Rheumatoid Arthritis Severity Scale: a brief, physician-completed scale not confounded by patient self-report of psychological functioning

The problem of residual pain in the assessment of rheumatoid arthritis activity

Residual pain is a major unmet medical need observed in patients suffering from rheumatoid arthritis (RA), which decreases their quality of life, even after achieving remission or low disease activity. The article has two aims: 1) to present mechanisms involved in the pathophysiology of residual pain, both inflammatory and non-inflammatory, i.e. neuropathic and nociplastic pain, as well as secondary pain syndromes, i.e. osteoarthritis and fibromyalgia, which can contribute to residual pain; 2) to show the limitations of current disease activity measures recommended by European Alliance of Associations for Rheumatology (EULAR) and American College of Rheumatology (ACR), which raise the need for a separate assessment of pain, and examples of methods that could be used by medical professionals to assess the pain and make a differential diagnosis. In conclusion, establishing a valid method to assess pain is essential to identify the pathomechanism of residual pain and to create treatments tailored specifically to individual RA patients.

Development of triamcinolone acetonide-hyaluronic acid conjugates with selective targeting and less osteoporosis effect for rheumatoid arthritis treatments

Rheumatoid arthritis (RA) is a common systemic autoimmune disease in developed countries. In clinical treatment, steroids have been used as bridging and adjunctive therapy after disease-modifying anti-rheumatic drug administration. However, the severe side effects caused by the nonspecific targeting of organs followed by long-term administration have limited their usage in RA. In this study, poorly water-soluble triamcinolone acetonide (TA), a highly potent corticosteroid for intra-articular injection, is conjugated on hyaluronic acid (HA) for intravenous purposes with increased specific drug accumulation in inflamed parts for RA. Our results demonstrate that the designed HA/TA coupling reaction reveals >98 % conjugation efficiency in the dimethyl sulfoxide/water system, and the resulting HA-TA conjugates show lower osteoblastic apoptosis compared with that in free TA-treated osteoblast-like NIH3T3 cells. Furthermore, in a collagen-antibody-induced arthritis animal study, HA-TA conjugates enhanced the initiative targeting ability to inflame tissue and reduce the histopathological arthritic changes (score = 0). Additionally, the level of bone formation marker P1NP in HA-TA-treated ovariectomized mice (303.6 ± 40.6 pg/mL) is significantly higher than that in the free TA-treated group (143.1 ± 3.9 pg/mL), indicating the potential for osteoporotic reduction using an efficient HA conjugation strategy for the long-term administration of steroids against RA.

Workplace activity limitation and quality of life: A study on rheumatoid arthritis patients

BACKGROUND: Rheumatoid arthritis (RA) causes disabilities that affect people in working age and can impair their working activity and quality of life (QoL). OBJECTIVES: To assess work activity limitation and QoL among RA patients and to explore the associated risk factors. METHODS: A cross-sectional study on 344 RA patients was conducted at the outpatient clinic using a number of standardized questionnaires including the Health Assessment Questionnaire Disability Index, Workplace Activity Limitation Scale, and RA QoL. Clinical examinations were also performed including the measurement of pain intensity, assessment of disease activity, and the Rheumatoid Arthritis Severity Scale. RESULTS: Most of the employed participants (87%) experienced high work activity limitations. Increasing work limitations were significantly associated with a decrease in QoL domains scores. The most significant risk factors affecting work limitation by logistic regression were high disease activity, the severity of the disease, married females, and a high health assessment disability index among RA patients. CONCLUSIONS: RA patients experience limitations that affect their productivity at work and their QoL. Paying more attention to early management to prevent the upcoming unfavorable health and economic consequences for RA patients is significantly important.

Will 14-3-3η Be a New Diagnostic and Prognostic Biomarker in Rheumatoid Arthritis? A Prospective Study of Its Utility in Early Diagnosis and Response to Treatment

Results

Serum14-3-3η levels were significantly higher in all RA patients than in controls (P < 0.001), its sensitivity was 86.7% and 88.3% in early and established RA patients with a significant difference with RF and ACCP at early disease, and the specificity was 96.7%. There was a significant reduction of 14-3-3η levels 6 months after treatment in the first group (p=0.004), and there was a significant positive correlation between serum 14-3-3η levels and parameters of disease activity and severity.

