Management Of Rheumatoid Arthritis Patients Research Articles

Association between rheumatoid arthritis and autoimmune thyroid disease: evidence from complementary genetic methods.

To assess the causal association of Rheumatoid Arthritis (RA) with Autoimmune thyroid disease (AITD). Complementary genetic approaches, including genetic correlation, Mendelian randomization (MR) and colocalization analysis, were conducted to assess the potential causal association between RA and AITD using summary statistics from large-scale genome-wide association studies (GWASs). Various sensitivity analyses had been conducted to assess the robustness and the consistency of the findings. The linkage disequilibrium score regression revealed a shared genetic structure between RA and AITD, with the significant genetic correlation between RA and autoimmune hyperthyroidism and autoimmune hypothyroidism estimated to be 0.3945 (P = 2.83 × 10-6) and 0.2771 (P = 1.04 × 10-6) respectively. The results of MR analysis showed that RA had a positive causal relationship with autoimmune hypothyroidism and autoimmune hyperthyroidism. The odds ratio (OR) were 1.29 (95% CI, 1.17-1.42; P = 1.08 × 10-7) and 1.47 (95% CI, 1.25-1.72; P = 1.85 × 10-6), respectively. In reverse MR analysis, autoimmune hypothyroidism had a positive causal relationship with RA, OR was 1.51 (95% CI, 1.37-1.66; P = 1.10 × 10-16); autoimmune hyperthyroidism had no causal relationship with RA relationship (P = 0.22). Similar results were found using different MR methods. In addition, colocalization analysis suggested that shared causal variants existed between RA and AITD. Our study suggested a potentially causal effect of genetically predicted RA on autoimmune hyperthyroidism and a bidirectional causal relationship between RA and autoimmune hypothyroidism was also observed with complementary genetic approaches, which supports the importance and necessity of thyroid function screening and monitoring in RA patient management in clinical practice.

Evaluation of therapeutic potential of ivermectin against complete Freund's adjuvant-induced arthritis in rats: Involvement of inflammatory mediators.

Rheumatoid arthritis is a chronic systemic inflammatory disease with genetic manifestations. According to recently published case reports, patients taking corticosteroid medication for the management of rheumatoid arthritis develop strongloidiasis and are at high risk of developing associated infections. This study explored the antiarthritic role of ivermectin, a drug used in the treatment of strongyloides and to compare its results with dexamethasone. Thirty-two male Wistar rats were randomly divided into four groups: control, diseased, dexamethasone, and ivermectin groups. Rheumatoid arthritis in all rats except the control group was induced by using complete Freund's adjuvant. After 7days of rheumatoid arthritis induction, animals were treated with dexamethasone 5mg/kg and ivermectin 6mg/kg. Body weight, visual arthritic score, total leukocyte count, differential leukocyte count, proinflammatory genes, and histopathological findings were used to assess the effects of ivermectin on rheumatoid arthritis. Treatment with ivermectin showed a significant reduction in inflammatory cells levels, body weight, and visual arthritic score, indicating an improvement in the degree of inflammation as compared with the diseased group. Treatment with ivermectin and dexamethasone significantly reduced the augmentation in the mRNA expression levels of IL-17, TLR-2, TNF, and NF-κB as a result of arthritic development. Ivermectin treatment also showed a significant reduction in the severity of inflammation and destruction of joints and showed comparable effects to dexamethasone, a corticosteroid used for the treatment of rheumatoid arthritis. Ivermectin has significant antiarthritic properties and can be a novel treatment agent for the management of rheumatoid arthritis patients suffering from strongyloidiasis.

