Cohort Of Rheumatoid Arthritis Patients Research Articles

AB0230 Pre-methotrexate lung screening for interstitial lung disease – is a chest x-ray adequate?

BackgroundMethotrexate (MTX) is the most commonly used disease modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). Methotrexate pneumonitis (MP) is a potentially fatal hypersensitivity reaction with a...

SAT0481 Are TNF blocking agents associated with changes in work participation in patients with RA?

BackgroundBoth early and long-standing rheumatoid arthritis (RA) patients have a low prevalence of work participation, 60% and 40% respectively. Not only is this an economic loss for society, it is...

FRI0486-HPR Personal causation and spare time use in patients with rheumatoid arthritis and relationship with age and functionality

BackgroundPersonal causation is defined as motivation and desire to do daily life activities and it is affected by disease derived functional decline, psychological and social problems. Spare time utilization is...

FRI0065 Clinical factors associated with the progression of functional impairment in rheumatoid arthritis patients who maintained the remission criteria defined by the new acr/eular criteria

BackgroundRemission is considered a therapeutic target in the management of patients with rheumatoid arthritis (RA). In 2010, new remission criteria were proposed by ACR/EULAR to achieve better patient outcomes. We...

SAT0398 Diagnostic value of anti mutated citrullinated vimentin in comparison to anti-cyclic citrullinated peptide and anti-viral citrullinated peptide 2 antibodies in rheumatoid arthritis: A multicentric study by firma group

BackgroundIn recent years the diagnostic approach to rheumatoid arthritis (RA) significantly changed. Among new serological assays, an ELISA test detecting antibodies directed against recombinant mutated citrullinated vimentin (anti-MCV), a protein...

Hip score and disease activity correlation in patients with rheumatoid arthritis after total hip arthroplasty

The disease activity score including 28 joints (DAS28), the simplified disease activity index and the clinical disease activity index (CDAI) were developed in order to provide a quantifiable measure of rheumatoid arthritis (RA) activity. Although inflamed hip joints greatly impact activities of daily living (ADL) and walking ability, the hip joint was not included in the DAS28, SDAI or CDAI assessments. Although excellent clinical results have been reported for total hip arthroplasty (THA) in RA patients, correlations between disease activity and hip function in RA patients after THA remain unknown. We analysed the effect of RA disease activity on a hip function score in an observational cohort of RA patients after THA. Twenty-five registered RA patients who had undergone THA (33 joints) were included. Hip function was recorded and RA disease activity was measured on the same day. The mean age of the patients was 65.17 years. They were followed up for a mean of 5.24 years after surgery. The mean duration of disease following RA diagnosis for this patient group was 19.47 years. The Japanese Orthopaedic Association (JOA) hip score was used as a clinical outcome measure for hip dysfunction. RA disease activity and health-related quality of life were measured using the DAS28, SDAI, CDAI and the modified health assessment questionnaire (MHAQ). The mean JOA score for hip function was 80.48 at the final follow-up. The mean DAS28-ESR, DAS28-CRP, SDAI, CDAI and MHAQ measuring RA disease activity levels were 3.38, 2.65, 9.59, 8.63 and 0.44, respectively, at the final follow-up. There was a significant negative correlation between the JOA hip score and all disease activity assessments observed after THA (DAS-ESR [P = 0.0067], DAS-CRP [P = 0.0008]), SDAI [P = 0.0034], CDAI [P = 0.0003]) and MHAQ [P = 0.0002]). We found significant negative correlations between JOA hip scores and all disease activity assessments in RA patients treated with THA.

