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Holten K, Paulshus Sundlisæter N, Sexton J, Nordberg LB, Uhlig T, Kvien TK, Solomon DH, Haavardsholm EA, Lillegraven S, Aga AB. Performance of the Rheumatoid Arthritis Impact of Disease (RAID) score in relation to flares in disease activity. RMD Open 2024; 10:e003486. [PMID: 38216290 PMCID: PMC10806476 DOI: 10.1136/rmdopen-2023-003486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/25/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES To explore the performance of the EULAR-initiated patient-reported Rheumatoid Arthritis Impact of Disease (RAID) questionnaire in relation to flares in disease activity, including comparison with other disease activity outcomes. METHODS Patients with rheumatoid arthritis in sustained remission were randomised to continued stable treatment or tapering in the ARCTIC REWIND project. In patients with flares within 12 months, we compared RAID (total score and components) at the flare visit with the visit prior to and the visit following flare, using Wilcoxon signed-rank test. Similar analyses were performed for patient global assessment, Disease Activity Score (DAS) and C reactive protein (CRP). The discriminative accuracies of RAID, patient global assessment, DAS and CRP with respect to disease activity flares were assessed by receiver operating characteristic (ROC) analyses based on logistic regression models. Flare was defined as a combination of DAS >1.6, a DAS increase ≥0.6 and ≥two swollen joints (of 44 examined) or could be recorded if patient and rheumatologist agreed that a clinically significant flare had occurred. RESULTS In total, 248 patients were included in the analyses, with 56 flares. RAID, patient global assessment, DAS and CRP all changed significantly at the visits related to flare (p<0.001). Area under the curve (95% CI) values indicated that RAID (0.88 (0.83 to 0.93)) was significantly more accurate than CRP (0.76 (0.69 to 0.84)) in discriminating flare, and less accurate than patient global assessment (0.92 (0.87 to 0.97)) and DAS (0.94 (0.90 to 0.98)). The RAID components with highest and lowest discriminative accuracies were pain (0.91 (0.86 to 0.95)) and sleep (0.69 (0.59 to 0.79)). CONCLUSION Disease activity flares were associated with a significant increase in median RAID, supporting its ability to respond to flare. TRIAL REGISTRATION NUMBER NCT01881308.
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Affiliation(s)
- Karen Holten
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nina Paulshus Sundlisæter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Lena Bugge Nordberg
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Till Uhlig
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Daniel H Solomon
- Division of Rheumatology, Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Espen A Haavardsholm
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Siri Lillegraven
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anna-Birgitte Aga
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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CKS2 and S100A12: Two Novel Diagnostic Biomarkers for Rheumatoid Arthritis. DISEASE MARKERS 2022; 2022:2431976. [PMID: 35789606 PMCID: PMC9250429 DOI: 10.1155/2022/2431976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic systematicness autoimmunity disease with joint inflammation. RA etiology is still unknown. Early and exact diagnosing is still hard to reach. In the paper, we purposed to discover novel diagnosis biological marker for RA. Two open, usable gene expression profiles of human RA as well as controlled specimens (dataset GSE17755 as well as GSE93272) were downloaded from the GEO database. Differentially expressed genes (DEGs) were screened between 331 RA and 88 control samples. Functional enrichment analysis was applied to explore the possible function of DEGs. Expression levels as well as diagnosis values of biological marker in RA were further verified in our cohort by the use of RT-PCR and ROC assays. We identified 13 DEGs between RA samples and control samples. 13 DEGs were remarkably abundant in NF-kappa B signal pathway. Among the 13 DEGs, CKS2, S100A12, LY96, and ANXA3 exhibited a strong diagnostic ability in screening RA specimens from normal specimens using all AUC > 0.8. Moreover, we confirmed that the expression of CKS2 and S100A12 was distinctly upregulated in RA specimens contrasted to normal specimens. Overall, serum CKS2 and S100A12 could be used as novel diagnosis biological markers for RA patients.