Conclusion

14-3-3η could be a novel, potent, and efficacious diagnostic, and prognostic marker for RA with high sensitivity, that may become a new therapeutic target for RA.

Treatment with TNF-α inhibitors versus methotrexate and the association with dementia and Alzheimer's disease

INTRODUCTION

Peripheral inhibition of tumor necrosis factor (TNF)-α, outside of the central nervous system, may result in clinical improvement of Alzheimer's disease (AD) outcomes. TNF-α inhibitors (TNFIs) are effective treatments for various autoimmune conditions and may be effective for preventing and/or treating AD. The objective of this study was to compare the risk of dementia and AD in patients initiating methotrexate versus those initiating TNFIs.

METHODS

Insurance claims data from databases of commercially insured and Medicare-eligible patients were used to estimate the risk of dementia and AD within patients with rheumatoid arthritis (RA) initiating a TNFI versus initiation of methotrexate. A sensitivity analysis included all patients without the RA diagnosis requirement. The at-risk period spanned from the index date until a diagnosis of the outcome, loss-to-follow-up, or receipt of the comparator drug. Patients were matched 1-to-1 using propensity scores. A Cox proportional hazards model was used to estimate the hazard ratio (HR). Negative controls were used to calibrate the results.

RESULTS

A total of 11,092 new TNFI patients and 44,023 new methotrexate patients were identified, and 8925 from each group were matched. The outcome of dementia occurred in 1.4% of patients in both groups. The calibrated results from the Cox regression found no difference between the two groups (commercially insured database: calibrated HR = 0.69, 95% confidence interval = 0.45 to 1.05; Medicare-only database: 1.14, 0.66 to 1.96). Results were similar in all sensitivity analyses: outcome of AD and including patients without RA.

DISCUSSION

No significant difference for the risk of dementia or AD was seen between patients initiating a TNFI versus methotrexate. Although this study cannot conclude whether use of TNFIs is protective against dementia and AD compared with receiving no treatment, there was no evidence that it is more protective than the active comparator methotrexate.

Tele-health interventions to support self-management in adults with rheumatoid arthritis: a systematic review

Rheumatoid arthritis (RA), a long-term auto-immune condition is a challenging condition for patients to manage. Goals of treatment include reducing pain, decreasing inflammation, and improving an individual's overall function. Increasingly technology is being utilised to support patients to self-manage their condition. The aim of this systematic narrative review was to synthesise and critically appraise published evidence concerning the effectiveness of tele-health interventions to support self-management in RA. Bibliographic databases searched from 2014 to March 2020 included MedLINE, Embase, Cochrane Library. Search strategy combined the following concepts: (1) rheumatoid arthritis, (2) tele-health interventions, and (3) self-management. Only randomised controlled trials (RCTs) involving adults with RA were included. Titles, abstracts, full-text articles were screened, any discrepancies were checked by a second reviewer. Risk of bias was assessed using Cochrane risk of bias tool and data were extracted utilising the Cochrane data collection form for RCT interventions along with the TiDier checklist. Due to high heterogeneity, results were not meta-analysed and instead data were synthesised narratively. The search identified 98 articles, seven were included. The completed RCTs varied in the nature of the interventions, duration/severity of RA, outcomes measured and effectiveness of the interventions. The completed RCTs included a total of 791 participants Disease duration was largely between 4 and 10 years and disease severity on average was moderate. There was extensive variation in intervention components, theories underpinning theories and outcomes measured. Five RCTs reported a positive effect on factors such as disease activity, medication adherence, physical activity and self-efficacy levels. This study suggests that tele-health interventions that are well-designed, tailored and multi-faceted can help to achieve positive self-management outcomes in RA. None of the studies showed evidence of harm.

