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Weman L, Vehmas J, Immonen J, Hannonen P, Sokka T. Real-world data on seropositive rheumatoid arthritis, then and now: ten-year outcomes of 1151 patients diagnosed between 1997 and 2011. Clin Exp Rheumatol 2023; 41:151-158. [PMID: 35765993 DOI: 10.55563/clinexprheumatol/kruuqi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/29/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To study 10-year outcomes in patients with early seropositive rheumatoid arthritis (RA) whether the outcomes improve over time. METHODS Data of 1754 patients with early RA, diagnosed in 1997-2011 were explored; 66% (n=1151) were seropositive and included in the analyses. Patients were divided into five groups by diagnosis year: 1997-1999, 2000-2002, 2003-2005, 2006-2008 and 2009-2011. Clinical parameters including disease activity and function were compared between the groups. RESULTS A total of 832 (72%) patients attended the 10-year visit, while 319 did not (e.g. 196 had died and 49 moved). The median (IQR) DAS28 decreased from 2.9 (2.2, 3.7) to 2.3 (1.4, 3.0) (p<0.001) between groups 1997-1999 and 2009-2011. The proportion of patients with 2 or more swollen joints on 46 joint count decreased from 33% to 13%, respectively. Median (IQR) pain decreased from 30 (15, 52) to 25 (6, 51) (p=0.03) and fatigue from 31 (12, 52) to 15 (2, 50) (p=0.012). Median (IQR) dr.global decreased from 20 (5, 40) to 0 (0, 5) p<0.001. The proportion of patients with a HAQ-score of ≤0.5 increased from 39% to 49% (p=0.002). The proportion of patients that had used methotrexate by the 10-year visit increased from 79% to 96% (p<0.001) and the proportion of patients who had used bDMARDs increased from 11% to 28% (p=0.001), respectively. CONCLUSIONS Several clinical outcomes were better in patients who were diagnosed more recently. More intensive use of medications over time might have contributed to these improvements.
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Affiliation(s)
- Lauri Weman
- Central Finland Central Hospital Rheumatology Outpatient Clinic, Jyväskylä, Finland.
| | - Johannes Vehmas
- Central Finland Central Hospital Rheumatology Outpatient Clinic, Jyväskylä, Finland
| | - Jaakko Immonen
- Central Finland Central Hospital Rheumatology Outpatient Clinic, Jyväskylä, Finland
| | - Pekka Hannonen
- Central Finland Central Hospital Rheumatology Outpatient Clinic, Jyväskylä, Finland
| | - Tuulikki Sokka
- Central Finland Central Hospital Rheumatology Outpatient Clinic, Jyväskylä, Finland
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Paalanen K, Puolakka K, Nikiphorou E, Hannonen P, Sokka T. Is seronegative rheumatoid arthritis true rheumatoid arthritis? A nationwide cohort study. Rheumatology (Oxford) 2021; 60:2391-2395. [PMID: 33175968 PMCID: PMC8121445 DOI: 10.1093/rheumatology/keaa623] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/28/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The classification of seronegative arthritides can be challenging. Our aim was to examine the incidence of SpA diagnosis among patients initially diagnosed as seronegative RA. METHODS Using nationwide Finnish registers from social insurance institutions, we identified all adult patients who were diagnosed with incident seronegative RA [International Classification of Diseases (ICD)-10 code M06] from 1 January 2000 to 31 December 2014. The patients whose diagnoses subsequently changed to the ICD-10 codes of SpA (M07, M45, M46, K50 and K51) were identified in the national care register, until 31 December 2016. RESULTS A total of 9784 adult seronegative RA patients were identified. Of these, 564 patients had their diagnosis subsequently changed to SpA: 275 (48.7%) patients with PsA, 245 (43.4%) patients with axial SpA and 44 (7.8%) patients with diagnoses related to IBD. The cumulative incidence of SpA diagnoses in 15 years was 10.4% (95% CI 8.9, 12.1) and 8.1% (95% CI 7.1, 9.3) in men and women, respectively. CONCLUSION This study calls for vigilance in seronegative RA patients, especially those with more atypical presentations, since the diagnosis could change. The possibility of SpA diagnosis should be considered and specifically looked for, as this could impact on management and response to treatment.
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Affiliation(s)
- Kirsi Paalanen
- Department of Medicine, Central Finland Central Hospital, Jyväskylä
| | | | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Pekka Hannonen
- Department of Medicine, Central Finland Central Hospital, Jyväskylä
| | - Tuulikki Sokka
- Department of Medicine, Central Finland Central Hospital, Jyväskylä.,University of Eastern Finland, Kuopio, Finland
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Paalanen K, Puolakka K, Nikiphorou E, Hannonen P, Sokka T. Erratum to: Is seronegative rheumatoid arthritis true rheumatoid arthritis? A nationwide cohort study. Rheumatology (Oxford) 2021; 60:2493-2494. [PMID: 33569582 PMCID: PMC8121439 DOI: 10.1093/rheumatology/keaa861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kirsi Paalanen
- Department of Medicine, Central Finland Central Hospital, Jyväskylä
| | | | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Pekka Hannonen
- Department of Medicine, Central Finland Central Hospital, Jyväskylä
| | - Tuulikki Sokka
- Department of Medicine, Central Finland Central Hospital, Jyväskylä.,University of Eastern Finland, Kuopio, Finland
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Paalanen K, Rannio K, Rannio T, Asikainen J, Hannonen P, Sokka T. Prevalence of calcium pyrophosphate deposition disease in a cohort of patients diagnosed with seronegative rheumatoid arthritis. Clin Exp Rheumatol 2020; 38:99-106. [PMID: 31140401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aimed to characterise the clinical and radiographical phenotype of calcium pyrophosphate dihydrate deposition (CPPD) disease in patients initially diagnosed with seronegative RA, and to increase the awareness that CPPD disease can be falsely diagnosed as seronegative rheumatoid arthritis (RA). METHODS Altogether 435 early seronegative RA patients were clinically diagnosed in a single rheumatology centre and scheduled for a 10-year follow-up. All clinical data were collected and reviewed. CPPD-related arthritis was suspected if a patient had typical radiographical findings and suitable clinical pattern of CPPD or calcium pyrophosphate crystals were found in the synovial fluid. These patients are the subjects of this study. RESULTS Among 435 seronegative RA patients, 17 patients (3.9%) (baseline mean age 71.2 years, 82% women) with CPPD disease were identified. CPPD resembling clinical patterns in these patients were: chronic CPP crystal inflammatory arthritis (9 patients), acute CPP crystal arthritis (6 patients) and OA with CPPD (2 patients). All had typical radiographical findings of CPPD: Chondrocalcinosis (CC) of triangular fibrocartilage (17 patients [100%]), CC of knee (9 patients [53%]), CC or narrowing of metacarpophalangeal joints (7 patients [41.2%]), CC of metatarsophalangeal joints (4 patients [23.5%]), CC of symphysis pubis (1 patient [5.8%]), CC of glenohumeral joint (1 patient [5.8%]) and scapholunate advanced collapse (5 patients [29.4%]). None of these patients developed typical RA-like erosions. CONCLUSIONS CPPD disease can mimic seronegative RA at baseline and is important in the differential diagnosis of seronegative arthritis at baseline and during follow-up. The prevalence of CPPD patients in our early seronegative RA patients was 3.9%, the percentage was 7.0% among patients ≥60 years at baseline.
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Affiliation(s)
- Kirsi Paalanen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland.
| | - Katja Rannio
- Department of Radiology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuomas Rannio
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Juha Asikainen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Pekka Hannonen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuulikki Sokka
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
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Sandström T, Rantalaiho V, Yli-Kerttula T, Kautiainen H, Malmi T, Karjalainen A, Uusitalo T, Julkunen H, Kaipiainen-Seppänen O, Paimela L, Puolakka K, Uutela T, Möttönen T, Hannonen P, Leirisalo-Repo M, Laasonen L, Kauppi M. Cervical Spine Involvement among Patients with Rheumatoid Arthritis Treated Actively with Treat-to-target Strategy: 10-year Results of the NEO-RACo Study. J Rheumatol 2019; 47:1160-1164. [DOI: 10.3899/jrheum.190139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the development of radiological changes of the cervical spine in patients with rheumatoid arthritis (RA) in the NEO-RACo trial treated with an intensive, remission-targeted combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and additional infliximab (IFX) or placebo (PLA) for the first 6 months.Methods.Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARD and prednisolone, and randomized to double-blindly receive either IFX (FIN-RACo+IFX) or PLA (FIN-RACo+PLA) infusions during the first 6 months. After 2 years the treatment strategies became unrestricted, but the treatment goal was strict NEO-RACo remission. At the 10-year visit, radiographs of the cervical spine were taken of 85 patients (38 in the FIN-RACo+IFX group and 47 in the FIN-RACo+PLA group). The study was registered at ClinicalTrials.gov (NCT 00908089).Results.There were 4/85 patients (4.7%) with cervical spine involvement (CSI) by 10 years. Atlantoaxial subluxation was found in 2/85 patients (2.4%), both in the FIN-RACo+IFX group, and none in the FIN-RACo+PLA group. Atlantoaxial impaction was found in 1/85 patients (1.2%) in the FIN-RACo+IFX group. Subaxial subluxation was found in 1/85 patients (1.2%).Conclusion.Early and intensive remission-targeted treatment has reduced the incidence of CSI and our results show that intensive treatment also prevents its development in the long run.