Disease-modifying anti-rheumatic drugs improve the cardiovascular profile in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting about 0. 5-1% of the adult population and manifesting as persistent synovitis, systemic inflammation and production of autoantibodies. Patients affected by RA not only experience chronic disease progression, but are also burdened by a 1.5-fold increased cardiovascular (CV) risk, which is comparable to the risk experienced by patients with type 2 diabetes mellitus. RA patients also have a higher incidence and prevalence of coronary artery disease (CAD). Although RA patients frequently present traditional CV risk factors such as insulin resistance and active smoking, previous studies have clarified the pivotal role of chronic inflammation-driven by proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha)-in accelerating the process of atherosclerosis and impairing the coagulation system. Over the last years, a number of studies have shown that disease-modifying anti-rheumatic drugs (DMARDs) reducing the inflammatory state in general improve the CV risk, however some drugs may carry some apparent negative effects. Thus, RA is a model of disease in which targeting inflammation may counteract the progression of atherosclerosis and reduce CV risk. Clinical and experimental evidence indicates that the management of RA patients should be tailored based on the positive and negative effects of DMARDs on CV risk together with the individual traditional CV risk profile. The identification of genetic, biochemical and clinical biomarkers, predictive of evolution and response to treatment, will be the next challenge for a precision approach to reduce the burden of the disease.

"You can't touch, you can't bond": Exploring COVID-19 pandemic impacts on rheumatoid arthritis patient goals and communication with clinicians.

"You can't touch, you can't bond": Exploring COVID-19 pandemic impacts on rheumatoid arthritis patient goals and communication with clinicians.

Cardiology co-management of rheumatoid arthritis patients with coronary artery disease as an intervention reduces hospitalization rates and adverse event occurrence.

IntroductionRheumatoid arthritis (RA) is a systemic autoimmune disease with important cardiovascular (CV) implications. CV disease represents over half of RA patient deaths and causes significant morbidity. CV manifestations in RA can be complex, raising concerns for adequate patient management and provider-dependent roles.MethodsThis is a retrospective study of patients diagnosed with RA and coronary artery disease (CAD). Patients were identified and filtered via EPIC Database search engine. Parameters were set from January 1, 2014, to December 31, 2020. Inclusion criteria consisted of patients who met diagnostic criteria for both RA and CAD. A total of 399 patients met criteria.ResultsOf the 399 identified patients, 272 were female (68.2%) and 127 were male (31.8%) with a median age of 73 (range 26–98). The population was further divided into two groups: those with established cardiology care versus those without. Patients without cardiology follow-up experienced significantly more hospitalizations (RR 1.63 95% CI 1.12, 2.38), higher rates of adverse events including myocardial infarction (MI) (RR 4.82 95% CI 1.94, 11.98), heart failure (HF) (OR 15.81 95% CI 3.54, 70.52), and stroke (RR 2.55 95% CI 1.29, 5.03). Patients not followed by cardiology also had numerical increases in CV death (4 deaths compared to none in those with cardiology follow) and all-cause mortality (HR 1.03 95% CI 0.63, 1.67).ConclusionPatients with regular cardiology follow-up demonstrated fewer cardiac-related adverse events. This suggests that co-management may have a role in adverse cardiac event risk reduction and should therefore be an early consideration. Key Points• Rheumatoid arthritis patients demonstrate higher rates of coronary disease compared to the general population. Traditional cardiac risk factors may not be entirely responsible for this phenomenon• Hospitalization rates and adverse event occurrence are significantly higher in patients with single-provider care (rheumatology only) compared to dual provider care (rheumatology and cardiology)• Cardiology co-management should be an early consideration in the management of RA patients• Early screening, risk stratification of coronary disease, and utilization of appropriate treatment algorithms are important to decrease morbidity and mortalitySupplementary InformationThe online version contains supplementary material available at 10.1007/s10067-022-06335-4.

Practices among General Practitioners in Rheumatoid Arthritis (GEPRA-I): results of a region-wide online survey

BackgroundTo assess current practice regarding the management of rheumatoid arthritis patients among general practitioners of a French region, and their perception about the deployment of a multidisciplinary collaboration.MethodsA cross-sectional online survey was sent to the general practitioners of a French region. The questionnaire comprised of 3 sections to collect data regarding 1/demographics, 2/practice and knowledge in rheumatoid arthritis, and 3/perception about the deployment of a multidisciplinary collaboration.Results1/A total of 247 general practitioners (M/F ratio: 1.4; mean age: 46.7 years) completed the survey. 2/More than half of general practitioners believed that their role was very or extremely important in disease diagnosis (72.5%), and management of comorbidities (67.2%). Among respondents, 6.1% considered that they did not face any difficulty concerning the patient management and 61.5% had already identified causes of non-adherence. 3/A total of 151 (61.1%) general practitioners were willing to participate in a multidisciplinary programme to improve medication adherence in rheumatoid arthritis.ConclusionsGeneral practitioners are motivated to contribute to an overall management of rheumatoid arthritis patients. Nevertheless, they need professional education about rheumatoid arthritis treatment and training in motivational interviews before getting involved in a multidisciplinary collaboration.