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Evaluation of the therapeutic potential of the selective p38 MAPK inhibitor Skepinone-L and the dual p38/JNK 3 inhibitor LN 950 in experimental K/BxN serum transfer arthritis. Inflammopharmacology 2019; 27:1217-1227. [PMID: 31037574 DOI: 10.1007/s10787-019-00593-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mitogen-activated protein kinase (MAPK) signaling plays an important role in inflammatory diseases such as rheumatoid arthritis (RA).The aim of our study was to elucidate the therapeutic potential of the highly selective p38 MAPK inhibitor Skepinone-L and the dual inhibitor LN 950 (p38 MAPK and JNK 3) in the K/BxN serum transfer model of RA. Additionally, we aimed to monitor MAPK treatment non-invasively in vivo using the hypoxia tracer [18F]fluoromisonidazole ([18F]FMISO) and positron emission tomography (PET). METHODS To induce experimental arthritis, we injected glucose-6-phosphate isomerase autoantibody-containing serum in BALB/c mice. MAPK inhibitor or Sham treatment was administered per os once daily. On days 3 and 6 after arthritis induction, we conducted PET imaging with [18F]FMISO. At the end of the experiment, ankles were harvested for histopathological analysis. RESULTS Skepinone-L and LN 950 were applicable to suppress the severity of experimental arthritis confirmed by reduced ankle swelling and histopathological analysis. Skepinone-L (3.18 ± 0.19 mm) and LN 950 (3.40 ± 0.13 mm) treatment yielded a significantly reduced ankle thickness compared to Sham-treated mice (3.62 ± 0.11 mm) on day 5 after autoantibody transfer, a time-point characterized by severe arthritis. Hypoxia imaging with [18F]FMISO revealed non-conclusive results and might not be an appropriate tool to monitor MAPK therapy in experimental RA. CONCLUSION Both the selective p38 MAPK inhibitor Skepinone-L and the dual (p38 MAPK and JNK 3) inhibitor LN 950 exhibited significant therapeutic effects during experimental arthritis. Thus, our study contributes to the ongoing discussion on the use of p38 MAPK as a potential target in RA.
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Bergstra SA, Allaart CF, Stijnen T, Landewé RBM. Meta-Regression of a Dose-Response Relationship of Methotrexate in Mono- and Combination Therapy in Disease-Modifying Antirheumatic Drug-Naive Early Rheumatoid Arthritis Patients. Arthritis Care Res (Hoboken) 2017; 69:1473-1483. [PMID: 27992656 DOI: 10.1002/acr.23164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/02/2016] [Accepted: 12/06/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate a possible short-term dose-response relationship of initial treatment with methotrexate (MTX) in monotherapy and combination therapy in recent-onset rheumatoid arthritis (RA) patients. METHODS A systematic literature search was performed on trials and cohorts, including early, disease-modifying antirheumatic drug (DMARD)-naive RA patients treated with MTX, with data on clinical results within 6 months from treatment start. Cohen's effect sizes were calculated for the Health Assessment Questionnaire (HAQ), erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) level, and/or Disease Activity Score (DAS)/in 28 joints (DAS28) in 4 treatment groups: MTX monotherapy, or MTX in combination with synthetic (cs) DMARDs, biologic (b) DMARDs, or glucocorticoids. Random-effects meta-regression analyses were performed for each outcome, with treatment group as the predictor corrected for baseline HAQ or disease activity and assessment point. RESULTS Thirty-one studies including 5,589 patients were included. The meta-regression did not support higher effectiveness of increasing MTX dose in monotherapy. The number of treatment groups using combination therapy with csDMARDs was too small to perform meta-regression analyses. In combination therapy with glucocorticoids, a higher MTX dose was associated with higher (worse) outcome HAQ, but not with DAS/DAS28 or ESR/CRP level. In combination therapy with bDMARDs, a higher MTX dose was associated with higher outcome HAQ and DAS/DAS28, but not with ESR/CRP level. All effect sizes were small. CONCLUSION In DMARD-naive, early RA patients who start MTX, either as monotherapy or in combination with bDMARDs or glucocorticoids, a higher initial dose of MTX was not associated with better clinical outcomes. This finding suggests that there is little short-term gain from starting with high compared to low MTX doses.
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Affiliation(s)
- S A Bergstra
- Leiden University Medical Center, Leiden, The Netherlands
| | - C F Allaart
- Leiden University Medical Center, Leiden, The Netherlands
| | - T Stijnen
- Leiden University Medical Center, Leiden, The Netherlands
| | - R B M Landewé
- Amsterdam Rheumatology & Immunology Center, Zuyderland Medical Center Heerlen, The Netherlands
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Sewerin P, Vordenbaeumen S, Hoyer A, Brinks R, Buchbender C, Miese F, Schleich C, Klein S, Schneider M, Ostendorf B. Silent progression in patients with rheumatoid arthritis: is DAS28 remission an insufficient goal in RA? Results from the German Remission-plus cohort. BMC Musculoskelet Disord 2017; 18:163. [PMID: 28420375 PMCID: PMC5395882 DOI: 10.1186/s12891-017-1528-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/07/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Remission is arguably the ultimate therapeutic goal in rheumatoid arthritis (RA). Applying modern strategies, clinical remission can be achieved in a substantial number of patients with early RA (ERA). Even in those patients, the number and scope of erosions can increase. We, therefore, investigated the value of MRI for the detection of radiological progression in patients with DAS28 improvement and/or clinical remission of the German Remission-plus cohort. METHODS Data-sets of 80 RA patients (according to 2010 ACR/EULAR criteria) from the Remission-plus study cohort, who fulfilled the following criteria, were retrospectively analysed: availability of two consecutive MRI scans (low-field MRI, follow-up interval 1 year) of the clinically dominant hand and wrist, and the presence of DAS28 (CRP) scores at both time points, which was used to assess disease activity. RESULTS Seventy-one of the 80 investigated patients presented a numerical improvement of the DAS28 (CRP) after 12 months (DAS28(CRP) T0 average (Ø) 4.96, SD 1.2; DAS28 T4 (12 month) Ø 2.6, SD 1.0), 73% of them also improved in the RAMRIS-Score, while 24% demonstrated an increase despite DAS28 improvement and 3% showed equal values. 48% of patients who improved in the DAS28 reached EULAR remission. 41% of these patients had an increase in the RAMRIS Erosion-subscore after 12 months. When considering EULAR response criteria (non-response (n = 7), moderate response (n = 19), good response (n = 45)), an increase of erosions was found in 71.4% of non-responders, 52.6% of moderate responders, and 31.1% of good responders after 12 months, all compared to baseline. CONCLUSION Up to 40% of patients in this study demonstrated a progressive erosive disease detected by MRI despite DAS28 improvement or EULAR remission. Future studies are needed to determine the prognostic clinical impact of disease progression in MRI despite clinical remission, and to investigate if DAS28 remission may be an insufficient therapeutic goal and should be accompanied by MRI remission criteria.