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Nikiphorou E, Hannonen P, Asikainen J, Borodina J, Kokko A, Paalanen K, Rannio T, Sokka T. Survival and safety of infliximab bio-original and infliximab biosimilar (CT-P13) in usual rheumatology care. Clin Exp Rheumatol 2019; 37:55-59. [PMID: 29998827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Reports to-date indicate similarity between infliximab biosimilar (IB) and infliximab bio-original (IO) in clinical efficacy and safety. This study examines the survival of IB and IO using routinely collected data over a 2-year period. METHODS Routinely collected clinical data inputted directly in an electronic database at a large rheumatology centre were analysed. Adult patients taking IO or IB for any rheumatological diagnosis were included. Kaplan-Meier survival analyses were used to examine IB and IO survival, with a sub-group analysis among those starting infliximab from 2008 onwards. RESULTS Out of 395 patients analysed, 53% (n=209) were female; the majority had rheumatoid arthritis (31%) followed by spondyloarthritis (28%). Ninety-nine patients had IB as the first infliximab drug. Patients who started on IB vs. IO as their first infliximab product, had better survival over the first 2 years (log rank=0.001). Discontinuation due to inefficacy was much commoner in IO versus IB users (18 vs. 5%). In patients switching from IO to IB, drug survival was better versus those receiving IB as the first infliximab drug (log rank=0.073). CONCLUSIONS IB was well-tolerated and comparable to IO, with no additional safety signals identified. The results suggest superior survival of IB over IO over the first 2 years.
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Affiliation(s)
- Elena Nikiphorou
- Academic Rheumatology Department, King's College London; and Rheumatology Department, Wittington, London, UK
| | - Pekka Hannonen
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Juha Asikainen
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Jelena Borodina
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Arto Kokko
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Kirsi Paalanen
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Tuomas Rannio
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Tuulikki Sokka
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland.
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Paalanen K, Rannio K, Rannio T, Asikainen J, Hannonen P, Sokka T. Does early seronegative arthritis develop into rheumatoid arthritis? A 10-year observational study. Clin Exp Rheumatol 2019; 37:37-43. [PMID: 29998832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate the 10-year clinical course of patients with seronegative arthritis with the emphasis of reclassification of diagnoses when applicable. METHODS A total of 1030 patients including 435 seronegative cases were classified as early RA in 1997-2005 at Jyväskylä Rheumatology Centre and prospectively scheduled for a ten-year follow-up. Clinical data from the follow-up visits and the case-reports until and including the 10-year visit or death, whichever happened earlier, were retrospectively collected and reviewed with re-classification of the cases when applicable. Descriptive statistics were used. RESULTS Among the 435 seronegative cases (69 % women, baseline mean age was 59 years), 13 (13/435 [3%]) could be reclassified as seropositive or erosive RA: 4 turned seropositive (2 for ACPA and 2 for RF [> 2x reference level]) and 9 developed erosions typical for RA. Reclassification revealed 68 (16%) cases of polymyalgia rheumatica, 46 (11%) psoriatic arthritis, 45 (10%) osteoarthritis, 38 (8.7%) spondyloarthritis, 15 (3.4%) plausible reactive arthritis, 10 (2.3%) gout, 17 (3.9%) pseudogout, 6 (1.4%) paraneoplastic arthritis, 6 (1.4%) juvenile arthritis, 2 (0.5%) haemochromatosis, 3 (0.7%) ankylosing spondylitis, 2 (0.5%) giant cell arteritis, and 8 miscellaneous diagnoses. The other 140 patients (32%) could not be reclassified in any clear-cut diagnosis and had features of transient arthritis (n=41), seronegative spondyloarthritis (n=47), while 49 remained unspecified. CONCLUSIONS Over a 10-year follow-up period, reclassification revealed significant heterogeneity in the diagnosis of seronegative RA. Therefore, seronegative arthritis should not be studied as a homogenous entity.
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Affiliation(s)
- Kirsi Paalanen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland.
| | - Katja Rannio
- Department of Radiology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuomas Rannio
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Juha Asikainen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Pekka Hannonen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuulikki Sokka
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
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Rantalaiho V, Sandström T, Koski J, Hannonen P, Möttönen T, Kaipiainen-Seppänen O, Yli-Kerttula T, Kauppi MJ, Uutela T, Malmi T, Julkunen H, Laasonen L, Kautiainen H, Leirisalo-Repo M. Early Targeted Combination Treatment With Conventional Synthetic Disease-Modifying Antirheumatic Drugs and Long-Term Outcomes in Rheumatoid Arthritis: Ten-Year Follow-Up Results of a Randomized Clinical Trial. Arthritis Care Res (Hoboken) 2018; 71:1450-1458. [PMID: 30295425 DOI: 10.1002/acr.23782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/02/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The short-term outcomes of remission-targeted treatments of rheumatoid arthritis (RA) are well-established, but the long-term success of such strategies is speculative, as is the role of early add-on biologics. We assessed the 10-year outcomes of patients with early RA treated with initial remission-targeted triple combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), 7.5-mg prednisolone, and additional infliximab (IFX) or placebo infusions. METHODS Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARDs and prednisolone and randomized to double-blind receipt of infusions of either IFX (the Finnish Rheumatoid Arthritis Combination Therapy Trial [FIN-RACo] + IFX) or placebo (FIN-RACo + placebo) during the first 6 months. After 2 years, the treatment strategies became unrestricted, but the treatment goal was strict remission in the TNF-Blocking Therapy in Combination With Disease-Modifying Antirheumatic Drugs in Early Rheumatoid Arthritis (NEO-RACo) study. At 10 years, the clinical and radiographic outcomes and the drug treatments used between 5 and 10 years were assessed. RESULTS Ninety patients (91%) were followed after 2 years, 43 in the FIN-RACo + IFX and 47 in the FIN-RACo + placebo group. At 10 years, the respective proportions of patients in strict NEO-RACo remission and in Disease Activity Score using 28 joints remission in the FIN-RACo + IFX and FIN-RACo + placebo groups were 46% and 38% (P = 0.46) and 82% and 72% (P = 0.29), respectively. The mean total Sharp/van der Heijde score was 9.8 in the FIN-RACo + IFX and 7.3 in the FIN-RACo + placebo group (P = 0.34). During the 10-year follow-up, 26% of the FIN-RACo + IFX group and 30% of the FIN-RACo + placebo group had received biologics (P = 0.74). CONCLUSION In early RA, excellent results can be maintained up until 10 years in most patients treated with initial combination csDMARDs and remission-targeted strategy, regardless of initial IFX/placebo infusions.
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Affiliation(s)
| | - Tia Sandström
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Timo Möttönen
- Turku University Central Hospital and University of Turku, Turku, Finland
| | | | | | - Markku J Kauppi
- Päijät-Häme Central Hospital, Lahti, and Tampere University, Tampere, Finland
| | | | - Timo Malmi
- Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | | | - Hannu Kautiainen
- Kuopio University Hospital, Kuopio, and Folkhälsan Research Center, Helsinki, Finland
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Väänänen T, Vuolteenaho K, Kautiainen H, Nieminen R, Möttönen T, Hannonen P, Korpela M, Kauppi MJ, Laiho K, Kaipiainen-Seppänen O, Luosujärvi R, Uusitalo T, Uutela T, Leirisalo-Repo M, Moilanen E. Glycoprotein YKL-40: A potential biomarker of disease activity in rheumatoid arthritis during intensive treatment with csDMARDs and infliximab. Evidence from the randomised controlled NEO-RACo trial. PLoS One 2017; 12:e0183294. [PMID: 28841649 PMCID: PMC5571914 DOI: 10.1371/journal.pone.0183294] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 08/02/2017] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE YKL-40, a chitinase-like glycoprotein associated with inflammation and tissue remodeling, is produced by joint tissues and recognized as a candidate auto-antigen in rheumatoid arthritis (RA). In the present study, we investigated YKL-40 as a potential biomarker of disease activity in patients with early RA at baseline and during intensive treatment aiming for early remission. METHODS Ninety-nine patients with early DMARD-naïve RA participated in the NEO-RACo study. For the first four weeks, the patients were treated with the combination of sulphasalazine, methotrexate, hydroxychloroquine and low dose prednisolone (FIN-RACo DMARD combination), and subsequently randomized to receive placebo or infliximab added on the treatment for further 22 weeks. Disease activity was evaluated using the 28-joint disease activity score and plasma YKL-40 concentrations were measured by immunoassay. RESULTS At the baseline, plasma YKL-40 concentration was 57 ± 37 (mean ± SD) ng/ml. YKL-40 was significantly associated with the disease activity score, interleukin-6 and erythrocyte sedimentation rate both at the baseline and during the 26 weeks' treatment. The csDMARD combination decreased YKL-40 levels already during the first four weeks of treatment, and there was no further reduction when the tumour necrosis factor-α antagonist infliximab was added on the combination treatment. CONCLUSIONS High YKL-40 levels were found to be associated with disease activity in early DMARD-naïve RA and during intensive treat-to-target therapy. The present results suggest YKL-40 as a useful biomarker of disease activity in RA to be used to steer treatment towards remission.
