Early Inflammatory Arthritis Research Articles

171 Clinical and Patient-Reported Outcomes from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

171 Clinical and Patient-Reported Outcomes from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

I134 The National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis: An Update and Review of Data Collection

I134 The National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis: An Update and Review of Data Collection

163 Regional Variation in Delays from Initial Presentation to Primary Care and Referral for Specialist Assessment for Patients with a New Presentation of Inflammatory Arthritis: Observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

163 Regional Variation in Delays from Initial Presentation to Primary Care and Referral for Specialist Assessment for Patients with a New Presentation of Inflammatory Arthritis: Observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

098 Use of Disease-Modifying Therapies and Glucocorticoids in the Early Treatment of Rheumatoid Arthritis: Observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

098 Use of Disease-Modifying Therapies and Glucocorticoids in the Early Treatment of Rheumatoid Arthritis: Observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

I43 Determinants of Waiting Time for Patients with New Onset Inflammatory Arthritis: Observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

I43 Determinants of Waiting Time for Patients with New Onset Inflammatory Arthritis: Observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

156 The Best Practice Tariff for Early Inflammatory Arthritis—The First Year of Experience in a Large Urban District General Hospital

156 The Best Practice Tariff for Early Inflammatory Arthritis—The First Year of Experience in a Large Urban District General Hospital

149 Impact of New Arthritis on Ability to Work: Observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

149 Impact of New Arthritis on Ability to Work: Observations from the National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis

Association Between the Use of Oral Contraceptives and Patient-Reported Outcomes in an Early Arthritis Cohort.

To evaluate the association between exposure to oral contraceptives (OCs) and clinical outcomes in an early arthritis cohort. Female patients with early inflammatory arthritis, ages 18-60 years, who were enrolled in an early arthritis cohort and had no exposure to hormone replacement were studied (n = 273). Associations between OC exposure (current/past/never) and disease activity, treatment, and patient-reported outcomes, including the Rheumatoid Arthritis Impact of Disease Score (RAID), the Rheumatoid Arthritis Disease Activity Index (RADAI), the Profile of Mood and Discomfort (PROFAD), and the Hannover Functional Assessment (FFbH), were studied over 2 years. Linear mixed models adjusted for age, body mass index, parity, smoking, and education were used. Eighteen percent of patients had never used OCs, 63% had used OCs in the past, and 19% currently used OCs. After adjustment, the current/past OC use was associated with better RAID, PROFAD, RADAI, and FFbH scores at 12 months (P < 0.05 for all) compared to never use. Longitudinally over 2 years, the mean RAID scores were significantly better in women with current/past OC use (P < 0.001). Actual inflammatory markers were not associated with OC use. Glucocorticoids were used by a higher percentage of OC never users than by current/past users (P = 0.08), especially in patients with impaired function (FFbH <70: odds ratio 4.2 [95% confidence interval 1.6-11]). For past as well as current use, OCs seem to moderate patient-reported outcomes in inflammatory arthritis. Protective effects may be induced via central nervous pathways rather than through the suppression of peripheral inflammation.

Efficacy and safety of Tofacitinib in patients with active rheumatoid arthritis resistant to conventional therapy: Preliminary results of an open-label clinical trial

