Mean Health Assessment Questionnaire Research Articles

Bodyweight Exercise of Lower and Upper Extremities for Female Patients with Rheumatoid Arthritis and the Timed Up-and-Go Test.

At our hospital, orthopedic surgeons and physical and occupational therapists have developed bodyweight exercises for the lower and upper extremities (BELU) for rheumatoid arthritis (RA) patients, including walking [Timed Up-and-Go (TUG) test and figure-of-eight walking) and weight exercises. We aimed to clarify the effect of bodyweight exercise and the Health Assessment Questionnaire (HAQ) cut-off value for a TUG test result of 12 s (or longer) as a risk factor for a fall. All patients underwent BELU twice weekly at home for 6 weeks. We assessed the HAQ score, TUG time, and the strengths of quadriceps femoris, biceps brachii, handgrip, side pinch, and pulp pinch before and after the intervention. We analyzed the data of 42 participants. The mean age was 67.0 ± 12.1 years. The mean Disease Activity Score-28 for rheumatoid arthritis with erythrocyte sedimentation rate was 2.91 ± 0.91. The mean HAQ score was 0.69 ± 0.62. The dominant quadriceps femoris, biceps brachii, pulp pinch, and side pinch strengths were significantly strengthened. TUG time was improved from 9.0 ± 3.0 s to 8.6 ± 3.2 s (P=0.009). The receiver operating characteristic analysis revealed the cut-off value of HAQ for a TUG time of 12 s (or longer) was 1.0 (AUC 0.903, 95% confidence interval 0.792-1.0). Bodyweight exercises strengthened the muscles in female patients with RA, resulting in improved TUG test results. An indicative HAQ cut-off value of 1.0 (or greater) was identified for a TUG test result of 12 s or longer.

Childhood-onset rheumatoid arthritis at a tertiary hospital in Senegal, West Africa

BackgroundChildhood-onset rheumatoid arthritis (CORA), known as rheumatoid factor (RF)-positive juvenile idiopathic arthritis is a type of juvenile idiopathic arthritis that shares the same genetic factors and clinical features as adult-onset rheumatoid arthritis. In Africa, CORA hasn’t been the subject of a specific study.ObjectivesThe aim of this study is to describe the clinical features, disease activity, functional disability, and treatment of CORA at diagnosis in Senegal and compare the findings to other CORA populations.MethodsWe conducted a mixed cohort study by reviewing the medical records of patients diagnosed with CORA with an age of symptom onset < 18 years according to the 2019 PRINTO provisional criteria for RF-positive JIA from January 2020 to December 2022 at rheumatology department of Aristide Le Dantec Hospital in Dakar, Senegal. We collected demographic, clinical, paraclinical and therapeutic data. Disease activity score was assessed by DAS28-ESR and DAS28-CRP. Functional disability was assessed using Health Assessment Questionnaire (HAQ) or Childhood HAQ.ResultsA total of 21 patients were included. Eighteen (85.7%) were Females. The mean age at symptom onset was 13.0 ± 3.0 years, and at diagnosis was 16.4 ± 4.2 years. Morning stiffness, joint swelling, and joint deformities were found in 20, 18 and 13 patients respectively. Four patients had a family history of rheumatoid arthritis. Five patients had extra-articular involvement such as rheumatoid nodules. Two patients had interstitial lung disease. The biological inflammatory syndrome was found in 90% of cases. 16 of 21 (76.2%) patients had positive RF, and 18 of 20 (90%) patients had positive Anti-CCP. Seven of 12 (58.3%) patients had positive anti-nuclear antibodies. The mean DAS28-ESR was 5.7 ± 1.0. Fifteen (71.4%) patients had high disease activity (DAS28-ESR > 5.1). The mean DAS28-CRP was 5.4 ± 1.1. The median HAQ was 2.12 with a mean HAQ of 1.9. Nineteen (90.5%) patients were treated with methotrexate, while 17 (81%) had a combination of methotrexate and hydroxychloroquine. Oral prednisone was used in 17 (81%) cases. Non-steroidal anti-inflammatory drugs were used in 4 cases (19%). After 6 months of treatment, mean DAS28-CRP was 2.9.ConclusionIn our study, CORA mainly affects 13-year-old girls, characterised by high disease activity with joint deformity and significant functional impairment. Treatment is mainly based on methotrexate, prednisone and hydroxychloroquine. Further studies are needed to determine the exact clinical phenotype of this disease.

Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries.

Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease affecting the musculoskeletal system, skin and nails. The aim is to characterize sociodemographic and clinical patient profiles documented in dermatologic and rheumatologic care. Data of 704 patients with PsA from the dermatological Psoriasis Registry PsoBest (PB) and 1066 patients from the rheumatological disease registry RABBIT-SpA (RS) were analyzed. Comparable anamnestic and clinical variables were identified and descriptively analyzed. The mean age was 51.7 years in PB and 51.9 in RS. Disease duration of psoriasis was longer, mean cutaneous severity was higher in PB. However, more patients in RS vs. PB had tender joints and swollen joints. Mean Dermatology Life Quality Index was higher in PB and mean Health Assessment Questionnaire in RS. Patient reported global disease activity and pain were lower in PB. IL-23 inhibitors were used more frequently in PB, and TNF inhibitors in RS. Clinical specialization was associated with different clinical and treatment patterns of PsA. This may indicate a selection by dominant manifestation of psoriatic disease and potentially by effects of health care access. Psoriatic arthritis should be treated in a multidisciplinary approach considering all facets of this complex disease.

Cost of Illness, Quality of Life, and Work Productivity in Axial Spondyloarthritis Patients Receiving Biological Treatments in Greece.

To estimate the cost of illness, quality of life and work productivity in patients with Axial Spondyloarthritis (Axial SpA) under biological treatment in Greece. We conducted a prospective study of 12-month duration, of patients with Axial SpA from a tertiary hospital in Greece. Adult patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria were enrolled at the beginning of biological treatment due to active disease [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) >4] and failure of first line treatment. All participants completed questionnaires about quality of life, financial costs and work productivity at the same time with the disease activity assessment. 74 patients of whom 57 (77%) with a paid job, were included in the study. The total annual cost for Axial SpA patients is € 9,012.40 while the average cost of acquisition and administration of the drugs is € 8,364. The mean BASDAI in the 52 weeks of follow-up, was decreased from 5.74 to 3.2 and the mean Health Assessment Questionnaire (HAQ) also from 1.13 to 0.75. Work productivity of these patients as measured with the Work Productivity and Activity Impairment Questionnaire (WPAI), was significantly impaired at the baseline and improved after the initiation of biological treatment. The cost of illness in patients receiving biological treatments in Greece is high. However, these treatments except from the well-established positive effect on disease activity, can improve remarkably the work productivity and quality of life of Axial SpA patients.

P273 Factors related to insomnia in patients with psoriatic arthritis: a cross-sectional study

Abstract Background/Aims Several studies have demonstrated an increased prevalence of sleep disorders in patients with psoriatic arthritis (PsA). However, there are few data on the relationship between sleep disturbance and disease activity in PsA. We conducted a cross-sectional study to investigate the prevalence of insomnia symptoms and poor sleep quality in PsA and examine correlation with demographic, clinical and patient-reported outcome measures. Methods Patients were recruited from rheumatology clinics at a single centre. Patients had a diagnosis of PsA, met the CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria and were aged ≥ 18 and ≤ 80 years. They had no other confirmed sleep disorder diagnoses. Disease activity was calculated using the cDAPSA (Clinical Disease Activity in PSoriatic Arthritis) score. Disease impact was measured using a pain visual analogue scale (VAS) and the Psoriatic Arthritis Impact of Disease (PsAID)-12 questionnaire and functional impairment was assessed using the health assessment questionnaire (HAQ). We used the Sleep Condition Indicator (SCI) to assess symptoms of Diagnostic and Statistical Manual of Mental Disorders (DSM)-V insomnia disorder (ID). The SCI is a score from 0-30 with lower scores indicating worse subjective sleep. We used the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality. Relationships between clinical characteristics and sleep disturbance were examined using Pearson’s correlation coefficients and multivariable logistic regression. Results Thirty participants were enrolled in the study, of which 13 were female. Mean (SD) age of participants was 49 (13.5) years. Overall, the prevalence of probable DSM-V ID (SCI score ≤ 16) was 43.33% (13/30) with a mean (SD) SCI score of 6.80 (4.79). Mean (SD) PSQI score was 6.77 (3.22) with 60% (18/30) classified as subjective poor sleepers. Mean (SD) pain VAS, PsAID-12 and HAQ were 33.89 (28.67), 2.97 (2.05) and 46.12 (38.83), respectively. Mean (SD) cDAPSA score was 12.3 (15). A significant correlation was observed between the SCI score and cDAPSA (r=-0.3809, p = 0.038), and SCI and PsAID-12 scores (r=-0.3809, p = 0.033). No correlation was found between SCI score and HAQ, age, pain VAS, or disease duration. Multivariable logistic regression controlling for age found an association between cDAPSA and probable ID (OR:1.098 95%CI:1.014-1.253). This association did not persist once pain level, gender, PsAID-12 and HAQ scores were controlled for. Conclusion This cross-sectional analysis of patients with PsA demonstrates that sleep disturbance is highly prevalent. Symptoms of insomnia in this small cohort were related to higher baseline disease activity and self-reported disease impact. This study is the first to demonstrate these findings and warrants further exploration in a larger sample size with longitudinal data. It would be of interest to understand the relationship between insomnia and disease activity and whether insomnia is responsive to treating PsA to low disease activity levels. Disclosure D. McGagh: None. N.M. McGowan: None. S. Elahi: None. J. MacDonald: None. K.E.A. Saunders: None. L.C. Coates: None.