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Affiliation(s)
- Tuija Väänänen
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Katriina Vuolteenaho
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
- * E-mail:
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
- MedCare Ltd, Äänekoski, Finland
| | - Riina Nieminen
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Timo Möttönen
- Department of Rheumatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Hannonen
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Markku Korpela
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
| | - Markku J. Kauppi
- Department of Medicine, Päijät-Häme Central Hospital, Lahti, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Kari Laiho
- Department of Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Riitta Luosujärvi
- Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Uusitalo
- Department of Medicine, Hämeenlinna Central Hospital, Hämeenlinna, Finland
| | - Toini Uutela
- Department of Medicine, Lapland Central Hospital, Rovaniemi, Finland
| | | | - Eeva Moilanen
- The Immunopharmacology Research Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
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10
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Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Pirilä L, Kuusalo L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Aaltonen K, Kautiainen H, Sokka T. Three out of four disease-modifying anti-rheumatic drug-naïve rheumatoid arthritis patients meet 28-joint Disease Activity Score remission at 12 months: results from the FIN-ERA cohort. Scand J Rheumatol 2017; 46:425-431. [DOI: 10.1080/03009742.2016.1266029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Rannio
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - J Asikainen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - P Hannonen
- Department of Rheumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - T Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - P Ekman
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - L Pirilä
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - L Kuusalo
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Mali
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Puurtinen-Vilkki
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - S Kortelainen
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - J Paltta
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - K Taimen
- Department of Rheumatology, Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - M Kauppi
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - K Laiho
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - S Nyrhinen
- Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
| | - H Mäkinen
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - P Isomäki
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - T Uotila
- Department of Rheumatology, Tampere University Hospital, Tampere, Finland
| | - K Aaltonen
- Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - T Sokka
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Asikainen J, Nikiphorou E, Kaarela K, Lindqvist E, Häkkinen A, Kautiainen H, Hannonen P, Rannio T, Sokka T. Is long-term radiographic joint damage different between men and women? Prospective longitudinal data analysis of four early RA cohorts with greater than 15 years follow-up. Clin Exp Rheumatol 2016; 34:641-645. [PMID: 27156863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/14/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To examine gender-related differences in radiographic joint damage in rheumatoid arthritis (RA) using four prospective early RA cohorts. METHODS Radiographs of patients from four early prospective RA cohorts were examined. The extent of joint damage in hands and feet was assessed by three evaluators according to the Larsen score (0-100). Descriptive statistics and two-way bootstrap ANOVA with time as a covariate were employed. RESULTS A total of 312 patients were included who had at least 15 years of follow up: 68 from the Rheumatism Foundation Hospital in Heinola in the 1970s (Heinola1970), 117 patients from Lund University Hospital in the 1980s, (Lund1980), and 81 and 46 patients from Jyväskylä Central Hospital in the 1980s (JYV1980) and the 1990s (JYV1990), respectively. Median Larsen scores in seropositive women vs. men were 43 vs. 48 (p=0.57), 37 vs. 34 (p=0.25), 31 vs. 9.5 (p=0.008), and 3.0 vs. 4.0 (p=0.34) in the Heinola1970, Lund1980, JYV1980, and JYV1990 cohorts, respectively. The corresponding figures in seronegative women vs. men were 12 vs. 23 (p=0.59), 2.0 vs. 8.0 (p=0.36), and 1.0 vs. 1.5 (p=0.63), in the Lund1980, JYV1980 and JYV1990 cohorts. All Heinola patients were seropositive. CONCLUSIONS After a 15-20 year follow-up period, RA joint damage appears comparable in women and men. The results suggest that management should not differ at least based on gender.
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Affiliation(s)
| | | | | | - Elisabet Lindqvist
- Lund University, Skane University Hospital, Department of Rheumatology, Lund, Sweden
| | | | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, and Department of General Practice, University of Helsinki; and Unit of Primary Health Care, Kuopio University Hospital, Finland
| | | | | | - Tuulikki Sokka
- Jyväskylä Central Hospital; and University of Eastern Finland, Jyväskylä, Finland.
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Väre P, Nikiphorou E, Hannonen P, Sokka T. Delivering a one-stop, integrated, and patient-centered service for patients with rheumatic diseases. SAGE Open Med 2016; 4:2050312116654404. [PMID: 27437101 PMCID: PMC4941123 DOI: 10.1177/2050312116654404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/18/2016] [Indexed: 12/20/2022] Open
Abstract
Objective: To describe a one-stop, integrated rheumatology service and assess patient satisfaction. Methods: A descriptive report and patient satisfaction survey of a rheumatology clinic model first developed in 1996 to enhance the patient “journey” through rheumatology services. A patient-satisfaction survey over a 3-week period assessed several aspects of care including quality of services, consultations, and patient education. Results: All referrals are screened by a rheumatologist to pre-schedule laboratory/radiology/other tests for the visit. Upon arrival to the clinic, patients check-in at an electronic desk, and then complete the electronic GoTreatIT monitoring system which assesses patient-reported outcomes. The patient is reviewed by a doctor in a 30- to 60-min consultation, and then by a nurse (for diagnosis/treatment education, vaccinations). An ultrasound machine and capillaroscopy are available for use in the clinic. Patients can be scheduled on the same day to see a nutritionist, physiotherapist, or other heath professionals as necessary. An “early-rheumatoid arthritis treatment path” is available to ensure early, intensive treatment. A patient satisfaction survey revealed high rating of the overall service (90.6/100). None of the patients felt that they lacked education on their disease or medication. Only 6% of the respondents gave negative feedback, reasons including feeling overwhelmed with information or not being given a cause for their symptoms. The multi-disciplinary approach was highly valued and only 3% would rather see a doctor and nurse on separate days. Conclusion: The specific clinic model provides an ideal setting for a one-stop service, avoiding unnecessary visits, collecting patient data, and enhancing the patient experience and journey through the system. Where possible, the specific clinic model could be used or adapted to build similar models in other rheumatology departments. The clinic model could also form the basis for services in other specialties dealing with chronic conditions.
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Affiliation(s)
- Paula Väre
- Rheumatology Research Department, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Elena Nikiphorou
- Rheumatology Research Department, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Pekka Hannonen
- Rheumatology Research Department, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Tuulikki Sokka
- Rheumatology Research Department, Jyväskylä Central Hospital, Jyväskylä, Finland; Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Nikiphorou E, Sjöwall C, Hannonen P, Rannio T, Sokka T. Long-term outcomes of destructive seronegative (rheumatoid) arthritis - description of four clinical cases. BMC Musculoskelet Disord 2016; 17:246. [PMID: 27256084 PMCID: PMC4891827 DOI: 10.1186/s12891-016-1067-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/10/2016] [Indexed: 12/15/2022] Open
Abstract
Background Seronegative rheumatoid arthritis is associated with a milder course of progression compared to seropositive disease. However, long-term follow-up data of the clinical course of seronegative rheumatoid arthritis are sparse. Here we describe four cases with a rare disease entity of aggressive destructive seronegative (rheumatoid) arthritis with 20-35 years of follow-up. Case presentation The four cases are women with an initial presentation of seronegative rheumatoid arthritis in 1980-1996 and have received disease-modifying anti-rheumatic drugs since the diagnosis. In all cases, the condition has been refractory to treatments and evolved into a severe disease with destructions of the wrists, sub-talar and ankle joints, as well as large joints but not small joints of fingers and toes. All cases are negative with regard to rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antibodies against carbamylated proteins. Conclusions This report adds to the existing literature, making the reader aware of this sub-type of inflammatory arthritis which despite being seronegative, can have devastating disease consequences. The report highlights the need for further research into this field in order to better understand this disease sub-type, the pathogenesis, disease course and outcomes.
