Definite Rheumatoid Arthritis Research Articles

Acute onset of rheumatoid arthritis associated with administration of a dipeptidyl peptidase-4 (DPP-4) inhibitor to patients with diabetes mellitus

We describe the first case of a 63-year-old male patient with type 2 diabetes mellitus who was newly diagnosed with definitive rheumatoid arthritis (RA) 2 months after starting medication with a dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin. We subsequently performed a survey to determine if other such cases existed among patients who started taking sitagliptin at our university hospital and at hospitals in the Kashiwa and Noda districts. A survey of 147 patients treated with sitagliptin revealed an additional patient whose arthritis was also linked to the use of the DPP-4 inhibitor. This second patient had maintained her RA in a state of remission with diabetes for 15 years; however, 2 months after beginning sitagliptin therapy for control of diabetes, her arthritis relapsed as definitive RA. A recent study on patients with RA and on animals deficient in DPP-4 suggests that a decrease or absence of DPP-4 activity might be associated with cytokine-induced arthritis. On the other hand, a pooled analysis in the United States and a post-marketing monitoring in Japan have revealed that the occurrence of arthritis linked to pharmacologic inhibition of DPP-4 by sitagliptin is rare. Because DPP-4 might possibly be involved in the pathogenesis of RA, and the use of sitagliptin in our cases is linked to activation of RA, it is important to carefully follow patients treated with DPP-4 inhibitor to monitor for onset of RA, although the incidence rate of this adverse event is low.

2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative

ObjectiveThe 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticised for their lack of sensitivity in early disease. This...

2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative

The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA. A joint working group from the ACR and the European League Against Rheumatism developed, in 3 phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease--this being the appropriate current paradigm underlying the disease construct "rheumatoid arthritis." In the new criteria set, classification as "definite RA" is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0-5), serologic abnormality (score range 0-3), elevated acute-phase response (score range 0-1), and symptom duration (2 levels; range 0-1). This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct "rheumatoid arthritis."

Low‐dose aspirin in the primary prevention of rheumatoid arthritis: The women's health study

Low-dose aspirin may reduce the risk of developing rheumatoid arthritis (RA) through its effect on cyclooxygenase activity and its antioxidant pathways. Previous randomized trial data have demonstrated a beneficial effect of low-dose aspirin in reducing other inflammatory diseases, such as asthma and colorectal adenomas, but no trial has evaluated the role of aspirin in RA prevention. The Women's Health Study is a randomized, double-blind, placebo-controlled trial conducted between 1992 and 2004 designed to evaluate the risks and benefits of low-dose aspirin (100 mg every other day) and vitamin E in the primary prevention of cardiovascular disease and cancer among 39,876 female health care professionals age > or =45 years throughout the US. After excluding women with RA at baseline, 39,144 women were evaluated for the present study. A definite diagnosis of RA was assessed during followup by self-report and confirmed using a connective tissue disease screening questionnaire, followed by a medical record review by a rheumatologist for American College of Rheumatology criteria. During an average followup of 10 years, 106 women developed definite RA (48 women in the aspirin group and 58 in the placebo group). There was a nonsignificant risk for RA (relative risk [RR] 0.83, 95% confidence interval [95% CI] 0.56-1.21; P = 0.33) associated with aspirin. There were 64 seropositive RA cases (60%) and 42 seronegative RA cases (40%). Aspirin also had no significant effect on either seropositive RA (RR 1.0, 95% CI 0.61-1.63) or seronegative RA (RR 0.62, 95% CI 0.33-1.15). One hundred milligrams of aspirin taken every other day was not associated with a significant reduction in the risk of developing RA among women in a randomized, double-blind, placebo-controlled trial.

