Higher Disease Activity Scores Research Articles

THU0456 THE “JOINT CRITERIA” FOR FIBROMYALGIA DIAGNOSIS IN RHEUMATOID ARTHRITIS PATIENTS: RELIABILITY COMPARED TO THE 2010 ACR CLASSIFICATION CRITERIA FOR FIBROMYALGIA

Background:A significant proportion of rheumatoid arthritis (RA) patients have concomitant fibromyalgia (FM) (1). Associated FM diagnosis in RA patients can determine worse treatment outcomes compared to patients without FM (1). A difference between tender joint count (TJC) and swollen joint count (SJC) ≥7, also named the ”joint criteria” was proposed as being diagnostic for FM in patients with RA. The ”joint criteria” were validated against the 1990 ACR Classification Criteria for FM and are easy to apply to patients with RA (2). Since then, the 2010 ACR Classification criteria for FM, which include somatic symptoms besides pain sensitivity, were developed and validated.Objectives:We aimed to determine the reliability of the joint criteria for fibromyalgia in RA compared to the ACR 2010 Classification Criteria for FM and to compare RA patients diagnosed with FM (FRA) to those without FM in terms of clinical variables.Methods:We performed a cross-sectional study on RA patients who presented in our department during a 3 months period. Tender joint count (TJC), swollen joint count (SJC), patient global assessment of disease activity (PGA) were determined. DAS28 scores were calculated using CRP. We applied the 2010 ACR Classification Criteria and the joint criteria for FM diagnosis. Kappa agreement coefficient was used to determine the reliability of the joint criteria against the 2010 ACR Classification Criteria for FM in patients with RA. Differences between groups were assessed using Mann-Whitney U test for numerical data or Chi square test for ordinal data.Results:We included 100 consecutive RA patients, 84% female, with a mean age of 57.3(12) years and mean disease duration of 14(9) years. Twenty-four patients (24%) had associated FM according to the ACR 2010 Classification Criteria and 22 (22%) patients satisfied the joint criteria for associated FM. The level of agreement between the joint criteria and the ACR 2010 classification criteria for FM was kappa=0.66, p< 0.001, with a sensitivity of 70% and a specificity of 93%. FRA patients had similar demographic and disease characteristics compared to RA patients. Patients with FRA according to the joint criteria had significantly higher PGA, DAS28, and HAQ scores, but similar CRP values and SJC compared to RA patients (Table 1).Table 1.Demographic and clinical data of FRA and RA patientsVariableFRAn=22RAn=78p-valueAge (years)60 (10.7)59 (12.2)0.093Disease Duration (years)13.3 (13)12.2 (7.5)0.589ACPA seropositivity(%)69550.1SJC2(4)2(4)0.7CRP (g/dl)12.8(14.2)8.1(13.7)0.06DAS28CRP4 (1.7)3.5 (1.2)0.009HAQ1.75 (0.5)1 (0.7)<0.001PGA (mm)70(11)44(23)<0.001Data are expressed as mean (SD) or median (IQR)FRA- Fibromyalgic Rheumatoid Arthritis; RA- Rheumatoid Arthritis;ACPA- Anti- citrullinated Protein Antibodies; CRP- C-reactive Protein; SJC- Swollen Joint Count;DAS28CRP- Disease Activity Score; HAQ- Health Assessment Questionnaire; PGA- Patient Global AssessmentConclusion:The joint criteria are diagnostic for FM in RA patients with moderate reliability compared to the ACR 2010 Classification criteria. When diagnosed with the joint criteria, FRA patients have higher disease activity scores despite having similar clinical and laboratory inflammatory markers compared to RA patients.

Poor prognostic factors in predicting abatacept response in a phase III randomized controlled trial in psoriatic arthritis

In ASTRAEA (NCT01860976), abatacept significantly increased American College of Rheumatology criteria 20% (ACR20) responses at Week 24 versus placebo in patients with psoriatic arthritis (PsA). This post hoc analysis explored relationships between prospectively identified baseline characteristics [poor prognostic factors (PPFs) ] and response to abatacept. Patients were randomized (1:1) to receive subcutaneous abatacept 125 mg weekly or placebo for 24 weeks; those without ≥ 20% improvement in joint counts at Week 16 switched to open-label abatacept. Potential predictors of ACR20 response were identified by treatment arm using multivariate analyses. Likelihood of ACR20 response to abatacept versus placebo was compared in univariate and multivariate analyses in subgroups stratified by the PPF, as defined by EULAR and/or GRAPPA treatment guidelines. Odds ratios (ORs) were generated using logistic regression to identify meaningful differences (OR cut-off: 1.2). 424 patients were randomized and treated (abatacept n = 213; placebo n = 211). In abatacept-treated patients, elevated C-reactive protein (CRP), high Disease Activity Score based on 28 joints (CRP), presence of dactylitis, and ≥ 3 joint erosions were identified as predictors of response (OR > 1.2). In placebo-treated patients, only dactylitis was a potential predictor of response. In the univariate analysis stratified by PPF, ACR20 response was more likely (OR > 1.2) with abatacept versus placebo in patients with baseline PPFs than in those without; multivariate analysis confirmed this finding. Response to abatacept versus placebo is more likely in patients with features indicative of high disease activity and progressive disease; these characteristics are recognized as PPFs in treatment guidelines for PsA.