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Affiliation(s)
- Elena Nikiphorou
- Rheumatology/Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, FI-40620, Jyväskylä, Finland
| | - Christopher Sjöwall
- Rheumatology/AIR, Department of Clinical and Experimental Medicine, Linköping University, SE-581 85, Linköping, Sweden
| | - Pekka Hannonen
- Rheumatology/Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, FI-40620, Jyväskylä, Finland
| | - Tuomas Rannio
- Rheumatology/Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, FI-40620, Jyväskylä, Finland
| | - Tuulikki Sokka
- Rheumatology/Medicine, Jyväskylä Central Hospital, Keskussairaalantie 19, FI-40620, Jyväskylä, Finland. .,Faculty of Health Sciences, University of Eastern Finland, Jyväskylä Central Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
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Asikainen J, Rannio T, Kautiainen H, Hannonen P, Sokka T. THU0056 Women, Men, and Rheumatoid Arthritis: Radiographic Progression over Ten Years in The Current Millennium. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Pirilä L, Kuusalo L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Aaltonen K, Kautiainen H, Sokka T. SAT0090 Three out of Every Four Patients with Dmard-Naive Early Rheumatoid Arthritis Meet DAS28 Remission at 12 Months in Finland. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rannio T, Asikainen J, Kokko A, Hannonen P, Sokka T. Early Remission Is a Realistic Target in a Majority of Patients with DMARD-naive Rheumatoid Arthritis. J Rheumatol 2016; 43:699-706. [DOI: 10.3899/jrheum.141480] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 12/28/2022]
Abstract
Objective.We analyzed remission rates at 3 and 12 months in patients with rheumatoid arthritis (RA) who were naive for disease-modifying antirheumatic drugs (DMARD) and who were treated in a Finnish rheumatology clinic from 2008 to 2011. We compared remission rates and drug treatments between patients with RA and patients with undifferentiated arthritis (UA).Methods.Data from all DMARD-naive RA and UA patients from the healthcare district were collected using software that includes demographic and clinical characteristics, disease activity, medications, and patient-reported outcomes. Our rheumatology clinic applies the treat-to-target principle, electronic monitoring of patients, and multidisciplinary care.Results.Out of 409 patients, 406 had data for classification by the 2010 RA criteria of the American College of Rheumatology/European League Against Rheumatism. A total of 68% were female, and mean age (SD) was 58 (16) years. Respectively, 56%, 60%, and 68% were positive for anticyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), and RF/anti-CCP, and 19% had erosive disease. The median (interquartile range) duration of symptoms was 6 (4–12) months. A total of 310 were classified as RA and 96 as UA. The patients with UA were younger, had better functional status and lower disease activity, and were more often seronegative than the patients with RA. The 28-joint Disease Activity Score (3 variables) remission rates of RA and UA patients at 3 months were 67% and 58% (p = 0.13), and at 12 months, 71% and 79%, respectively (p = 0.16). Sustained remission was observed in 57%/56% of RA/UA patients. Patients with RA used more conventional synthetic DMARD combinations than did patients with UA. None used biological DMARD at 3 months, and only 2.7%/1.1% of the patients (RA/UA) used them at 12 months (p = 0.36).Conclusion.Remarkably high remission rates are achievable in real-world DMARD-naive patients with RA or UA.
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Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, Kvien TK, Navarro-Compán MV, Oliver S, Schoels M, Scholte-Voshaar M, Stamm T, Stoffer M, Takeuchi T, Aletaha D, Andreu JL, Aringer M, Bergman M, Betteridge N, Bijlsma H, Burkhardt H, Cardiel M, Combe B, Durez P, Fonseca JE, Gibofsky A, Gomez-Reino JJ, Graninger W, Hannonen P, Haraoui B, Kouloumas M, Landewe R, Martin-Mola E, Nash P, Ostergaard M, Östör A, Richards P, Sokka-Isler T, Thorne C, Tzioufas AG, van Vollenhoven R, de Wit M, van der Heijde D. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016; 75:3-15. [PMID: 25969430 PMCID: PMC4717393 DOI: 10.1136/annrheumdis-2015-207524] [Citation(s) in RCA: 941] [Impact Index Per Article: 117.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Reaching the therapeutic target of remission or low-disease activity has improved outcomes in patients with rheumatoid arthritis (RA) significantly. The treat-to-target recommendations, formulated in 2010, have provided a basis for implementation of a strategic approach towards this therapeutic goal in routine clinical practice, but these recommendations need to be re-evaluated for appropriateness and practicability in the light of new insights. OBJECTIVE To update the 2010 treat-to-target recommendations based on systematic literature reviews (SLR) and expert opinion. METHODS A task force of rheumatologists, patients and a nurse specialist assessed the SLR results and evaluated the individual items of the 2010 recommendations accordingly, reformulating many of the items. These were subsequently discussed, amended and voted upon by >40 experts, including 5 patients, from various regions of the world. Levels of evidence, strengths of recommendations and levels of agreement were derived. RESULTS The update resulted in 4 overarching principles and 10 recommendations. The previous recommendations were partly adapted and their order changed as deemed appropriate in terms of importance in the view of the experts. The SLR had now provided also data for the effectiveness of targeting low-disease activity or remission in established rather than only early disease. The role of comorbidities, including their potential to preclude treatment intensification, was highlighted more strongly than before. The treatment aim was again defined as remission with low-disease activity being an alternative goal especially in patients with long-standing disease. Regular follow-up (every 1-3 months during active disease) with according therapeutic adaptations to reach the desired state was recommended. Follow-up examinations ought to employ composite measures of disease activity that include joint counts. Additional items provide further details for particular aspects of the disease, especially comorbidity and shared decision-making with the patient. Levels of evidence had increased for many items compared with the 2010 recommendations, and levels of agreement were very high for most of the individual recommendations (≥9/10). CONCLUSIONS The 4 overarching principles and 10 recommendations are based on stronger evidence than before and are supposed to inform patients, rheumatologists and other stakeholders about strategies to reach optimal outcomes of RA.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Ferdinand C Breedveld
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd R Burmester
- Department of Rheumatology, Clinical Immunology Free University and Humboldt University, Charité-University Medicine, Berlin, Germany
| | - Vivian Bykerk
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, Cornell University, New York, USA
| | - Maxime Dougados
- Department of Rheumatology B, Cochin Hospital, René Descartes University, Paris, France
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital,Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Monika Schoels
- 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria
| | - Marieke Scholte-Voshaar
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Tanja Stamm
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Michaela Stoffer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Jose Louis Andreu
- Rheumatology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Martin Aringer
- Department of Medicine III, University Medical Center TU Dresden, Dresden, Germany
| | - Martin Bergman
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Neil Betteridge
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Hans Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, and VU University Medical Center, Amsterdam, The Netherlands
| | - Harald Burkhardt
- Division of Rheumatology, Department of Medicine, Johann-Wolfgang-Goethe University Frankfurt, German
| | - Mario Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Michoacán, Mexico
| | - Bernard Combe
- Service d'Immuno-Rhumatologie, Montpellier University, Lapeyronie Hospital, Montpellier, France
| | - Patrick Durez
- Pôle de Recherche en Rhumatologie, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joao Eurico Fonseca
- Rheumatology Research Unit, Instituto de de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Rheumatology Department, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Alan Gibofsky
- Weill Medical College, Cornell University Hospital for Special Surgery, New York, USA
| | - Juan J Gomez-Reino
- Rheumatology Unit, Santiago University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Pekka Hannonen
- Department of Medicine, Central Hospital, Jyväskylä, Finland
| | | | - Marios Kouloumas
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Robert Landewe
- Academic Medical Center, University of Amsterdam, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | | | - Peter Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - Mikkel Ostergaard
- Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew Östör
- Rheumatology Clinical Research Unit, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, UK
| | - Pam Richards
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | | | - Carter Thorne
- Division of Rheumatology, Southlake Regional Health Centre, Newarket, Ontario, Canada
| | | | | | - Martinus de Wit
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Desirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Hannonen P, Rantanen T, Jussila A. [What have biological drugs changed in inflammatory rheumatic, skin and bowel diseases?]. Duodecim 2016; 132:357-364. [PMID: 27017788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Biological drugs are the most rapidly growing group of medicinal agents. In addition to hormone and vaccine products, the significance of drugs produced using genetic engineering has increased in numerous indications, especially in oncology. Furthermore, they have significantly contributed to the treatment of inflammatory musculoskeletal as well as cutaneous and intestinal diseases. Their use is limited by parenteral administration, immunogenicity, uncertainty about possible severe adverse effects and especially the high price of the drugs. The cessation of patent protection of the original brand pharmaceuticals, and marketing of biosimilar drugs are expected to lower the prices of the original biological, as well.