Despite the advances in the therapy of rheumatoid arthritis (RA), which are associated with the use of biological anti-rheumatic drugs, the problem of effective treatment of RA is not still solved. Inclusion of new methods in treatment strategies, in particular the so-called «small mole cules», i.e. synthetic compounds acting on intracellular signaling pathways, such as Tofacitinib (TOFA) approved for use in rheumatologic practice, is very important. Objective: to evaluate the efficacy and safety of therapy with TOFA in combination with synthetic disease-modifying anti-rheumatic drugs (s-DMARDs), primarily methotrexate (MTX) in in patients with active RA in real clinical practice. Subjects and methods . This ongoing open-label trial is a part of the scientific program «Russian Investigation of Methotrexate and Biologics in Early Active Inflammatory Arthritis» (REMARCA) that explores the possibility of adapting the «treat-to-target» strategy in real prac-tice in Russia. The study included RA patients with moderate to high disease activity despite treatment with MTX or other DMARDs. A total of 41 patients with RA were included (8 males, 33 females; mean age 52.6±14.2 years, disease duration 47.2±49.7 months, 82.9% RF+ and 80.5% anti-CCP+,DAS28-ESR 5.45±0.95, SDAI 30.2±12.2). All the patients had previously received s-DMARDs; 12 (29.3%) patients also had biological DMARDs (1 to 4 biologics). Oral TOFA 5 mg in combination with MTX or leflunomide was administered twice daily to 40 and 1 patients, respectively, with the possibility of increasing the dose up to 10 mg BID. To date, 37 and 12 patients received TOFA for 3 and 6 months, respectively. Results. TOFA was used as a second-line drug (after s-DMARDs failure) in 29 (70.7%), as a third line drug (after s-DMARDs and biologics failure) in 12 (29.3%) patients. The dose was escalated to 10 mg BID in 13 (31.2%) patients, on the average, 11.2±1.7 weeks after treatment initiation. TOFA was not discontinued in the reporting period. There was a significant reduction in disease activity following just 4 weeks of TOFA therapy. At 3 months, 27% of patients achieved low disease activity (LDA) by the SDAI; 29.7% had SDAI remission; 35% had HAQ ≤0.5; at 6 months, LDA, SDAI remission, had HAQ ≤0.5 were seen in 41.7, 41.7, and 67%, respectively. There were no significant differences in the suppression of RA activity depending on whether second- or third-line TOFA therapy was performed. There were no serious adverse events (SAEs) or serious infections. Conclusions . Second- and third-line TOFA therapy allows the majority of patients to quickly achieve the T2T goals (56.7 and 83.4% of patients at 3 and 6 months, respectively), so the drug can be quite successfully «integrated» into the T2T strategy along with biologics. The drug effectively inhibits granulomatous inflammation (by the example of rheumatoid nodules) and shows a sufficient safety (no SAEs).

Anticarbamylated protein antibodies are associated with long-term disability and increased disease activity in patients with early inflammatory arthritis: results from the Norfolk Arthritis Register

ObjectivesAnticarbamylated protein (anti-CarP) antibodies are a novel family of autoantibodies recently identified in patients with inflammatory arthritis. The aim of this study was to investigate their association with long-term outcomes...

Interleukin-27 inhibits ectopic lymphoid-like structure development in early inflammatory arthritis.

Ectopic lymphoid-like structures (ELSs) reminiscent of secondary lymphoid organs often develop at sites of chronic inflammation where they contribute to immune-mediated pathology. Through evaluation of synovial tissues from rheumatoid arthritis (RA) patients, we now show that low interleukin-27 (IL-27) expression corresponds with an increased incidence of ELS and gene signatures associated with their development and activity. The presence of synovial ELS was also noted in mice deficient in the IL-27 receptor (IL-27R) after the onset of inflammatory arthritis. Here, pathology was associated with increased synovial expression of pro-inflammatory cytokines, homeostatic chemokines, and transcriptional regulators linked with lymphoid neogenesis. In both clinical and experimental RA, synovial ELS coincided with the heightened local expression of cytokines and transcription factors of the Th17 and T follicular helper (Tfh) cell lineages, and included podoplanin-expressing T cells within lymphoid aggregates. IL-27 inhibited the differentiation of podoplanin-expressing Th17 cells, and an increased number of these cells were observed in IL-27R-deficient mice with inflammatory arthritis. Thus, IL-27 appears to negatively regulate ELS development in RA through control of effector T cells. These studies open new opportunities for patient stratification and treatment.

Clinimetric properties of the Chinese version of the early inflammatory arthritis detection tool.