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Affiliation(s)
- Philipp Sewerin
- Department of Rheumatology & Hiller Research Unit, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany.
| | - Stefan Vordenbaeumen
- Department of Rheumatology & Hiller Research Unit, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany
| | - Annika Hoyer
- German Diabetes Centre, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Duesseldorf, 40225, Germany
| | - Ralph Brinks
- Department of Rheumatology & Hiller Research Unit, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany
| | - Christian Buchbender
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany
| | - Falk Miese
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany
| | - Sabine Klein
- Department of Rheumatology & Hiller Research Unit, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany
| | - Matthias Schneider
- Department of Rheumatology & Hiller Research Unit, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany
| | - Benedikt Ostendorf
- Department of Rheumatology & Hiller Research Unit, University Hospital Düsseldorf, Moorenstreet 5, Duesseldorf, 40225, Germany
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Newman ED, Lerch V, Billet J, Berger A, Kirchner HL. Improving the quality of care of patients with rheumatic disease using patient-centric electronic redesign software. Arthritis Care Res (Hoboken) 2015; 67:546-53. [PMID: 25417958 DOI: 10.1002/acr.22479] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/16/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Electronic health records (EHRs) are not optimized for chronic disease management. To improve the quality of care for patients with rheumatic disease, we developed electronic data capture, aggregation, display, and documentation software. METHODS The software integrated and reassembled information from the patient (via a touchscreen questionnaire), nurse, physician, and EHR into a series of actionable views. Core functions included trends over time, rheumatology-related demographics, and documentation for patient and provider. Quality measures collected included patient-reported outcomes, disease activity, and function. The software was tested and implemented in 3 rheumatology departments, and integrated into routine care delivery. Post-implementation evaluation measured adoption, efficiency, productivity, and patient perception. RESULTS Over 2 years, 6,725 patients completed 19,786 touchscreen questionnaires. The software was adopted for use by 86% of patients and rheumatologists. Chart review and documentation time trended downward, and productivity increased by 26%. Patient satisfaction, activation, and adherence remained unchanged, although pre-implementation values were high. A strong correlation was seen between use of the software and disease control (weighted Pearson's correlation coefficient 0.5927, P = 0.0095), and a relative increase in patients with low disease activity of 3% per quarter was noted. CONCLUSION We describe innovative software that aggregates, stores, and displays information vital to improving the quality of care for patients with chronic rheumatic disease. The software was well-adopted by patients and providers. Post-implementation, significant improvements in quality of care, efficiency of care, and productivity were demonstrated.
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Navarro-Compán V, Smolen JS, Huizinga TWJ, Landewé R, Ferraccioli G, da Silva JAP, Moots RJ, Kay J, van der Heijde D. Quality indicators in rheumatoid arthritis: results from the METEOR database. Rheumatology (Oxford) 2015; 54:1630-9. [DOI: 10.1093/rheumatology/kev108] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Indexed: 11/13/2022] Open
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Schleich C, Müller-Lutz A, Sewerin P, Ostendorf B, Buchbender C, Schneider M, Antoch G, Miese F. Intra-individual assessment of inflammatory severity and cartilage composition of finger joints in rheumatoid arthritis. Skeletal Radiol 2015; 44:513-8. [PMID: 25367672 DOI: 10.1007/s00256-014-2045-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/22/2014] [Accepted: 10/17/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To intra-individually assess the association of inflammation severity and cartilage composition measured by RAMRIS synovitis sub-score and delayed gadolinium-enhanced magnetic resonance imaging of the cartilage (dGEMRIC) of metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA). METHODS Forty-three patients with RA according to ACR/EULAR classification criteria (age 52.9 ± 14.5 years, range, 18-77 years) were included in this study. All study participants received 3-T MRI scans of the metacarpophalangeal joints of the second and third finger (MCP 2 and 3). The severity of synovitis was scored according to the RAMRIS synovitis sub-score by two readers in consensus. In the cases with identical synovitis sub-scores, two radiologists decided in consensus on the joint with more severe synovitis. Cartilage composition was assessed with dGEMRIC. To test the association of inflammation severity and cartilage damage and in order to eliminate inter-patient confounders, each patient's MCP 2 and 3 were dichotomized into the joint with more severe synovitis versus the joint with less severe synovitis for a paired Wilcoxon test of dGEMRIC value. RESULTS There was a significant difference of dGEMRIC value (median of difference: 47.12, CI [16.6; 62.76]) between the dichotomized MCPs (p = 0.0001). There was a significant correlation between dGEMRIC value and RAMRIS synovitis grading of the joint with more severe synovitis (r = 0.5; p < 0.05) and the joint with less severe synovitis (r = 0.33; p < 0.05). CONCLUSIONS Our data concur with the concept that synovitis severity is associated with cartilage damage. The local inflammatory status on a joint level correlated significantly with the extent of cartilage degradation in biochemical MRI.