The significance of serum 14-3-3η level in rheumatoid arthritis patients

BACKGROUND

RA is a systemic inflammatory condition characterized by chronic arthritis and often associated with irreversible joint damage.

OBJECTIVES

To assess the significance of serum level of 14-3-3η in RA and its association with clinical and serological features of the disease.

METHODS

This is a case-control study done on 80 participants. They were divided into 2 groups. Group 1: 40 rheumatoid arthritis patients compared to group 2: 40 healthy participants matched for age and sex. Laboratory investigations including complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPAs), and serum 14-3-3η were done to all participants. Radiological examination in the form of plain X-ray for hands and feet was done to all patients.

RESULTS

Serum levels of 14-3-3η were significantly higher in RA patients compared to the control group (p < 0.001). Serum 14-3-3η was the only predictor of high Larsen's score (p = 0.013) on using linear regression analysis. Serum 14-3-3η can predict RA in healthy controls in univariate (p = 0.001) and multivariate (p = 0.004) analyses. The receiver operating characteristic (ROC) curve of 14-3-3η was constructed for discrimination between RA and control subjects. The best cut-off value was 61.9 ng/mL, with fair AUC (0.773, p < 0.001), 95% CI (0.656-0.889), and the sensitivity and specificity of 14-3-3η for RA diagnosis as 65% and 95% respectively. Also, we constructed ROC curves for RF, ACPA, 14-3-3η, and their combinations; we found that the highest test sensitivity of 95.7% appeared on adding the 3 markers together, and the highest test specificity of 100% was detected on adding RF to ACPA, 14-3-3η to ACPA or the 3 molecules together.

CONCLUSION

14-3-3η could be a valuable marker for the diagnosis of RA patients and it may have prognostic value. Key Points • 14-3-3η is a valuable marker for the diagnosis of RA patients. • 14-3-3η reflects disease severity and joint damage in RA patients.

Augmentation of Physician Assessments with Multi-Omics Enhances Predictability of Drug Response: A Case Study of Major Depressive Disorder

This work proposes a "learning-augmented clinical assessment" workflow to sequentially augment physician assessments of patients' symptoms and their socio-demographic measures with heterogeneous biological measures to accurately predict treatment outcomes using machine learning. Across many psychiatric illnesses, ranging from major depressive disorder to schizophrenia, symptom severity assessments are subjective and do not include biological measures, making predictability in eventual treatment outcomes a challenge. Using data from the Mayo Clinic PGRN-AMPS SSRI trial as a case study, this work demonstrates a significant improvement in the prediction accuracy for antidepressant treatment outcomes in patients with major depressive disorder from 35% to 80% individualized by patient, compared to using only a physician's assessment as the predictors. This improvement is achieved through an iterative overlay of biological measures, starting with metabolites (blood measures modulated by drug action) associated with symptom severity, and then adding in genes associated with metabolomic concentrations. Hence, therapeutic efficacy for a new patient can be assessed prior to treatment, using prediction models that take as inputs, selected biological measures and physician's assessments of depression severity. Of broader significance extending beyond psychiatry, the approach presented in this work can potentially be applied to predicting treatment outcomes for other medical conditions, such as migraine headaches or rheumatoid arthritis, for which patients are treated according to subject-reported assessments of symptom severity.

Long-term Chikungunya Sequelae in Curaçao: Burden, Determinants, and a Novel Classification Tool

Background

Beyond the acute illness phase, chikungunya constitutes a public health problem given its chronic disease phase, which may include long-term arthralgia, arthritis, fatigue, and depression. Currently, there is no consensus on how to define chikungunya chronicity.

Methods

A comprehensive cross-sectional survey was performed in Curaçao in June and July 2015 to evaluate 304 adult laboratory-confirmed chikungunya patients 3-16 months after diagnosis. We developed a novel tool, the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score, to classify chronic chikungunya disease and estimate its burden regarding disease duration, clinical presentation, and impact on quality of life.