Matching by Propensity Score in Cohort Studies with Three Treatment Groups

Nonrandomized pharmacoepidemiology generally compares one medication with another. For many conditions, clinicians can benefit from comparing the safety and effectiveness of three or more appropriate treatment options. We sought to compare three treatment groups simultaneously by creating 1:1:1 propensity score-matched cohorts. We developed a technique that estimates generalized propensity scores and then creates 1:1:1 matched sets. We compared this methodology with two existing approaches-construction of matched cohorts through a common-referent group and a pairwise match for each possible contrast. In a simulation, we varied unmeasured confounding, presence of treatment effect heterogeneity, and the prevalence of treatments and compared each method's bias, variance, and mean squared error (MSE) of the treatment effect. We applied these techniques to a cohort of rheumatoid arthritis patients treated with nonselective nonsteroidal anti-inflammatory drugs, COX-2 selective inhibitors, or opioids. We performed 1000 simulation runs. In the base case, we observed an average bias of 0.4% (MSE × 100 = 0.2) in the three-way matching approach and an average bias of 0.3% (MSE × 100 = 0.2) with the pairwise technique. The techniques showed differing bias and MSE with increasing treatment effect heterogeneity and decreasing propensity score overlap. With highly unequal exposure prevalences, strong heterogeneity, and low overlap, we observed a bias of 6.5% (MSE × 100 = 10.8) in the three-way approach and 12.5% (MSE × 100 = 12.3) in the pairwise approach. The empirical study displayed better covariate balance using the pairwise approach. Point estimates were substantially similar. Our matching approach offers an effective way to study the safety and effectiveness of three treatment options. We recommend its use over the pairwise or common-referent approaches.

Safety of Abatacept Administered Intravenously in Treatment of Rheumatoid Arthritis: Integrated Analyses of up to 8 Years of Treatment from the Abatacept Clinical Trial Program

To assess the overall safety, including rare events, of intravenous (IV) abatacept treatment in rheumatoid arthritis (RA). Data from 8 clinical trials of IV abatacept in RA were pooled. Safety events were assessed during the short-term (duration ≤ 12 months) and cumulative (short-term plus longterm extensions) abatacept treatment periods. Incidence rates per 100 patient-years were calculated. Standardized incidence ratios (SIR) for hospitalized infections and malignancies were compared with external RA cohorts and, for malignancies, with the US general population. There were 3173 IV abatacept-treated patients with 2331 patient-years of exposure in the short-term periods, and 4149 IV abatacept-treated patients with 12,132 patient-years of exposure in the cumulative period. Incidence rates for serious infections were low and consistent over time (3.68 for abatacept vs 2.60 for placebo during the short-term, and 2.87 for abatacept during the cumulative period). Hospitalized infections were generally similar to external RA patient cohorts and were consistent over time. Incidence rates of malignancies were similar for abatacept- and placebo-treated patients during the short-term period (0.73 vs 0.59) and remained low during the abatacept cumulative period (0.73). SIR of some tissue-specific malignancies (e.g., colorectal and breast) in the cumulative period tended to be lower, while others (lymphoma and lung) tended to be higher, compared with the general population; however, incidence rates were comparable with RA cohorts. Autoimmune events were rare and infusion reactions uncommon. Longterm safety of IV abatacept was consistent with the short-term, with no unexpected events and low incidence rates of serious infections, malignancies, and autoimmune events.

Performance of Matrix‐Based Risk Models for Rapid Radiographic Progression in a Cohort of Patients With Established Rheumatoid Arthritis

Matrix-based risk models have been proposed as a tool to predict rapid radiographic progression (RRP) in rheumatoid arthritis (RA), but the experience with such models is limited. We tested the performance of 3 risk models for RRP in an observational cohort. Subjects from an observational RA cohort with hand radiographs and necessary predictor variables to be classified by the risk models were identified (n = 478). RRP was defined as a yearly change in the Sharp/van der Heijde score of ≥5 units. Patients were placed in the appropriate matrix categories, with a corresponding predicted risk of RRP. The mean predicted probability for cases and noncases, integrated discrimination improvement, Hosmer-Lemeshow statistics, and C statistics were calculated. The median age was 59 years (interquartile range [IQR] 50-66 years), the median disease duration was 12 years (IQR 4-23 years), the median swollen joint count was 6 (IQR 2-13), 84% were women, and 86% had erosions at baseline. Twelve percent of patients (32 of 271) treated with synthetic disease-modifying antirheumatic drugs (DMARDs) at baseline and 10% of patients (21 of 207) treated with biologic DMARDs experienced RRP. Most of the predictor variables had a skewed distribution in the population. All models had a suboptimal performance when applied to this cohort, with C statistics of 0.59 (model A), 0.65 (model B), and 0.57 (model C), and Hosmer-Lemeshow chi-square P values of 0.06 (model A), 0.005 (model B), and 0.05 (model C). Matrix risk models developed in clinical trials of patients with early RA had limited ability to predict RRP in this observational cohort of RA patients.