BackgroundTimely rheumatologic referral and management are crucial for patients with potential inflammatory arthritis. To meet this need, tools such as the early inflammatory arthritis (EIA) detection tool was developed and has been evaluated in Western populations. The aims of this study were to translate the English version of the EIA detection tool to Chinese and to determine its clinimetric properties in Taiwanese patients.MethodsTwenty controls and 111 patients with established diagnosis of osteoarthritis, rheumatoid arthritis, systemic autoimmune diseases, psoriatic arthritis, and ankylosing spondylitis were recruited from a regional hospital in south Taiwan. Multivariate logistic regression analysis was used to evaluate the independent and significant variables associated with diagnosis by rheumatologists. A prediction model was also developed for differentiating between patients with inflammatory arthritis and those with non-inflammatory arthritis musculoskeletal conditions.ResultsThe Chinese version of the EIA detection tool showed acceptable internal consistency (KR-20 coefficient 0.78) and test-retest reliability (κ statistic ranged from 0.43 to 0.94). A prediction model consisting of three EIA detection tool items (joint pain, swelling in hands or wrists, and ever been told to have rheumatoid arthritis) and sex was able to differentiate inflammatory arthritis and non-inflammatory arthritis musculoskeletal conditions with a sensitivity of 0.84, a specificity of 0.86, a positive predictive value of 0.92, and a negative predictive value of 0.76.ConclusionsThe Chinese version of the EIA detection tool showed good clinimetric properties in this study population and it can be used to differentiate Taiwanese patients with inflammatory arthritis and non-inflammatory arthritis musculoskeletal conditions.

Identification of novel antiacetylated vimentin antibodies in patients with early inflammatory arthritis

ObjectiveTo investigate serum antibody reactivity against a panel of post-translationally modified vimentin peptides (PTMPs) in patients with early inflammatory arthritis.MethodsA panel of PTMPs was developed. Microtitre plates were coated with...

Development and Validation of a Patient Reported Experience Measure (PREM) for Patients with Rheumatoid Arthritis (RA) and other Rheumatic Conditions.

Patient experience is not routinely measured in rheumatoid arthritis (RA) and no accepted standardised Patient Reported Experience Measures (PREM) tools currently exist. Commissioning for Quality in Rheumatoid Arthritis (CQRA) has developed, piloted and validated PREMs for RA and other rheumatic conditions. Focus groups were held with RA patients to identify key elements of the patient experience. These were mapped against the UK Department of Health Patient Experience Framework and a PREM questionnaire developed with questions specifically relating to RA and rheumatology services. The RA PREM was piloted and Cronbach's alpha used to assess internal consistency. The PREM was modified to capture experience of patients with other rheumatic conditions and further validated. Ten UK sites and 524 patients were included in the RA PREM pilot and validation analysis. The RA PREM reliably captured RA patient experience and had good construct validity. Cronbach's alpha within the multiquestion domains ranged from 0.61 to 0.90 and the percentage agreement ranged from 22.5% to 70.4% with overall care. The modified PREM was evaluated in 11 UK sites and 110 patients with a range of rheumatic conditions. Cronbach's alpha ranged from 0.76 to 0.91 and the percentage agreement similarly ranged from 70% to 90% with the question on overall care. The RA PREM and the modified PREM provide new valuable validated tools for capturing the patient experience in a range of rheumatic conditions. The RA PREM is currently being used in a UK National Clinical Audit of Rheumatoid and Early Inflammatory Arthritis.