Results

Disease persistence was estimated to be 79% one month after symptom onset and 64% after 400 days. Chikungunya persistence was characterized by higher proportions of arthralgia, weakness, myalgia, and age 41-60 years. Individuals were classified as "highly affected," "mildly affected," and "recovered." "Highly affected" disease status was associated with clinical complaints (arthralgia, weakness, loss of vitality, and being diabetic) and major decreases in quality-of-life scores.

Conclusions

In the Caribbean, a high proportion of chikungunya patients remains chronically affected. We propose the CLTCS as a suitable score to easily and rapidly classify the severity of chikungunya chronic disease and to assess the need for symptom-alleviating treatment.

Physical Activity and Correlates of Physical Activity Participation Over Three Years in Adults With Rheumatoid Arthritis

OBJECTIVE

To characterize physical activity participation (moderate-to-vigorous physical activity [MVPA], ≥150 minutes of moderate physical activity or 75 minutes of vigorous physical activity per week), to examine associations between disease activity and MVPA, and to identify MVPA correlates in adults with rheumatoid arthritis (RA) over 3 years.

METHODS

This study included 573 RA patients (94% white, 83% female, mean age 61 years, mean RA duration 19.5 years) with ≥1 annual registry visit and who completed the physical activity questionnaire. Baseline and annual measures included demographics/medical history, self-efficacy for disease management, quality of life, patient/physician global assessment, physical function, and self-reported physical activity. A logistic repeated-measures model using the generalized estimating equation examined the relationship between disease activity and MVPA.

RESULTS

Average disease activity (from the 3-variable Disease Activity Score in 28 joints using the C-reactive protein level) was mean ± SD 3.1 ± 1.4, 36% were physically inactive, and 29% met MVPA recommendations. There was a negative borderline association with disease activity (odds ratio [OR] 0.89 [95% confidence interval (95% CI) 0.79-1.00]). Correlates of meeting MVPA recommendations, adjusting for disease activity, were being white (OR 2.95 [95% CI 1.29-6.75]), older age (ages >69 years OR 0.58 [95% CI 0.36-0.92]), poor mental health (OR 0.63 [95% CI 0.41-0.95]), poor physical function (OR 0.59 [95% CI 0.34-1.01]), overweight/obese (body mass index [BMI] >25-30 OR 0.69 [95% CI 0.50-0.95], BMI >30-39.9 OR 0.60 [95% CI 0.41-0.88], and BMI ≤40 OR 0.24 [95% CI 0.08-0.74]), and patient global assessment (≥10-20 OR 0.57 [95% CI 0.39-0.83]).

CONCLUSION

A small proportion of patients met MVPA recommendations despite well-controlled disease. Disease activity was negatively associated with physical activity over time. Physical activity correlates were linked to lifestyle, mental health, and patient perceptions of disease, suggesting physical activity interventions that address patient perspectives may facilitate RA management.

Targeting Medication Non-Adherence Behavior in Selected Autoimmune Diseases: A Systematic Approach to Digital Health Program Development

BACKGROUND

29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn's Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans.

OBJECTIVE

Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies.

METHODS

Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn's Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence.

RESULTS

Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%).

CONCLUSIONS

This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.

Cissus quadrangularis reduces joint pain in exercise-trained men: a pilot study

BACKGROUND

Strenuous, high-volume exercise is often associated with inflammation and joint pain. Cissus quadrangularis (CQ) has been reported to have anti-inflammatory activity. The purpose of our study was to determine the therapeutic effects of CQ supplementation in healthy, exercise-trained men with joint-specific pain.

METHODS

Twenty-nine men between the ages of 20 and 46 years, who reportedly experienced chronic joint pain as a result of strenuous exercise, participated in our pilot study. All men received CQ 3200 mg daily for 8 weeks. Before and after the 8-week intervention period, subjects completed a questionnaire to determine their degree of joint pain (Western Ontario and McMaster Universities Index of Osteoarthritis [WOMAC]). Clinical measures (eg, heart rate, blood pressure, blood biomarkers) were also collected for each subject pre- (baseline) and post-intervention.

