Assessment Of Rheumatoid Arthritis Patients Research Articles

Assessment of rheumatoid arthritis patients' knowledge about foot problems related to their illness and foot care practice.

Foot problems are very common in rheumatoid arthritis (RA). Podiatric intervention through therapeutic education of RA patients on the different potential foot problems could improve patients' knowledge and management of their foot problems. This study aimed to evaluate the knowledge of RA patients on podiatric problems related to their illness and foot care practices. This was a cross-sectional study including patients diagnosed with RA and aged older than 18years. Sociodemographic data, disease characteristics, and therapeutic data were collected. RA foot problems knowledge and foot care practice were assessed using a questionnaire combining questions developed from the literature search and a pretested validated questionnaire. Overall, 103 patients were included of whom 94 were female. The mean age was 56years (±10years) and the mean disease duration was 15years (±10years). Over 77% of patients reported never having received foot-health-related education. With regard to their knowledge about RA foot involvement, patients were aware that RA can affect the feet similarly to the hands (83%), lead to deformation of the foot (86%), lead to walking difficulties and falling (68%), and produce skin lesions of the foot (31%). Regarding participant's knowledge of appropriate footwear, 65% agreed that it would be beneficial to wear quality standard sports shoes. However, less than one-third of patients know the podiatrist's skills. Our study showed an awareness of the repercussions of RA on feet but a lack of knowledge on proper foot care, thus identifying a need for foot health therapeutic education.

The Sustained Physical Activity Role in Overcoming Fatigue in Patients with Rheumatoid Arthritis

Lack of knowledge about the causes of fatigue often leads to ignoring this symptom in rheumatoid arthritis (RA). The severity of fatigue in patients with RA can be significantly reduced by actively using non-pharmacological treatment strategies. Aim. To evaluate the effectiveness of aerobic exercise (walking) to reduce fatigue in RA patients during long-term follow-up. Material and methods. The study involved 102 patients with RA (women 100%; average age 54.38 ± 11.3 years; disease duration 9.5[5;15] years; DAS28-ESR activity 2.85[2.32;3.06] points; fatigue on the VAS scale ≥50), who completed the stage of sanatorium treatment in full (21 days) and provided data on aerobic physical activity (steps quantity per day) and fatigue scores on the British Rheumatoid Arthritis Fatigue Scale – Numerical Rating Scale (BRAF-NRS V2). RA patients were divided into two groups according to their level of physical activity: group I (n=53) with a sedentary lifestyle (less than 5–6 thousand steps/day) and group II (n=49) with a recommended (mobile) lifestyle (more than 7–8 thousand steps/day). Assessment of RA patients’ adherence to physical activity was carried out 2 months after return from the sanatorium, and the dynamics of BRAF-NRS fatigue indexes were recorded. Results and discussion. Seventy-six people (74.5%) agreed to participate in the final survey: 32 patients from a group I and 44 patients from a group II. Commitment to daily aerobic activity (more than 5,000 steps per day) was maintained by 34% of participants in the group I and 59% in the group II (p=0.033). The majority of respondents (51.3%) decreased the physical activity level and significantly reduced the time for aerobic exercise after returning from the sanatorium, citing a lack of incentives and time. 47% of the group I patients (15/32) felt able to devote more attention to physical activity, but only 25% confirmed a strong belief that they would dedicate at least 30 minutes to aerobic exercise 5 times a week over the next three months. In the group II, 48% of patients (p=0.044) reported maintaining or even increasing the corresponding physical activity level, confirming the effectiveness of individual physical activity programs formed during the sanatorium treatment and then integrated into daily life. Two months after returning from the sanatorium, group II patients showed lower fatigue scores on all BRAF-NRS scales: NRS-severity (p=0.04), NRS-effect (p=0.005), and NRS-overcoming (p=0.034). The analysis of variance revealed a decrease in the level of fatigue in the medium term (up to 2 months) regardless of the level of physical activity of the patients, but in RA patients committed to an active lifestyle and regular aerobic physical activity (group II), the positive changes were most pronounced (p<0.001). Conclusion. The positive effect of aerobic exercise (walking) on reducing fatigue is significantly negated even in the med-term, if patients do not continue to lead an active lifestyle. After completion of the sanatorium stage of treatment (with selection of optimal dose and frequency of physical activity), RA patients should be further encouraged to do daily aerobic exercises and be supported to continue rehabilitation programs in the community in order to achieve a better effect in the long term.