P206 Cardiovascular risk knowledge in patients of South Asian origin living with rheumatoid arthritis: data from India and the UK

Abstract Background South Asians have a higher risk of cardiovascular disease (CVD). Rheumatoid arthritis (RA) increases the risk of premature atherosclerosis. Therefore, we compared the level of CVD risk knowledge among patients of South Asian origin with RA in India and in the UK. Methods In this cross-sectional survey, patients of South Asian origin with RA from India and the UK were recruited from secondary care settings. Data were collected via Heart Disease Fact Questionnaire-Rheumatoid Arthritis (HDFQ-RA), a validated self-completion questionnaire. The HDFQ-RA was translated into Hindi and piloted among patients from South Asian background before use. Additionally, clinical and demographic data was collected. Results Among 118 patients from each country, 84% were female and they had similar age, education level, employment status and co-morbidities. Patients from India had longer disease duration (5.5 years versus 4.1 years (p = 0.012) whereas those from the UK had higher disease activity score (4.0 + 0.8 versus 3.1 + 0.7, p < 0.01). Regarding modifiable risk factors for CVD only 44.6% from India and 45.4% in the UK were aware of them (p=ns). However, awareness of the link between RA and increased risk of CVD was even more limited (38.1% in India and 40.7% in UK (p=ns). Conclusion Patients of South Asians origin with RA from both countries had limited knowledge about CVD risk. There is a need to educate them about CVD risk during consultation, as this will result in better outcomes. Disclosures K. Kumar None. S. Arya None. P. Nightingale None. T. Sheeran None. A. Aggarwal None.

Influence of Severe Vitamin D Deficiency on the Clinical Course of Inflammatory Bowel Disease.

Previous studies have shown vitamin D status to be associated with disease activity in patients with inflammatory bowel disease (IBD), but its influence on the clinical course of IBD has not been established. We aimed to analyze whether the serum 25-hydroxyvitamin D3 [25(OH)D] status is associated with clinical characteristics and affects the risk of surgery in patients with IBD. From the IBD registry of the Asan Medical Center, we identified all patients who had at least one 25(OH)D measurement; we then analyzed the association between clinical factors and 25(OH)D status. 25(OH)D was considered borderline deficient, deficient, and severely deficient at levels of < 30, < 20, and < 10ng/mL, respectively. We included 711 Crohn's disease (CD) and 764 ulcerative colitis (UC) patients who had not undergone surgery before 25(OH)D was measured. Both in CD and in UC patients, reduced 25(OH)D was associated with higher disease activity scores and CRP levels (p < 0.001). Severe 25(OH)D deficiency was associated with ileocolonic disease and complicated behavior in CD (p < 0.05) and was relevant to the disease extent in UC (p < 0.001). Additionally, severe 25(OH)D deficiency was associated with CMV colitis in patients with UC (p < 0.001). In multivariable analysis, severe deficiency of 25(OH)D was an independent risk factor for surgery in both CD (HR 1.93, 95% confidence interval [CI] 1.38-2.70) and UC (HR 2.77, 95% CI 1.14-6.74). Severe 25(OH)D deficiency may be a marker of a more aggressive clinical course of IBD.