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Affiliation(s)
- C Schleich
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
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Dasgupta B, Combe B, Louw I, Wollenhaupt J, Zerbini CAF, Beaulieu A, Schulze-Koops H, Durez P, Wolff V, Yao R, Weng HH, Govoni M, Vastesaeger N. Patient and Physician Expectations of Add-On Treatment With Golimumab for Rheumatoid Arthritis: Relationships Between Expectations and Clinical and Quality of Life Outcomes. Arthritis Care Res (Hoboken) 2014; 66:1799-807. [DOI: 10.1002/acr.22371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Ingrid Louw
- Panorama Medical Centre; Cape Town South Africa
| | | | | | | | | | - Patrick Durez
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc; Brussels Belgium
| | | | - Ruji Yao
- Merck & Co., Inc.; Kenilworth New Jersey
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Navarro-Compán V, Gherghe AM, Smolen JS, Aletaha D, Landewé R, van der Heijde D. Relationship between disease activity indices and their individual components and radiographic progression in RA: a systematic literature review. Rheumatology (Oxford) 2014; 54:994-1007. [PMID: 25416711 DOI: 10.1093/rheumatology/keu413] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between different disease activity indices (DAIs) and their individual components and radiographic progression in patients with RA. METHODS A systematic literature review until July 2013 was performed by two independent reviewers using the Medline and Embase databases. Longitudinal studies assessing the relationship between DAIs and single instruments and radiographic progression were included. The results were grouped based on the means of measurement (baseline vs time integrated) and analysis (univariable or multivariable). RESULTS Fifty-seven studies from 1232 hits were included. All published studies that assessed the relationship between any time-integrated DAI including joint count and radiographic progression reached a statistically significant association. Among the single instruments, only swollen joint count and ESR were associated with radiographic progression, while no significant association was found for tender joint count. Data with respect to CRP are conflicting. Data on patient's global health, pain assessment and evaluator's global assessment are limited and do not support a positive association with progression of joint damage. CONCLUSION Published data indicate that all DAIs that include swollen joints are related to radiographic progression while, of the individual components, only swollen joints and acute phase reactants are associated. Therefore composite DAIs are the optimal tool to monitor disease activity in patients with RA.
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Affiliation(s)
- Victoria Navarro-Compán
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Ana Maria Gherghe
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Josef S Smolen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Daniel Aletaha
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
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Anatomic-functional (perfusion-based) magnetic resonance imaging follow-up in patients with rheumatoid arthritis treated with anti-interleukin 6 antibodies: a comparison with clinical scores and serologic data. J Comput Assist Tomogr 2014; 39:75-82. [PMID: 25279845 DOI: 10.1097/rct.0000000000000152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE On a 3-T magnetic resonance scanner, morphologic and perfusion changes of 9 patients with rheumatoid arthritis were evaluated after start of anti-interleukin 6 receptor antibody Tocilizumab (TCZ) treatment. METHODS Morphologic and perfusion-based magnetic resonance imaging (MRI) parameters were assessed before and 4, 12, and 24 after the start of TCZ treatment. Furthermore, serologic biomarkers and clinical assessment scores were evaluated 4, 12, 24, and 52 weeks after treatment initiation. RESULTS Results of MRI parameters showed significant group differences between responders and nonresponders for synovial volume, transfer constant, and blood plasma volume fraction already at week 12 as well as relative enhancement and rate of early enhancement at week 24. CONCLUSIONS Considering the temporal change of perfusion-derived MRI parameters (transfer constant, blood plasma volume fraction, relative enhancement, and rate of early enhancement) as well as morphologic MRI parameters (synovial volume measurements), a quantifiable assessment of response to TCZ therapy in rheumatoid arthritis seems possible at an even earlier time point compared with clinical assessment scores, whereas serologic biomarkers proved nonspecific in this respect.