Efficacy of Wushaoshe Qufeng Tablet and leflunomide combination therapy in the management of rheumatoid arthritis, and its influence on incidence of adverse drug reactions

Purpose: To study the effectiveness and safety of combined use of Wushaoshe Qufeng tablets andleflunomide in the treatment of rheumatoid arthritis patients.Methods: A retrospective trial was conducted among 120 patients with rheumatoid arthritis hospitalized in Heyuan Hospital of Traditional Chinese Medicine, Heyuan, from February 2020 to February 2021. The patients were equally divided into study group (n = 60) and control group (n = 60). Both groups received conventional treatment. in addition, the control group received leflunomide, whereas the experimental group received Wushaoshe Qufeng tablets. The two groups were compared with respect to laboratory indicators, TCM syndrome scores, and adverse events.Results: The post-treatment TCM syndrome scores was lower in the experimental group versus control group (p < 0.001). After treatment, the study group was superior to the control group in terms of their biochemical indicators (p < 0.001). Safety profile was better in the study group than in the control group (p < 0.05). Treatment effectiveness was significantly higher in the study group than in the control group (p < 0.05).Conclusion: Combined treatment of rheumatoid arthritis patients with Wushaoshe Qufeng tablets and leflunomide shows improved biochemical indicators, mitigates clinical symptoms, and enhances treatment effectiveness. Moreover, the combination therapy is safe, and therefore, should be considered for the management of rheumatoid arthritis patients.

Downmodulation of lysophosphatidic acid by Berberine loaded folate-conjugated glycol chitosan nanoparticles (BFGCN) to mitigate Rheumatoid arthritis (RA) & Cardio-vascular disease(CVD): Current knowledge and future perspectives

The perils of cardiovascular diseases (CVD) are enhanced by systemic chronic inflammation in autoimmune disorders like Rheumatoid arthritis (RA), in which the patients generally exhibit a high inflammatory burden, dyslipidemia causing 50-60% of RA patients susceptible to CVD dependent mortality. Lysophosphatidic acid (LPA) is a polar, pleiotropic lipid molecule that is water soluble and present in the synovial fluid that can be exploited as an effective biomarker for lipid-signalling. Current research on alternative medicine has recognized various new molecular targets of Berberine (BBR) and established novel signals in support of the efficacy and therapeutic potential of BBR to fight CVD. Therefore, BBR, an alkaloid with poor aqueous solubility could be foreseen as a therapeutic strategy for the reduction of inflammation induced lipidemia by targeting the macrophages and modulating their functions. Hence, a novel BBR loaded folate-conjugated glycol chitosan nanoparticles (BFGCN) could be hypothesized as a three-pronged approach to target activated macrophages, fibroblasts of synovial fluid for downmodulation of LPA. The greatest challenge is the heterogeneity, complexity and interdependence of RA and CVD. Investigation of prognostic and predictive biomarkers is urgently required. Therefore, an improved understanding of the pathogenesis of RA would facilitate identifying an improved targeted treatment and management of RA patients.

COVID-19 and Rheumatoid Arthritis Crosstalk: Emerging Association, Therapeutic Options and Challenges.