TREATMENT RESPONSE PREDICTION IN PATIENTS WITH RHEUMATOID ARTHRITIS. Review

Relevance. A variety of targeted therapies for rheumatoid arthritis (RA) treatment exist. Therefore, reliable predictors are needed that could be used to accurately predict the efficacy or inefficacy of these therapies in individual patients. This could allow clinicians to improve diagnosis and prognosis, to make the treatment personalized and to reduce healthcare expenses.&#x0D; Objectives: to analyze and systemize the predictors of response to treatment in patients with RA.&#x0D; Materials and Methods. We analyzed the recently discovered predictors of treatment response in RA patients using papers cited on PubMed, Lilacs, and EMBASE databases from Jan 2005 until Jan 2020. Predictive factors were grouped into four categories: methotrexate (MTX)-treated RA, tumor necrosis factor (TNF)-α inhibitors-treated RA, interleukin (IL)-6 inhibitors-treated RA, and rituximab (RTX)-treated RA.&#x0D; Results. Based on the results of several studies, predictors of response to methotrexate were high Disease Activity Score (DAS), concentration of myeloid-related proteins 8/14, high P-glycoprotein levels, low serum calprotectin and leptin levels, baseline serum concentration of tumor necrosis factor (TNF)-α, TNF receptor I, interleukin (IL)-1β, soluble CD163, numbers of CD14+highCD16, vascular cell adhesion molecule, lower expression of hsa-miR-132-3p, hsa-miR-146a-5p, and hsa-miR-155-5p. A positive response to biological therapy was determined by male gender, younger age, lower health assessment questionnaire, erythrocyte sedimentation rate or C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, tender joint count (or swollen joint count) scores, absence of comorbidities, baseline albumin, IL-34, IL-1β, D-dimer, fibrinogen, matrix metalloproteinase 3, DAS 28 and Simplified Disease Activity Index (SDAI). The plasma interferon (IFN) activity and the IFN beta/alpha ratio, IL-1Ra level were predictive in TNF antagonist-treated patients. Predictors of response to IL-6 inhibitors were anti–citrullinated protein antibody (ACPA)+, baseline Sharp/van der Heijde score, myeloid soluble intercellular adhesion molecule 1, serum levels of sIL-6R, IL-8, calprotectin, and lymphoid activation and bone remodeling markers. The prediction of the best response for rituximab was determined to be a combination of IL-33, rheumatoid factor or ACPA, IgG, and also lower number of previous biological therapies. Genetic factors, such as single-nucleotide polymorphisms at gene locus rs10919563, rs11541076, rs12083537, rs11265618, and rs1801274, and rs396991 can also be used to predict a response to treatment.&#x0D; Conclusions. One of the leading problems in the development of predictors remains the collection of high-quality and complete information from a large number of patients. For this, it is necessary to develop an digital program for collecting specific data (depending on the specific disease) and developing new algorithms for predicting the response to treatment.

Evaluation of Serum Calprotectin Level and Disease Activity in Patients with Rheumatoid Arthritis.

Rheumatoid Arthritis (RA) is the most common type of chronic inflammatory arthritis with unknown etiology marked by a symmetric, peripheral polyarthritis. Calprotectin also can be used as a biomarker of disease activity in inflammatory arthritis and other autoimmune diseases. In this study, we evaluated the association between serum calprotectin level and severity of RA activity. A cross-sectional study was conducted on 44 RA patients with disease flare-up. Serum samples were obtained from all patients to measure calprotectin, ESR, CRP prior to starting the treatment and after treatment period in the remission phase. Based on Disease Activity Score 28 (DAS28), disease activity was calculated. Of 44 RA patients, 9(20.5%) were male and 35(79.5%) were female. The mean age of our cases was 53±1.6 years. Seventeen (38.6%) patients had moderate DAS28 and 27(61.4%) had high DAS28. The average level of calprotectin in the flare-up phase was 347.12±203.60 ng/ml and 188.04±23.58 ng/ml in the remission phase. We did not find any significant association between calprotectin and tender joint count (TJC; P=0.22), swollen joint count (SJC; P=0.87), and general health (GH; P=0.59), whereas significant associations were found between the calprotectin level and ESR (p=0.001) and DAS28 (p=0.02). The average calprotectin level in moderate DAS28 (275.21±217.96 ng/ml) was significantly lower than that in high DAS28 (392.4±183.88 ng/ml) (p=0.05). We showed that the serum level of calprotectin can be a useful and reliable biomarker in RA activity and its severity. It also can predict treatment response.

Activation of TGR5 alleviates inflammation in rheumatoid arthritis peripheral blood mononuclear cells and in mice with collagen II‑induced arthritis.