The 158VV Fcgamma receptor 3A genotype is associated with response to rituximab in rheumatoid arthritis: results of an Italian multicentre study

ObjectiveThe polymorphism 158V/F of Fc fragment of IgG (FCGR) type 3A may influence the response to rituximab (RTX) in rheumatoid arthritis (RA). We investigated the FCG3A polymorphism in a large...

Lack of correlation between IL-21 and type I IFN signature suggests different roads to pathogenesis in Rheumatoid Arthritis

Event Abstract Back to Event Lack of correlation between IL-21 and type I IFN signature suggests different roads to pathogenesis in Rheumatoid Arthritis Rachel Ettinger1*, Jodi Karnell1, Christopher A. Morehouse1, Ethan Grant1, Devon Taylor1, Mildred Wilson2, Raphaela Goldbach-Mansky2, Yihong Yao1, Ronald Herbst1 and Laura Carter1 1 MedImmune, LLC, Research, United States 2 NIH, NIAMS, United States IL-21 and IFNa are increased in several autoimmune syndromes including Rheumatoid Arthritis (RA). These cytokines have pleiotropic actions on cell types of lymphoid and non-lymphoid origin and both have been reported to induce plasma cell differentiation. In a cohort of RA patients (n=42), we tested if a correlation exists between IL-21 and type I IFN (IFN) and how these cytokines segregate with particular autoantibodies and immunologic mediators. In ~50% of the RA patients examined, IL-21 serum levels were elevated (up to ~500 pg/ml) vs. the majority of normal individuals under 20 pg/ml (n=30/31). Increased IL-21 was not part of general cytokine activation, as only 8/97 analytes measured associated significantly with increased IL-21 levels. Strikingly, a tight correlation existed between IL-21 levels and the presence of IgM Rheumatoid Factor (RF) p=0.0003 as well as to cyclic citrullinated peptide autoantibodies (CCP) p=0.0155, but not to anti-ss or -dsDNA Ab titers in which only 6/42 and 5/42, respectively of RA had titers. In this RA cohort, ~20% of the patients had a 4-gene IFN signature of whole blood. Importantly, there was no correlation between increased IL-21 levels and IFN signature score. IFN signature score was independent of RF or anti-CCP titers, but correlated to ssDNA autoantibody titers p=0.0367 and trended towards an association with anti-dsDNA autoantibody titers. These data suggest that while both IL-21 and IFN are believed to be involved in the pathogenesis of rheumatic disease, these pathways do not appear to intersect in RA patients, and may represent distinct targets for disease intervention. Keywords: IL-21, IFNa, rheumatoid arthritis (RA), dsDNA Ab, Autoantibody, CCP Ab Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Translational immunology and immune intervention Citation: Ettinger R, Karnell J, Morehouse CA, Grant E, Taylor D, Wilson M, Goldbach-Mansky R, Yao Y, Herbst R and Carter L (2013). Lack of correlation between IL-21 and type I IFN signature suggests different roads to pathogenesis in Rheumatoid Arthritis. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00653 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 12 Jun 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Rachel Ettinger, MedImmune, LLC, Research, Gaithersburg, MD, 20878, United States, ettingerc@medimmune.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Rachel Ettinger Jodi Karnell Christopher A Morehouse Ethan Grant Devon Taylor Mildred Wilson Raphaela Goldbach-Mansky Yihong Yao Ronald Herbst Laura Carter Google Rachel Ettinger Jodi Karnell Christopher A Morehouse Ethan Grant Devon Taylor Mildred Wilson Raphaela Goldbach-Mansky Yihong Yao Ronald Herbst Laura Carter Google Scholar Rachel Ettinger Jodi Karnell Christopher A Morehouse Ethan Grant Devon Taylor Mildred Wilson Raphaela Goldbach-Mansky Yihong Yao Ronald Herbst Laura Carter PubMed Rachel Ettinger Jodi Karnell Christopher A Morehouse Ethan Grant Devon Taylor Mildred Wilson Raphaela Goldbach-Mansky Yihong Yao Ronald Herbst Laura Carter Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Rheumatoid arthritis patients are not at increased risk for 30-day cardiovascular events, infections, or mortality after total joint arthroplasty.