Features of diagnosis and treatment of anemic syndrome in patients with rheumatoid arthritis

Features of diagnostics and course of anemic syndrome in rheumatoid arthritis patients Objective. To study features of anemic syndrome in rheumatoid arthritis (RA) pts, to estimate influence of disease modifying anti – rheumatic drug therapy efficacy on the course of anemic syndrome. Material and methods. 62 pts with definite RA and level of hemoglobin less than 130g\l for men and less than 120g\l for women were examined. Research of hemoglobin, red cells count, mean corpuscular volume (MCV), mean concentration of hemoglobin (MCH), serum iron and ferritin was carried out. In a part of pts serum transferrin receptor and erythropoietin concentrations was defined. 30 pts were examined after 6 month of disease modifying therapy. Results. In 49(79 %) of the pts the anemia was an easy degree of weight, MCH decreased in 33(53 %) of the pts and 15(24 %) pts had decreased values for MCV. Deficiency of iron in 16(26%) of pts has been established at research of concentration a ferritin, sTfR and an index sTfR \log ferritin. At the dynamic research after 6 month of disease modifying therapy the authentic gain levels of hemoglobin, red cells count and serum iron significantly increased in the pts with good and satisfactory effect of therapy. Сonclusion. Definition of MCH, MCV and ferrokinetic data for assessment of iron defi- ciency in the RА pts is necessary. sTfR and sTfR\log ferritin may be study for pts with normal and increased ferritin levels. The major factor influencing on the course of anemia of chronic disease in the rheumatoid arthritis pts is the course rheumatoid arthritis, that efficacy disease modifying treatment to control.

Methylprednisolone pulse therapy induced fall in natural killer cell activity in rheumatoid arthritis.

Natural killer (NK) cell activity was studied in 8 patients with classic or definite rheumatoid arthritis (RA) by investigating the killing of K 562 cells by peripheral blood lymphocytes before, during, and after intravenous methylprednisolone pulse therapy (MPPT). MPPT produced a considerable fall in NK activity and after 3 months NK activity was less than half that before MPPT.

Sixty percent of patients with rheumatoid arthritis in Japan have used dietary supplements or health foods

We conducted a survey on the use of dietary supplements and health foods (DS/HF) in definite rheumatoid arthritis (RA) patients treated by RA specialists. Among 296 patients (male 48, female 248), 179 patients (60.5%) had experience of DS/HF use. Prevalence of DS/HF use was significantly higher in female than in male patients (63.7% versus 43.8%). Overall, patients who have used DS/HF were significantly younger than those who have not used; it was particularly notable in female patients. The proportion of current users was significantly higher in those less than 5 years from diagnosis than those who had been diagnosed for 5 years or more. Products of herbs or algae (44.1%) and components of cartilage (40.8%) were the most popular DS/HF. Primary sources of product information were family members or friends (56.4%) and advertisements in the mass media (34.1%). Of the users, 73.7% did not disclose DS/HF use to their physicians. The users expected alleviation of the symptoms (35.2%) and improvement of health (34.6%). However, 59.2% of the users were unsure of the benefits. In conclusion, physicians should be aware of the high prevalence of DS/HF usage in patients with RA in Japan.

Predicting the development of rheumatoid arthritis in patients with early undifferentiated arthritis

Diagnosis of rheumatoid arthritis (RA) at the beginning of the disease is a difficult task especially due to presence of a large group of pts with “undifferentiated arthritis” (UA) i.e. with inflammation of one or more joints which does not comply with a definite nosology. According to clinical experience UA is quite a serious condition which during a year transforms in definite RA in at least one third of pts. In 2007 Van der Helm-van Mil et al. proposed special criteria (“prediction rule”) allowing predicting transforming UA intoRA by counting prognostic index (PI). PI6 means low and PI8 - high probability of RA 37development during 1 year. Objective. To assess possibility of using prognostic criteria for determination of transforma- tion of UA into RA in Russian pts. Material and methods. 93 pts (84,9% - female) with early (disease duration no more than 12 months) UA were included. Mean age was 44,3±15,2 years, mean disease duration – 128,9±82,1 days (4,3±2,7 months). 59,1% of pts had olygoarthritis, 26,9% were rheumatoid factor seropositive, anti-cyclic citrullinated peptide antibodies (ACCP) were revealed in 29%. Examination with above mentioned methods to specify the diagnosis was performed trice during 12 months: at baseline, after 6 and 12 months. Results. During a year of follow up RA developed in 39(41,9%) pts. Mean value of PI was 5,18±2,48 (median 5,02 [3,01; 7,02]). PI values in pts with disease transformation into RA during a year were significantly higher (6,55±2,33) than in the rest of pts (4,18±2,1), p<0,0001. Analysis of discriminatory curve (ROC) was performed. Area under the curve statistics was 0,77 (SE 0,048, p=0,0001, 95% confidence intervals 0,68; 0,87). 64 (68,8%)pts had PI6, 17(18,3%) - PI≥8 and 12 (12,9%) – PI between 6 and 8. 17(26,6%) pts with PI≥6, 13 (76,5%) pts with PI≥8 and 9 (75%) pts with PI between 6 and 8 fulfilled criteria of RA in a year. Published data on European pts with UA cohorts analysis were compared with results of the present study. Conclusion. Using prognosis criteria for pts with UA in Russian pts gave satisfactory result. ROC analysis revealed PI level dividing transforming and not transforming into RA pts not around 8 as was demonstrated earlier but around 6. Differences between results of the present study and published data may be due to different factors including genetic features as well as clinical heterogeneity of pt groups from Western and Eastern Europe.