Oral Health and Rheumatoid Arthritis: A Case Control Study.

Introduction:Association between oral health and rheumatoid arthritis is well established. Oral health-related quality of life was determined in patients diagnosed with rheumatoid arthritis (RA).Materials and Methods:This study was conducted among 45 patients (males 25 and female 20) (Group I) of RA and 45 healthy participants as control (Group II). Disease activity score 28 test, health assessment questionnaire (HAQ), and general oral health assessment index (GOHAI) questionnaire were applied.Results:The mean HAQ score in Group I was 1.14 and in Group II was 0.36. The mean GOHAI score in Group I was 36.4 and in Group II was 52.8. The mean HAQ in males was 0.94 and in females was 34.6. The mean GOHAI in males was 12.6 and in females was 38.2. In Group I, there were 15 patients with HAQ level 1 and 30 with HAQ level 2 and in Group II was 40 with HAQ levels 1 and 5 with HAQ level 2. In Group I, 42 had Dt GOHAI = 0 and 3 had Dt GOHAI = 1 and in Group II, 10 had Dt GOHAI = 0 and 35 had Dt GOHAI = 1. The difference was statistically significant (P < 0.05). There was a statistically significant difference in the mean value of HAQ and GOHAI in degree of disease activity (P < 0.05). There was an increase in HAQ and decreases GOHAI scores with the deterioration of disease. There was a correlation between age and involved joints with HAQ and inverse relationship between age and involved joints with GOHAI.Conclusion:Authors found that RA patients had poor oral health quality of life. It was found that aging and with the deterioration of disease, GOHAI, and the oral health quality of life of patients decreased.

Direct healthcare resource utilisation, health-related quality of life, and work productivity in patients with moderate rheumatoid arthritis: an observational study

BackgroundThe aim was to describe the population of patients with moderate rheumatoid arthritis (RA) in the United Kingdom and the burden of disease from the perspectives of the patient, caregiver, and health service.MethodsIn this descriptive study, retrospective patient-level data were extracted from hospital medical records to assess healthcare resource utilisation and validated outcome measures were administered via questionnaire to patients with moderate RA (Disease Activity Score [DAS28] between 3.2 and 5.1) from eight secondary care centres, and their caregivers. Patient-reported outcome instruments were scored according to licensed manuals.ResultsOutcome measures were completed by 102 patients and 38 caregivers. The mean EuroQoL-5 dimension-5 level crosswalk index value for patients was 0.62 (SD 0.24) compared to an England population norm of 0.82. Mean pain VAS score was 37.7 (SD 24.0) and mean Health Assessment Questionnaire Disability Index was 1.1 (SD 0.8). In employed patients who completed the Work Productivity and Activity Impairment questionnaire (n = 26), a mean 29% (SD 26%) reduction in work productivity was recorded. Patients experienced significant fatigue as a result of their RA (median Functional Assessment of Chronic Illness Therapy fatigue score 17.2 of a possible 52, interquartile range [IQR] 11.0–28.8). Over 50% of caregivers reported providing > 7 h of support care per week to the patient with RA, and 16 and 11% took paid/unpaid leave or reduced working hours, respectively. Mean Caregiver Reaction Assessment subscale scores were 1.9 (SD 0.9) for finance, 1.7 (SD 0.8) for health, 2.3 (SD 1.0) for schedule disruption, and 1.9 (SD 0.8) for family support. Patients had a mean 5.5 (SD 4.1) outpatient attendances and a median 9.0 (IQR 2.0–20.0) diagnostic and monitoring tests in the 12 months prior to enrolment.ConclusionsThis study shows that moderate RA has a considerable impact on healthcare resources and on patients’ and caregivers’ lives. There is scope to improve the management of patients with moderate RA.