IntroductionSerious infection, cardiovascular disease, and mortality are increased in rheumatoid arthritis (RA). Whether RA affects the risk for these complications after total joint arthroplasty (TJA) is unknown, we hypothesize that it does. We compared the occurrence of 30-day postoperative complications and mortality in a large cohort of RA and osteoarthritis (OA) patients undergoing hip or knee TJA.MethodsAnalyses included 7-year data from the Veterans Affairs Surgical Quality Improvement Program. The 30-day complications were compared by diagnosis by using logistic regression, and long-term mortality was examined by using Cox proportional hazards regression. All analyses were adjusted for age, sex, and clustering by surgical site. Additional covariates included sociodemographics, comorbidities, health behaviors, and operative risk factors.ResultsThe 34,524 patients (839 RA, 33,685 OA) underwent knee (65.9%) or hip TJA. Patients were 95.7% men with a mean (SD) age of 64.4 (10.7) years and had 3,764 deaths over a mean follow-up of 3.7 (2.3) years. Compared with OA patients, those with RA were significantly more likely to require a return to the operating room (odds ratio (OR), 1.45 (95% CI, 1.08 to 1.94), but had similar rates of 30-day postoperative infection, OR 1.02 (0.72 to 1.47), cardiovascular events, OR 0.69 (0.37 to 1.28), and mortality, OR 0.94 (0.38 to 2.33). RA was associated with a significantly higher long-term mortality; hazard ratio (HR), 1.22 (1.00 to 1.49).ConclusionIn this study of US veterans, RA patients were not at an increased risk for short-term mortality or other major complications after TJA, although they returned to the operating room more often and had increased long-term mortality.

Development and evaluation of a crosswalk between the SF-36 physical functioning scale and Health Assessment Questionnaire disability index in rheumatoid arthritis

BackgroundThe SF-36 physical functioning scale (PF-10) and the Health Assessment Questionnaire disability index (HAQ-DI) are the most frequently used instruments for measuring self-reported physical function in rheumatoid arthritis (RA). The objective of this study was to develop a crosswalk between scores on the PF-10 and HAQ-DI in RA.MethodsItem response theory (IRT) methods were used to co-calibrate both scales using data from 1791 RA patients. The appropriateness of a Rasch-based crosswalk was evaluated by comparing it with crosswalks based on a two-parameter and a multi-dimensional IRT model. The accuracy of the final crosswalk was cross-validated using baseline (n = 532) and 6-month follow-up (n = 276) data from an independent cohort of early RA patients.ResultsThe PF-10 and HAQ-DI adequately fit a unidimensional Rasch model. Both scales measured a wide range of functioning, although the HAQ-DI tended to better target lower levels of functioning. The Rasch-based crosswalk performed similarly to crosswalks based on the two-parameter and multidimensional IRT models. Agreement between predicted and observed scale scores in the cross-validation sample was acceptable for group-level comparisons. The longitudinal validity in discriminating between disease response states was similar between observed and predicted scores.ConclusionThe crosswalk developed in this study allows for converting scores from one scale to the other and can be used for group-level analyses in patients with RA.

Phenotypic signature of B cell subsets as a tool for the investigation of immunogenicity.

