American Rheumatism Association Research Articles

Effect of knee osteoarthritis on the postoperative outcome of proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly: a retrospective analysis

BackgroundThe proximal femoral nail anti-rotation (PFNA) is a commonly used internal fixation system for intertrochanteric fractures (IFs) in older adults. Knee osteoarthritis (KOA) is a degenerative lower extremity disease that occurs most frequently in the elderly. Some patients have already had KOA before the IFs. However, whether KOA impacts the postoperative outcome of IFs has not been reported.ObjectiveThis study aimed to investigate the effect of KOA on the fracture side on the outcome after PFNA for IFs in the elderly.MethodsBetween January 2016 and November 2021, 297 elderly patients treated with PFNA for IFs were enrolled in this study. They were divided into two groups according to the American Rheumatism Association KOA clinical and radiographic criteria: the control group and the KOA group. Intraoperative bleeding, operative time, length of hospital stay, postoperative time out of bed, fracture healing time, postoperative complications, postoperative Harris hip function score, and Barthel ability to daily living Score were compared between the two groups. Follow-up was routinely scheduled at 1, 3, 6, and 12 months postoperatively.ResultsBased on the exclusion criteria, 254 patients who met the requirements were left to be included in this study, including the control group (n = 133) and the KOA group (n = 121). Patients were followed up for a mean of 17.5 months (12–24 months). There was no significant difference between the two groups in preoperative demographic data, intraoperative blood loss, operation time, and length of stay in the hospital. The control group was statistically significant compared to the KOA group in terms of postoperative time out of bed (17.8 ± 4.0 days vs. 19.1 ± 5.8 days), fracture healing time (13.7 ± 2.2 weeks vs. 14.6 ± 3.7 weeks), and postoperative complications (12.8 vs. 23.1%). The Harris hip function score and Barthel ability to daily living score were higher in the control group than in the KOA group at 1, 3, 6, and 12 months postoperatively (the control group: 63.8 ± 10.9, 71.8 ± 10.3, 81.5 ± 8.7, and 91.6 ± 6.3 vs. The KOA group 61.0 ± 10.4, 68.6 ± 9.1, 79.0 ± 9.2, and 88.5 ± 5.9).ConclusionsIn elderly patients with IFs combined with KOA of the fracture side treated with PFNA internal fixation, KOA increases the incidence of postoperative complications of the fracture, prolongs postoperative time out of bed and fracture healing, and reduces postoperative hip function and ability to daily living. Therefore, treating KOA on the fractured side needs to be considered when treating IFs in the elderly.

Efficacy and Safety of Muscle Rub Ointment in The Management of Arthritis and Certain Musculoskeletal Disorders

Traditional Indian medicine has long used Muscle Rub Ointment to treat rheumatoid arthritis (RA), but its safety and effectiveness have not been well studied. To bridge this gap, an extensive investigation was carried out to evaluate the efficacy and safety of a specially designed Muscle Rub Ointment for individuals with RA. Over a 7-year period, 290 RA patients received customized care from Ayurvedic doctors in accordance with established practices. The American Rheumatism Association criteria were used for monitoring every six weeks, and treatment regimens varied from one to six months. Based on statistical analysis (repeated measures t-test), 33 discharged patients' first-year data were the subject of the study. There were notable improvements even among the most severely disabled patients in a number of indicators, such as functional class, rheumatoid factor, grip strength, walking time, swollen joints, painful joints, joint count, and erythrocyte sedimentation rate. Despite the fact that some patients did not get regular follow-up, the data that was available indicated persistent gains after discharge, especially in grip strength. The results of this study highlight the potential benefits of using ancient Ayurvedic medicine to treat RA and highlight the need for further emphasizing the need for further controlled investigations into its efficacy.

Serum CHI3L1 as a biomarker of interstitial lung disease in rheumatoid arthritis.