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Christie A, Dagfinrud H, Dale Ø, Schulz T, Hagen KB. Collection of patient-reported outcomes;--text messages on mobile phones provide valid scores and high response rates. BMC Med Res Methodol 2014; 14:52. [PMID: 24735061 PMCID: PMC3995761 DOI: 10.1186/1471-2288-14-52] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/10/2014] [Indexed: 11/12/2022] Open
Abstract
Background Patients with inflammatory rheumatic diseases have expressed a need for more frequent measurement of relevant outcomes, due to the variations in their symptoms during the day and from day to day. At present, patient-reported outcomes are extensively collected with questionnaires completed with pen and paper. However, as a measurement tool in frequent data collection the questionnaires are impractical. In contrast, text messages on mobile phones are suitable for frequent data collection. The aim of this study was two-fold; to compare daily registrations of patient-reported outcomes assessed with text-messages on mobile phones (SMS) or with questionnaires completed with pen and paper (P&P), with regard to scores and variation of scores, and to examine feasibility of the SMS method in a multicentre clinical study. Methods To compare scores, 21 patients with an inflammatory, rheumatic disease performed daily assessments of pain, fatigue, stiffness and ability to carry out daily activities on a numeric rating scale (NRS). The patients were asked to assess the variables every other day with the SMS method and every other day with the P&P method for 28 consecutive days. In total each participant had to answer 14 P&P forms and 14 SMS messages. Mean scores and variation, expressed as the pooled standard deviation or as the average range between the maximum and minimum scores for the two methods, were compared using paired sample t-tests or Wilcoxon Signed Rank Test. To examine feasibility, 36 patients with an inflammatory, rheumatic disease assessed the same four variables with SMS twice a week for 35 weeks. Feasibility of the SMS method was expressed as mean response-rate (%) in the total group and per centre. Results Mean scores, standard deviation of mean scores and mean range scores did not differ significantly between the two methods (p > 0.05). Response-rate with the SMS method was 97.9% for the whole group and for the three centres 97.1%, 98.3% and 98.4%, respectively. Conclusion Outcomes assessed on numeric rating scales and reported with text-messages on mobile phones or with questionnaires completed with pen and paper provide comparable scores. Further, the SMS method provided high response rates (> 97%) in a multicentre setting. Our results encourage the use of text messages on mobile phones in studies requiring frequent data collection and real-time assessment, as in fluctuating diseases such inflammatory, rheumatic diseases.
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Affiliation(s)
- Anne Christie
- National resource center for rehabilitation in rheumatology - NKRR, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, 0319 Oslo, Norway.
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Seto Y, Inoue E, Shidara K, Hoshi D, Sugimoto N, Sato E, Tanaka E, Nakajima A, Taniguchi A, Momohara S, Yamanaka H. Functional disability can deteriorate despite suppression of disease activity in patients with rheumatoid arthritis: a large observational cohort study. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0816-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ndosi M, Lewis M, Hale C, Quinn H, Ryan S, Emery P, Bird H, Hill J. The outcome and cost-effectiveness of nurse-led care in people with rheumatoid arthritis: a multicentre randomised controlled trial. Ann Rheum Dis 2013; 73:1975-82. [PMID: 23982436 PMCID: PMC4215359 DOI: 10.1136/annrheumdis-2013-203403] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of nurse-led care (NLC) for people with rheumatoid arthritis (RA). METHODS In a multicentre pragmatic randomised controlled trial, the assessment of clinical effects followed a non-inferiority design, while patient satisfaction and cost assessments followed a superiority design. Participants were 181 adults with RA randomly assigned to either NLC or rheumatologist-led care (RLC), both arms carrying out their normal practice. The primary outcome was the disease activity score (DAS28) assessed at baseline, weeks 13, 26, 39 and 52; the non-inferiority margin being DAS28 change of 0.6. Mean differences between the groups were estimated controlling for covariates following per-protocol (PP) and intention-to-treat (ITT) strategies. The economic evaluation (NHS and healthcare perspectives) estimated cost relative to change in DAS28 and quality-adjusted life-years (QALY) derived from EQ5D. RESULTS Demographics and baseline characteristics of patients under NLC (n=91) were comparable to those under RLC (n=90). Overall baseline-adjusted difference in DAS28 mean change (95% CI) for RLC minus NLC was -0.31 (-0.63 to 0.02) for PP and -0.15 (-0.45 to 0.14) for ITT analyses. Mean difference in healthcare cost (RLC minus NLC) was £710 (-£352, £1773) and -£128 (-£1263, £1006) for PP and ITT analyses, respectively. NLC was more cost-effective with respect to cost and DAS28, but not in relation to QALY utility scores. In all secondary outcomes, significance was met for non-inferiority of NLC. NLC had higher 'general satisfaction' scores than RLC in week 26. CONCLUSIONS The results provide robust evidence to support non-inferiority of NLC in the management of RA. TRIAL REGISTRATION ISRCTN29803766.