Systemic inflammation response index (SIRI) as a novel biomarker in patients with rheumatoid arthritis: a multi-center retrospective study.

To evaluate the potential ability of systemic inflammation response index (SIRI) as a novel biomarker in patients with rheumatoid arthritis (RA) and explore the mechanisms. Patients fulfilling the 2010 ACR/EULAR classification criteria for RA were enrolled in this study. Demographic, clinical, and laboratory characteristics of all subjects were collected. Neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), and SIRI were calculated. Statistical analysis was performed, and P-values < 0.05 were considered statistically significant. One thousand four hundred ninety-nine RA patients from five hospitals were included, with 366 healthy volunteers served as controls. The NLR, MLR, PLR, and SIRI significantly increased in RA patients. Receiver operating characteristics (ROC) curve analysis showed SIRI, and NLR could distinguish RA from healthy controls. Correlation analysis and multiple linear regression analysis indicated that SIRI and PLR positively correlated with disease activity in RA. The NLR, MLR, and SIRI increased significantly in patients with RA-associated interstitial lung disease (ILD). There was a good accuracy of SIRI in differentiating RA-ILD from RA patients without ILD. SIRI was also found to be higher in RA patients with tumor and could differentiate them from RA patients without tumor. SIRI could be evaluated as a novel, non-invasive, and suitable biomarker for assisting in the diagnosis process and demonstrating the disease activity of RA, as well as predicting RA-ILD and tumor development of RA patients. Key Points • As a novel biomarker, systemic inflammation response index (SIRI) may assist in the diagnosis process and indicate the disease activity of RA patients • SIRI may predict the development of RA-associated interstitial lung disease (RA-ILD) and tumor in RA patients • SIRI is more satisfactory than other blood cells-based indexes in the assessment of RA patients.

Emerging Value of Platelet-to-Hemoglobin Ratio and Monocyte-to-Hemoglobin Ratio in Assessment of Rheumatoid Arthritis Patients

Abstract Background: Rheumatoid arthritis (RA) is chronic au-toimmune disease associated with systemic inflammation that affects mainly synovial joints. Inflammation is the main reason of tissue destruction, physical disability and excess of mortality in RA. There is a need to find accurate inexpensive valuable inflammatory markers to be helpful in early diagnosis, prompt treatment and strict follow-up of RA patients. Aim of Study: To assess platelet-to-hemoglobin ratio (PHR) and monocyte-to-hemoglobin ratio (MHR) in RA patients. In addition to evaluate their associations with clinical and laboratory markers of RA disease activity and severity. Patients and Methods: The study included 175 adult RA patients and 186 age and gender healthy individuals were enrolled as control group. Disease activity score (DAS28) and RA medical records-based index of severity (RARBIS) were assessed in RA patients. PHR and MHR were measured in patients and controls. Results: They were 154 females and 21 males RA patients with a mean age of 45.43±10.5 years and disease duration of 9.3±0.47 years. PHR and MHR were significantly higher in patients (27.04±9.52, 0.03±0.02) than controls (21.58±5.6, 0.02±0.01) respectively, (p < 0.001). PHR and MHR had diag-nostic ability to discriminate RA patients from controls with sensitivity of 75%, 73.94% respectively and specificity of 53.23% in both. PHR had significant positive correlations with DAS28 (r=0.25, p=0.003), RARBIS (r=0.20, p=0.041), erythrocyte sedimentation rate (ESR) (r=0.41, p < 0.001), C-reactive protein (CRP) (r=0.4, p < 0.001) and anti-cyclic cit-rullinated peptide antibodies (anti-CCP abs) (r=0.3, p=0.001). MHR was only correlated with CRP (r=0.24, p=0.002). Mul-tivariate linear regression for the increase in PHR among RA patients revealed that ESR (b=0.100; p < 0.001, CI=0.05-0.145) and CRP (b=0.091; p=0.004, CI=0.02-0.152) were significant predictors. Conclusion: PHR and MHR were significantly increased in RA patients than controls. In addition, PHR and to lesser extent MHR were associated with RA disease activity and severity clinical as well as laboratory markers. This means they may serve as novel, inexpensive and easily obtainable inflammatory RA markers helping in evaluation and monitoring of RA patients disease activity and severity.