Hyperactivation of immune responses resulting in excessive release of pro-inflammatory mediators in alveoli/lung structures is the principal pathological feature of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The cytokine hyperactivation in COVID-19 appears to be similar to those seen in rheumatoid arthritis (RA), an autoimmune disease. Emerging evidence conferred the severity and risk of COVID-19 to RA patients. Amid the evidence of musculoskeletal manifestations involving immune-inflammation-dependent mechanisms and cases of arthralgia and/or myalgia in COVID-19, crosstalk between COVID-19 and RA is often debated. The present article sheds light on the pathological crosstalk between COVID-19 and RA, the risk of RA patients in acquiring SARS-CoV-2 infection, and the aspects of SARS-CoV-2 infection in RA development. We also conferred whether RA can exacerbate COVID-19 outcomes based on available clinical readouts. The mechanistic overlapping in immune-inflammatory features in both COVID-19 and RA was discussed. We showed the emerging links of angiotensin-converting enzyme (ACE)-dependent and macrophage-mediated pathways in both diseases. Moreover, a detailed review of immediate challenges and key recommendations for anti-rheumatic drugs in the COVID-19 setting was presented for better clinical monitoring and management of RA patients. Taken together, the present article summarizes available knowledge on the emerging COVID-19 and RA crosstalk and their mechanistic overlaps, challenges, and therapeutic options.

Менеджмент пацієнтів з ревматоїдним артритом у періопераційному періоді

Пацієнти з ревматоїдним артритом (РА), незважаючи на успіх консервативної терапії, мають високу потребу у проведенні ортопедичних хірургічних втручань, а також операцій за соматичними показаннями. Таким пацієнтам необхідна ретельна періопераційна оцінка та підготовка для досягнення сприятливих результатів оперативного лікування й менеджменту в післяопераційному періоді. Повинен бути зібраний детальний анамнез, проведено детальне фізикальне обстеження з відповідною лабораторною оцінкою функції органів і систем, з диференціюванням ураження органів, вторинного щодо РА або пов’язаного з коморбідними станами. Слід поінформувати пацієнтів про потенційні ризики хірургічного втручання, зокрема підвищення ризику інфікування, уповільнення загоєння ран і розвиток венозних тромбоемболій, а також про основні можливі серцево-судинні, легеневі й неврологічні порушення, що можуть бути зумовлені хірургічним втручанням. В оглядовій статті підбито підсумки останніх досягнень у цій галузі та розглянуто останні рекомендації, запропоновані Американською колегією ревматологів і Американською асоціацією хірургів, щодо періопераційного ведення й тактики антиревматичної терапії в пацієнтів перед тотальним ендопротезуванням колінних і кульшових суглобів 2017 року і керівництво з біологічної безпеки хворобомодифікуючих антиревматичних препаратів (ХМАРП) Британського товариства ревматологів при запальних артритах. Менеджмент ХМАРП у передопераційному періоді має здійснюватися згідно з рекомендаціями основних провідних ревматологічних спільнот, але підхід повинен бути індивідуалізований, із залученням мультидисциплінарної команди. На сьогодні рекомендації підтримують продовження прийому синтетичних ХМАРП упродовж усього періопераційного періоду й рекомендують короткочасне переривання біологічної терапії на один інтервал дозування перед операцією з продовженням прийому через 14 днів після операції. Більш високі дози глюкокортикоїдів роблять значно більший внесок у ризик післяопераційної інфекції, аніж біологічна терапія. Рекомендується уникати планової операції в пацієнтів, які приймають преднізолон в дозі більше за 20 мг/д. Рекомендується зниження дози глюкокортикоїдів до мінімально можливої перед операцією. Незважаючи на те, що невизначеність залишається, ці недавні дослідження та рекомендації дозволяють більш раціонально і науково обґрунтовано підходити до ведення пацієнтів з РА, яким заплановано хірургічне втручання або яким необхідно провести її терміново.

Equivalence and switching between biosimilars and reference molecules in rheumatoid arthritis: protocol for a systematic review and meta-analysis