Interstitial lung disease (ILD) is a relatively prevalent extra-articular manifestation of rheumatoid arthritis (RA) and contributes to significant morbidity and mortality. This study aimed to analyze the association between chitinase-3 like-protein-1(CHI3L1) and the presence of RA-ILD. A total of 239 RA patients fulfilling the American Rheumatism Association (ACR) 1987 revised criteria were enrolled and subclassified as RA-ILD and RA-nILD based on the results of high-resolution computed tomography scans (HRCT) of the chest. The disease activity of RA was assessed by Disease Activity Score for 28 joints (DAS28) and categorized as high, moderate, low, and remission. Chemiluminescence immunoassays were applied to determine the serum levels of CHI3L1. Univariate analysis was performed and the receiver operating characteristics (ROC) curves were plotted to evaluate the correlation between RA-ILD and CHI3L1. Among the eligible RA patients studied, 60 (25.1%) patients were diagnosed with RA-ILD. Compared with RA-nILD, RA patients with ILD had significantly higher median age (median [IQR], 68.00 [62.00-71.75] vs 53.00 [40.00-63.00], p<0.001) and a higher proportion of males (21 (35.0%) vs 30 (16.8%), p=0.003). Notably, differences in DAS28 scores between the two groups were not observed. The serum level of CHI3L1 was significantly higher in RA-ILD patients (median [IQR], 69.69 [44.51-128.66] ng/ml vs 32.19 [21.63-56.99] ng/ml, p<0.001). Furthermore, the areas under the curve (AUC) of CHI3L1 attained 0.74 (95% confidence interval [CI], 0.68-0.81, p<0.001) in terms of identifying patients with RA-ILD from those without ILD. Similar trends were seen across the spectrum of disease activity based on DAS28-ESR. Our findings of elevated serum CHI3L1 levels in RA-ILD patients suggest its possible role as a biomarker to detect RA-ILD noninvasively.

Prevalence and predictors of long-term remission in rheumatoid arthritis in real-world practice: a longitudinal study.

The aim of the present study was to provide real-world evidence for factors predicting long-term remission in a longitudinal study of rheumatoid arthritis (RA) patients. Long-term remission was defined by meeting American Rheumatism Association (ARA) criteria for remission and prednisolone dose ≤ 5mg/d for at least 5years. Patients in this cohort were treated by tight control strategy using step-up combination therapy with conventional synthetic DMARDs (csDMARDs), biologic DMARDs. The parameters associated with long-term remission were subjected to univariate analysis, and parameters with P-values of < 0.1 in univariate analysis were included in a multivariate regression analysis. One thousand two hundred and eighty-six RA subjects were considered for eligibility, and finally, 499 patients were included in the study. Median duration of follow-up was 108months. Long-term remission occurred in 157 (31.5%) patients. Median time to long-term remission was 8 (5, 41) months. Predictors of long-term remission were absence of flare during the course of disease, occurrence of sustained remission during 6months after starting therapy, age at the disease onset > 60, being anti-citrullinated protein antibodies (ACPA) negative, and Disease Activity Score-28 (DAS28) at cohort entry ≤ 5.1. In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. Absence of flare during the course of disease, occurrence of sustained remission during 6months after starting therapy, age at the disease onset > 60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission. Key Points • In real-world practice, long-term remission occurs in 31.5% of patients treated with a tight control strategy. • Median time to long-term remission was 8months. • Absence of flare during the course of disease, occurrence of sustained remission during 6months after starting therapy, age at the disease onset >60, being ACPA negative, and DAS28 at baseline ≤ 5.1 are independent predictors of long-term remission.

Fibromiyalji Sendromlu Kadın Hastaların Partnerlerinin Yaşam Kalitesi, Uyku Bozuklukları ve Psikolojik Durumları

Objectives:To investigate and compare scores of quality of life(QoL),sleep disturbances,and psychological status between the partners of female patients with fibromyalgia syndrome(FMS) and those of healthy controls. Materials and Methods:The study included partners of 100 female FMS patients under the 1990 criteria of the American Rheumatism Association(ACR) and partners of 100 female healthy controls.The partners of FMS patients and controls were investigated through Beck Depression Inventory(BDI),Beck Anxiety Inventory(BAI),Visual Analog Scale(VAS), Sensitive Point Number(SPN), Pittsburgh Sleep Quality Index(PSQI), and Short Form-36 (SF-36). Results:There was a statistically significant difference between partners of patients and controls concerning average scores of VAS, HNS, BDI, BAI, and PSQI (p