Rheumatoid arthritis (RA) is characterized by chronic inflammatory synovitis resulting in progressive joint destruction. Persistent synovial inflammation is induced by activation of various inflammatory cells. G-protein-coupled bile acid receptor 1 (TGR5) is a G-protein-coupled receptor activated by various bile acids, which has been reported to act as a key adaptor in regulating various signaling pathways involved in inflammatory responses and a diverse array of physiological processes, including bile acid synthesis, lipid and carbohydrate metabolism, carcinogenesis, immunity and inflammation. In the present study, TGR5 expression was detected in RA peripheral blood mononuclear cells (PBMCs), and its association with clinical disease activity, histological synovitis severity and radiological joint destruction was analyzed. Subsequently, the role and potential underlying mechanisms of TGR5 in the PBMCs of patients with RA and mice with collagen II-induced arthritis (CIA) were investigated. PBMCs were obtained from 50 patients with RA and 40 healthy controls (HCs). The mRNA and protein expression levels of TGR5 were detected in PBMCs via reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and immunofluorescence staining, respectively. Additionally, the levels of proinflammatory cytokines were analyzed by RT-qPCR and enzyme-linked immunosorbent assay (ELISA). The activation of nuclear factor-κB (NF-κB) and IκB kinase a was determined via western blot analysis. The anti-arthritic and anti-inflammatory effects of LCA on mice with CIA were then investigated. The arthritis score was assessed, and the protein levels of proinflammatory cytokines in the plasma of mice were detected via ELISA. TGR5 mRNA expression was significantly downregulated in the PBMCs of patients with RA compared with in those of the HCs (0.53±0.58 for patients vs. 1.49±0.83 for HCs; P<0.001); similar findings were observed at the protein level. The mRNA expression levels of TGR5 in the PBMCs of patients with RA with a high 28-Joint Disease Activity Score (DAS28) were significantly decreased compared with in patients with a low DAS28 (0.81±0.65 for low score vs. 0.35±0.46 for high score; P=0.002). Furthermore, TGR5 expression was significantly correlated with the levels of C-reactive protein (r=−0.429; P=0.002) and the DAS28 (r=−0.383; P=0.006). RT-qPCR and ELISA analyses indicated that lithocholic acid (LCA, 10 mg/kg/day) attenuated lipopolysaccharide-induced proinflammatory cytokine production via inhibition of NF-κB activity in the PBMCs of patients with RA. In addition, the arthritis score was significantly decreased in LCA-treated CIA mice compared with in non-treated CIA mice. The increased production of tumor necrosis factor-α, interleukin (IL)-1β, IL-6 and IL-8 was significantly reduced in the plasma of LCA-treated CIA mice compared with the control. In conclusion, TGR5 may contribute to the inflammation of PBMCs in patients with RA and mice with CIA.

Prevalence of feet and ankle arthritis and their impact on clinical indices in patients with rheumatoid arthritis: a cross-sectional study

BackgroundWe aimed to evaluate the prevalence of foot and/or ankle arthritis (FAA) and its impact on clinical indices in patients with rheumatoid arthritis (RA).MethodsThis cross-sectional study used data from the Korean College of Rheumatology Biologics & Targeted therapy registry to observe clinical outcomes of patients undergoing biologics therapy and conventional therapy. FAA was defined as ≥1 tender or swollen joint in the ankle and/or 1st-5th metatarsophalangeal (MTP) joints. Disease Activity Score 28 (DAS28), Routine Assessment of Patient Index Data 3 (RAPID3), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) were assessed.ResultsAmong 2046 patients, 598 had FAA. The ankle joint was the most commonly involved joint in FAA (tender joint, 71.4%; swollen joint, 59.5%), followed by the third and second MTP joints. Patients with FAA showed higher DAS28, RAPID3, SDAI, and CDAI scores. FAA presence was significantly associated with non-remission as per DAS28-ESR (odds ratio, 3.4; 95% confidence interval, 2.0–5.8), DAS28-CRP (3.6, 2.4–5.3), SDAI (6.3, 2.8–14.6), CDAI (7.6, 2.4–24.3), and RAPID3 (5.6, 2.7–11.5) indices on adjusting for age, sex, disease duration, presence of rheumatoid factor, presence of anti-cyclic citrullinated peptide antibody, lung disease, use of methotrexate, and previous use of biological disease-modifying anti-rheumatic drugs. Patients with FAA were less likely to achieve remission of SDAI (n = 6, 1.0%) and CDAI (n = 3, 0.5%) than that of DAS28-ESR (n = 21, 3.5%), DAS28-CRP (n = 38, 6.4%), and RAPID3 (n = 12, 2.0%).ConclusionsFAA represents a severe disease activity and is an independent risk factor for non-remission in patients with RA.

Takayasu Arteritis With Coronary Artery Involvement: Differences Between Pediatric and Adult Patients

BackgroundThe clinical features, angiographic findings, and outcomes have not been compared between pediatric and adult patients with Takayasu arteritis (TA) with coronary involvement. MethodsOf 1056 consecutive patients with TA hospitalized and followed from 1990 to 2018 in our hospital, 38 patients including 9 children and 29 adults (mean age at diagnosis of 14.3 ± 3.3 years and 38.6 ± 12.0 years, respectively) were diagnosed with coronary artery involvement by imaging. Clinical manifestations, coronary lesion characteristics, and outcomes were compared between the pediatric and adult patients. ResultsCompared with adults, pediatric patients with TA with coronary involvement had a significantly shorter disease duration (median, 2 months; interquartile range [IQR], 1-38 vs median, 48 months [IQR, 18-90], P = 0.019) and higher disease activity score (median, 3 [IQR, 2-4] vs median, 2 [IQR, 1-3], P = 0.013) on the first positive coronary assessment. Although all recruited patients except 1 child had coronary stenosis, coronary aneurysmal dilation was found in 6 patients and was more frequent in children than in adults (55.6% vs 3.4%, P = 0.001). Moreover, the children with coronary aneurysmal dilation had a higher incidence of dilation in large vessels than children without aneurysmal dilation (80.0% vs 0%, P = 0.048). ConclusionPediatric patients with TA with coronary involvement had higher inflammation status and were more prone to coronary aneurysmal dilation on the first positive coronary assessment compared with adults. Dilation in the aorta and its major branches might be an indicator of coronary aneurysmal dilation in these pediatric patients.