RESULTS

Subject ratings for multiple variables within the WOMAC Index improved (decreased) significantly (P < 0.05), with the subject mean total WOMAC score decreasing from 25.4 ± 2.4 to 17.4 ± 2.1 (~31%), pre- to post-intervention. No clinical measure was significantly impacted by use of CQ supplementation.

CONCLUSION

An 8-week course of supplementation with CQ reduced joint pain in a sample of 29 young, otherwise healthy, exercise-trained men. Additional study is needed to extend these findings, including comparison with a placebo-controlled cohort, and possibly, examining effects of CQ use in women and older adult subjects.

Patient-physician discordance in assessments of global disease severity in rheumatoid arthritis

OBJECTIVE

To determine the degree of discordance between patient and physician assessment of disease severity in a multiethnic cohort of adults with rheumatoid arthritis (RA), to explore predictors of discordance, and to examine the impact of discordance on the Disease Activity Score in 28 joints (DAS28).

METHODS

Adults with RA (n = 223) and their rheumatologists completed a visual analog scale (VAS) for global disease severity independently. Patient demographics, the 9-item Patient Health Questionnaire (PHQ-9) depression scale score, the Health Assessment Questionnaire score, and the DAS28 were also collected. Logistic regression analyses were used to identify predictors of positive discordance, defined as a patient rating minus physician rating of >25 mm on a 100-mm VAS (considered clinically relevant). DAS28 scores stratified by level of discordance were compared using a paired t-test.

RESULTS

Positive discordance was found in 30% of cases, with a mean +/- SD difference of 46 +/- 15. The strongest independent predictor of discordance was a 5-point increase in PHQ-9 score (adjusted odds ratio 1.61, 95% confidence interval 1.02-2.55). Higher swollen joint count and Cantonese/Mandarin language were associated with lower odds of discordance. DAS28 scores were most divergent among subjects with discordance.

CONCLUSION

Nearly one-third of RA patients differed from their physicians to a meaningful degree in assessment of global disease severity. Higher depressive symptoms were associated with discordance. Further investigation of the relationships between mood, disease activity, and discordance may guide interventions to improve care for adults with RA.

[An estimate of functional state in patients with rheumatoid arthritis]

INTRODUCTION

Rheumatoid arthritis is an inflammatory chronic disease that affects 0.5-1% of the population, many of whom develop disease as working-age adults.

MATERIAL AND METHODS

The aim of examination was to estimate functional disability in patients with rheumatoid arthritis and relationship between radiological damage, disease duration, disease activity, functional disability. The examination involved 60 patients with rheumatoid arthritis, aged (53.92 +/- 7.06) of both genders (48 female, 12 male). The following variables were assessed at one time point: swollen and tender joint count, visual analogue scale for pain, erythrocite sedimentation rate, health assessment questionnaire (HAQ) score, anatomical stage and functional class according to Stenbrocker's criteria. Disease activity was expressed as 28 joint disease activity score (DAS28). Correlations were calculated by Spearman's coefficient of correlation.

RESULTS

In our study 82% of the patients had II and III anatomical stage and 80% of the patients had II and III functional class according to Steinbrocker's criteria. The median HAQ score was 1.25 +/- 0.70, and the median DAS28 was 5.74 +/- 0.98. Poor functional status was observed in 37 (61.66%) of the patients with an HAQ score of = 2. Functional disability in patients with rheumatoid arthritis was most strongly related to the presence of pain (rs=0.338, p<0.01) and to a lesser extent to anatomical and functional stage, disease duration, disease activity.

DISCUSSION AND CONCLUSION

The results of the study show that functional disability significantly correlated with subjective pain score (rs=0.338, p<0.01). We observed strong correlation between functional disability presented by HAQ score and pain but no significant correlation with other common clinical variables used for rheumatoid arthritis patients evaluation such as disease duration, disease activity, radiological damage.

Effect of Mindfulness-Based stress reduction in rheumatoid arthritis patients

OBJECTIVE

To assess the effect of a meditation training program, Mindfulness-Based Stress Reduction (MBSR), on depressive symptoms, psychological status, and disease activity in patients with rheumatoid arthritis (RA) through a randomized, waitlist-controlled pilot study.