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Nikiphorou E, Kautiainen H, Hannonen P, Asikainen J, Kokko A, Rannio T, Sokka T. Clinical effectiveness of CT-P13 (Infliximab biosimilar) used as a switch from Remicade (infliximab) in patients with established rheumatic disease. Report of clinical experience based on prospective observational data. Expert Opin Biol Ther 2015; 15:1677-83. [DOI: 10.1517/14712598.2015.1103733] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rannio T, Asikainen J, Hannonen P, Yli-Kerttula T, Ekman P, Kuusela L, Pirilä L, Mali M, Puurtinen-Vilkki M, Kortelainen S, Paltta J, Taimen K, Kauppi M, Laiho K, Nyrhinen S, Mäkinen H, Isomäki P, Uotila T, Sokka T. FRI0057 Two Thirds of Patients with Early Rheumatoid Arthritis (ERA) Meet DAS28 Remission at 3 Months-Results from the Finnish Early Rheumatoid Arthritis Study (FIN-ERA). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Turunen S, Hannonen P, Koivula MK, Risteli L, Risteli J. Separate and overlapping specificities in rheumatoid arthritis antibodies binding to citrulline- and homocitrulline-containing peptides related to type I and II collagen telopeptides. Arthritis Res Ther 2015; 17:2. [PMID: 25573503 PMCID: PMC4320812 DOI: 10.1186/s13075-014-0515-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 12/23/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Our objective was to find out if there are antibodies binding to homocitrulline-containing type I and II collagen carboxyterminal telopeptides in sera of patients with rheumatoid arthritis (RA), and if these antibodies cross-react with citrulline and homocitrulline in the same peptide sequence. Methods A total of 72 RA and 72 control sera were analyzed for binding using enzyme-linked immunosorbent assay to citrulline- or homocitrulline-containing type I and II collagen carboxyterminal telopeptides, as well as to cyclic citrullinated peptide (CCP) and to mutated citrullinated vimentin (MCV). Specificities of the antibodies were tested using inhibition-ELISA. Results Of the RA sera, 39 (54%) and 41 (57%) were positive for binding to CCP and MCV, respectively. Further, 34 (47%) and 30 (42%) of the patients had specific antibodies binding to and being inhibited by citrulline-containing type I collagen telopeptides and by citrulline-containing type II collagen carboxyterminal telopeptides, respectively. The corresponding figures regarding homocitrulline-containing type I and homocitrulline-containing type II collagen telopeptides were 16 (22%) and 14 (19%). Most of the patients, who were seropositive for citrullinated peptides, showed binding in multiple assays. A total of 10 (14%) RA patients were positive for all the tested peptide pairs, while 28 (39%) of them had antibodies that contained overlapping specifities between citrulline and homocitrulline in the same peptide sequence. Conclusions Antibodies to both citrulline and homocitrulline containing type I and II collagen telopeptides can be found in sera of RA patients. These antibodies are not constant from one RA patient to another, but contain separate or overlapping specificities within the same peptide sequence varying between individuals. Our results suggest some relationship between citrulline and homocitrulline-recognizing antibodies, since homocitrulline antibodies exist mainly in individuals seropositive to anti-CCP and anti-MCV. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0515-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sanna Turunen
- Department of Clinical Chemistry, Institute of Diagnostics, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland. .,Northern Laboratory Centre NordLab and Medical Research Centre, Oulu University Hospital, Oulu, Finland.
| | - Pekka Hannonen
- Department of Medicine, Central Hospital, Jyväskylä, Finland.
| | - Marja-Kaisa Koivula
- Department of Clinical Chemistry, Institute of Diagnostics, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland. .,Northern Laboratory Centre NordLab and Medical Research Centre, Oulu University Hospital, Oulu, Finland.
| | - Leila Risteli
- Department of Clinical Chemistry, Institute of Diagnostics, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland. .,Northern Laboratory Centre NordLab and Medical Research Centre, Oulu University Hospital, Oulu, Finland.
| | - Juha Risteli
- Department of Clinical Chemistry, Institute of Diagnostics, University of Oulu, P.O. Box 5000, Oulu, FI-90014, Finland. .,Northern Laboratory Centre NordLab and Medical Research Centre, Oulu University Hospital, Oulu, Finland.
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Rantalaiho V, Kautiainen H, Järvenpää S, Korpela M, Malmi T, Hannonen P, Kaipiainen-Seppänen O, Yli-Kerttula T, Möttönen T, Mustila A, Karjalainen A, Paimela L, Uutela T, Leirisalo-Repo M. Failure in Longterm Treatment is Rare in Actively Treated Patients with Rheumatoid Arthritis, But May Be Predicted by High Health Assessment Score at Baseline and by Residual Disease Activity at 3 and 6 Months: The 5-year Followup Results of the Randomized Clinical NEO-RACo Trial. J Rheumatol 2014; 41:2379-85. [DOI: 10.3899/jrheum.140267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective.With modern initial aggressive combination treatments with synthetic disease-modifying antirheumatic drugs (sDMARD), most patients with rheumatoid arthritis (RA) achieve remission, have marginal radiographic progression, and sustain normal function. Here we aim to identify the patients failing these targets even after aggressive treatment.Methods.Ninety-nine patients with early, active RA were treated with a combination of 3 sDMARD and prednisolone (PRD), and either infliximab or placebo infusions during the first 6 months, aiming at strict remission. After 24 months, the treatments became unrestricted. At 60 months, 4 evident clinical features of treatment failure were defined: area under curve (AUC) between 6–60 months for disease activity score assessing 28 joints > 2.6; AUC 6–60 for health assessment questionnaire > 0.5; progression in total Sharp/van der Heijde score 0–60 months > 3 units; and need of PRD or biologic DMARD treatment at 60 months.Results.A total of 93 patients were followed up for 60 months. Of them, 45 had no features of treatment failure, 30 had 1, 10 had 2, 7 had 3, and 1 patient had all 4 features. Having 2–4 features of treatment failure at 5 years was predicted by the health assessment score at baseline, and by even low residual disease activity at 3 and 6 months.Conclusions.Only 20% of the patients with RA treated early with combination sDMARD and PRD have more than 1 clinical feature of treatment failure at 60 months. Residual clinical disease activity at 3–6 months was the most important predictor for identifying these patients. The study was registered at www.clintrials.gov (NCT00908089).
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Sokka-Isler T, Kautiainen H, Rannio T, Asikainen J, Hannonen P. AB0297 Does Delay of Therapy Affect Outcomes of Early RA in A T2T Clinic?: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vuolteenaho K, Kautiainen H, Möttönen T, Hannonen P, Korpela M, Kauppi M, Kaipiainen-Seppänen O, Luosujärvi R, Nieminen R, Leirisalo-Repo M, Moilanen E. FRI0254 Predictive Value of Pretreatment Resistin Levels for Erosive Disease in Early RA Treated with DMARDS and Infliximab. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sokka-Isler T, Haugeberg G, Rannio T, Widding Hansen I, Soldal D, Asikainen J, Hannonen P. FRI0221 More Health for Lower Costs – Data from Two Clinics Treating RA in 2012-13: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rantalaiho V, Korpela M, Hannonen P, Kaipiainen-Seppänen O, Möttönen T, Kauppi M, Karjalainen A, Laiho K, Kautiainen H, Leirisalo-Repo M. OP0147 Targeted treatment with combination DMARDs produces excellent clinical and radiographic long-term outcomes in early rheumatoid arthritis regardless of initial infliximab. The 5-year follow-up results of the neo-raco trial. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2012-eular.1830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gauffin J, Hankama T, Hannonen P, Kautiainen H, Pohjolainen T, Haanpää M. Do fibromyalgia patients use active pain management strategies? A cohort study. J Rehabil Med 2013; 45:477-80. [PMID: 23532255 DOI: 10.2340/16501977-1133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the types of pain management strategies used by patients with fibromyalgia. METHODS A total of 158 patients with primary fibromyalgia attended a clinical visit to confirm the diagnosis. They completed 3 questionnaires: (i) a self-made questionnaire, (ii) Beck Depression Inventory IA (BDI IA), and (iii) Finnish version of Fibromyalgia Impact Questionnaire. The self-made questionnaire included questions about: intensity of current pain; general well-being; pain management strategies, including pain medications; efficacy of the pain management methods; current health problems other than fibromyalgia. The pain management strategies were subcategorized (e.g., physical exercise, massage and heat treatment). The strategies were also divided into active and passive types. RESULTS The most frequently reported pain management strategies were physical exercise (54%), physical therapy (32%) and cold treatment (27%). The use of active pain management strategies, BDI IA < 10 points and age were independent predictors of the reported pain management efficacy. Patients who used active pain management strategies reported better efficacy with the BDI IA score ≥ 10 points. CONCLUSION Active pain management strategies are most efficacious for fibromyalgia patients, regardless of the severity of fibromyalgia or optional comorbid depression.
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Affiliation(s)
- Jarno Gauffin
- ORTON Rehabilitation Centre, ORTON Foundation, 00280 Helsinki, Finland.