Persistent anemia and hypoalbuminemia in rheumatoid arthritis patients with low serum triiodothyronine level

Objectives: To determine the clinical characteristics of rheumatoid arthritis (RA) patients with low serum triiodothyronine (T3) levels.Methods: We evaluated serum free T3 (fT3), free T4, and thyroid-stimulating hormone (TSH) levels in 338 RA patients. After excluding patients taking anti-thyroid drugs or having anti-thyroid antibodies, we compared the clinical characteristics of the RA patients with low fT3 to those with normal/high fT3, before and after RA treatment.Results: Six percent of RA patients had low fT3 levels. Patients with low fT3 were older and had higher disease activity scores (DAS28), higher Steinbrocker stage, higher health assessment questionnaire scores, lower body mass index, and lower hemoglobin and albumin levels compared with normal/high-fT3 patients. After RA treatment, fT3 levels normalized in half of the low-fT3 patients and remained low in the other half. Although DAS28 scores were similarly improved in both subgroups of the low-fT3 patients, anemia and hypoalbuminemia did not normalize in the persistently low-fT3 subgroup.Conclusion: Low serum fT3 levels represent the profound wasting seen in RA patients that is characterized by anemia and hypoalbuminemia and that cannot be evaluated by DAS28 scores alone.

Metabolic Syndrome Among Patients with Rheumatoid Arthritis and the Correlation with Disease Activity

Rheumatoid arthritis is a systemic inflamatory disease that affects primarily the synovial joints and it is associated with a progressive disability and a important socio-economic burden. [1] Although the main characteristic is the joint involvement, it is important to remember that RA is a disorder with systemic involvement mainly due to it�s chronic inflamation. Patients with RA have a higher risk of cardio-vascular mortality that in general population. There are numerous studies that sugest that inflamation plays a key�role in the develompent of aterosclerosis and heart disease, therefore a better understanding of the inflamatory response in RA may lead to better outcomes for patients with RA. Metabolic Syndrome is described as a congregate of major risk factors for cardiovascular diseases (CVD): Diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood presure[2]. The clustering of CVD risk factors that typifies the metabolic syndrome is now considered to be the driving force for a new CVD epidemic [3]. The conducted study aims to assess and evaluate the presence of metabolic syndrome (MetS) in RA patients. 120 patients with RA (89 women and 31 men) and 120 (85 women and 35 men) patients without RA were included in the study. The prevalence of MetS in RA patients was 39.16% and 22.5% for the control group. RA patients with MetS had significantly higher disease activity score of 28 joints index (DAS28-ESR) than patients without MetS ( 3.70 � 0.644 vs. 3.35 �0.725; p=0.006).

Pragmaticism of Randomized Controlled Trials of Biologic Treatment With Methotrexate in Rheumatoid Arthritis: ASystematic Review.

Randomized controlled trials (RCTs) exist along a spectrum, from explanatory, designed to evaluate interventions under ideal conditions, to pragmatic, designed to reflect usual care. This study assessed the pragmatism of RCTs of advanced therapeutics in rheumatoid arthritis (RA). A systematic review was conducted to identify RA RCTs comparing biologic or targeted synthetic therapy in combination with methotrexate, to placebo or any other disease-modifying antirheumatic drugs (DMARDs). Trials were rated using the Pragmatic Explanatory Continuum Indicator Summary-2 (PRECIS-2) tool in 9 domains, each rated from 1 (very explanatory) to 5 (very pragmatic). Latent class and regression analyses examined the heterogeneity in PRECIS-2 scores and the relationship to trial characteristics. In total, 96 trials were included. Eligibility, follow-up, and flexibility of delivery of the intervention were rated as explanatory, with mean ± SD PRECIS-2 scores of 2.0 ± 0.7, 2.0 ± 1.1, and 2.1 ± 0.7, respectively, reflecting strict inclusion criteria, intensive follow-up, and rigid protocols. Studies were rated as pragmatic in setting (3.6 ± 1.5) because many were international, multicenter trials, and in primary analysis (4.1 ± 1.3), because most used intent-to-treat analyses. In latent class analyses, 2 groups were identified; the majority (74%) were rated as explanatory for most domains assessed. These trials had larger sample sizes, were more likely to be industry-funded, and enrolled patients with higher Disease Activity Score in 28 joints and Health Assessment Questionnaire disability index scores, but were less likely to be at high risk of bias. RCTs of biologic DMARD treatment in combination with methotrexate for RA were rated as predominantly explanatory, which may affect the generalizability of trial results to clinical practice.