The impact of cardiorespiratory fitness on classical cardiovascular disease risk factors in rheumatoid arthritis: a cross-sectional and longitudinal study

Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Advanced measures of cardiorespiratory fitness (CRF) are associated with CVD risk factors. The present study aimed to examine whether CVD risk factors can predict clinic-based measures of CRF, using the Siconolfi step test and to determine if exercise can improve RA patients’ cardiovascular health. Sixty-five RA patients (46 females, age 58 ± 11 years) completed assessments of CRF, CVD risk factors, body composition and RA characteristics. Ten patients participated in a follow-up 8-week exercise intervention. CRF was low (22 ml kg−1 min−1) and associated with higher diastolic blood pressure (r = − 0.37, p = 0.002), higher global CVD risk (r = − 0.267, p = 0.031) and worse body composition profile (body fat, r = − 0.48, p < 0.001; waist, r = − 0.65, p < 0.001; hip, r = − 0.58, p < 0.001). Regular exercise significantly improved CRF (p = 0.021), lower body strength (p < 0.001), agility (p < 0.001), systolic blood pressure (p = 0.021), body fat (p = 0.018), waist circumference (p = 0.035), hip circumference (p = 0.016), disease activity (p = 0.002), disability (p = 0.007) and QoL (p = 0.004). Elevated diastolic blood pressure and worse body composition profile are strong predictors of clinic-based measures of CRF. CRF is an important determinant of CVD risk and warrants inclusion in the routine assessment of RA patients. Regular exercise can improve CRF and CVD risk factors without any exacerbation of disease activity and should be offered as part of routine care.

Role of physical activity in the management and assessment of rheumatoid arthritis patients

ObjectivesRheumatoid arthritis (RA) is a chronic inflammatory disease affecting diarthrodial joints, in which patients tend to perform less physical activity (PA) than recommended. This review focuses on the existing evidence about the relationship of PA and RA, specifically how the former influences joint inflammation, disability, quality of life and pain in RA patients, and also how disease activity potentially impacts PA in these patients. MethodsA literature search of EMBASE and MEDLINE databases from January 2000 to January 2015. ResultsThe evidence indicating that PA in RA patients is safe and the benefits from regularly performing, both aerobic and resistance exercises, in these patients include improvement in: quality of life, functionality, pain and number of swollen joints. Interestingly, recent studies suggest that changes in disease activity in RA patients inversely correlate with variations in PA, as assessed by accelerometry. ConclusionsThe regular monitoring of PA in RA patients might facilitate a more objective evaluation of variations in disease activity, helping physicians to make general and therapeutic recommendations that will improve both the health status and the joint functionality of these patients.

Relationship between clinical evaluation and ultrasound assessment of rheumatoid arthritis patients using a 12 joint score

To identify if the use of a systematic ultrasound (US) evaluation has relevance in the determination of disease activity in rheumatoid arthritis patients on biological disease-modifying anti-rheumatic drug treatment. A 12 joint US assessment was performed on the same day of the routine clinical examination. Both Grey-scale (GS) and Power Doppler (PD) were graded semi-quantitatively (0-3 scale). Forty-one patients were included. GS or PD > 0 were found in 24% and 3% of the ankles, 21% and 17% of the wrists, 19% and 9% of the second metacarpophalangeal joints (MCP), 7% and 2% of the third MCP, 6% and 0% of the knees and 5% and 0% of the elbows, respectively; tenosynovitis of the tibialis posterior was found in 19% of the ankles. Eight of the patients with Disease Activity Score of 28 joints (DAS28) ≤ 2.6 (n = 15) had an US score of 0. Twenty-seven joints (6.7%) had US evidence of synovitis but were not considered to be swollen; 10 (2.5%) were considered to be swollen but had no US evidence of synovitis. Using a 12 joint US assessment, a high proportion of patients with DAS28 < 2.6 were found to have inflammatory US activity, and a significant proportion of patients had evidence of tenosynovitis of the tibialis posterior, which may be difficult to clinically detect. A regular and standardized US assessment of RA patients is therefore warranted to complement clinical evaluation and better define disease activity.