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Rantalaiho V, Kautiainen H, Korpela M, Puolakka K, Blåfield H, Ilva K, Hannonen P, Leirisalo-Repo M, Möttönen T. Physicians' adherence to tight control treatment strategy and combination DMARD therapy are additively important for reaching remission and maintaining working ability in early rheumatoid arthritis: a subanalysis of the FIN-RACo trial. Ann Rheum Dis 2013; 73:788-90. [PMID: 24297374 DOI: 10.1136/annrheumdis-2013-204271] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Vappu Rantalaiho
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, , Tampere, Finland
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Rantalaiho V, Kautiainen H, Korpela M, Hannonen P, Kaipiainen-Seppänen O, Möttönen T, Kauppi M, Karjalainen A, Laiho K, Laasonen L, Hakola M, Peltomaa R, Leirisalo-Repo M. Targeted treatment with a combination of traditional DMARDs produces excellent clinical and radiographic long-term outcomes in early rheumatoid arthritis regardless of initial infliximab. The 5-year follow-up results of a randomised clinical trial, the NEO-RACo trial. Ann Rheum Dis 2013; 73:1954-61. [DOI: 10.1136/annrheumdis-2013-203497] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Sokka T, Haugeberg G, Asikainen J, Widding Hansen I, Kokko A, Rannio T, Soldal D, Hannonen P. FRI0095 Similar clinical outcomes in rheumatoid arthritis with more vs. Less expensive treatment strategies. Results from two rheumatology clinics with standard monitoring of all patients:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rannio T, Asikainen J, Hannonen P, Sokka T. SAT0023 High Remission Rates in Patients with Early RA (ERA) in Usual Care. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sokka T, Puolakka K, Rannio T, Asikainen J, Kautiainen H, Hannonen P. SAT0092 Determinants of Perceived Risk of Work Disability in Patients with Rheumatoid Arthritis (RA). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Asikainen J, Kaarela K, Geborek P, Lindqvist E, Häkkinen A, Hannonen P, Rannio T, Sokka T. FRI0056 Joint damage in patients with rheumatoid arthritis over 15-20 years – are there differences between women and men? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sokka T, Haugeberg G, Rannio T, Hansen IJ, Soldal DM, Asikainen J, Hannonen P. SAT0024 Use of Biologic Drugs and Clinical Effectiveness of Care of Early RA in Two Clinics with Different Treatment Tradition in Their T2T Approach. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sokka T, Haugeberg G, Asikainen J, Widding Hansen IJ, Kokko A, Rannio T, Soldal DM, Hannonen P. Similar clinical outcomes in rheumatoid arthritis with more versus less expensive treatment strategies. Observational data from two rheumatology clinics. Clin Exp Rheumatol 2013; 31:409-414. [PMID: 23415074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 10/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Selection of efficacious medications for rheumatoid arthritis (RA) has tremendously increased over a decade including new costly biologic agents and inexpensive conventional anti-rheumatic drugs, used in combinations for more efficacy. Treatments aim at remission or at least low disease activity. Our objective was to study whether treatment target is reached and to what cost, in patients with RA in two Nordic rheumatology clinics. METHODS Cross sectional observational clinical data of all patients with RA seen in 2010 in two Nordic county hospital rheumatology units: Kristiansand, Norway and Jyväskylä, Finland, which both serve a population of about 275,000. Measures included patient demographic measures, clinical characteristics, disease activity, functional status, and treatments. Annual costs of medications to the society were calculated per 100 patients, using an assumption that a patient is taking current medications for one year. RESULTS Patient populations from Kristiansand and Jyväskylä were similar according to age, gender, disease duration, and prevalence of RF and CCP. Disease activity was low and patients' functional status well reserved in both clinics. Almost twice as many patients in Kristiansand than in Jyväskylä (33% vs. 17%) used biologic agents. A combination of conventional anti-rheumatic drugs was currently used by <1% of patients in Kristiansand and by 37% of patients in Jyväskylä. Estimated annual costs of medications per 100 patients were €508,000 in Kristiansand and €280,000 in Jyväskylä. CONCLUSIONS Treatment target of remission/low disease activity and good functional status can be reached in RA using expensive and less-expensive anti-rheumatic drugs.
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Gauffin J, Hankama T, Kautiainen H, Hannonen P, Haanpää M. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study. BMC Neurol 2013; 13:21. [PMID: 23409793 PMCID: PMC3582578 DOI: 10.1186/1471-2377-13-21] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 02/08/2013] [Indexed: 11/10/2022] Open
Abstract
Backround Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia. Methods 158 patients with primary fibromyalgia underwent a neurological examination including bedside sensory testing. They also fulfilled four questionnaires: PainDETECT, Beck depression inventory IA (BDI IA), Fibromyalgia Impact Questionnaire (FIQ) and a self-made questionnaire regarding present pain and pain relieving methods of the patients. The results of the clinical evaluation and questionnaires were then compared. Results Clinically verified neuropathic pain was diagnosed in 53/158 [34% (95% Cl: 26 to 41)] patients. The ROC curve achieved a maximum Youden´s index at score of 17 when sensitivity was 0.79 (95% Cl: 0.66 to 0.89) and specificity 0.53 (95% Cl: 0.43 to 0.63). The PainDETECT total score (OR: 1.14 95% Cl: 1.06 to 1.22), FM as the worst current pain (OR: 0.31; 95% 0.16 to 0.62), body mass index (BMI) (OR: 1.05; 95% Cl: 1.00 to 1.11) and the intensity of current pain (OR: 1.20; 95% Cl: 1.01 to 1.41) were significantly associated with the presence of neuropathic pain in univariate analyses. Conclusion This study highlights the importance of thorough clinical examination. The Neuropathic pain screening tool PainDETECT is not as useful in patients with fibromyalgia as in patients with uncompromised central pain control.
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Affiliation(s)
- Jarno Gauffin
- ORTON Rehabilitation Centre, ORTON Foundation, Helsinki, Finland.
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Hakala M, Kröger H, Valleala H, Hienonen-Kempas T, Lehtonen-Veromaa M, Heikkinen J, Tuomiranta T, Hannonen P, Paimela L. Once-monthly oral ibandronate provides significant improvement in bone mineral density in postmenopausal women treated with glucocorticoids for inflammatory rheumatic diseases: a 12-month, randomized, double-blind, placebo-controlled trial. Scand J Rheumatol 2013; 41:260-6. [PMID: 22803768 DOI: 10.3109/03009742.2012.664647] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To study the efficacy and safety of once-monthly oral ibandronate in the prevention of glucocorticoid (GC)-induced osteoporosis (GIOP) in postmenopausal women with inflammatory rheumatic diseases. METHOD A randomized, double-blind, placebo-controlled, parallel-group study of 140 postmenopausal women was conducted. At baseline, the mean lumbar spine (LS) (L1-L4) bone mineral density (BMD) was normal or osteopaenic (T-score ≥ -2.0) and the patients were receiving treatment with 5-15 mg/day of prednisone equivalent. Patients were randomized 1:1 to receive either monthly oral ibandronate 150 mg or placebo for 12 months. All patients received vitamin D and calcium supplements. The primary endpoint was the relative change in mean LS BMD from baseline to 12 months. RESULTS Mean LS BMD increased significantly by 2.6% and 3.2% from baseline to 6 and 12 months with ibandronate compared to 0.3% and -0.1% with placebo, respectively (p < 0.001). Comparable significant mean increases were also found in trochanter, femoral neck and total hip BMDs at 12 months. Reductions in the serum levels of bone turnover markers C-terminal telopeptide of type I collagen (sCTX), N-terminal propeptide of type I procollagen (P1NP), and tartrate-resistant acid phosphatase (TRACP) were significantly more marked in the ibandronate group than in the placebo group at 1, 6, and 12 months. Adverse events (AEs) were reported at a similar frequency in both groups. A higher proportion of serious AEs (SAEs) were reported in the ibandronate group without emergence of any single SAE. CONCLUSIONS Once-monthly oral ibandronate provides a significant increase in LS and total hip BMD with an acceptable safety profile in postmenopausal women treated with low-dose GCs for inflammatory rheumatic diseases.
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Affiliation(s)
- M Hakala
- Department of Musculoskeletal Medicine and Rehabilitation, Medical School, University of Tampere, Tampere, Finland.
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Whittle SL, Colebatch AN, Buchbinder R, Edwards CJ, Adams K, Englbrecht M, Hazlewood G, Marks JL, Radner H, Ramiro S, Richards BL, Tarner IH, Aletaha D, Bombardier C, Landewé RB, Müller-Ladner U, Bijlsma JWJ, Branco JC, Bykerk VP, da Rocha Castelar Pinheiro G, Catrina AI, Hannonen P, Kiely P, Leeb B, Lie E, Martinez-Osuna P, Montecucco C, Ostergaard M, Westhovens R, Zochling J, van der Heijde D. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative. Rheumatology (Oxford) 2012; 51:1416-25. [PMID: 22447886 PMCID: PMC3397467 DOI: 10.1093/rheumatology/kes032] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/25/2012] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). METHODS A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008-09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. RESULTS A total of 49,242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. CONCLUSIONS Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice.
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Affiliation(s)
- Samuel L Whittle
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, South Australia 5011, Adelaide, Australia.
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Rantalaiho V, Puolakka K, Korpela M, Hannonen P, Möttönen T. Long-term results of the FIN-RACo trial; treatment with a combination of traditional disease-modifying anti-rheumatic drugs is an excellent option in early rheumatoid arthritis. Clin Exp Rheumatol 2012; 30:S27-S31. [PMID: 23073350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 09/19/2012] [Indexed: 06/01/2023]
Abstract
The Finnish Rheumatoid Arthritis Combination Therapy Trial (FIN-RACo) started in 1993, in an era of disappointing results in the treatment of rheumatoid arthritis (RA). The FIN-RACo was the first trial aiming at remission and comparing two different treatment strategies: initially triple therapy with compulsory prednisolone (FIN-RACo strategy), or monotherapy with optional prednisolone (SINGLE strategy). The results at 2, 5 and at 11 years are in favour of the initial FIN-RACo strategy without an increase in adversities. Nevertheless, with targeted treatment, even the SINGLE strategy group patients show low disease activity and moderate radiographic progression. Most leading Finnish rheumatologists participated in the FIN-RACo trial and have become convinced of the excellent results, good safety, and feasible administration of the FIN-RACo strategy. They have thus adopted it in real life and tutored the next generation to do the same. This has undoubtedly affected the Finnish approach to treating early RA; the Finnish Current Care Guideline recommends the FIN-RACo combination as the first treatment choice in early, active RA. As a consequence, the use of biologics in early RA is less frequent in Finland compared to many countries. Simultaneously, however, at least one hard outcome of RA, work disability, has decreased.