Ultrasonographic features of tibialis posterior tendon in rheumatoid arthritis patients with pes planovalgus

AimThe aim of this study was to assess the relationship between ultrasonographic features of tibialis posterior (TP) tendon in rheumatoid arthritis (RA) patients and associated pes planovalgus (PPV) foot deformity.Patients and methodsThis study included 20 (40 feet) RA patients with PPV and ultrasound-proven TP tenosynovitis. The following variables were recorded for patients: the number of tender and swollen foot joints count, foot posture index (FPI), Health Assessment Questionnaire, and Disease Activity Score 28 (DAS28). FPI is a clinical tool used to quantify the degree to which a foot is pronated, neutral, or supinated using the set criteria. Patients underwent high-resolution ultrasound of the TP tendon. Measurement of tendon diameter was recorded in the retromalleolar region. The presence of fluid around the TP tendon and levels of power Doppler signal (PDS) were assessed.ResultsHigh disease activity was detected in patients (mean DAS28 of 5.89). Eighteen (45%) feet had thickened transverse diameter and 15 (37.5%) feet had thickened longitudinal diameter. Twenty-three feet showed PDS. Nineteen feet had fluid around the tendon, detected only in the retromalleolar region. Regarding FPI, 14 feet were mild to moderate pronated feet and 26 feet were highly pronated feet. There were direct correlation between FPI and both DAS28 (p=0.05) and transverse diameter thickness (p=0.01). Highly pronated feet had higher DAS28 (p=0.03), increased transverse diameter thickness (p=0.04), more detection of fluid around the TP tendon (p=0.005) as well as higher incidence of PDS around the TP tendon (p=0.002).ConclusionHigher degree of pronation in RA feet with PPV is associated with ultrasonographic increased tendon thickness, PDS, and fluid around TP tendon. Early diagnosis and intervention for TP tenosynovitis may prevent progressive PPV foot deformity.

Association of rheumatoid arthritis disease activity, severity with electrocardiographic findings, and carotid artery atherosclerosis

AimThe aim was to detect specific ECG changes in rheumatoid arthritis (RA) patients as well as to study atherosclerotic changes of the carotid arteries as an indicator of cardiovascular system risk factors and to correlate findings with disease activity and severity parameters to elucidate possible associations between these variables.Patients and methodsThis study included 30 RA patients, 30 age-matched and sex-matched systemic lupus erythematosus patients and 30 age-matched and sex-matched healthy volunteers as control groups. The patients were subjected to clinical examination, assessment of disease activity score-28 (DAS28), functional disability Health Assessment Questionnaire, and laboratory and radiological assessments. ECG and measurement of the carotid intima media thickness (CIMT) by carotid ultrasound scan was also done.ResultsTen (33.3%) RA patients had ECG abnormalities, with ST or T-wave abnormality being the most common abnormality present. RA patients had the highest frequencies of ECG abnormalities. Most ECG changes occurred in RA patients using steroids (90%). ST or T-wave abnormality in RA occurred more in patients with a higher swollen joint count, higher DAS28, and a higher patients’ global health assessment. RA patients had the highest mean. The mean CIMT was significantly higher in RA patients with ECG abnormalities. There were significant positive correlations of average CIMT with DAS28, Health Assessment Questionnaire, and Simple Erosion Narrowing Score. There were significant positive correlations of mean CIMT with the level of triglycerides, cholesterol, high-density lipoprotein, erythrocyte sedimentation rate, and a highly significant correlation between mean CIMT and C-reactive protein. CIMT at a cut-off point of 0.75 mm can predict ECG abnormalities with high sensitivity and specificity.ConclusionECG changes were present in 33.3% of RA patients. Increased CIMT was observed in RA patients and correlated well with disease activity and severity parameters.

Recent-onset of rheumatoid arthritis leads to increase in wall thickness of left anterior descending coronary artery. An evidence of subclinical coronary artery disease.