052. Patients with Early Inflammatory Arthritis Who are Anti-CCP Antibody Positive have Antibodies Against Acetylated and Carbamylated Vimentin Peptides

052. Patients with Early Inflammatory Arthritis Who are Anti-CCP Antibody Positive have Antibodies Against Acetylated and Carbamylated Vimentin Peptides

O01. Anti-Carbamylated Protein Antibodies are Associated with Long Term Disability and Disease Activity in Patients with Early Inflammatory Arthritis: Results from the Norfolk Arthritis Register

O01. Anti-Carbamylated Protein Antibodies are Associated with Long Term Disability and Disease Activity in Patients with Early Inflammatory Arthritis: Results from the Norfolk Arthritis Register

158. A Pre-Post Test Pilot Trial of Compression Gloves in Early Inflammatory and Rheumatoid Arthritis

Background: Compression gloves are increasingly provided by occupational therapists (OTs) to people with rheumatoid arthritis (RA). Gloves are provided to: reduce hand joint pain (day and/or night), swelling and stiffness; and improve hand function. A systematic review identified only four trials (n= 8-24), of poor/moderate quality, indicating glove-wear may lead to small reductions in proximal interphalangeal joint (PIPJ) swelling but effects on hand symptoms and function are unclear. The aim of this study was to evaluate compression gloves’ effects on hand symptoms and function, to assist planning a randomised controlled trial. Methods: A pre-post-test study was conducted. Participants: were recruited from 10 Rheumatology OT departments; had recent onset inflammatory (IA)/RA, or RA; no steroid injections in 4/52; and no new/changed medication in 12/52, unless recent-onset IA/RA. Participants wore right and/or left Isotoner ¾ finger gloves, day and/or night as required. Assessments at 0 and 4 weeks included: hand pain on activity and at night, hand stiffness (all 0-10 numeric rating scales: none to very severe); swelling (joint circumference: cms); composite finger flexion to distal wrist crease (CFF: cms); Measure of Activity Performance-Hand [MAP-HAND]; Grip Ability Test [GAT]. OTs were trained in assessments: inter-rater reliability (ICC,11) was good: 2nd PIPJ circumference (0.91); CFF (0.76-0.93); GAT (0.98). Data were analysed using paired t-tests and effect sizes calculated using eta-squared (0.14+ = large effect). Results: 41 participated (early IA/RA = 14; RA = 27): 33 women, 8 men; average age = 59.10 (SD 12.54) years; time since diagnosis 2.33 (IQR 0.23-8.5) years; 7 (early IA) had medication changes in 12/52. Early IA and RA results were combined as similar (Table 1). Table 1: Mean (SD) outcomes pre- and post- 4 weeks of compression glove wear (Right hand only; n=38). Outcome measures 0 weeks 4 weeks p Effect size Hand pain on activity (0-10) 5.69 (2.13) 4.67 (2.32) 0.006* 0.18 Hand pain at night (0-10) 4.26 (3.26) 3.41 (2.30) 0.03* 0.12 Hand stiffness (0-10) 5.51 (2.61) 3.92 (2.25) 0.001* 0.33 2nd PIPJ circumference (cm) 6.66 (0.58) 6.57 (0.55) 0.03* 0.12 CFF Middle (cms) 5.45 (1.66) 4.88 (1.35) 0.002* 0.23 MAP-HAND 21.91 (7.83) 19.78 (7.36) 0.02* 0.12 GAT 39.44 (20.82) 32.73 (2.86) 0.005* 0.20 Conclusion: Compression gloves led to significant improvements in: pain (day/night), stiffness, swelling, finger flexion and hand function, with moderate to large effect sizes, although PIPJ swelling changes were small. The lack of a control group means improvements may not be due to compression gloves. A randomised controlled trial is required, including longer follow-up.

Association of anti-carbamylated protein antibodies with long-term disability and increased disease activity in patients with early inflammatory arthritis: results from the Norfolk Arthritis Register