METHODS

Participants were randomized to either an MBSR group, where they attended an 8-week course and 4-month maintenance program, or to a waitlist control group, where they attended all assessment visits and received MBSR free of charge after study end. Participants received usual care from their rheumatologists throughout the trial. Self-report questionnaires were used to evaluate depressive symptoms, psychological distress, well-being, and mindfulness. Evaluation of RA disease activity (by Disease Activity Score in 28 joints) included examination by a physician masked to treatment status. Adjusted means and mean changes in outcomes were estimated in mixed model repeated measures analyses.

RESULTS

Sixty-three participants were randomized: 31 to MBSR and 32 to control. At 2 months, there were no statistically significant differences between groups in any outcomes. At 6 months, there was significant improvement in psychological distress and well-being (P = 0.04 and P = 0.03, respectively), and marginally significant improvement in depressive symptoms and mindfulness (P = 0.08 and P = 0.09, respectively). There was a 35% reduction in psychological distress among those treated. The intervention had no impact on RA disease activity.

CONCLUSION

An 8-week MBSR class was not associated with change in depressive symptoms or other outcomes at 2-month followup. Significant improvements in psychological distress and well-being were observed following MBSR plus a 4-month program of continued reinforcement. Mindfulness meditation may complement medical disease management by improving psychological distress and strengthening well-being in patients with RA.

Insulin resistance and impaired beta cell function in rheumatoid arthritis

OBJECTIVE

To identify factors that regulate glucose metabolism in rheumatoid arthritis (RA).

METHODS

We evaluated the homeostatic model assessment of insulin resistance (HOMA-IR) and beta cell function (HOMA-B) in 94 RA patients. We investigated the relationship between characteristics known to affect glucose metabolism in the general population (age, abdominal obesity [waist circumference], hypertension, antihypertensive therapy) as well as characteristics of RA (disease activity, glucocorticoid therapy) and insulin resistance and beta cell function.

RESULTS

Patients with high-grade inflammation (high-sensitivity C-reactive protein value >1.92 mg/liter) (n = 81) were more insulin resistant than patients with low-grade inflammation (n = 13), whereas beta cell function was similar in both groups. Insulin resistance and beta cell function were similar in both groups after adjustment for waist circumference. All recorded characteristics except for age were associated with HOMA-IR or/and HOMA-B in univariate analyses. In mixed regression models, abdominal obesity and patient's assessment of disease activity (by visual analog scale) were predictors of insulin resistance. The Disease Activity Score assessed using 28-joint counts for swelling and tenderness, tender joint count, and patient's assessment of disease activity were associated with reduced beta cell function, and the cumulative dose of glucocorticoids was associated with enhanced beta cell function. The cumulative glucocorticoid dose in all study patients was a mean of only 536 mg (95% confidence interval 239-1,173). In patients with high-grade inflammation, age was further associated with impaired beta cell function, whereas use of angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers was associated with enhanced beta cell function.

CONCLUSION

The modifiable factors of abdominal obesity, antihypertensive therapy, disease activity, and use of glucocorticoids appear to affect glucose metabolism in RA.

The validity of a rheumatoid arthritis medical records-based index of severity compared with the DAS28