High Remission Rates in a Brazilian Cohort of Initial Rheumatoid Arthritis after 15 Years of Follow-Up

Introduction: Rheumatoid arthritis (RA) is a chronic systemic rheumatic disease which is usually treated with corticosteroids and immunobiologicals. The goal of this article is to carry out an assessment of disease activity indices in a cohort of patients with rheumatoid arthritis. Patients and Methods: This is a prospective cohort study. Individuals from the Initial Rheumatoid Arthritis Brasilia Cohort, which is an incident cohort of early RA diagnosed patients, were monitored at the Rheumatology Service of the Hospital Universitario de Brasilia (HUB), University of Brasilia (UnB), Brazil. A cross-sectional analysis was carried out from 2017 to 2018 to evaluate patients with 15 or more years of follow-up, through a direct interview and review of medical records. The main focus of the study is on the assessment of disease activity, based on the indices: 28-joint Disease Activity Score based on Creactive protein (DAS 28 CPR) and based on erythrocyte sedimentation rate (DAS 28 ESR), Clinical Disease Activity Index (CDAI), and Simple Disease Activity Index (SDAI). The reference remission criteria used were the Composite Disease Activity Indices. Results: 107 patients were evaluated, mostly women, mean age of 55.1 years. Concerning the disease characteristics, 75.5% of the patients were positive for rheumatoid factor and 12 (11.3%) had documented erosive disease. The mean Health Assessment Questionnaire (HAQ) at the time of assessment was 0.6 (median 0.35). The indices analyzed showed: DAS28-ESR 48.6% of patients were in remission and 12.1% had low activity levels, DAS28-CRP 55.1% and 11.2%, SDAI 42% and 26.1%, CDAI 41.1% and 27.1%. These remission and low disease activity levels are higher than those generally found in the literature. Conclusion: This study presents a cohort of patients with RA who started treatment at an early stage of the disease and who achieved higher rates of remission and lower disease activity than those reported in the literature.

Evaluation of the Effect of Diabetes on Rheumatoid Arthritis-related Outcomes in an Electronic Health Record-based Rheumatology Registry.

Patients with rheumatoid arthritis (RA) who also have diabetes mellitus (DM) might have worse clinical outcomes and adverse events compared to patients with RA who do not have DM. We evaluated the effects of DM on Health Assessment Questionnaire (HAQ) changes and outpatient infection rates in patients with RA. Using the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) electronic health record-based registry, we identified patients with RA who had ≥ 1 rheumatologist visit with a HAQ measured in 2016 (index visit), ≥ 1 previous visit, and a subsequent outcome visit with the same HAQ measured at 12 months (± 3 months). We identified DM by diagnosis codes, medications, or laboratory values. Outpatient infection was defined by diagnosis codes or antiinfective medications. We calculated mean HAQ change and incidence rate (IR) of outpatient infections among patients with and without DM. Generalized linear models and Cox regression were used to calculate the adjusted mean HAQ change and HRs. We identified 3853 RA patients with DM and 18,487 without DM. The mean HAQ change between index and outcome visit among patients with DM was 0.03 and without DM was 0.002 (P < 0.01). We identified 761 outpatient infections for patients with DM with an IR of 22.6 (95% CI 21.0-24.2) per 100 person-years and 3239 among patients without DM with an IR of 19.8 (95% CI 19.1-20.5). The adjusted HR of outpatient infections among patients with DM was 0.99 (95% CI 0.91-1.07), compared to patients without DM. Patients with RA with concomitant DM had greater worsening, or less improvement, in their functional status, suggesting additional interventions may be needed for RA patients with DM to optimize treatment and management of other comorbidities.

Clinical trial protocol: PRednisolone in early diffuse cutaneous Systemic Sclerosis (PRedSS).