The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort

To compare rheumatologists' prescription for first disease modifying antirheumatic drug (DMARD) in early rheumatoid arthritis (RA) in real-life settings with 2 clinical practice guidelines (CPG), the French Society of Rheumatology/STPR 2004 and EULAR/ESCISIT 2007, and thus assess the gap between practices and guidelines. Method. ESPOIR was a French multicenter cohort study of 813 patients with early arthritis between 2002 and 2005. "Definite" and "probable" RA were defined according to ACR criteria and the level of diagnostic certainty. The objectives were to assess conformity between the observed first-line DMARD prescribed for those patients and the DMARD recommended in the guidelines; and to conduct a mail survey of patients' usual rheumatologists to investigate the reasons for their nonconformity with guidelines. In total 627 patients with definite or probable RA were identified. Conformity rates were 58% for STPR guidelines and 54% for EULAR guidelines. At 6 months, 83 (34%) patients with early RA did not receive any DMARD. Main determinants associated with conformity to guidelines were disease activity and presence of severity-predictive factors. The main reason leading to a discrepancy between guidelines and daily practice appeared to be diagnostic uncertainty, i.e., the difficulty to reliably assess RA diagnosis as early as the first visits to the rheumatologist. There is a substantial gap between CPG and rheumatologists' daily practice concerning the first DMARD to prescribe in early RA. This is explained mainly by diagnostic uncertainty. More attention should be paid in future guidelines to the diagnostic difficulties of early RA.

Sixty percent of patients with rheumatoid arthritis in Japan have used dietary supplements or health foods

We conducted a survey on the use of dietary supplements and health foods (DS/HF) in definite rheumatoid arthritis (RA) patients treated by RA specialists. Among 296 patients (male 48, female 248), 179 patients (60.5%) had experience of DS/HF use. Prevalence of DS/HF use was significantly higher in female than in male patients (63.7% versus 43.8%). Overall, patients who have used DS/HF were significantly younger than those who have not used; it was particularly notable in female patients. The proportion of current users was significantly higher in those less than 5 years from diagnosis than those who had been diagnosed for 5 years or more. Products of herbs or algae (44.1%) and components of cartilage (40.8%) were the most popular DS/HF. Primary sources of product information were family members or friends (56.4%) and advertisements in the mass media (34.1%). Of the users, 73.7% did not disclose DS/HF use to their physicians. The users expected alleviation of the symptoms (35.2%) and improvement of health (34.6%). However, 59.2% of the users were unsure of the benefits. In conclusion, physicians should be aware of the high prevalence of DS/HF usage in patients with RA in Japan.

Early inflammatory arthritis versus rheumatoid arthritis

Rheumatoid arthritis (RA) has started to be perceived as a potentially curable condition with early, aggressive use of disease-modifying antirheumatic drugs. We review the pathophysiological concepts of RA development, the technological advances used to estimate the individual risk of progression to RA, and the impact of antirheumatic therapy for patients presenting with early inflammatory arthritis. The finding of a strong gene-environment interaction has modified our concepts of RA pathogenesis and opened new opportunities for disease prevention and therapeutic interventions. Anticyclic citrullinated antibodies and prediction rules have improved our ability to estimate the risk of progression to RA in individual patients presenting with early inflammatory arthritis. In patients at high risk of developing RA, results from trials suggest that treating these patients with potent antirheumatic therapies may slow the progression from early inflammatory arthritis to definite RA and inhibit the progression of joint damage. Early inflammatory arthritis is a critical period of the disease, during which therapy may have a durable effect and change the natural course of the condition. Physicians need to assess the individual risk of progression to RA in patients presenting with early inflammatory arthritis and consider initiating early disease-modifying antirheumatic drug therapy in patients at high risk of developing RA.