BackgroundAnti-citrullinated protein antibodies (ACPA) predict increased disease activity and disability in patients with inflammatory arthritis such as rheumatoid arthritis. However, the absence of these antibodies does not confer universally good prognosis. Recently, a new set of antibodies, anti-carbamylated (anti-CarP) antibodies, have been identified in patients with rheumatoid arthritis. This study aimed to investigate the association between anti-CarP antibodies, disability, and disease activity in these patients. MethodsAdults with two or more swollen joints for at least 4 weeks were recruited from the Norfolk Arthritis Register (NOAR). At baseline patients completed the health assessment questionnaire (HAQ). The Disease Activity Score in 28 joints (DAS28) was calculated and rheumatoid arthritis classification criteria applied. ACPA and anti-CarP antibodies were measured on stored serum samples obtained within the first year of the study. The HAQ was repeated after 1, 2, 3, 5, 7, 10, 12, 15, and 20 years, and DAS28 scores done every 5 years. Generalised estimating equations (GEE) tested the association between anti-CarP antibodies and longitudinal HAQ and DAS28 scores. Findings1995 patients were included; 1310 (66%) were women and median age at onset was 55 years (IQR 43–66). Anti-CarP antibodies were positive in 460 patients (23%), and 1221 (61%) met rheumatoid arthritis classification criteria. Median follow-up was 7 years (IQR 5–11). Patients who were anti-CarP antibody positive had significantly more disability over time and higher levels of disease activity than those who were negative (multivariate GEE adjusted for age, sex, smoking status, ACPA, and year of recruitment to NOAR: β coefficient for HAQ 0·13, 95% CI 0·03–0·23, and for DAS28 0·31, 0·12–0·49). Statistically significant associations were also seen in a subanalysis of 1092 ACPA-negative patients (HAQ 0·15, 0·02–0·29; DAS28 0·37, 0·11–0·63). In ACPA-positive and rheumatoid arthritis subgroups, anti-CarP antibodies were significantly associated with DAS28 (0·30 [0·02–0·57] and 0·21 [0·04–0·37], respectively), and positive associations were also seen with HAQ scores, but these did not meet statistical significance. InterpretationIn this study the presence of anti-CarPA was associated with increased burden of disability as measured by the HAQ and higher disease activity in patients with inflammatory arthritis. Since GEE models include outcome data at all timepoints, these associations are long term. Our results suggest that anti-CarP antibodies might provide additional prognostic information to ACPA and in particular identify ACPA-negative patients with poor prognosis. FundingArthritis Research UK.

Depression is a stronger predictor of the risk to consider work disability in early arthritis than disease activity or response to therapy

ObjectivesTo evaluate the factors that influence patients with early inflammatory arthritis to consider a disability pension.MethodsA total of 528 patients aged 63 or younger from an early arthritis cohort with...

Contribution of Nail Fold Videocapillaroscopy in Patients with Early Inflammatory Arthritis.

ABSTRACT: Background: Early inflammatory arthritis (EIA) a condition defined by joint swelling, with or without morning stiffness, and/or swelling of metacarpophalangeal and/or metatarsophalangeal joints. Nail fold video-capillaroscopy (NVC) is important for the evaluation of microcirculation in vivo. There are limited data about the role of NVC in EIA. Objectives: To study the capillaroscopic pattern in patients with EIA. Patients and methods: 27 patients with EIA - 21 women, 6 men, mean age of 41.6±4.2 yrs, mean disease duration of 6.9±3.1 months. Anamnesis and clinical examination were perform to identify clinical signs associated with connective tissue diseases. All the patients were nonsmokers and had no personal medical history of diabetes or non-immune mediated occlusive vascular disease. Blood and urine samples were collected for bio-chemical and immunological evaluation. All the patients were interrogated by NVC. Results: Raynaud's phenomenon was found in 9 patients, puffy fingers in 2 pts, telangiectasia in 2 pts, Sicca symptoms in 6 pts, malar rash in 2 pts, photosensitivity and psoriasis plaque in one patient. Combined information from clinical exam, NVC and immunological assessment allowed a specific diagnosis in 5 patients. Conclusions: Nail fold capillaroscopy assessment can provide further information and has diagnostic value in some cases of early arthritis. Nail fold capillaroscopy assessment contribution to the differential diagnosis in patients with early arthritis is sometimes significant, especially in poorly clinical and immunological defined cases.