Functional outcomes of Tai Chi exercise prescription in women with knee osteoarthritis

Knee Osteoarthritis (KOA) is the most common type of knee joint injury and also a risk factor for multiple health consequences and is prevalent among older women. The updated clinical guidelines for KOA treatment by the American Rheumatism Association recommend Tai Chi exercise. However, a literature review outlined limitations in Tai Chi intervention implementations. This study aimed to address some of the gaps. This study selected thirty female patients to participate in Tai Chi exercises and undergo relevant tests. The subjects were randomly assigned to Tai Chi or education groups. Independent sample t-tests were conducted to compare the difference in health indicators between the two groups after the intervention. The difference-in-differences (DID) regression was performed to assess the difference in the health outcomes between the two groups at baseline and follow-up and the difference in the differences. After the completion of the intervention, the Tai Chi group reported significantly improved KOA symptoms, physical fitness, and health status indicators than the control group. Specifically, the group differences were significantly larger at the baseline than at the follow-up. Our findings provide compelling evidence of the effects of the innovative Tai Chi exercise prescription specifically designed for KOA patients. The empirical evidence on its effectiveness in alleviating KOA symptoms and improving the overall health of middle-aged and elderly women with KOA suggested that Tai Chi intervention exercise has huge prospects for integration in KOA rehabilitation therapy.

Regarding Arthroscopy: Can Orthopedists and Rheumatologists Be Friends?

Rheumatologists' interest in arthroscopy began before the 1980s, when many era practitioners began to take up the procedure in earnest. Some of the important players in pre-World War II explorations of arthroscopy were rheumatologists, and the father of modern arthroscopy Makei Watanabe counted many rheumatologists among his postwar students, who were publishing about arthroscopic insights into rheumatic conditions in the 1960s and 1970s. We chose to review this evolution to demonstrate the diverging interests of rheumatologists and orthopedists in arthroscopy and emphasize the chances for reconciliation and cooperation. Methods involve our personal recollection and review of the literature. Guidelines for the practice of arthroscopy were published by the American Rheumatism Association (now the American College of Rheumatology) 7 years before similar guidelines appeared from the Arthroscopy Association of North America. American rheumatologists ceased arthroscopy when controlled trials showed no effect in osteoarthritis beyond placebo and biologics for synovitis virtually eliminated situations in which synovectomy might be considered. The research potential of arthroscopy has been realized mainly by European rheumatologists, although the ultrasound-guided biopsy is supplanting arthroscopy as means to secure synovium for investigation, despite the advantages of the latter, such as the ability to obtain larger amounts of tissue, select tissue based on macroscopic appearance, sample multiple area in the same joint, and deliver the potentially therapeutic effect of washout. New miniscopes suitable for office use could restore some of the lagging interest in arthroscopy for investigation. Orthopedists have generally been resistant to rheumatologists doing arthroscopy but would not be sharing any turf with rheumatologists using the miniscope. We hope that we orthopedists and rheumatologists could be friends as we enter this new phase of arthroscopy as we use the technique for different purposes.

Frequency of Renal Involvement in Patients of Systemic Lupus Erythematosus

Objective: To determine the frequency of renal involvement in patients of systemic lupus erythematosus.&#x0D; Methodology: This descriptive study was conducted at Department of Medicine, Ghulam Muhammad Mahar Medical College Teaching Hospital Sukkur, Pakistan, during six months after the approval of synopsis from October 30, 2018 to April 29, 2019. All the SLE patients fulfilling the clinical and laboratory criteria of the American Rheumatism Association, aged between 18 to 40 years and of either gender, who visited above stated study setting were included. Well-versed written consent was obtained after explaining the risks, procedure, and benefits of this study. Proven cases of Systemic Lupus erythematosus were assessed for renal involvement indicated by proteinuria &gt;0.5 gm/24 hrs. or cellular casts (tubular, red, and granular cells) or serum creatinine &gt;1.3 mg/dl. The study data was recorded electronically using proforma.&#x0D; Results: Mean of patients’ age was 29.11±5.80 years. Mean ± SD of serum urea, serum creatinine, and serum albumin was 48.58±18.61, 1.28±0.43 and 3.44±0.42 mg/dL respectively. Mean of urine protein was 1448.88±1278.76 mg. Out of 95 patients, 37 were males and 58 were females. Renal involvement was noted in 34 (35.8%) patients.&#x0D; Conclusion: In conclusion, renal involvement is very prevalent in people with systemic lupus erythematosus. Systemic lupus erythematosus patients should get a kidney biopsy as early as clinical indications of nephritis appear in order to expedite treatment decisions and reduce the risk of irreparable kidney damage caused by inflammation.