Event Abstract Back to Event Phenotypic signature of B cell subsets as a tool for the investigation of immunogenicity. William J. Sanderson1*, Elizabeth C. Jury1, Jessica Manson1 and Claudia Mauri1 1 University College London, United Kingdom It has recently become clear that different B cell subsets contribute both to the pathogenesis of immune related disorders, as well as to the maintenance of tolerance, and are therefore implicated in the development of autoimmunity. Patients with diseases such rheumatoid arthritis (RA) and systemic lupus erythematosus are characterised by an increase in pathogenic B cells (e.g. memory), and either a decrease or functional impairment of regulatory B cells (Bregs), the latter known to play an important role in the maintenance of immune tolerance via the production of interleukin-10. In humans, we and others have shown that B cells with suppressive capacity are enriched in the CD19+CD24hiCD38hi compartment. These cells are able to interrupt T cell-B cell positive feedback, suppress effector T cell proliferation, and induce the differentiation of regulatory T cells. Progress has been made with respect to their mechanisms of action, yet conclusive markers for the identification of a pure Breg population, distinct from those with pathogenic capacity, have not been found. Here we describe a new immunophenotyping platform, with which we can screen the differential expression of 242 cell-surface markers in parallel by flow cytometry. This technology has enabled us to generate a surface marker “signature” for different B cell subsets, and provided us with a phenotypic counterpart to gene array data. A major goal in the development of biopharmaceutical drugs is to predict which patients are likely to develop anti-drug antibodies (ADAs) – one of the principal drawbacks of biological therapies. We will implement our method to compare B cell subset signatures in a longitudinal cohort of RA patients treated with anti-TNFα, in order to identify predictive markers for those patients who will become ADA positive. Keywords: B cells, Immunogenicity, biomarkers, Flow Cytometry, Autoimmune Diseases, Immune Regulation Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Translational immunology and immune intervention Citation: Sanderson WJ, Jury EC, Manson J and Mauri C (2013). Phenotypic signature of B cell subsets as a tool for the investigation of immunogenicity.. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.01077 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Jun 2013; Published Online: 22 Aug 2013. * Correspondence: Mr. William J Sanderson, University College London, London, United Kingdom, william.sanderson.12@ucl.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers William J Sanderson Elizabeth C Jury Jessica Manson Claudia Mauri Google William J Sanderson Elizabeth C Jury Jessica Manson Claudia Mauri Google Scholar William J Sanderson Elizabeth C Jury Jessica Manson Claudia Mauri PubMed William J Sanderson Elizabeth C Jury Jessica Manson Claudia Mauri Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Asymptomatic Preclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease

Objective. Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA) and a significant cause of morbidity and mortality. The objective of this study was to define high-resolution chest CT (HRCT) and pulmonary function test (PFT) abnormalities capable of identifying asymptomatic, preclinical forms of RA-ILD that may represent precursors to more severe fibrotic lung disease. Methods. We analyzed chest HRCTs in consecutively enrolled RA patients and subsequently classified these individuals as RA-ILD or RA-no ILD based on the presence/absence of ground glass opacification, septal thickening, reticulation, traction bronchiectasis, and/or honeycombing. Coexisting PFT abnormalities (reductions in percent predicted FEV1, FVC, TLC, and/or DLCO) were also used to further characterize occult respiratory defects. Results. 61% (63/103) of RA patients were classified as RA-ILD based on HRCT and PFT abnormalities, while 39% (40/103) were designated as RA-no ILD. 57/63 RA-ILD patients lacked symptoms of significant dyspnea or cough at the time of HRCT and PFT assessment. Compared with RA-no ILD, RA-ILD patients were older and had longer disease duration, higher articular disease activity, and more significant PFT abnormalities. Conclusion. HRCT represents an effective tool to detect occult/asymptomatic ILD that is highly prevalent in our unselected, university-based cohort of RA patients.