Validation of the Russian version of the Quality of Life-Rheumatoid Arthritis Scale (QOL-RA Scale)

To translate the English version of the Quality of Life-Rheumatoid Arthritis Scale (QOL-RA Scale) into Russian, test the reliability and validity of the Russian version and compare the scaling assumptions, reliability, and validity of the English, Spanish and Russian versions. The development of a Russian version of the Quality of Life-Rheumatoid Arthritis Scale (QOL-RA Scale) involved translating the English version of the instrument into Russian, linguistic adaptation, 50 face-to-face interviews with outpatients with definite rheumatoid arthritis (RA) and testing the reliability and validity. The QOL-RA Scale, an 8-item scale, took about 3 minutes to administer. Psychometric analysis revealed that the psychometric attributes of English, Spanish and Russian questionnaires are satisfactory. The Russian version of the QOL-RA scale is a reliable and valid measure of RA-specific QOL.

Vitamin E in the primary prevention of rheumatoid arthritis: The women's health study

Vitamin E supplements may reduce the risk of developing rheumatoid arthritis (RA) through antioxidant effects. Although previous observational studies have investigated this question, no randomized trial data are available. The Women's Health Study is a randomized, double-blind, placebo-controlled trial designed to evaluate the benefits and risks of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer among 39,876 female health professionals age > or = 45 years throughout the US, conducted between 1992 and 2004. After excluding women with self-reported RA at baseline, 39,144 women were included in the present study. The primary end point, definite RA, was confirmed using a connective tissue disease screening questionnaire, followed by medical record review for American College of Rheumatology criteria. During an average followup of 10 years, 106 cases of definite RA occurred, 50 in the vitamin E group and 56 in the placebo group. Sixty-four (60%) RA cases were rheumatoid factor positive and 42 (40%) were rheumatoid factor negative. There was no significant association between vitamin E and risk of definite RA (relative risk [RR] 0.89, 95% confidence interval [95% CI] 0.61-1.31). There were also no significant risk reductions for either seropositive RA (RR 0.64, 95% CI 0.39-1.06) or seronegative RA (RR 1.47, 95% CI 0.79-2.72). Six hundred IU of vitamin E supplements taken every other day is not associated with a significant reduction in the risk of developing RA among women in a randomized, double-blind, placebo-controlled trial.

Erythrocyte Membrane Gold Levels After Treatment with Auranofin and Sodium Aurothiomalate

Triethylphosphine gold-2,3,4,6-tetra-o-acetyl-L-thio-D-glucopyranoside (auranofin and sodium aurothiomalate; Myocrisin are two chemically different gold compounds used to treat rheumatoid arthritis. This study highlights the interaction, in vivo, of these drugs with erythrocyte membrane in patients with rheumatoid arthritis. Fifty-eight patients with definite or classical rheumatoid arthritis were included in this study and randomly allocated to three groups as 18 patients in the Myocrisin group, 20 patients in the auranofin group, and 20 patients in the placebo group. The drugs appeared to react, in vivo, in different ways. With Myocrisin, the level of gold in erythrocyte membrane was, initially, very high and decayed exponentially afterwards, whereas auranofin produced a constant high level up to 36 weeks. The erythrocyte membrane gold level in nonsmokers was higher than that in smokers in the auranofin group, and it decreased with an increase in the number of cigarettes smoked (r = 0.836 P < 0.01); no such correlation was observed in the Myocrisin group. In a changeover study, auranofin appeared to change the nature of erythrocyte membrane after reacting with it and rendering it incapable of picking up any gold from Myocrisin. In the case of auranofin, the hemolysate membrane gold level was found to correlate with clinical improvement.

Interferon bei chronischer Polyarthritis: Positive Wirkung in der klinischen Prüfung

During the last two years, 80 patients with definite chronic rheumatoid arthritis were treated with interferon-gamma. Considerable improvement in the clinical picture occurred in 58, with pain decreasing rapidly and lastingly or even disappearing. Even in largely immobile patients the ability to walk and general mobility were nearly fully restored. The treatment was well tolerated in 74 patients. As the substance is administered subcutaneously it is suitable for out-patient treatment.