Role of physical activity in the management and assessment of rheumatoid arthritis patients

ObjectivesRheumatoid arthritis (RA) is a chronic inflammatory disease affecting diarthrodial joints, in which patients tend to perform less physical activity (PA) than recommended. This review focuses on the existing evidence about the relationship of PA and RA, specifically how the former influences joint inflammation, disability, quality of life and pain in RA patients, and also how disease activity potentially impacts PA in these patients. MethodsA literature search of EMBASE and MEDLINE databases from January 2000 to January 2015. ResultsThe evidence indicating that PA in RA patients is safe and the benefits from regularly performing, both aerobic and resistance exercises, in these patients include improvement in: quality of life, functionality, pain and number of swollen joints. Interestingly, recent studies suggest that changes in disease activity in RA patients inversely correlate with variations in PA, as assessed by accelerometry. ConclusionsThe regular monitoring of PA in RA patients might facilitate a more objective evaluation of variations in disease activity, helping physicians to make general and therapeutic recommendations that will improve both the health status and the joint functionality of these patients.

Assessment of Rheumatoid Arthritis Patients’ Adherence to Treatment

BackgroundReports on adherence among patients with rheumatoid arthritis (RA) in Egypt and the Middle East region are lacking. This study aimed to measure adherence to treatment among a sample of patients with RA at Ain Shams University Rheumatology outpatient clinic and to assess factors affecting it. MethodsA cross-sectional descriptive study was carried out at the rheumatology outpatient clinic on a sample of 140 patients with RA. An interview questionnaire was used to measure adherence using the 8-item Morisky’s scale, factors affecting adherence to treatment like patients satisfaction were assessed using the short form patient satisfaction questionnaire, also patients’ knowledge, beliefs and rate of prescription refilling were assessed. Disease Activity Score—28 was used as an objective method to assess RA disease activity. ResultsAccording to Morisky’s scale, 90.6% and 9.4% were classified as low and moderately adherent, respectively, none was classified as highly adherent to treatment. important barriers to adherence reported were fear of side effects, nonavailability of free drugs in hospital pharmacy and cost of medications. Younger patients (P=0.002) and those reporting greater general satisfaction (P=0.02) were more likely to be adherent. in addition, on-time refill rates of medication (P=0.001) and disease activity (P=0.02) were associated with higher adherence scores and thus further validated the results of the adherence questionnaire. ConclusionsHigher adherence was associated with more positive beliefs on medication, greater satisfaction with health care and less disease activity.

The soluble biomarker calprotectin (a S100 protein) is associated to ultrasonographic synovitis scores and is sensitive to change in patients with rheumatoid arthritis treated with adalimumab

IntroductionCalprotectin (MRP8/MRP14, S100A8/A9) is associated with disease activity in patients with rheumatoid arthritis (RA). Ultrasonography (US) is a reliable method for evaluation of synovitis (B-mode (BM) and power Doppler (PD)). The present objectives were to explore in RA patients the associations between calprotectin and a comprehensive US examination, as well as the responsiveness of calprotectin compared to other inflammatory markers during anti-TNF treatment.MethodsA total of 20 RA patients starting treatment with adalimumab were examined longitudinally by US (BM and PD (semi-quantitative scores 0 to 3) of 78 joints, 36 tendons/tendon groups and 2 bursae) and clinically at baseline and after 1, 3, 6 and 12 months. Associations between the US sum scores and the inflammatory markers calprotectin, serum amyloid A (SAA), CRP and ESR were explored by correlation and linear regression analyses, and the response to treatment was assessed by Standardized Response Mean (SRM).ResultsThe inflammatory markers, clinical examinations and US sum scores improved during treatment (P < 0.001). Of the inflammatory markers, calprotectin had the highest correlation coefficients with the total BM and PD sum scores (median (range) 0.59 (0.37 to 0.76) for BM and 0.56 (0.38 to 0.72) for PD). Even higher correlations were found between calprotectin and sum US scores of reduced number of joint counts. Calprotectin made a considerable contribution to total US sum scores in the linear regression analyses (P = 0.001 to 0.031) and among the inflammatory markers, calprotectin had the highest SRM (0.84 at one month).ConclusionsCalprotectin was associated with the sum scores from a comprehensive US assessment and was responsive to change during anti-TNF treatment. Thus, examination of this leukocyte protein could be of additional value in the assessment of RA patients on biologic treatment.