The objective of this work was to assess the convergent validity of a previously developed rheumatoid arthritis medical records-based index of severity (RARBIS) by comparing it with the 28-joint Disease Activity Score (DAS28). This study was conducted in subjects within the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS). We selected 100 patients with rheumatoid arthritis (RA) from the BRASS with DAS28 scores equally distributed in four quartiles. The medical records were reviewed to calculate the RARBIS, which includes indicators from the following categories: prior surgical history, radiologic and laboratory findings, clinical and functional status, and extra-articular manifestations. The Spearman correlation between the RARBIS and the DAS28 was assessed in the total study population and in relevant subgroups. We re-weighted on subscales and recalculated the RARBIS score. This was performed based on findings of correlations between the DAS28 and subscales; and also the result from a multiple linear regression with the DAS28 (as a dependent variable) and five subscales (as independent variables). The mean RARBIS was 4.36 (range 0–11). Among the total study cohort, the RARBIS was moderately correlated with the DAS28 (r = 0.41, 95% confidence interval [CI] 0.23–0.56). In subgroup analyses, including age, gender, rheumatoid factor status, and disease duration, we found no statistically significant differences in the correlations. After re-weighting, the correlation between the RARBIS and the DAS28 was somewhat improved (r = 0.48, 95% CI 0.31–0.62). In conclusion, the RARBIS correlated moderately well with the DAS28 in this population. The RARBIS has both face and convergent validity for patients with RA and relevant subgroups and may have application for medical records studies in patients with RA.

Patient perception and provider assessment of severity of heart failure as predictors of hospitalization

OBJECTIVE

To assess the agreement between 2 methods of assigning New York Heart Association (NYHA) functional class to patients with chronic heart failure (CHF): deriving NYHA class from self-report interview data versus clinician assignment. To then determine the ability of each method to predict all-cause hospitalization.

METHODS

Adults with CHF > or = 50 years old from an urban health system in Indianapolis, Indiana, were administered the Kansas City Cardiomyopathy Questionnaire (a validated CHF symptom questionnaire) at baseline. Patient self-reported functional data were then used to derive NYHA class. Clinical providers who were blinded to patients' questionnaire data independently assessed NYHA functional class. We used a weighted kappa statistic to evaluate the agreement between the NYHA class from patient-derived and that from provider-assigned methods. We then assessed the ability of patient and provider NYHA to predict time to hospitalization using Cox proportional hazards models.

RESULTS

Of 156 patients with complete 6-month follow-up (mean age 63 years +/- 9 SD, 53% African American, and 68% women), the correlation coefficient was 0.43 between the patient-derived and provider-assigned NYHA methods. The weighted kappa statistic was 0.278, and the 95% confidence interval was 0.18 to 0.37, indicating only slight agreement. Patients classified themselves in worse categories than did their providers. Provider-assigned NYHA was a better predictor of hospitalization (P = .06).

CONCLUSIONS

There is only slight agreement between patient-derived and clinician-assigned NYHA functional class. A different approach with patients may be needed if providers hope to use patients' reports to identify those at risk for hospitalization.

Effects of chondroitin and glucosamine sulfate in a dietary bar formulation on inflammation, interleukin-1beta, matrix metalloprotease-9, and cartilage damage in arthritis

This study examined the effects of chondroitin sulfate (CS) alone and CS plus glucosamine sulfate (GS) in a dietary bar formulation on inflammatory parameters of adjuvant-induced arthritis and on the synthesis of interleukin-1beta (IL-1beta) and matrix metalloprotease-9 (MMP-9). Following 25 days pretreatment with dietary bars containing either CS alone, CS plus GS, or neither CS nor GS, rats were either sham injected or injected with Freund's complete adjuvant into the tail vein. Rats were fed their respective bars for another 17 days after inoculation. Parameters of disease examined included clinical score (combination of joint temperature, edema, hyperalgesia, and standing and walking limb function), incidence of disease, levels of IL-1beta in the serum and paw joints, levels of MMP-9 in the paw joints, paw joint histology, and joint cartilage thickness. Treatment with CS plus GS, but not CS alone, significantly reduced clinical scores, incidences of disease, joint temperatures, and joint and serum IL-1beta levels. Treatment with CS alone and CS plus GS inhibited the production of edema and prevented raised levels of joint MMP-9 associated with arthritis. Similarly, CS alone and CS plus GS treatment also prevented the development of cartilage damage associated with arthritis. Combination CS plus GS treatment in a dietary bar formulation ameliorates clinical, inflammatory, and histologic parameters of adjuvant-induced arthritis. The benefits of CS and GS in combination are more pronounced than those of CS alone. The reduction of arthritic disease by CS plus GS is associated with a reduction of IL-1beta and MMP-9 synthesis.