BackgroundBiologic drugs such as adalimumab, etanercept, and infliximab represent major first-line and second-line treatments for rheumatoid arthritis (RA) patients. However, their high cost poses a massive burden on healthcare systems worldwide. The expiration of patents for these biologics has driven the production of biosimilar drugs, which are potentially less costly and remarkably similar, albeit not identical to the reference molecules. This paper aims to outline the protocol of a systematic review that will investigate the efficacy and safety profile of biosimilars compared to biologics (objective 1) and the impact of switching between biosimilar drugs and reference biologics on the management of RA patients (objective 2).MethodsWe will investigate the effects of any biosimilars of adalimumab, etanercept, and infliximab on RA patients. We will include randomized controlled trials (RCTs) or quasi-RCTs to assess efficacy and safety outcomes and RCTs with two- or multiple-part designs to evaluate the consequences of switching from reference biologics to biosimilar drugs (and vice-versa). Electronic searches will be performed through MEDLINE (via PubMed), EMBASE, LILACS, and CENTRAL (from inception to April 2021). Two independent reviewers will screen studies, extract data, and evaluate the risk of bias. The latter will be carried out considering specific domains from equivalence trials and switching studies. Random-effects models will be fitted to obtain summary estimates using either relative risk or standardized mean difference as a metric. The primary outcome will be the rate of treatment success according to the American College of Rheumatology 20 (ACR20), and the co-primary outcome will be the Health Assessment Questionnaire—Disability Index (HAQ-DI). Conclusions will be based on equivalence hypothesis testing using predefined margins of equivalence elicited from a group of experienced rheumatologists and prior studies. The overall certainty of the evidence will be assessed based on the GRADE system.DiscussionThe present investigation proposes a comprehensive, clinician-oriented approach to assess the equivalence and the impact of switching between biosimilars and biologics on the management of patients with RA. Our results will elucidate the efficacy, safety, immunogenicity of biosimilars, and the clinical consequences of substituting biologics with biosimilars in the management of RA.Systematic review registrationPROSPERO CRD42019137152 and CRD42019137155

Body mass index, serum rheumatoid factor and c-reactive protein among individuals with rheumatoid arthritis in Kano Metropolis

Background: Rheumatoid arthritis (RA) is becoming a global health menace associated with joints swelling, pain, stiffness, and progressive loss of function of extremities etc. This study aimed at evaluating the Body Mass Index (BMI), Serum Rheumatoid Factor (RF) and C-Reactive Protein (CRP) among RA Patients in Kano Metropolis. Methods: A total of 111 participants comprising 74 Rheumatoid Arthritis patients and 37 apparently healthy controls were recruited for this study. Exactly 29 were males while 44 were females aged between 25 to 75 years. Using standard techniques, BMI was calculated using the weight and height taken from the participants. Blood samples were collected for serum RF and CRP and were analysed using Enzyme linked immunosorbent assay technique. Statistical Package for Social Sciences version 21 was used for the analysis of data. Results: Our findings reveal that, females recorded higher percentage frequency of 45 (60.8%) while males recorded a lower percentage frequency of 29(39.2%) of RA patients with the ratio of 1.55:1, the higher percentage frequencies of 35(47.3%) was observed in overweight BMI patients of between 25- 29.9 kg m-2. The mean serum value of RF was significantly (p = 0.00) higher in case group (4.4 ±1.5 ng/ml) compared with the control group (2.0 ±1.5 ng/ml) and also the mean serum value of CRP was significantly (p = 0.00) higher in case group (13.0 ±5.0 mg/L) compared with the control group (5.5±5.0 mg/L). A significant positive correlation was established between serum RF and CRP (r = 0.48, p=0.00). Conclusion: Our findings show increased RF and CRP in RA case group. Quantitative evaluation of immunological parameter such as RF, CRP and BMI monitoring may aid in proper management of RA patients.

THE EXPERIENCE IN CONDUCTING THE EDUCATIONAL PROGRAM FOR RHEUMATOID ARTHRITIS PATIENTS IN AN ONLINE MODE (IN THE FORM OF A WEBINAR)

The educational program ("School of Health") is an integral part of comprehensive management of rheumatoid arthritis patients. In connection with the pandemic of the new coronavirus infection (COVID-19), as part of prophylactic measures to prevent its spread, to reduce contacts between patients, distance learning becomes an ideal way to conduct an educational program. The aim of this work was to develop and evaluate the effectiveness of the educational program for rheumatoid arthritis patients, implemented in an online mode in the form of webinars. The study involved 16 rheumatoid arthritis patients (14 of them were women) aged 24 to 53 years with average disease duration of 13.6±8.2 years. The "School of Health" consisted of 5 online classes in the form of webinars on Zoom platform lasting 30 minutes each, held at intervals of 3-4 days. The educational program included 4 modules (4 classes): 1) the concept of rheumatoid arthritis, diagnosis and pharmacological therapy; 2) rehabilitation: physical and psychological; orthotics; 3) dietary recommendations, private questions; 4) physical activity, physical therapy. The fifth lesson was aimed at consolidating the knowledge, discussing the issues of entrance testing and the results of questionnaires filled out by patients during the educational process using the Google Forms service. At the end of the training, the level of patients' awareness about their disease increased by 16.3%. One of the positive aspects of distance learning is the opportunity to repeatedly view the training material – all videos of online classes have open access on Youtube resource. In current epidemiological situation, one of the best ways of communication between a doctor and a rheumatoid arthritis patient is an educational program conducted in an online mode in the form of webinars, giving the patient a holistic view of his disease, the goals and tactics of treatment, developing skills of rational behavior in non-professional and professional activities.