Adherence with bisphosphonate therapy in US veterans with rheumatoid arthritis

Pharmacy Benefits Management program data for patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were linked with clinical data to determine bisphosphonate adherence and persistence among US veterans with rheumatoid arthritis (RA) and to determine factors associated with adherence. The primary outcome measures were the duration of bisphosphonate therapy and the medication possession ratio (MPR). Patients with an MPR <0.80 were classified as nonadherent. Potential covariates considered in the analysis included patient demographics, RA disease activity and severity parameters, and factors associated with osteoporosis risk. Associations of patient factors with duration of therapy and adherence were examined using multivariable regression modeling. Bisphosphonates were prescribed to 573 (41.5%) of 1,382 VARA subjects. The mean ± SD duration of therapy for bisphosphonates was 39.2 ± 31.4 months. A longer duration of therapy correlated with older age, more years of education, and dual x-ray absorptiometry testing. The mean ± SD MPR of VARA subjects for bisphosphonate therapy was 0.69 ± 0.28; 302 (52.7%) were nonadherent. In multivariate analyses, nonadherence with bisphosphonate therapy was associated with a longer duration of RA disease (odds ratio [OR] 1.02, 95% confidence interval [95% CI] 1.00-1.04) and duration of bisphosphonate therapy >32 months (OR 1.63, 95% CI 1.04-2.57). Whites were less likely to have a low MPR compared with nonwhites (OR 0.52, 95% CI 0.30-0.88). Nonadherence with bisphosphonates was common in this cohort of RA patients and was associated with nonwhite ethnicity, a longer duration of RA disease, and a greater duration of bisphosphonate therapy.

Significance of sex in achieving sustained remission in the consortium of rheumatology researchers of north america cohort of rheumatoid arthritis patients

To determine whether men with rheumatoid arthritis (RA) are more likely to achieve remission compared to women. RA patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) cohort between October 2001 and January 2010 were selected for the present analyses. Detailed clinical, demographic, and drug utilization data were available at enrollment (baseline) and at subsequent followup visits. We examined the influence of sex on the Clinical Disease Activity Index remission score (≤2.8) using sustained remission or point remission as the primary outcome measure in multivariate stepwise logistic regression models. We stratified the data by RA duration at baseline (≤2 years or >2 years) to investigate whether RA duration had differential effects on remission in men and women. A total of 10,299 RA patients (2,406 men and 7,893 women) were available for this study. In both early and established RA, women had more severe disease at baseline with worse disease activity measures, modified Health Assessment Questionnaire disability index score, pain on a visual analog scale, and depression. Women were also more likely to have been treated with disease-modifying antirheumatic drugs and anti-tumor necrosis factor therapy compared to men. In the regression models, male sex was associated with sustained remission in early RA (odds ratio [OR] 1.38, 95% confidence interval [95% CI] 1.07-1.78, P = 0.01), but not in established RA. However, for point remission, an inverse association was observed with male sex in established RA (OR 0.65, 95% CI 0.48-0.87, P = 0.005) and not in early RA. Within the large real-life CORRONA cohort of RA patients, men were more likely to achieve sustained remission compared to women in early RA, although not in established RA.

Association of vitamin D with cardiometabolic risk factors in rheumatoid arthritis

Individuals with rheumatoid arthritis (RA) are at a greater risk for cardiovascular disease (CVD). Vitamin D deficiency is a potential risk factor for CVD and metabolic syndrome. Since patients with RA have a high prevalence of vitamin D deficiency, we investigated the association of vitamin D levels with cardiometabolic risk factors in a cohort of RA patients with no prior history of CVD. Serum 25-hydroxyvitamin D (25[OH]D) levels were measured among RA patients enrolled in a cohort study of subclinical CVD. The cross-sectional associations of 25(OH)D levels with traditional CVD risk factors such as insulin resistance (IR; estimated using the homeostatic model assessment [HOMA]), adipokines, markers of systemic inflammation, and endothelial activation were explored, adjusting for pertinent sociodemographic, lifestyle, and RA characteristics. Among 179 RA patients, 73 (41%) had a 25(OH)D level <30 ng/ml. Only 23 patients (13%) had a 25(OH)D level ≥45 ng/ml. After adjusting for demographics and body mass index (BMI), 25(OH)D remained significantly associated with high-density lipoprotein (HDL) cholesterol and inversely associated with HOMA-IR, fibrinogen, E-selectin, and soluble intercellular adhesion molecule 1 (sICAM-1). Significant associations with HDL cholesterol, E-selectin, and sICAM-1 were maintained after adjusting for the Disease Activity Score in 28 joints (DAS28) and autoantibody status. These associations were similar between the groups subdivided by sex, ethnicity, BMI, DAS28 level, and autoantibody status. These data suggest that vitamin D deficiency is common in RA and may be independently associated with several cardiometabolic intermediates in this population.