Ultrasound in Rheumatoid Arthritis

Ultrasound is a promising tool for assessment of rheumatoid arthritis patients. While acceptable ultrasound assessment was previously confined to large joints, high-frequency linear array transducers now allow high-resolution imaging of superficially located structures such as the joints of the hands and feet. Ultrasound has a particular advantage over magnetic resonance imaging in that an experienced observer can rapidly screen several joints for erosions in a relatively short time. Further data regarding important methodological and measurement issues must be obtained before ultrasound gains wider acceptance.

Ultrasonography in rheumatoid arthritis: a very promising method still needing more validation.

Through recent technological advances, ultrasonography allows high-resolution visualization of inflammatory and destructive changes in the small superficial joints of hands and feet, and ultrasonography is increasingly used by rheumatologists for assessment of rheumatoid arthritis patients. It is, therefore, highly relevant to consider the validity of ultrasonographic measures of rheumatoid joint inflammation and damage. Organized by type of validity, data on ultrasonography in rheumatoid arthritis are reviewed. Encouraging reports of high agreement of ultrasonographic findings between observers, with MRI and, in knee and hip joints, histopathologic assessments were recently published. New quantitative and semiquantitative evaluation methods have been suggested, and the first systematic follow-up studies suggest an ability of ultrasonography to monitor joint inflammation and damage. However, a number of essential issues are still largely unexplored, including interscanner variability, sensitivity to change, prognostic value, and value in the diagnosis of rheumatoid arthritis. Suggested areas of priority in research and development of ultrasonography in rheumatoid arthritis are outlined. Ultrasonography is a very promising method in the assessment of rheumatoid arthritis joints, but still needs more validation before it can take up its expected role on a scientific basis as an important tool for diagnosis, monitoring, and prognostication of patients with rheumatoid arthritis and suspected rheumatoid arthritis.

Valor pronóstico del índice de Sharp en la respuesta clínica y de laboratorio a un pulso intravenoso de metilprednisolona en pacientes con artritis reumatoídea

No reliable variables to predict clinical or laboratory response to treatment in patients with rheumatoid arthritis were available until recently. To asses the potential predictive value of the Sharp's modified radiographic joint damage index for the assessment of clinical and laboratory response to a methylprednisolone i.v. pulse. Twenty-two patients suffering from rheumatoid arthritis received a single i.v. pulse of 1 g of methylprednisolone. Hand X-rays were taken at baseline and blindly scored by two trained radiologists. Clinical and laboratory variables were assessed at baseline and at weekly intervals up to 30 days plus a 60 days final evaluation. Improvement was defined as a 50% amelioration in 4 variables. Assessment of radiographic scores had a high correlation between and within observers (intraclass correlation = 0.998). Sharp score did not reach statistical significance as global predictor for the inflammatory variable response to methylprednisolone. However, when the number of swollen joints was taken into account, patients with a low erosive score (Sharp < or = 50) had a more prolonged clinical response, than patients with higher erosive score (Sharp > 50) (Fisher test p = 0.023). It is of clinical importance to point out that among patients with high Sharp score there were also responders who reached a high level of improvement. A statistically significant correlation between the basal PCR serum titers and the radiographic score (p < 0.02) was observed. The number of swollen joints and other variables that consider joint structural changes should be considered for the assessment of rheumatoid arthritis patients.