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Gauffin J, Hankama T, Kautiainen H, Arkela-Kautiainen M, Hannonen P, Haanpää M. Validation of a Finnish version of the Fibromyalgia Impact Questionnaire (Finn-FIQ). Scand J Pain 2012; 3:15-20. [PMID: 29913759 DOI: 10.1016/j.sjpain.2011.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 10/19/2011] [Indexed: 10/14/2022]
Abstract
Background and purpose Fibromyalgia (FM) is a chronic pain syndrome, which affects up to 5% of the general population. The aetiology of FM is unclear. The lack of specific diagnostic laboratory tests or imaging options combined with the severe burden on both patients and society caused by the FM syndrome demands the development of valid instruments able to measure the current health status of the FM patients. The Fibromyalgia Impact Questionnaire (FIQ) is the most widely used of these instruments. Our objective was to translate the Fibromyalgia Impact Questionnaire (FIQ) into Finnish and evaluate its validity in Finnish speaking FM patients. Methods FIQ was translated by two bilingual researchers into the Finnish version (Finn-FIQ) and linked to the categories of International Classification of Functioning, Disability and Health (ICF). Finn-FIQ was administered to 162 patients who had prior fibromyalgia diagnoses M79.0 according to ICD-10 year 2006 version. They also filled in the Health Assessment Questionnaire (HAQ), the Rand 36-item Health Survey (RAND-36), the Beck Depression Inventory IA (BDIIA), the Chronic Pain Acceptance Questionnaire (CPAQ), the International Physical Activity Questionnaire Short Form (IPAQ), and they assessed their general well-being on a 0-100 mm visual analogue scale while attending a clinical check-up visit. Internal consistency was estimated according to Cronbach's alpha internal consistency. An exploratory factor analysis was performed to identify related items and to show construct validity. Correlation coefficients were calculated by the Spearman method. Results From the 162 participants 153 were female and 9 male, 119 (73%) had an active job or were students, 21 (13%) were unemployed, 16 (10%) were retired and 6 (4%) were on sick leave. The mean age was 47 years. The internal consistency value (95% CI) was 0.90 for the overall Finn-FIQ. The factor analysis performed for construct analysis showed that Finn-FIQ was loaded on 4 factors. These factors were loaded on components of ICF and explained 69% of total variance. Significant correlations were obtained between patients own assessments of general well-being and Finn-FIQ total score (r = 0.64 [95% CI 0.53-0.73]) and also between Finn-FIQ total score and HAQ total score (r = 0.56 [95% CI 0.44-0.66]). Finn-FIQ questions had significant correlations with RAND-36 domains. Conclusion Finn-FIQ is a valid and feasible instrument to mirror the functioning of FM patients according to its internal consistency, correlation to general well-being, convergent validity and response rate. It covers the main components of the ICF framework hence reflecting the whole spectrum of functioning. Implications In our study Finn-FIQ was proven as a valid instrument with Finnish speaking FM patients. Original FIQ and other validated translations have already confirmed their place in fibromyalgia research. After this study Finnish fibromyalgia research can be included in those using the best-known instrument in validated form and native language. Current study showed also Finn-FIQ's ability to measure functioning of the FM patients, and it had good applicability among Finnish speaking patients. Therefore it can be recommended also for monitoring individual FM patients and their functioning for example during different treatment trials.
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Affiliation(s)
- Jarno Gauffin
- ORTON Rehabilitation Centre, Tenholantie 10, 00280 Helsinki, Finland
| | - Tiina Hankama
- Department of Medicine, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Hannu Kautiainen
- Unit of Family Practice, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.,Unit of Primary Health Care, Kuopio University Hospital, P.O. Box 1777, FI 70211 Kuopio, Finland
| | - Marja Arkela-Kautiainen
- Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Pekka Hannonen
- Department of Medicine, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Maija Haanpää
- ORTON Rehabilitation Centre, Tenholantie 10, 00280 Helsinki, Finland.,Etera Mutual Pension Insurance Company, Palkkatilanportti 1, 00240 Helsinki, Finland
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Mustila A, Korpela M, Haapala AM, Kautiainen H, Laasonen L, Möttönen T, Leirisalo-Repo M, Ilonen J, Järvenpää S, Luukkainen R, Hannonen P. Anti-citrullinated peptide antibodies and the progression of radiographic joint erosions in patients with early rheumatoid arthritis treated with FIN-RACo combination and single disease-modifying antirheumatic drug strategies. Clin Exp Rheumatol 2011; 29:500-505. [PMID: 21640044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 02/03/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate the impact of antibodies to cyclic citrullinated peptide (ACPAs) on radiographic progression in patients with early rheumatoid arthritis (RA) initially treated either with a combination of 3 disease-modifying antirheumatic drugs (DMARDs) or with a single DMARD. METHODS This study included 129 patients with early active RA initially randomised to treatment either with a combination of methotrexate, sulfasalazine, hydroxychloroquine, and prednisolone (FIN-RACo) (n=69) or with a single DMARD (initially sulfalasalazine) with or without prednisolone (SINGLE) (n=60). After 2 years, the use of DMARDs and prednisolone became unrestricted. Radiographic progression in hands and feet was assessed at baseline and at 1, 2, 3, 4 and 5 years. ACPAs at baseline were determined with enzyme immunoassay. RESULTS ACPAs were positive in 92 (71%) patients. ACPA-positive vs. negative patients were more frequently rheumatoid factor (RF) positive (83% vs. 22%, p<0.001) and had an erosive disease (54% vs. 22%, p<0.001) at baseline. The presence of ACPA was associated with radiographic progression in FIN-RACo group even when the impact of RF was controlled; the radiographic progression was remarkably slower in ACPA-negative than in ACPA-positive cases (RF adjusted change over time between groups p=0.034). In the SINGLE group, the radiographic changes progressed parallel in ACPA-negative and positive patients. CONCLUSIONS Most ACPA-positive RA patients have joint erosions already at diagnosis. ACPA positivity in early RA was related to radiographic progression even in patients treated initially with the FIN-RACo regimen. The initial FIN-RACo therapy seems to slow down the progression of joint damage in ACPA-negative patients.
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Affiliation(s)
- A Mustila
- Centre for Laboratory Medicine, Pirkanmaa Hospital District, Tampere, Finland.
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Uutela T, Hannonen P, Kautiainen H, Hakala M, Häkkinen A. Sustained improvement of health-related quality of life in patients with early rheumatoid arthritis: a ten-year follow-up study. Clin Exp Rheumatol 2011; 29:65-71. [PMID: 21345294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 12/15/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To assess long-term impact of RA on the HR-QoL in a cohort of working-age patients with early disease treated by a multidisciplinary team including early and active use of disease-modifying anti-rheumatic drugs (DMARDs). METHODS Fifty-five consecutive patients with RA who were naïve to DMARDs and glucocorticoids were assessed at baseline and at 6 months, 1, 2, 5 and 10 years. HR-QoL, disease activity, function, and joint destruction of hands and feet were assessed by using the Nottingham Health Profile (NHP) instrument, the 28-joint based Disease Activity Score (DAS28), the Health Assessment Questionnaire (HAQ), and the Larsen scores, respectively. GEE (generalised estimation equations)-method was used to evaluate longitudinal relationships between the HR-QoL changes and other variables. RESULTS All NHP dimensions except social isolation improved significantly during the first six months and remained favourable up to 10 years. The most prominent improvements were seen in the dimensions for pain and emotional reaction (p<0.001). In longitudinal evaluation statistically significant associations (p<0.001) were found between the DAS28 and the NHP dimensions for pain, energy and emotional reaction, and between the HAQ and the NHP dimensions for pain, energy and mobility. The extent of joint damage had no statistically significant associations to the six dimensions of the NHP instrument. CONCLUSIONS Early improvements in HR-QoL carried over the ten-year follow-up in patients with recent-onset RA treated with a multidisciplinary strategy including early and active DMARD therapy. HR-QoL changes were longitudinally associated especially with disease activity and function.
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Affiliation(s)
- Toini Uutela
- Department of Medicine, Central Hospital of Lapland, Rovaniemi, Finland.