Biomarkers of Good EULAR Response to the B Cell Depletion Therapy in All Seropositive Rheumatoid Arthritis Patients: Clues for the Pathogenesis

ObjectiveTo find out whether a high number of auto-antibodies can increase the probability of a “good-EULAR response” and to identify the possible biomarkers of response in seropositive rheumatoid arthritis (RA) patients undergoing the B cell depletion therapy (BCDT).Patients and MethodsOne hundred and thirty-eight patients with long standing RA (LSRA), 75% non or poorly responsive to one or more TNFα blockers, all seropositive for at least one autoantibody (AAB) (RF-IgM, RF-IgA, RF-IgG, anti-MCV, ACPA-IgG, ACPA-IgA, ACPA-IgM) received one full course of BCDT. The major outcomes (moderate or good-EULAR response) were assessed after 6 months of therapy. The IL6 and BAFF levels were also determined.ResultsAt a 6-month follow-up, 33 (23.9%) of the RA patients achieved a good EULAR response. Having up to 5-AABs positivity increased the chances for treatment response. After a logistic regression analysis, however, only 4 baseline factors arose as associated with a good-EULAR response: no steroid therapy (OR = 6.25), a lymphocyte count <1875/uL (OR = 10.74), a RF-IgG level >52.1 IU/ml (OR = 8.37) and BAFF levels <1011 pg/ml (OR = 7.38). When all the AABs, except for RF-IgM and ACPA-IgG, were left in the analysis, the two final predictors were no-steroid therapy and low lymphocyte count.DiscussionThe number of AABs increased the chances of being a “good-EULAR” responder. The only predictors, however, at the baseline of a good response in this seropositive cohort of RA patients were 2 simple variables – no steroids and lymphocyte count – and two laboratory assays – IgG-RF and BAFF.

Reliability study of tibialis posterior and selected leg muscle EMG and multi-segment foot kinematics in rheumatoid arthritis associated pes planovalgus

ObjectiveTo determine within- and between-day reliability characteristics of electromyographic (EMG) activity patterns of selected lower leg muscles and kinematic variables in patients with rheumatoid arthritis (RA) and pes planovalgus. MethodsFive patients with RA underwent gait analysis barefoot and shod on two occasions 1week apart. Fine-wire (tibialis posterior [TP]) and surface EMG for selected muscles and 3D kinematics using a multi-segmented foot model was undertaken barefoot and shod. Reliability of pre-determined variables including EMG activity patterns and inter-segment kinematics were analysed using coefficients of multiple correlation, intraclass correlation coefficients (ICC) and the standard error of the measurement (SEM). ResultsMuscle activation patterns within- and between-day ranged from fair-to-good to excellent in both conditions. Discrete temporal and amplitude variables were highly variable across all muscle groups in both conditions but particularly poor for TP and peroneus longus. SEMs ranged from 1% to 9% of stance and 4% to 27% of maximum voluntary contraction; in most cases the 95% confidence interval crossed zero. Excellent within-day reliability was found for the inter-segment kinematics in both conditions. Between-day reliability ranged from fair-to-good to excellent for kinematic variables and all ICCs were excellent; the SEM ranged from 0.60° to 1.99°. ConclusionMulti-segmented foot kinematics can be reliably measured in RA patients with pes planovalgus. Serial measurement of discrete variables for TP and other selected leg muscles via EMG is not supported from the findings in this cohort of RA patients. Caution should be exercised when EMG measurements are considered to study disease progression or intervention effects.