Future use of musculoskeletal ultrasonography and magnetic resonance imaging in rheumatoid arthritis.

Musculoskeletal ultrasonography (MSUS) and magnetic resonance imaging (MRI) play important roles in diagnosis, monitoring, and prognostication of rheumatoid arthritis. This review highlights recent literature in this field and aims to provide insight into the future use in clinical practice. Recent studies concerning the use of MSUS and MRI in clinical practice show how MSUS and MRI can improve diagnosis and monitoring of rheumatoid arthritis and how they can predict both radiographic progression and clinical outcome (e.g., successful tapering of medical treatment). Moreover, novel technical developments of the two imaging modalities, such as 3D ultrasonography, ultrasound image reading with convolutional neural network, image fusion (MSUS and MRI) and whole-body MRI show promising results. Further validation of these novel techniques is required prior to implementation. MSUS and MRI will be important parts of the future management of rheumatoid arthritis patients, mostly because of their ability to detect rheumatoid arthritis changes at a very early stage and to predict the course of disease. However, the exact role in routine clinical practice is still to be defined.

Antibodies to synthetic citrullinated peptide epitope correlate with disease activity and flares in rheumatoid arthritis.

Rheumatoid arthritis (RA), caused by the abnormal recognition of human joint cells by autoimmune antibodies, remains the world’s most prevalent autoimmune disease, with over five million people affected and as much as 4% of the population at risk of RA. To prevent rapid disease development, hormonal and anti-inflammatory therapies require fast and reliable RA diagnosis. However, difficulty in detecting early specific biomarkers for RA means that it is unclear when treatment needs to begin. Here, we combined synthesis of citrullinated peptide epitopes with molecular diagnostics to verify a new specific biomarker for early RA diagnosis and flare prediction. A fibrinogen-derived 21-amino-acid-long citrullinated peptide showed high reactivity toward autoantibodies in RA samples. Additionally, the level of antibodies to this epitope was elevated prior to flares. In contrast, other citrullinated protein variants had lower reactivity and poorer sensitivity to disease activity. In conclusion, fibrinogen-derived epitope E2 subjected to citrullination facilitated a reliable RA diagnosis with a strong correlation to disease activity. This is of a high value for the diagnosis and management of RA patients who respond poorly to treatment.

This Study is to Investigate the Effect of Etanercept in Early Versus Delayed Referral for Management of Rheumatoid Arthritis Patients.

This Study is to Investigate the Effect of Etanercept in Early Versus Delayed Referral for Management of Rheumatoid Arthritis Patients.

Assessment of renal involvement in an Iraqi cohort of rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is an autoimmune chronic systemic inflammatory disease involves synovial joints but may involve extra-articular organ as well. Objectives: to determine the prevalence of indicators of renal involvement in patients with RA with implications of impact of related drugs on the kidney. Materials and Methods: This cross-sectional study was conducted from May 1, 2019, to November 1, 2019, in the Outpatient Rheumatology Clinic of Hawler teaching hospital, Erbil, Iraq. One hundred and seventy-six patients with seropositive RA were enrolled, other 13 were dropped because of missing data. Participant's characteristics and data regarding drug history were collected. Body mass index (BMI), erythrocyte sedimentation rate (ESR), and serum creatinine were measured; renal function was assessed from the estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease formula. Urine examined for proteinuria, microscopic hematuria, and noninfectious leucocyturia. When eGFR 0.5). Conclusions: Renal disorder is common in RA patients. Regular monitoring of renal involvement by using eGFR and urinary dipstick is crucial, especially in the elderly obese RA patients with a long duration of the disease and proteinuria. Early identification of renal disease can facilitate the early intervention and achieve the better management of RA patients.