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Rantalaiho V, Korpela M, Laasonen L, Kautiainen H, Järvenpää S, Hannonen P, Leirisalo-Repo M, Blåfield H, Puolakka K, Karjalainen A, Möttönen T. Early combination disease-modifying antirheumatic drug therapy and tight disease control improve long-term radiologic outcome in patients with early rheumatoid arthritis: the 11-year results of the Finnish Rheumatoid Arthritis Combination Therapy trial. Arthritis Res Ther 2010; 12:R122. [PMID: 20576092 PMCID: PMC2911916 DOI: 10.1186/ar3060] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 02/18/2010] [Accepted: 06/24/2010] [Indexed: 12/18/2022] Open
Abstract
Introduction Early treatment of rheumatoid arthritis (RA) has been shown to retard the development of joint damage for a period of up to 5 years. The aim of this study was to evaluate the radiologic progression beyond that time in patients with early RA initially treated with a combination of three disease-modifying antirheumatic drugs (DMARDs) or a single DMARD. Methods A cohort of 199 patients with early active RA were initially randomized to receive treatment with a combination of methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone (FIN-RACo), or treatment with a single DMARD (initially, sulfasalazine) with or without prednisolone (SINGLE). After 2 years, the drug-treatment strategy became unrestricted, but still targeted remission. The radiographs of hands and feet were analyzed by using the Larsen score at baseline, 2, 5, and 11 years, and the radiographs of large joints, at 11 years. Results Sixty-five patients in the FIN-RACo and 65 in the SINGLE group had radiographs of hands and feet available at baseline and at 11 years. The mean change from baseline to 11 years in Larsen score was 17 (95% CI, 12 to 26) in the FIN-RACo group and 27 (95% CI, 22 to 33) in the SINGLE group (P = 0.037). In total, 87% (95% CI, 74 to 94) and 72% (95% CI, 58 to 84) of the patients in the FIN-RACo and the SINGLE treatment arms, respectively, had no erosive changes in large joints at 11 years. Conclusions Targeting to remission with tight clinical controls results in low radiologic progression in most RA patients. Patients treated initially with a combination of DMARDs have less long-term radiologic damage than do those treated initially with DMARD monotherapy. Trial registration Current Controlled Trials ISRCTN18445519.
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Affiliation(s)
- Vappu Rantalaiho
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland.
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Valleala H, Korpela M, Möttönen T, Hienonen-Kempas T, Kauppi M, Hannonen P, Leirisalo-Repo M. Rituximab therapy in patients with rheumatoid arthritis refractory or with contraindication to anti-tumour necrosis factor drugs: real-life experience in Finnish patients. Scand J Rheumatol 2009; 38:323-7. [DOI: 10.1080/03009740902946355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Korpela M, Hakala M, Luukkainen R, Vuori K, Blåfield H, Leirisalo‐Repo M, for the FIN‐RACo Trial Group. Use of the Stanford Health Assessment Questionnaire in estimation of long‐term productivity costs in patients with recent‐onset rheumatoid arthritis. Scand J Rheumatol 2009; 38:96-103. [DOI: 10.1080/03009740902756515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hakala M, Risteli J, Åman S, Kautiainen H, Korpela M, Hannonen P, Leirisalo‐Repo M, Laasonen L, Paimela L, Möttönen T, for the FIN‐RACo Trial Group. Combination drug strategy in recent‐onset rheumatoid arthritis suppresses collagen I degradation and is associated with retardation of radiological progression. Scand J Rheumatol 2009; 37:90-3. [DOI: 10.1080/03009740701753689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Pohjolainen T, Korpela M, Vuori K, Ilva K, Yli-Kerttula U, Järvinen P, Leirisalo-Repo M. Cost of Finnish statutory inpatient rehabilitation and its impact on functional and work capacity of patients with early rheumatoid arthritis: experience from the FIN‐RACo trial. Scand J Rheumatol 2009; 36:270-7. [PMID: 17763204 DOI: 10.1080/03009740701286847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the cost of the statutory inpatient rehabilitation system in Finland and its impact on the functional and work capacity of patients with early rheumatoid arthritis (RA). METHODS In the Finnish Rheumatoid Arthritis Combination-Therapy trial (FIN-RACo), 195 patients with recent-onset RA, 162 of them available for the work force, were randomly assigned to two different drug treatment strategies for 2 years. Otherwise, the patients received routine multidisciplinary care and, if their functional or work capacity was endangered, were referred to inpatient rehabilitation. After a 5-year follow-up, data on rehabilitation, sick leave, and RA-related disability pensions were obtained from official registers. RESULTS Of the 162 patients, 49 (30%) underwent inpatient rehabilitation at an average cost of EURO5400. The rehabilitated patients more often worked in white-collar jobs and had more pain and a worse Health Assessment Questionnaire (HAQ) score (1.0 vs. 0.78; p = 0.01) at baseline. Their HAQ scores remained higher throughout follow-up (p<0.001); no change appeared over inpatient periods [mean 0.01; 95% confidence interval (CI) -0.13 to 0.16]. No independent impact of rehabilitation on the HAQ score emerged in an adjusted generalized estimating equations (GEE) model (p = 0.55). Nor did any improvement in work capacity appear: average lost productivity (human capital approach) per patient-year was EURO10 155 (95% CI 6994-14 196) before and EUR 12 839 (95% CI 8589-19 139) after the start of rehabilitation. CONCLUSION For patients with recent-onset RA, the Finnish statutory inpatient rehabilitation system had no positive impact on either functional or work capacity during the first few years, despite its considerable cost.
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Affiliation(s)
- K Puolakka
- Department of Medicine, Lappeenranta Central Hospital, Lappeenranta, Finland.
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Rantalaiho V, Korpela M, Hannonen P, Kautiainen H, Järvenpää S, Leirisalo-Repo M, Hakala M, Puolakka K, Julkunen H, Luosujärvi R, Möttönen T. The good initial response to therapy with a combination of traditional disease-modifying antirheumatic drugs is sustained over time: the eleven-year results of the Finnish rheumatoid arthritis combination therapy trial. ACTA ACUST UNITED AC 2009; 60:1222-31. [PMID: 19404945 DOI: 10.1002/art.24447] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the evolution of functional and clinical outcomes over 11 years in patients with early rheumatoid arthritis (RA) initially treated with a combination of 3 disease-modifying antirheumatic drugs (DMARDs) or with a single DMARD. METHODS A cohort of 199 patients with early active RA were initially randomized to receive treatment with a combination of methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone or treatment with a single DMARD (initially, sulfasalazine) with or without prednisolone. After 2 years, the drug treatment strategy became unrestricted, but still targeted remission. At 11 years, function was assessed with the Health Assessment Questionnaire (HAQ), and clinical outcomes were assessed with the modified Minimal Disease Activity (MDA) measure and the American College of Rheumatology (ACR) criteria for remission. RESULTS At 11 years, 138 patients were assessed (68 in the combination-DMARD group and 70 in the single-DMARD group). The mean+/-SD HAQ scores were 0.34+/-0.54 in the combination-DMARD group and 0.38+/-0.58 in the single-DMARD group (P=0.88). Modified MDA was achieved by 63% (95% confidence interval [95% CI] 51, 77) and by 43% (95% CI 32, 55) (P=0.016) of the combination-DMARD group and the single-DMARD group, respectively, and ACR remission by 37% (95% CI 26, 49) and by 19% (95% CI 11, 29) (P=0.017), respectively. CONCLUSION Initial therapy with a combination of DMARDs in early RA results in higher rates of patients achieving modified MDA and strict ACR remission even over the long term than initial single-DMARD therapy. Targeting remission with tight clinical controls results in good functional and clinical outcomes in most RA patients.
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Affiliation(s)
- Vappu Rantalaiho
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland.
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Puolakka K, Kautiainen H, Möttönen T, Hannonen P, Korpela M, Hakala M, Viikari-Juntura E, Solovieva S, Arkela-Kautiainen M, Leirisalo-Repo M. A mismatch between self-reported physical work load and the HAQ: early identification of rheumatoid arthritis patients at risk for loss of work productivity. Clin Exp Rheumatol 2009; 27:422-429. [PMID: 19604434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To explore the combination of data on functioning and work load for early identification of patients at risk for diminished work productivity in rheumatoid arthritis (RA). PATIENTS AND METHODS In the FIN-RACo trial, 162 patients with recent onset RA and available for the workforce were treated with either a combination of disease-modifying antirheumatic drugs (DMARDs) or a single DMARD for 2 years. Otherwise, they received routine care and were followed up for 5 years. Data on their individual income and lost work days came from official registers. Loss of productivity was computed by the human capital approach. Self-reported data on physical work demand (Finnish Institute for Occupational Health Questionnaire) at baseline and on functioning (HAQ) at 6 months were linked according to the International Classification of Functioning, Disability and Health. RESULTS Data on 112 patients were analyzable at 6 months; 35 (31%) of them had diminished capacity in functions required at paid work. Any mismatch between perceived abilities and requirements predicted future (7 through 60 months) loss of productivity - on average Euro 14,040 (95% confidence interval (CI): 9,143-20,511) per year in patients with the mismatch compared to Euro 3,043 (1,623-5,534) in those without any mismatch - and was associated with RA-related permanent work disability (hazard ratio: 11.6; 95%CI: 4.0-33.4). CONCLUSION Linking together self-reported data about functioning and work load helps in early identification of the RA patients at risk for loss of working days.
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Affiliation(s)
- K Puolakka
- Department of Medicine, Lappeenranta Central Hospital, FI-53130 Lappeenranta, Finland.
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