessment of current and novel interventions in rheumatoid arthritis. PLoS One 2018; 13:e0205013. [PMID: 30289926 PMCID: PMC6173427 DOI: 10.1371/journal.pone.0205013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to evaluate current approaches to economic modeling in rheumatoid arthritis (RA) and propose a new conceptual model for evaluation of the cost-effectiveness of RA interventions. We followed recommendations from the International Society of Pharmacoeconomics and Outcomes Research-Society of Medical Decision Making (ISPOR-SMDM) Modeling Good Research Practices Task Force-2. The process involved scoping the decision problem by a working group and drafting a preliminary cost-effectiveness model framework. A systematic literature review (SLR) of existing decision-analytic models was performed and analysis of an RA registry was conducted to inform the structure of the draft conceptual model. Finally, an expert panel was convened to seek input on the draft conceptual model. The proposed conceptual model consists of three separate modules: 1) patient characteristic module, 2) treatment module, and 3) outcome module. Consistent with the scope, the conceptual model proposed six changes to current economic models in RA. These changes proposed are to: 1) use composite measures of disease activity to evaluate treatment response as well as disease progression (at least two measures should be considered, one as the base case and one as a sensitivity analysis); 2) conduct utility mapping based on disease activity measures; 3) incorporate subgroups based on guideline-recommended prognostic factors; 4) integrate realistic treatment patterns based on clinical practice/registry datasets; 5) assimilate outcomes that are not joint related (extra-articular outcomes); and 6) assess mortality based on disease activity. We proposed a conceptual model that incorporates the current understanding of clinical and real-world evidence in RA, as well as of existing modeling assumptions. The proposed model framework was reviewed with experts and could serve as a foundation for developing future cost-effectiveness models in RA.
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Affiliation(s)
- Evo Alemao
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb (BMS), Lawrence, New Jersey, United States of America
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maiwenn J. Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Annelies A. Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Matthew D. Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Suzanne M. M. Verstappen
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kaleb Michaud
- Department of Rheumatology and Immunology, University of Nebraska Medical Center, Omaha, New England, United States of America
| | - Michael E. Weinblatt
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts, United States of America
| | - Maureen P. M. H. Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Zhang YH, Li K, Xiao J, Zhang HD, Zhang XY. Comparison of Ultrasound, Radiography, and Clinical Investigations in the Diagnosis of Early Rheumatoid Synovitis in Patients with Nonspecific Musculoskeletal Symptoms: A Multicenter Cross-Sectional Study. Med Sci Monit 2018; 24:4372-4378. [PMID: 29939979 PMCID: PMC6048998 DOI: 10.12659/msm.908755] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of rheumatoid synovitis can reduce the progression of rheumatoid arthritis (RA). However, in the early stages of rheumatoid synovitis, patients may only have non-specific musculoskeletal symptoms, and plain film radiographs may not detect early synovial changes. The aim of this study was to compare the sensitivity and specificity of ultrasound with radiography, and clinical investigations in the detection of rheumatoid synovitis in patients presenting with nonspecific musculoskeletal symptoms. MATERIAL AND METHODS This was a non-randomized, cross-sectional, clinical study that included 189 patients who had nonspecific musculoskeletal symptoms. All patients underwent clinical investigations, postero-anterior and dorsal radiographic imaging, and bilateral grey-scale ultrasound examinations of the third and second metacarpophalangeal (MCP) joints, the third and the second proximal interphalangeal (PIP) joints, the second and the fifth metatarsophalangeal (MTP) joints, and the wrist. RESULTS There was no clear predictive value for detection of early synovitis by clinical investigations alone. Plain film radiography of patients only provided accurate information of joint erosions but less information for synovitis. Grey-scale ultrasound was more effective at detecting early synovitis compared with clinical investigations (p=0.00015; q=4.548) and compared with plain film radiography (p=0.0002; q=4.537), and quantified the synovial changes. The predictive values of plain film radiography and clinical investigations had 0.43 and 0.24 sensitivity and 0 specificity compared with ultrasound. CONCLUSIONS The findings of this study support the use of grey-scale ultrasound in the detection of early rheumatoid synovitis of the fingers and the wrist.
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Affiliation(s)
- Ying-Hua Zhang
- Department of Ultrasonography, Jining No. 1 Peoples' Hospital, Jining, Shandong, China (mainland)
| | - Kang Li
- Department of Bone and Joint Surgery, Heze Municipal Hospital, Heze, Shandong, China (mainland)
| | - Jing Xiao
- Department of Ultrasonography, Jining No. 1 Peoples' Hospital, Jining, Shandong, China (mainland)
| | - Hai-Dong Zhang
- Department of Functional Studies, Yanzhou Hospital of Traditional Chinese Medicine, Yanzhou, Shandong, China (mainland)
| | - Xiao-Yan Zhang
- Department of Ultrasonography, Rencheng District First Maternal and Child Health Care Hospital, Jining, Shandong, China (mainland)
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