Background:Many of the painful, disabling features of early diffuse cutaneous systemic sclerosis have an inflammatory component and are potentially treatable with corticosteroid therapy. These features include painful and itchy skin, fatigue and musculoskeletal involvement. Yet many clinicians are understandably reluctant to prescribe corticosteroids because of the concern that these are a risk factor for scleroderma renal crisis. The aim of PRedSS (PRednisolone in early diffuse cutaneous Systemic Sclerosis) is to evaluate the efficacy and safety of moderate dose prednisolone in patients with early diffuse cutaneous systemic sclerosis, specifically whether moderate dose prednisolone is (a) effective in terms of reducing pain and disability, and improving skin score and (b) safe, with particular reference to renal function.Methods:PRedSS is a Phase II, multicentre, double-blind randomised controlled trial which aims to recruit 72 patients with early diffuse cutaneous systemic sclerosis. Patients are randomised to receive either prednisolone (dosage approximately 0.3 mg/kg) or placebo therapy for 6 months. The two co-primary outcome measures are the difference in mean Health Assessment Questionnaire Disability Index at 3 months and the difference in modified Rodnan skin score at 3 months. Secondary outcome measures include patient reported outcome measures of itch, hand function, anxiety and depression, and helplessness.Results:Recruitment commenced in December 2017 and after a slow start (due to delays in opening centres) 25 patients have now been recruited.Conclusion:PRedSS should help to answer the question as to whether clinicians should or should not prescribe prednisolone in early diffuse cutaneous systemic sclerosis.

Impact of Rheumatoid Arthritis and disease activity on work productivity and quality of life

Introduction: Rheumatoid Arthritis (RA) physical disability can impair the Quality of Life (QoL) and professional activity. Aim of the work: to assess the impact of RA on work productivity and functional impairment in Tunisian patients. Relation to the disease activity was also considered. Patients and mehods: The study included 25 RA patients having a professional occupation at the time of disease onset. The Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and 'Work Productivity and Activity Impairment' (WPAI) questionnaire were assessed. Results: The mean age of the patients was 50.4 ± 8.3 years with a female: male ratio of 1.08. The mean age at onset was 40.6 ± 9.8 years and the mean disease duration was 9.8 ± 9.68 years. The patients' occupation involved a manual job in 84% of cases. The mean of DAS28 was 4.3 ± 1.6; 72% had moderate to severe disease activity. The mean HAQ was 1.4 ± 0.7 and 76% had moderate to severe disability. The evaluation of the work productivity and activity impairment objectified an absenteeism of 30.7 ± 39.4%, presenteeism of 46.7 ± 26.4%, work productivity loss of 60.4 ± 33.8% and an activity impairment of 57.2 ± 25.4%. A significant correlation was noted between WPAI parameters and HAQ (p<0.0001) and of the decline in productivity and daily activity with DAS28 (p=0.01). Conclusion: Functional impairment and disease activity affected productivity and work ability in Tunisian RA patients. Absenteeism, increase of presenteeism, decline of productivity and daily activity were associated with the HAQ and the latter 2 with the disease activity but not with the age of patients or disease duration.

Prevalence of musculoskeletal complaints in urban communities in multi-ethnic Suriname: a cross-sectional study with the COPCORD methodology (stage 1, phase 1 and 2).

Musculoskeletal complaints (MSCs) are a major burden worldwide. In Suriname, a South American developing country, the epidemiology of MSCs and its related disorders is still unknown. Therefore, a cross-sectional survey was carried out to determine prevalence and risk factors of MSCs in urban areas of Suriname. This is the first Community Oriented Program for the Control of Rheumatic Diseases survey in a Caribbean Community. Trained interviewers collecting self-reported data conducted this house-to-house community-based survey. Data was analyzed using SPSS version 23 and Stata version 14.1. The prevalence of MSCs was 62.1% with a higher prevalence rate among women compared with men (resp. 64.3% vs. 58.6%) (Odds ratio = 1.185; p ≤ 0.05). The most decisive self-reported variables associated with MSCs were older age (defined as ≥ 45years) and moderate to heavy physical workload. The prevalence of MSCs was also associated with women, low educational level, smoking, alcohol use, high-intensity physical activity level, and body mass index (≥ 25kg/m2). The highest prevalence of MSCs was found among African descendants (Maroons (68.8%) and Creoles (68.0%)), followed by the Indigenous (65.0%) and Asian descendants (Hindustani (64.3%) and Javanese (49.5%)). Most persons with MSCs (75.7%) reported multisite complaints with lower back, knee, and shoulder being the most frequently reported sites. In our study population, MSCs were not considered disabling (mean Health Assessment Questionnaire Disability Index score of 0.23). The prevalence of MSCs in this urban multi-ethnic Surinamese community is high; therefore, future research is needed to further explore the burden of MSCs in Suriname.Key Points• Musculoskeletal complaints are highly prevalent in different ethnic groups in an urban Surinamese community; almost two-thirds of the population reported MSCs with the highest prevalence rate among women and African descendants.• The most decisive self-reported variables associated with MSCs were older age (defined as ≥ 45years) and moderate to heavy physical workload. Gender, educational level, smoking, alcohol use, high-intensity physical activity, and body mass index were also significantly associated with musculoskeletal complaints.