English

BACKGROUND The prevalence of rheumatoid arthritis (RA) in India is 0.28% to 0.7%, 15-45% of patients with RA develop ocular manifestations. Ocular disabilities can be reduced with timely interference by an ophthalmologist. Keratoconjunctivitis sicca (Sjogren’s syndrome) is the most common ocular association of RA. This study was done to find out various ocular manifestations in rheumatoid arthritis patients. METHODS A cross sectional study was conducted among the patients attending the rheumatology clinic at Government Medical College, Trivandrum. Patients in the age group of 18-60 years were screened and further evaluated at regional institute of ophthalmology, Trivandrum. Screening for RA was done using the American Rheumatism Association criteria. A complete ophthalmic examination was done for those who satisfied the criteria. The various ocular manifestations in RA are described and presented as proportions. RESULTS Ocular manifestation was found in 38% of total patients attending the rheumatology clinic. There were 54 females (80.5%) and 13 males (19.4%). Age group mainly affected were in 46-50 yr (17.9%). The duration of rheumatoid arthritis ranged from few months to 25 years. Keratoconjunctivitis sicca was the commonest manifestation found, detected in 22(84%) patients, episcleritis was noted in two patients (7.6%), scleritis in 1 patient (3.8%) and marginal furrowing in 1 patient (3.8%). CONCLUSIONS In this clinic-based study there was a high proportion (38%) of ocular involvement in RA and hence it is essential to include ophthalmic evaluation as a routine in RA patients. The most common manifestation was keratoconjunctivitis sicca followed by episcleritis, diffuse anterior scleritis and marginal corneal furrowing. KEY WORDS Rheumatoid Arthritis, Keratoconjunctivitis Sicca, Ocular Manifestations, Scleritis, Episcleritis

English

BACKGROUND RA Factor positivity is one of the criteria for diagnosis of Rheumatoid arthritis. High levels of rheumatoid factor (generally above 20 IU/mL. 1:40 or over the 95th percentile) are indicative of Rheumatoid arthritis (present in 80 %). Rheumatoid Factor positivity is associated with more severe and more active disease and extraarticular disease. This study was done in Rheumatoid arthritis patients to assess the proportion of ocular manifestations in them and also an association between RF positivity and ocular manifestation and treatment-related ocular complications among Rheumatoid arthritis patients. METHODS A cross-sectional study was conducted among the patients attending the rheumatology clinic at Government Medical College, Trivandrum. Patients in the age group of 18-60 years who satisfied the American Rheumatism Association criteria were selected for the study and all of them underwent complete ophthalmic examination as well as RA Factor assessment by latex agglutination. The qualitative variables were expressed in proportion. The chi-square test was used to determine the association between qualitative variables. RESULTS A total of 67 RA patients were screened of which 26 (38.8 %) had ocular manifestations and among the total patients, 57 (85 %) were rheumatoid factor positive. Among the total patients with ocular manifestations, 24 (92 %) patients were rheumatoid factor positive. The association between RF positivity and ocular manifestation was found to be statistically not significant (P-value -0.33). In the present study, no other treatment-related ocular complications were seen except for one patient on long term steroids who had subcapsular cataract. CONCLUSIONS The presence of the RA factor does not show a positive association with the occurrence of ocular manifestation and the use of a low dose of methylprednisolone and DMARDs in RA has reduced the incidence of steroid-related complications. The more commonly used DMARDs -methotrexate, salazopyrin and hydroxychloroquine were found to be safe since no drug toxicity was noted in the present study. KEY WORDS RA Factor, Rheumatoid arthritis, Ocular Manifestation.