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Affiliation(s)
- Mwidimi Ndosi
- Academic and Clinical Unit for Musculoskeletal Nursing, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | - Claire Hale
- Academic and Clinical Unit for Musculoskeletal Nursing, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK School of Healthcare, University of Leeds, Leeds, UK
| | - Helen Quinn
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Howard Bird
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Jackie Hill
- Academic and Clinical Unit for Musculoskeletal Nursing, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Chakr RMDS, Mendonça JA, Brenol CV, Xavier RM, Brenol JCT. Assessing rheumatoid arthritis disease activity with ultrasound. Clin Rheumatol 2013; 32:1249-54. [PMID: 23700041 DOI: 10.1007/s10067-013-2291-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/13/2013] [Indexed: 01/19/2023]
Abstract
In practice, composite indices are used for rheumatoid arthritis (RA) disease activity evaluation. Despite valid and widely used, not rarely composite indices miss accuracy. Ultrasound (US) is more precise than clinical examination in synovitis appraisal. US-based disease activity estimation depends on the detection of synovitis. The most common synovitis abnormalities are proliferation, effusion, and neoangiogenesis. Gray scale ultrasound identifies synovial hypertrophy and effusion with its good soft tissue contrast. Additionally, power Doppler ultrasound depicts neoangiogenesis within synovia, remarking local inflammation. Several studies have combined local US findings to develop a patient level disease activity index. Most of them summed selected joint scores in an overall score of disease activity and evaluated its correlation with clinical composite indexes. To be incorporated into clinical practice, an overall US score must have some fundamental characteristics such as reproducibility, viability, and sensitivity to change over time. In global US score development, finding the joints that truly estimate individual disease activity is highly challenging. This article presents an up-to-date literature review on assessing RA disease activity with US and depicts the challenges in finding the perfect global US score.
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Affiliation(s)
- Rafael Mendonça da Silva Chakr
- Rheumatology Division Faculty, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, suite 645, Porto Alegre, Rio Grande do Sul, CEP 90035-903, Brazil.
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Functional disability can deteriorate despite suppression of disease activity in patients with rheumatoid arthritis: a large observational cohort study. Mod Rheumatol 2013; 23:1179-85. [PMID: 23319067 DOI: 10.1007/s10165-012-0816-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To analyze the relationship between the progression of disability and disease activity in patients with rheumatoid arthritis (RA) in daily practice. METHODS Patients from an observational cohort, IORRA, who completed surveys during 2009-2011 were eligible. Linear regression of disease activity score 28 (DAS28), Japanese version of Health Assessment Questionnaire (J-HAQ), and EQ-5D from baseline were calculated, and the angles of the regression lines were designated DAS28 slope, J-HAQ slope, and EQ-5D slope, respectively, in each patient; averages were compared between treatment groups. RESULTS A total of 5,038 patients [84.0% female, mean age 59.4 (SD 13.1) years, disease duration 13.2 (9.6) years, DAS28 3.29 (1.14), and J-HAQ 0.715 (0.760)] were analyzed. The average DAS28 slope indicated improvement in all groups, whereas J-HAQ slopes were negative in patients on methotrexate (MTX), biologics, combination biologics/disease-modifying antirheumatic drugs (DMARDs), and combination biologics/MTX at baseline, but positive in patients on prednisolone >5 mg/day [0.010 (0.153)] and not on MTX at baseline [0.007 (0.122)], representing a worsening of disability. CONCLUSION There is some disparity between improvement of disease activity and progression of disability, suggesting that quality of remission must be considered.
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Epis OM, Giacomelli L, Deidda S, Bruschi E. Tight control applied to the biological therapy of rheumatoid arthritis. Autoimmun Rev 2012; 12:839-41. [PMID: 23219770 DOI: 10.1016/j.autrev.2012.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the last decade, treatment strategies for rheumatoid arthritis (RA) have included the early use of disease-modifying anti-rheumatic drugs, since prompt suppression of disease activity is associated with a reduction in radiological damage. This strategy has now been incorporated into the broader concept of "tight control", defined as a treatment strategy tailored to each patient with RA, which aims to achieve a predefined level of low disease activity or remission within a certain period of time. To pursue this goal, tight control should include careful and continuous monitoring of disease activity, and early therapeutic adjustments or switches should be considered as necessary. It is noteworthy that the key role of tight control of RA has been stressed by the recent EULAR Guidelines. This review discusses the most recent evidence concerning the role of a tight control strategy in the treatment of RA, and on how this strategy should be pursued.