Rheumatoid arthritis and bacterial infections

To study features of bacterial infections course in pts with rheumatoid arthritis (RA) and changes of laboratory measures after focus of infection sanation. Material and methods. 46 pts with definite rheumatoid arthritis were examined at the time of comorbid infection (Cl) detection and after infection focus sanation. Bacteriological test with evaluation of flora sensitivity to antibiotics by disco-diffusion method was performed at baseline and after the course of antibacterial therapy to assess its efficacy. Hemogram, serum fibrinogen, rheumatoid factor, circulating immune complexes (CIC), C-reactive protein levels were assessed. Serum interleukin (IL) 1(3, IL6 and neopterin concentrations were examined by immune-enzyme assay in a part of pts. Typical clinical features of Cl were present in only 28 (60,9%) pts. 13 (28,3%) pts had fever, 12 (26,0%) — leukocytosis, 15 (32,6%) — changes of leucocyte populations. Some laboratory measures (thrombocytes, fibrinogen, CIC, neopterin levels) significantly decreased (p<0,05) after infection focus sanation without correction of disease modifying therapy. Cl quite often develop as asymptomatic processes most often in pts with high activity and can induce disturbances promoting appearance of endothelial dysfunction, atherothrombosis and reduction of life duration. So timely detection and proper sanation of infection focuses should be performed in pts with RA

Anti-cyclic citrullinated peptide revised criteria for the classification of rheumatoid arthritis

Objective:The classification of rheumatoid arthritis (RA) is increasingly important as new therapies can halt the disease in its early stages. Antibodies to cyclic citrullinated peptides (anti-CCP) are widely used for...

Incidence and predictors of severe extra-articular disease manifestations in an early rheumatoid arthritis inception cohort

There are limited data on extra-articular disease from the long-term follow-up of rheumatoid arthritis inception studies. In the Lund early rheumatoid arthritis prospective study1 consecutive patients with definite rheumatoid arthritis...

Validation of functional activity index in patients with rheumatoid arthritis (RAS)

Objective. To evaluate psychometric properties of Patient Activity Scale (PAS) index and possibility of its application for assessment of pt functional activity (PFA) and therapy efficacy in pts with rheumatoid arthritis (RA). Materia l and methods . Validity assessment was performed on 454 pts with definite RA,mainly female (85,2%) with mean age 51,3±11,3 years, mean disease duration was 9,1±8,5 years, 59,7% of pts were seropositive on rheumatoid factor, most pts had moderate or high inflammatory activity of the disease (95,6%), II or III radiological stage ( 44,7% and 27,8% respectively, II (53,5%) or III (31,8%) functional class. Constructive validity of the index was assessed by calculation of coefficients of correlation with “external criteria”. Sensitivity was assessed with ACR criteria in 285 pts after 6 months of standard therapy. Reliability (reproducibility and internal constancy) were assessed in 92 pts in 3 days after admission. Results. Assessment of PAS reliability with test-retest analysis did not reveal differences between first and repeat examination of pts whose state had not change after 3 days (mean scores 5,07±1,27 and 5,17±1,34 respectively, p=0,45). Intra-class Cronbach alpha coefficient was 0,95 (p<0,000001). Constructive validity assessment revealed moderate relationship of PFA with disease inflammatory activity measures: morning stiffness duration (r= 0,33, p<0,0000001), DAS 28 value (r=46, p<0,001), tender joint count (r=0,39, p<0,0000001), swollen joint count (r=0,28, p<0,0002) and weak relationship with ESR and radiological stage of the disease (r=0,17, p<0,00001). PAS correlation relationships with quality of life measures assessed on all SF-36 scales varied from -0,37 to -0,58. Index sensitivity to changes assessment showed that PAS change exceeding 0,22 corresponded to at least 20% health improvement according to ACR criteria. Conclusion . PAS is a reliable, valid and sensitive instrument of pt functional state self assessment and can be used for dynamic evaluation of pts state and treatment efficacy in outpatient practice

New onset or exacerbation of psoriatic skin lesions in patients with definite rheumatoid arthritis receiving tumour necrosis factor α antagonists

New onset or exacerbation of psoriatic skin lesions in patients with definite rheumatoid arthritis receiving tumour necrosis factor α antagonists