Epidemiology and Trends in Survival of Systemic Sclerosis in Olmsted County (1980-2018): A Population-based Study.

To update the epidemiology of systemic sclerosis (SSc) and evaluate the performance of the ACR/EULAR 2013 vs. 1980 ARA classification criteria in a U.S. population-based cohort. An inception cohort of patients with incident SSc from January 1, 1980, through December 31, 2018, in Olmsted County, Minnesota, was identified based on comprehensive individual medical record review. Incidence and prevalence rates were age- and sex-adjusted to the 2010 US white population. Survival rates were compared with expected rates in the general population. Fulfillment of 1980 and 2013 classification criteria was ascertained. A total of 85 incident cases of SSc (91% female, mean age 55.4 ± 16 y) and 49 prevalent cases on Jan 1, 2015 were identified. The overall age- and sex-adjusted annual incidence was 25 (95% CI 20-31) per million population, with no change in incidence over time. The age- and sex-adjusted prevalence was 436 (95% CI: 313-558) per 1,000,000 population. 77 (91%) patients fulfilled the 2013 classification criteria, and 38 (45%) fulfilled the 1980 criteria. Mortality among patients with SSc was significantly higher in comparison to the general population, with a standardized mortality ratio of 2.48 (95% CI:1.76-3.39) and no evidence of improvement over time. SSc developed in 25 persons/million/year with no change over the 39-year study period. The 2013 classification criteria perform significantly better than the 1980 criteria but failed to classify 9% of patients. SSc portends a 2.5-fold higher risk of mortality than the general population, with no evidence of improved survival over time.

Association between Malnutrition and Quality of Life in Elderly Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a progressive articular disease. In addition to damaging the joints, it may cause multiple organ complications, and considerably impair the patient’s functioning. Elderly patients with RA report pain, fatigue, mood disorders, sleep disorders and insomnia, accompanied by weakness, poor appetite, and weight loss. All these factors combined have an adverse effect on the patient’s perceived quality of life (QoL). Due to the chronic nature of RA and the high risk of malnutrition in this patient group, the present study investigated QoL, activities of daily living, and frailty syndrome severity in relation to MNA (Mini Nutritional Assessment) questionnaire scores among elderly RA patients. The study included 98 patients (aged over 60) diagnosed with RA per the ARA (American Rheumatism Association) criteria. The following standardized instruments were used: WHOQoL-BREF for QoL, the Edmonton Frail Scale for frailty syndrome severity, MNA for nutritional status assessment, and MMSE (Mini-Mental State Examination) to assess any cognitive impairment. Medical data were obtained from hospital records. Patients with a different nutritional status differed significantly in terms of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Higher levels of malnutrition were associated with greater limitations in activity. An adverse impact of lower body weight on cognitive function was also observed (dementia was identified in 33.33% of malnourished patients vs. 1.79% in patients with a normal body weight). Likewise, frailty was more common in malnourished patients (mild frailty syndrome in 33.3%, moderate in 16.67%, and severe in 16.67%). Malnourished patients had significantly lower QoL scores in all WHOQoL-BREF questionnaire domains than those with a normal body weight, and multiple-factor analysis for the impact of selected variables on QoL in each domain demonstrated that frailty was a significant independent determinant of poorer QoL in all domains: perceived quality of life (β = −0.069), perceived health (β = −0.172), physical domain (β = −0.425), psychological domain (β = −0.432), social domain (β = −0.415), environmental domain (β = −0.317). Malnutrition was a significant independent determinant of QoL in the “perceived health” domain (β = −0.08). In addition, regression analysis demonstrated the positive impact of male sex on QoL scores in the psychological (β = 1.414) and environmental domains (β = 1.123). Malnourished patients have a lower QoL than those with a normal body weight. Malnutrition adversely affects daily functioning, cognitive function, and the severity of frailty syndrome. Frailty syndrome is a significant independent determinant of poorer QoL in all WHOQoL BREF domains.