Health-related quality of life in patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily affects joints with some extraarticular involvement. If inappropriately treated, it usually results in persistent joint pain, irreversible deformities, and functional disability, leading to poor quality of life. Our objective was to evaluate health-related quality of life (HRQoL) and related factors in patients with RA.MethodsFour hundred sixty-four patients from the Rheumatoid Arthritis registries of Siriraj and Phramongkutklao teaching hospitals were enrolled. Sociodemographic, clinical and laboratory data related to disease activity, and functional status were collected. HRQoL was assessed using the Thai version of EuroQol five dimensional questionnaire (EQ-5D) and EQ global health visual analogue scale (EQ VAS). Univariate and multivariate analyses were employed to identify factors related to HRQoL.ResultsEighty-five percent were female with a mean age ± SD of 59.15 ± 11.43 years and a mean disease duration ± SD of 11.53 ± 8.3 years. The mean educational level ± SD was 9.42 ± 5.21 years. Almost half were unemployed or retired (47%). They had moderate disease activity (mean cumulative DAS28 ± SD, 3.5 ± 0.8) and mild functional impairment (mean HAQ ± SD, 0.70 ± 0.68). The mean EQ-5D ± SD (0–1) was 0.87 ± 0.13 and mean EQ VAS ± SD (0–10) was 7.94 ± 1.7. Based on the EQ-5D domain, 49% reported that they had no problem with mobility, 83% had no difficulties with self-care, 65% had no difficulties with usual activity, 30% had no pain or discomfort, and 61% had no depression or anxiety. The relationship between problems of each dimension in EQ-5D significantly increased according to severity of RA assessed by the Disease Activity Score (DAS) 28 and Health Assessment Questionnaire (HAQ) (p < 0.01). In multivariate analyses, high cumulative disease activity, functional disability, depression, and anxiety were negatively associated with EQ-5D (adjusted R20.38, p < 0.001) and EQ VAS (adjusted R20.19, p < 0.001).ConclusionDisease severity and psychological disturbance have a negative impact on quality of life in patients with RA. These factors should be considered in management of RA patients to improve the standard of care.

Outcomes of infliximab dose escalation in patients with rheumatoid arthritis.

Dose escalation of infliximab in both primary and secondary nonresponders is widely reported; however, the usefulness of dose escalation has been disputed. The objective of this analysis is to evaluate trends in clinical efficacy following multiple infliximab dose escalations in patients with rheumatoid arthritis (RA). Patients enrolled in a US RA registry were included if they initiated infliximab at 3mg/kg every 8weeks, received ≥ 1 infliximab dose escalation within 12months of initiation, and had ≥ 1 visit following dose escalation. Trends in mean Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire (HAQ) scores from visits following dose escalations were evaluated. In patients who received 2 or 3 dose escalations, the initial (1 or 2) dose escalations resulted in reduced mean CDAI scores, but subsequent escalations did not further reduce disease activity. In patients who received ≥ 4 dose escalations, mean CDAI scores did not further reduce disease activity over time. Mean HAQ scores were stable over time in patients who received 2 or 3 dose escalations. In patients who received ≥ 4 dose escalations, mean HAQ scores decreased following 1 dose escalation but progressively increased following subsequent dose escalations. Initial dose escalations (from 3mg/kg to the equivalent of approximately 5 to 7mg/kg) may be useful in controlling disease activity; however, there may be diminishing clinical benefit of further escalations, which can also increase the potential risk for infection and increase incremental drug costs. • Initial infliximab dose escalations (1 to 2) may be useful in lowering disease activity in patients with rheumatoid arthritis. • There does not appear to be a clinical benefit in infliximab dose escalations above the equivalent of 5 to 7 mg/kg.

Assessment of nutritional status by dual X-Ray absorptiometry in women with rheumatoid arthritis: A case-control study.