Primary care providers’ awareness, knowledge, and practice with regard to cardiovascular risk in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic auto-inflammatory disease associated with increased cardiovascular risk. Early identification and aggressive cardiovascular risk factor modification are critical for improvement in morbidity and mortality in patients with RA. This study is a cross-sectional survey with the purpose of evaluating primary care providers' awareness, practice patterns, and satisfaction with continuing medical education on cardiovascular risk in patients with RA. Our study showed that 71% of clinicians felt that the CME on RA patient management regarding CV risk factors is inadequate. Only 37% of providers reported feeling well prepared to manage CV risk for RA patients. Only 15% of participants were actively initiating a discussion regarding CV risk with RA patients. A better understanding of the educational needs and practice patterns of primary care providers may warrant the development of strategies for cardiovascular risk management in patients with RA.

Impact of residential area on the management of rheumatoid arthritis patients initiating their first biologic DMARD: Results from the Ontario Best Practices Research Initiative (OBRI).

Access to care and management of Rheumatoid Arthritis (RA) patients may differ based on residential area. We described differences in the profile of patients initiating their first biologic disease modifying antirheumatic drug (bDMARD) based on their residential area type.Cross-sectional analysis of 793 adult RA patients in the longitudinal Ontario Best Practices Research Initiative (OBRI) registry initiating their first bDMARD <30 days prior to or anytime post-enrolment. Patient residential and clinic areas (rural vs. urban) were classified using 2 methods: postal codes and Statistics Canada population centres. Sociodemographics, disease characteristics, and RA medications (tumor necrosis factor inhibitor [TNFi] vs. non-TNFi, concurrent use of conventional synthetic DMARDs [csDMARDs], and intravenous [IV] vs. subcutaneous [SC] bDMARD) at initiation of first bDMARD were contrasted between residential area types.Other than marital status, first language, and race (higher proportion of married, English speaking, Caucasian patients in rural areas), no significant differences were observed in the demographic and disease characteristics of patients living in rural and urban areas. In multivariate analysis, there was no association between residential area type and type of bDMARD use, concurrent csDMARD(s) use or route of bDMARD. However, patients living farther from their treating clinic were significantly less likely to initiate IV bDMARD. Female rheumatologist and rural clinic location were independently associated with lower odds of IV bDMARD use.The use of SC vs. IV bDMARD was associated with being seen in a clinic located in a rural area, being treated by a female rheumatologist, and living farther from treating clinic. These results suggest possible prescription bias in bDMARD selection and/or patient preferences due to convenience.

Medical audit guideline about rheumatoid arthritis diagnosis and treatment.

rheumatoid arthritis is a frequent inflammatory disease and a leading cause of potentially-treatable disability. Rheumatoid arthritis is associated with an increased risk of general morbidity and mortality. New therapeutic options have dramatically improved the evolution of patients. in this joint work of the Association of Auditing and Quality of Medical Care of Córdoba (ASACAM) and the Argentine Society of Rheumatology (SAR), we generated recommendations to especially assist medical auditors in making decisions to improve the quality of the medical and life care of patients and reduce costs in the management of rheumatoid arthritis patients. in addition to medical auditors, these recommendations can be expanded to general practitioners, rheumatologists and clinicians, and eventually to the general public. Conclusions: suggestions for the diagnosis and treatment of patients with rheumatoid arthritis (including biological therapies) are described, based on the Clinical Practice Guidelines for the Treatment of Rheumatoid Arthritis (SAR, 2013), the resolutions of the Compulsory Medical Program and the Unique Reimbursement System currently used in in addition to medical auditors, these recommendations can be expanded to general practitioners, rheumatologists and clinicians, and eventually to the general public. suggestions for the diagnosis and treatment of patients with rheumatoid arthritis (including biological therapies) are described, based on the Clinical Practice Guidelines for the Treatment of Rheumatoid Arthritis (SAR, 2013), the resolutions of the Compulsory Medical Program and the Unique Reimbursement System currently used in Argentina.