Pulmonary arterial hypertension associated with systemic lupus erythematosus

Pulmonary arterial hypertension (PAH) associated with connective tissue diseases is the most common cause of pulmonary hypertension. Systemic lupus Erythematosus (SLE) is characterized by the second highest prevalence of pulmonary arterial hypertension (PAH), after systemic sclerosis, among the connective tissue diseases. The prevalence of PAH in SLE is less than 4% when the PAH diagnosis is based on the gold standard, namely right heart catheterization. The aim of this study was to describe the clinical and biological presentation of PAH in SLE. The study population consisted of 238 Tunisian patients with SLE who fulfilled the revised criteria of the American Rheumatism Association and were admitted to the internal medicine and rheumatology department in Fattouma Bourguiba University Hospital between 2010 and 2020. All patients underwent Doppler echocardiography study. PAH was hemodynamically defined by increased systolic pulmonary artery pressure (SPAP) at rest ≥ 25 mmHg. Of the 238 patients, 12 women presented PAH (5%). Mean age were 38, 2 years. SPAP ranged from 25 to 36 mmHg. Two patients had associated systemic scleroses. Comparison of patients with and without PAH found out that patients with PAH had significantly higher frequency of Reynaud's phenomenon (41,7% VS 13,4%; P = 0.023) and serositis (50% VS 21%; P = 0.046). Immunological variables associated with PAH include anti-SSA ( P = 0.003), anti-SSB ( P = 0.023) and anticardiolipine antibodies IgM/IgG ( P = 0.029). No significant differences between the two groups regarding cardiac involvement, thrombosis, anti-DNA and anti-SM antibodies were found. On follow up, the PAH was associated with an increased risk of mortality (OR = 7, 23; 95% CI = 1.294–40.447). PAH is a rare complication of SLE. Other studies are needed to confirm whether the presence of PAH is a risk factor for mortality in SLE patients.

CLINICAL ASSESSMENT OF THE ROLE OF KANSA HARITAKI AND VIRECHANA IN THE MANAGEMENT OF AMAVATA

Amavata is a clinical condition described in Ayurveda that closely resembles with the clinical features of Rheumatoid Arthritis. A Clinical Study was conducted at IPGT and RA, Jamnagar in Kaya Chikitsa de-partment to evaluate the efficacy of Virechan Karma with Eranda Taila and Trivrita Kwatha in patients suffering from Amavata and compared with the trial drug Kansa Haritaki described in Charak Samhita. Efficacy of both of these was compared with the known common drug Trayodashanga Guggulu. In this study, 38 patients of Amavata were registered, of which 29 patients completed the course of the treatment and 9 patients discontinued before completion of course against medical advice. The disease was diag-nosed on the basis of signs and symptoms as described in Ayurvedic and Modern text, aided by American Rheumatism Association Criteria (1988). RA factor test was done in all the patients. The Routine Blood examination (CBC, ESR) with Serum Uric acid, Urine and Stool examination was done to rule out other pathological conditions.

A Three Year Retrospective Analysis Of Anti-Tnf Treatment Outcomes In Rheumatoid Arthritis And Ankylosing Spondylitis Patients

AbstractBackground/Aims:To investigate the effectiveness and reliability of anti-TNF treatment in Ankylosing Spondylitis-Rheumatoid arthritis patients.Methods:180 patients (110 Rheumatoid arthritis (RA) patients diagnosed according to 1987 American Rheumatism Association criteria, 70 Ankylosing Spondylitis (AS) patients diagnosed according to Modified NewYork Criteria) admitted to the hospital for arthritis and related compliants who were followed up and treated with anti-TNF treatment in the department of Rheumatology&amp;amp;Immunology from 2009 to 2011. We enrolled 100 patients with RA (76 women, 24 men) and 60 patients with AS (16 women, 44 men) to the study, excluded 20 patients according to the exclusion criterias. The response of the patients to the anti-TNF treatment was evaluated by comparing the clinical parameters BASDAI, DAS28 and VAS score; and laboratory measurements of erytrocyte sedimentation rate, C-reactive protein levels of rheumatoid arthritis and ankylosing spondylitis before and six months after the treatment.Results:After the six months of anti Tnf treatment, BASDAI score for AS, DAS28 score for RA, VAS, ESR and CRP levels for both diseases showed a statistically significant improvement, moreover it was determined that demographic variations did not affect these values.Conclusions: Our results demonstrated that anti-TNF treatment is safe and effective treatment modality in patients with Ankylosing Spondylitis and Rheumatoid arthritis. These findings are short-term results of a study, and therefore future studies with larger patient series and long term follow-up are needed to look at outcomes of long term therapies.