Objectives:To explore the atherosclerotic changes of the left anterior descending coronary artery (LADCA) in patients with early onset of rheumatoid arthritis (RA).Methods:Transthoracic echocardiographic scans were performed on 15 early RA patients and 20 control subjects, free of rheumatological diseases, diabetes mellitus (DM), and cardiovascular disease (CVD). Out of 15 RA patients, 10 were matched for age and gender with control. Left anterior descending coronary artery wall thickness was compared between RA subjects and their matched control. Among early RA patients, correlation was assessed between LADCA wall thickness and the demographic features, RA activity features, and cardiovascular risk factors.Results:Left anterior descending coronary artery wall thickness was significantly increased (p=0.001) in early RA compared to controls, as it was reported to be 0.61±0.04 mm (CI: 0.52-0.7); and 0.48±0.08 mm (CI: 0.44-0.51) respectively. Within early RA, LADCA wall thickness was related to the disease activity score (p=0.025, ß-coefficient 0.066, CI: 0.01-0.122) as well as to the patient global assessment of disease activity (PGADA) at RA onset (p=0.006, ß-coefficient 0.003, CI: 0.001-0.005), in a positive linear relationship. Left anterior descending coronary artery wall thickness was found to be thicker among RA patients with rheumatoid factor (RF) positive (p=0.015, CI: 0.53-0.66).Conclusion:Early RA patients have increased coronary arteries atherosclerotic burden compared to healthy subjects matched for age, and gender. Rheumatoid factor positivity, high disease activity score and PGADA were found to be associated with coronary artery wall thickness.

Depressive Symptoms Are Associated With Low Treatment Adherence in African American Individuals With Systemic Lupus Erythematosus.

African American (AA) people with systemic lupus erythematosus (SLE) are at high morbidity and mortality risk, and they often require multiple medications. Low medication adherence is a highly prevalent, multidimensional problem associated with poor outcomes in people with SLE. Depression, a predictor of low adherence in people with chronic conditions, has been described in over 35% of AAs with SLE. We hypothesized that depressive symptoms would be increasingly associated with low adherence in this population. Research subjects predominantly belong to the Georgians Organized Against Lupus cohort, a population-based cohort of predominantly AA individuals with SLE in the Atlanta metropolitan area. Medication adherence and severity of depressive symptoms were measured using validated self-reported tools: the 8-item Morisky Medication Adherence Scale and the 9-item Patient Health Questionnaire, respectively. We used univariate and multivariate logistic regression to examine the odds ratios of low medication adherence across individuals with increasing severity of depressive symptoms. Among 632 AA SLE participants, 336 (54%) reported low medication adherence and 217 (34.6%) reported "moderate" or "severe" depressive symptoms. In univariate logistic regression, significant risk factors for low adherence were depressive symptoms, low self-efficacy, poor satisfaction with care, female sex, younger age, hurried patient-physician communication, poorer shared decision-making, less compassionate physician communication style, poor/fair health, and higher disease activity score. In multivariate regression, younger age, female sex, and more severe depressive symptoms were associated with low medication adherence. This is the first study to examine factors associated with low medication adherence among a population-based cohort of AA individuals with SLE. Depression was a strong correlate of low medication adherence. Mental health interventions aiming to address and treat depression may increase medication adherence.

Factors affecting walking ability in female patients with rheumatoid arthritis.

ObjectiveTo determine the factors associated with gait parameters in female patients with rheumatoid arthritis (RA).MethodsThe gait analysis was performed in a large cohort of RA patients, and three basic gait parameters (step length, cadence and gait speed) were calculated. Clinical and laboratory data were also collected. Factors associated with gait parameters were analyzed using multivariable linear regression in the three models with forced entry. Then, we divided those patients with Health Assessment Questionnaire disability index (HAQ) scores ≤ 0.5 into two groups according to their gait speed that were compared to identify the characteristics of patients with a good HAQ score but poor walking ability.ResultsA total of 318 female patients were analyzed. Knee extension strength had the strongest positive association with all three gait parameters (P < 0.0001), while methotrexate use was also positively associated with all three gait parameters (step length: P < 0.05, cadence: P < 0.05 in model 1 and 2; P < 0.01 in model 3, gait speed: P < 0.01). The disease activity score was negatively associated with step length and gait speed (step length, gait speed: P < 0.01 in model 1 and 2; P < 0.05 in model 3). 26% of patients with good HAQ scores showed slow gait speed. Patients with good HAQ scores and slow gait speed had higher disease activity scores (P < 0.05) and lower knee extension strength (P < 0.0001) than those with good HAQ scores and normal gait speed.ConclusionsHigh knee extension strength, low disease activity and administration of methotrexate were strongly associated with good walking ability in female patients with RA. And, even if patients showed good HAQ scores, about quarter of those patients had poor walking ability, and they showed higher disease activity, lower knee extension strength, compared to the patients with normal gait speed.