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Jung YO, Kim HA. Recent paradigm shifts in the diagnosis and treatment of rheumatoid arthritis. Korean J Intern Med 2012; 27:378-87. [PMID: 23269876 PMCID: PMC3529234 DOI: 10.3904/kjim.2012.27.4.378] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 06/18/2012] [Indexed: 12/14/2022] Open
Abstract
Rheumatoid arthritis (RA) is a progressive inflammatory disease with severe symptoms of pain and stiffness. Chronic persistent inflammation of RA often leads to joint destruction, deformity and limitation of function, which ultimately results in significant deterioration of quality of life (QoL). RA is characterized pathogenetically by immunologically driven, chronic synovitis, and production of autoantibodies, such as rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Although the cause of RA is yet unknown, advances in the molecular biology led to in-depth understanding of its pathogenesis, and have fostered the recent development of novel treatments. The last decade has seen the dramatic change in the landscape of RA treatment with more aggressive therapy early in the disease course and with treatment guided by a structured assessment of disease activity, with the ultimate goal of reaching remission. In addition, prevention and control of joint damage and improvement in QoL are important goals. To achieve these goals, a multidisciplinary approach to reduce disease activity with disease modifying antirheumatic drugs and biological therapy is needed. We also need to find ways to identify those patients who are at risk for more rapid disease progression who would benefit from intensive therapy early in the course of disease.
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Affiliation(s)
- Young Ok Jung
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
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Larsson I, Bergman S, Fridlund B, Arvidsson B. Patients' experiences of a nurse-led rheumatology clinic in Sweden: A qualitative study. Nurs Health Sci 2012. [DOI: 10.1111/j.1442-2018.2012.00723.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Stefan Bergman
- Research and Development Centre; Spenshult Hospital; Oskarström; Sweden
| | - Bengt Fridlund
- School of Health Sciences; Jönköping University; Jönköping; Sweden
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Buchbender C, Sewerin P, Mattes-György K, Miese F, Wittsack HJ, Specker C, Antoch G, Müller HW, Schneider M, Scherer A, Ostendorf B. Utility of combined high-resolution bone SPECT and MRI for the identification of rheumatoid arthritis patients with high-risk for erosive progression. Eur J Radiol 2012. [PMID: 23181974 DOI: 10.1016/j.ejrad.2012.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate the utility of sequentially acquired, post hoc fused, magnetic resonance imaging (MRI) and multi-pinhole single photon emission computed tomography (MPH-SPECT) with technetium-99m-labeled disphosphonates (Tc99m-DPD) for the identification of finger joints with later erosive progression in early rheumatoid arthritis (ERA) patients. METHODS Ten consecutive ERA patients prospectively underwent MPH-SPECT and MRI of metacarpophalangeal (MCP) joints prior to and after 6 months methotrexate therapy. Tc99m-DPD uptake was measured at proximal and distal MCP sites using regional analysis. The course of joint pathologies was scored according to the Rheumatoid Arthritis MRI Score (RAMRIS) criteria. RESULTS The frequency of increased Tc99m-DPD uptake, synovitis and bone marrow edemadecreased under MTX therapy; but the number of bone erosions increased. Joints with progressive and new erosions on follow-up had a higher baseline Tc99m-DPD uptake (2.64 ± 1.23 vs. 1.43 ± 0.91) (p=0.02). CONCLUSIONS Joints with erosive progression are characterized by an early increased Tc99m-DPD uptake, even in absence of MRI bone pathologies. Tc99m-DPD MPH-SPECT might thus be of additional value to morphological MRI for the identification of RA patients with a high risk for erosive progression.
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Affiliation(s)
- Christian Buchbender
- Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstr. 5, D-40225 Dusseldorf, Germany.
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De Mits S, Mielants H, De Clercq D, Woodburn J, Roosen P, Elewaut D. Quantitative assessment of foot structure in rheumatoid arthritis by a foot digitizer: detection of deformities even in the absence of erosions. Arthritis Care Res (Hoboken) 2012; 64:1641-8. [PMID: 22807070 DOI: 10.1002/acr.21794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Foot involvement is a major feature in rheumatoid arthritis (RA), leading to structural deformities. Methods to allow a 3-dimensional (3-D) evaluation of foot structure in RA to be applicable in daily clinical practice have not been evaluated. This study assessed the use of a foot digitizer, a noninvasive 3-D scanner collecting objective quantitative data of the feet, to evaluate the presence of foot structure abnormalities in an RA outpatient cohort. METHODS Foot digitizer data of RA patients were compared with healthy controls. Subanalyses were performed to find relationships with erosive disease and the presence of swollen and/or tender joints. Linear mixed models were applied with correction, including sex, age, body weight and height, foot length, Disease Activity Score in 28 joints, and disease duration. RESULTS Forty-one percent of the patients showed >1 abnormal parameter, measured with the 3-D foot scanner. Most differences found were located in the forefoot, the most frequently affected area of the RA foot. Strikingly, even in the absence of joint erosions, marked alterations were found. Comparable differences were also observed between the patients with and without swollen and/or tender joints. Additionally, alterations were not strongly related to foot pain and disability, suggesting the capacity of the foot digitizer to detect early changes in foot structure. CONCLUSION The results highlight the impact of RA on foot structure, even in the absence of clinical signs of swelling or radiographic erosions. The foot digitizer offers a valuable tool to screen for such foot deformities before the presence of erosions.