Cutaneous Manifestations of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic illness defined and classified according to strict criteria of the American Rheumatism Association. Cutaneous disease may complicate RA or the drugs used in its treatment. Cutaneous vasculitis is potentially a prognostic factor in patients with RA. Controversy exists regarding the role of corticosteroids in the development of rheumatoid vasculitis. Two illustrative cases of RA with cutaneous complications are presented and the joint and cutaneous manifestations are reviewed herein.

Subjective sleep disturbances at the time of diagnosis in patients with polymyalgia rheumatica and in patients with seronegative elderly-onset rheumatoid arthritis. A pilot study.

ObjectivesTo investigate subjective sleep disturbances in patients with recent-onset polymyalgia rheumatica (PMR) and in patients with recent-onset seronegative elderly-onset rheumatoid arthritis (SEORA).Material and methodsThe study involved patients consecutively referred to two outpatient clinics from January to June 2018, with a diagnosis of PMR according to 2012 European League Against Rheumatism and American College of Rheumatology provisional criteria, and patients with a diagnosis of SEORA according to 1987 American Rheumatism Association criteria + age + absence of rheumatoid factor and anti-citrullinated peptide antibodies. All patients were naive to glucocorticoid (GC) therapy. After informed consent, we asked the patients to fill out a questionnaire including the Medical Outcomes Study – Sleep Scale (MOS-SS), pain Visual Analogic Scale (VAS), Cumulative Illness Rating Scale (CIRS), Neuropsychiatric Inventory (NPI), and how many minutes their morning stiffness (MS) lasted, at baseline and after 1 (T1) and 12 (T2) months. Differences between groups were calculated with the t-test; all p-values were two-sided and p < 0.05 was used to determine statistical significance. The study was approved by the local ethics committee and carried out in accordance with the Helsinki Declaration.ResultsThe MOS-SS scores and MS duration were the only variables to show at T0 a significant difference between the two groups. In particular, MOS-SS scores were 47.6 ±8.4 (PMR) and 28.26 ±12.4 (SEORA), with p-values = 0.000. The MS duration was 90 ±9.9 minutes and 45 ±5.5 minutes, with p-value = 0.000. At T1 and T2, MOS-SS scores and MS duration decreased in the two groups, and no significant differences were found.ConclusionsThe study suggests that the assessment of subjective sleep disturbances can be useful in the differential diagnosis between recent-onset PMR and SEORA.

Mapping analysis to predict EQ-5D-5\u2009L utility values based on the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires in the Spanish population suffering from lower limb osteoarthritis

BackgroundThe EQ-5D-5 L is a quality-of-life questionnaire based on individuals’ preferences that is widely employed for cost-effectiveness analysis. Given the current demand for mapping algorithms to directly assign “utilities”, this study aimed to generate different mapping models for predicting EQ-5D-5 L utility values based on scores of the Oxford Hip Score (OHS) and Oxford Knee Score (OKS) questionnaires provided by patients suffering from hip and knee osteoarthritis (OA), respectively, and to assess the predictive capability of these functions.MethodsThis was a prospective, observational study. Following the criteria of the American Rheumatism Association, 361 patients with hip OA and 397 with knee OA from three regions in Spain were included. Health-related quality of life (HRQoL) was assessed through the EQ-5D-5 L general questionnaire and the OHS and OKS specifically for lower limb OA.Based on the scores on the OHS and OKS questionnaires, EQ-5D-5 L utilities were estimated using 4 models: ordinary least squares (OLS), Tobit, generalized linear model (GLM), and beta regression (Breg).The models were validated on the same patients after 6 months: the mean absolute error (MAE) and mean squared error (MSE) with their 95% confidence intervals (CI), mean values of standard errors (SE), intraclass correlation coefficients (ICC), and Bland-Altman plots were obtained.ResultsThe lowest MAEs were obtained using GLM and Breg models, with values of 0.1103 (0.0993–0.1214) and 0.1229 (0.1102–0.1335) for hip OA, and values of 0.1127 (0.1014–0.1239) and 0.1141 (0.1031–0.1251) for knee OA. MSE values were also lower using GLM and Breg. ICCs between predicted and observed values were around or over the 0.8 cut-off point. Bland-Altman plots showed an acceptable correlation, but precision was lower for subjects with worse HRQoL, which was also evident when comparing MAEs of the bottom and top halves of the utilities scale. Predictive equations for utilities based on OHS/OKS scores were proposed.ConclusionsThe OHS and OKS scores allow for estimating EQ-5D-5 L utility indexes for patients with hip and knee OA, respectively, with adequate validity and precision. GLM and Breg produce the best predictions. The predictive power of proposed equations is more consistent for subjects in better health condition.