Rheumatoid arthritis (RA) has been related to an impairment of the nutritional status. Body mass index (BMI) has been used but questions arise about how to properly evaluate nutritional status in RA patients. Few studies have evaluated it by dual-energy X-ray absorptiometry.In women with RA, to analyze: (1)their nutritional status compared to that of a control population,(2)differences between the prevalence of impairment of nutritional status measured by dual energy X ray absorptiometry (DXA) and by classical methods used in clinical care,(3)determinants of nutritional status,(4)prevalence of sarcopenia.Case–control study including 89 women with RA. The control group was composed by 100 patients affected by non-inflammatory rheumatic disorders. Study variables included age, RA duration, history, activity and disability, and in relation to nutritional status: BMI, serum albumin (ALB), whole body DXA assessment, and skeletal muscle index (SMI).Mean age of patients was 62 ± 8 years, mean duration of RA was 14 ± 9 years, mean disease activity score (DAS28) was 3.7 ± 1.4 and mean Health Assessment Questionnaire was 0.88 ± 0.77. BMI was 27.43 ± 5.16 Kg/m2 in patients and 27.78 ± 3.98 Kg/m2 in controls (P: ns). ALB was within normal range in all patients.By whole body DXA, RA patients presented a statistically significant lower lean mass in all locations and lower fat mass in limbs than controls. Patients had a redistribution of fat mass to trunk. Lean mass directly correlated with fat mass.Neither BMI nor ALB correlated with DXA parameters.BMI, appendicular lean mass and SMI correlated inversely with disease duration. Trunk lean mass correlated inversely, and fat mass directly, with RA disability parameters.RA patients fulfilled criteria of sarcopenia in 44% of cases versus 19% of controls (P <.001). In RA patients, regarding SMI, BMI showed a high specificity to detect sarcopenia (94% of the patients with low BMI had sarcopenia) but low sensitivity (47% of the patients with normal BMI or overweight had sarcopenia).RA patients have an impairment of nutritional status associated to disease duration that looks like sarcopenia and that is not predicted by BMI.

Burden of Psoriatic Arthritis According to Different Definitions of Disease Activity: Comparing Minimal Disease Activity and the Disease Activity Index for Psoriatic Arthritis

ObjectiveTreat‐to‐target strategies have improved outcomes in rheumatic diseases. In psoriatic arthritis (PsA), the proposed targets are the multidimensional target minimal disease activity (MDA) and the articular target Disease Activity index for PsA (DAPSA). The aim of this study was to compare the disease burden of PsA in patients with low disease activity according to the 2 definitions, MDA and DAPSA low disease activity (DAPSA‐LDA), 1 year after diagnosis.MethodsWe obtained data on MDA, DAPSA‐LDA and disease burden 1 year after diagnosis for patients included in the Dutch southwest early PsA cohort. Disease burden was assessed in 2 domains: “Body functions,” including the Short Form 36 bodily pain (SF‐36 BP) measure, and “Activity,” including the Health Assessment Questionnaire (HAQ).ResultsAmong the 292 patients included, 48% achieved MDA and 74% achieved DAPSA‐LDA. Average scores for Body functions and Activity were better in patients who achieved MDA and those who achieved DAPSA‐LDA. The scores were significantly better in the 46% of patients who achieved both MDA and DAPSA‐LDA than in the 29% of patients who achieved only DAPSA‐LDA. The average SF‐36 BP score was higher in patients achieving both targets (73.8; 95% confidence interval [95% CI] 71.1‐76.5) than in patients achieving only DAPSA‐LDA (57.6; 95% CI 54.5‐60.8). Similarly, mean HAQ scores measuring Activity were 0.21 (95% CI 0.15‐0.26) and 0.63 (95% CI 0.53‐0.72), respectively.ConclusionAmong patients with newly diagnosed PsA, 48% achieved MDA and 74% achieved DAPSA‐LDA after 1 year of receiving usual care. The average disease burden was better in patients who achieved MDA and those who achieved DAPSA‐LDA. Also, patients who achieved only DAPSA‐LDA reported worse outcomes than those who also achieved MDA.

Hospital Anxiety and Depression Scale Score Is an Independent Factor Associated With the EuroQoL 5-Dimensional Descriptive System in Patients With Rheumatoid Arthritis.