Interleukin-6 and IgA-rheumatoid factor are crucial for baseline erosiveness, and anti-citrullinated peptide antibodies for radiographic progression in early rheumatoid arthritis treated according to a treat-to-target strategy

Objectives: To define baseline clinical and immunological characteristics [anti-citrullinated peptide antibodies (ACPAs), immunoglobulin M (IgM)- and IgA-rheumatoid factor (RF), and interleukin-6 (IL-6) levels] involved in determining baseline erosiveness, outcome, and radiographic progression among seropositive and seronegative early rheumatoid arthritis (ERA) patients.Method: The 408 ERA patients enrolled in the study were monitored every 3 months according to the treat-to-target strategy. At baseline and after 12 months, hand and foot radiographs were evaluated using the Sharp/van der Heijde erosion score.Results: At diagnosis, seronegative patients were older and had higher Disease Activity Scores (DASs) than seropositive patients. A higher risk of erosiveness at baseline was conferred by IgA-RF positivity and IL-6 plasma levels ≥7.6 pg/mL, particularly when simultaneously present. In multivariate analysis, disease duration and IL-6 plasma levels ≥7.6 pg/mL arose as independent variables associated with presence of erosions at onset. Radiographic progression at 1 year follow-up, which occurred in 11.1% of ERA patients, was predicted by ACPA positivity, together with higher age at diagnosis. Despite similar percentages of good European League Against Rheumatism response, DAS and Boolean remission being observed over time among seropositive and seronegative patients and between erosive and non-erosive subjects, ERA patients who were erosive at onset, IgA-RF seropositive, and simultaneously having high baseline IL-6 plasma levels (≥7.6 pg/mL) were treated to a greater extent with tumour necrosis factor blockers after 12 months.Conclusion: IgA-RF positivity and IL-6 plasma levels are crucial for baseline erosiveness, while ACPA positivity represents the strongest risk factor for developing radiographic progression in ERA.

High prevalence of occupational exposure to solvents or silica in male systemic sclerosis patients: a Belgian cohort analysis.

Increasing evidence supports a relation of some occupational exposures to systemic sclerosis pathogenesis. We aimed to evaluate occupational exposure and clinical characteristics in male patients with systemic sclerosis followed in two Belgian academic hospitals. One hundred and three male patients, included in the Belgian Systemic Sclerosis Cohort, were identified. An expert in occupational medicine reviewed the occupational history and allocated the patients to one of the following groups: probable exposure to crystalline silica, probable exposure to solvents, probable exposure to other toxins, or no suspected occupational exposure. Clinical characteristics were extracted from the Belgian Systemic Sclerosis Cohort database. Sufficient data were available for 96/103 patients. Most of these male patients (70/96, 72.9%) had a history of occupational exposure, 55 patients were likely exposed to crystalline silica, 11 patients to solvents, 2 patients to both silica and solvents, and 2 patients to asbestos. Only 26 patients had no suspected occupational exposure (27.1%). We noticed a significant difference in smoking status between exposed and non-exposed patients, with the highest percentage of ever smokers in the group with solvent exposure (p = 0.011). We found no significant differences in disease phenotype between exposed and non-exposed patients. However, we noted a trend to a higher prevalence of anti-Scl70 antibodies, cardiac dysfunction, and higher disease activity score in patients with occupational exposure. We observed a strikingly high prevalence of occupational exposure to both silica and solvents in male systemic sclerosis patients. Occupational exposure to silica or solvents is highly prevalent in male systemic sclerosis patients.

Outcome of transition phase patients with juvenile idiopathic arthritis

Objectives: Across diagnosis groups, successful transition of adolescent and young adults from children’s hospitals to adult care is often associated with decreased treatment adherence and treatment results. The aim of this study was to characterize disease activity and anti-rheumatic medications following transfer of care of juvenile idiopathic arthritis (JIA) patients to the adult clinic.Method: All consecutive JIA patients aged 16–20 years who visited the specific transition clinic in the rheumatology outpatient clinic of Helsinki University Hospital between November 2012 and May 2013 and between April 2015 and April 2016 were evaluated.Results: A total of 214 patients were identified, and 23 appeared in both cohorts. Females had higher disease activity scores (DAS) than males (DAS28-CRP 1.9 ± 0.7 versus 1.6 ± 0.3, p = .019; and DAS44-CRP 1.0 ± 0.7 versus 0.7 ± 0.5, p = .005; respectively) in the latter cohort. Disease-modifying antirheumatic drugs (DMARDs) were prescribed to 86% of patients, and 48% were on biological DMARDs (bDMARDs), whereas 14% had no specific treatments.Conclusion: Disease activity and clinic attendance remained stable during the transition period. The proportion of transition phase JIA patients on bDMARDs was high and disease activity was low. Reasons for lower disease activity in males in the latter cohort require further investigation.