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Wollenhaupt J, Krüger K. [Early and advanced rheumatoid arthritis. Diagnosis and state of the art therapy strategy]. Z Rheumatol 2012; 71:53-61; quiz 62-3. [PMID: 22286356 DOI: 10.1007/s00393-011-0932-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The diagnosis of rheumatoid arthritis (RA) is often based on classification criteria. In 2010 ACR and EULAR presented new classification criteria for RA which allow patients with a high risk for persistent, chronic and erosive arthritis and therefore fulfill the current definition of RA, to be defined. Therapy of RA should be initiated as early as possible. Methotrexate remains the first-line therapy of RA. In patients showing insufficient response of RA, biological agents have been demonstrated to be an effective second-line therapy. It is essential to define and follow an individual treatment target to obtain remission or low disease activity. This target should be reassessed regularly and treatment should be correspondingly adapted to achieve the target.
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Affiliation(s)
- J Wollenhaupt
- Klinik für Rheumatologie und klinische Immunologie und Rheumatologikum, Schön Klinik Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland.
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Current World Literature. Curr Opin Rheumatol 2012; 24:342-9. [DOI: 10.1097/bor.0b013e328352d26c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khan NA, Spencer HJ, Abda EA, Alten R, Pohl C, Ancuta C, Cazzato M, Géher P, Gossec L, Henrohn D, Hetland ML, Inanc N, Jacobs JW, Kerzberg E, Majdan M, Oyoo O, Peredo-Wende RA, Selim ZI, Skopouli FN, Sulli A, Hørslev-Petersen K, Taylor PC, Sokka T. Patient's global assessment of disease activity and patient's assessment of general health for rheumatoid arthritis activity assessment: are they equivalent? Ann Rheum Dis 2012; 71:1942-9. [PMID: 22532638 DOI: 10.1136/annrheumdis-2011-201142] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchangeably in calculating common RA activity assessment composite indices. METHODS Data of 7023 patients from 30 countries in the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) was analysed. PTGL and GH determinants were assessed by mixed-effects analyses of covariance models. PTGL and GH equivalence was determined by Bland-Altman 95% limits of agreement (BALOA) and Lin's coefficient of concordance (LCC). Concordance between PTGL and GH based Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) indices were calculated using LCC, and the level of agreement in classifying RA activity in four states (remission, low, moderate, high) using κ statistics. RESULTS Significant differences in relative and absolute contribution of RA and non-RA related variables in PTGL and GH ratings were noted. LCC of 0.64 and BALOA of -4.41 to 4.54 showed that PTGL and GH are not equivalent. There was excellent concordance (LCC 0.95-0.99) for PTGL and GH based DAS28, CDAI and RAPID3 indices, and >80% absolute agreement (κ statistics 0.75-0.84) in RA activity state classification for all three indices. CONCLUSIONS PTGL and GH ratings differ in their determinants. Although they are individually not equivalent, they may be used interchangeably for calculating composite indices for RA activity assessment.
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Affiliation(s)
- Nasim Ahmed Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences, 4301 West Markham Street, # 509, Little Rock, AR 72205, USA.
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Epis O, Giacomelli L, Bruschi E. Imaging in rheumatology: ultrasafe + ultrasure = ultrasound. Rheumatol Int 2012; 33:1901-3. [DOI: 10.1007/s00296-012-2403-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 03/11/2012] [Indexed: 11/28/2022]
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Kalden JR, Burkhardt H, Buss B, Donhauser-Gruber U, Erstling U, Gromnica-Ihle E, Karberg K, Karger T, Kneitz CH, Krause A, Krüger K, Lorenz HM, Müller-Ladner U, Rubbert-Roth A, Steffens-Korbanka P, Tony HP, Wendler J, Wollenhaupt J, Burmester G. [Strategies for improved healthcare of people with the endemic disease rheumatism exemplified by rheumatoid arthritis]. Z Rheumatol 2011; 70:641-50. [PMID: 21979315 DOI: 10.1007/s00393-011-0763-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
New therapeutic principles and considerable diagnostic advances have made it possible to define different rheumatic diseases and especially rheumatoid arthritis (RA) at an early stage and by starting an early and aggressive medication a considerable proportion of patients with RA will reach the status of low disease activity or even remission. With the additional development of composite measures to estimate the disease activity of RA, it was the goal of an international working group consisting of rheumatologists and patients to develop recommendations for treating rheumatoid arthritis in a similar way as for patients with hypertension or diabetes, with the aim to achieve remission as often as possible. This treat-to-target initiative has taken off in quite a number of different countries including Germany leading to discussions on how this initiative can be integrated into the specific national healthcare systems and what possibilities would exist for its implementation. To develop strategies for an improved healthcare of people suffering from rheumatic diseases and using RA as an example, action elements and postulates were developed which will be discussed in more detail in the present manuscript.
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Affiliation(s)
- J R Kalden
- Abteilung für Molekulare Immunologie, Universitätsklinikum Erlangen, Glückstr. 6, 91054, Erlangen, Deutschland.
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