A new laboratory surrogate (Monocyte Chemotactic Protein-1) for Disease Activity Score28: a favourable indicator for remission in rheumatoid arthritis

This prospective one-year follow-up study was conducted from 835 visits in 178 rheumatoid arthritis (RA) patients. Tender-/swollen-joint count, Health Assessment Questionnaire Disability Index (HAQ-DI), Disease Activity Score 28-ESR (DAS28-ESR), DAS28-CRP, Simplified Disease Activity Index (SDAI) and DAS28-monocyte chemotactic protein-1 (DAS28-MCP-1) scores were obtained every 3 months. Radiographs of hands and feet were acquired at baseline and one year. We evaluated the correlation and accuracy of activity scores in predicting remission, HAQ-DI changes and radiographic changes. DAS28-MCP-1 correlated strongly with DAS28-ESR, DAS28-CRP and SDAI scores (0.830, 0.899 and 0.931, respectively, with all P < 0.001). Score changes of DAS28-MCP-1 were comparable to those of DAS28-ESR, DAS28-CRP and SDAI in predicting changes in HAQ-DI and bone erosion. DAS28-MCP-1 (<2.2) was better than DAS28-ESR (<2.6) in indicating modified American Rheumatism Association remission and 2011 American College of Rheumatology/European League Against Rheumatism remission (75.61% vs. 36.99% and 81.71% vs. 49.13%, respectively) with odds ratios of 5.28 and 4.62 (both P < 0.001), respectively. We compared DAS28-MCP-1 with SDAI (≦3.3) in indicating remission with odds ratios of 2.63 (P = 0.002) and 0.98, respectively (and DAS28-MCP-1 with DAS28-CRP < 2.5: 1.33 and 0.92). Therefore, DAS28-MCP-1 is useful as an alternative in assessing RA activity.

CLINICAL CHARACTERISTICS OF THREE COHORTS OF PATIENTS WITH EARLY- AND LATE-ONSET RHEUMATOID ARTHRITIS (AT 50 YEARS OR OLDER). GENERALIZATION OF 40 YEARS’ EXPERIENCE

The paper presents three cohorts of patients with early rheumatoid arthritis (RA) who fell ill at 50 years or older and had a disease duration of 1.5 months to 1 year. To establish its diagnosis, the investigators used classification criteria for each cohort of its period: 1) the 1958 American Rheumatism Association (ARA) criteria; 2) the 1987 ARA criteria, and 3) the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. Along with a change in the criteria, diagnostic methods were improved in this period. Many qualitative laboratory parameters were replaced with their quantitative equivalent; new disease markers (including anti-cyclic citrullinated peptide antibodies) emerged; imaging methods were improved; treatment policies were changed, and targeted biological agents and numerous analogs of the original drugs appeared. Conflicting opinions about the course of RA in older age groups have repeatedly been published in the literature. In the period when the 1958 classification criteria were applied, the opinion that RA has a relatively favorable course was prevalent. Later on, when a more rigid approach to diagnosing RA was applied, there were more and more specialists who considered it to be a severe disease. In this study, the authors try to answer the question of whether the course of the disease changed in the older age groups at the earliest possible date after its onset, by comparing the three cohorts of patients. The findings are discussed.