This study aimed to examine anxiety and depression experienced by patients with rheumatoid arthritis (RA) using EuroQoL 5-Dimensional Descriptive System (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) scores. We analyzed 1005 Japanese patients with RA. Stepwise multiple linear regression analysis was performed to evaluate the independent influence of variables on EQ-5D and HADS scores. Pearson correlation coefficients were also calculated to explore relationships between variables. The mean EQ-5D score was 0.74 for all patients (mean age, 63.2 years; mean disease duration, 13.6 years; mean Health Assessment Questionnaire Disability Index [HAQ-DI], 0.78; mean HADS total [HADS-T] score, 10.3; mean disease activity score assessed by 28 joints based on CRP [DAS28-CRP], 2.8). The EQ-5D score was strongly correlated with HAQ-DI and was moderately correlated with age, Steinbrocker functional class, HADS-T score, tender joint count assessed by 28 joints, pain on a visual analog scale (pain-VAS), patient's global assessment of disease activity (general-VAS), and DAS28-CRP. The HADS-T score was moderately correlated with HAQ-DI, pain-VAS, general-VAS, and DAS28-CRP. Factors that influenced the EQ-5D score included HAQ-DI (β = -0.533), pain-VAS (β = -0.128), HADS-T score (β = -0.142), DAS28-CRP (β = -0.187), and prednisolone use (β = -0.056). Factors that influenced the HADS score included HAQ-DI (β = 0.348), general-VAS (β = 0.145), disease duration (β = 0.094), and worklessness (β = 0.083). The HADS score is an independent factor associated with EQ-5D in patients with RA. Our findings suggest that the assessment of anxiety and depression is essential in achieving better quality of life for patients with RA.

Impact of Joint Involvement on Patients Reported Outcomes in Systemic Lupus Erythematosus.

Joint involvement is common among patients with systemic lupus erythematosus (SLE). Aim of this work was to evaluate the correlation between the presence of joint involvement and patient-reported pain, perception of disease activity, general health and quality of life. Fifty consecutive SLE patients were enrolled in the study. All patients underwent a complete clinical evaluation including a 44-joint count; in addition, an ultrasound evaluation of joint involvement of hands and wrists was performed. The following patients reported outcomes (PROs) were completed: Visual Analog Scales 0-100 mm (VAS) evaluating patients reported pain, patient's perception of global disease activity and general health (GH) and a validated Italian version of the Health Assessment Questionnaire (HAQ). Fourteen patients (28%) reported a significant morning stiffness lasting for more than 30 minutes; hand or wrist arthritis was clinically detectable in 10 (20%) patients, while the US evaluation exhibited at least one joint or tendon pathology in 18 patients (36%). The mean VAS score for pain and disease activity perception was 27 (±27.7) mm and 25.3 (±25.2) mm, respectively, the mean of GH score was 33.2 (±24.3) mm, and the mean HAQ score was 0.34 (±0.5). A significant correlation was observed between VAS score for pain, patient's perception of disease activity and GH and the presence of arthritis. PROs may play an important role in guiding therapeutic decisions and suggest the utility of ultrasound evaluation in patients reporting articular symptoms.

Abatacept and tocilizumab tapering in rheumatoid arthritis patients: results of SONATA-a retrospective, exploratory cohort study.

ObjectivesAs data on disease-activity-guided dose optimization of abatacept and tocilizumab are scarce, we explored the feasibility, effectiveness and safety of dose optimization of these biological DMARDs in RA patients in daily practice. MethodsRA patients who had been treated with abatacept or tocilizumab for ≥6 months, with DAS28 <3.2, were included. Four groups were identified: abatacept dose reduction (DR) and usual care (UC), and tocilizumab DR and UC. Successful DR and discontinuation entailed being on a lower dose than at baseline or having discontinued abatacept or tocilizumab, while maintaining disease activity score with ESR using 28 joint count (DAS28) <3.2. Proportions of patients with successful DR or discontinuation at 12 months were described. Maintenance of DR was investigated using Kaplan–Meier curves. Between-group differences in mean DAS28 and Health assessment questionnaire disability index (HAQ-DI) change (Δ) over 6 and 12 months were estimated.ResultsOne hundred and nineteen patients were included. DR was attempted in 13 of 28 (46%; 95% CI: 28, 66%) abatacept and 64 of 91 (70%; 95% CI: 60, 79%) tocilizumab patients. At 12 months, 3 of 11 (27%; 95% CI: 6, 61%) abatacept and 20 of 48 (42%; 95% CI: 28, 57%) tocilizumab patients were successfully tapered. One of 11 (9%; 95% CI: 0, 41%) abatacept and 5 of 48 (10%; 95% CI: 3, 23%) tocilizumab patients were successfully discontinued. Mean ΔDAS28 and ΔHAQ-DI at months 6 and 12 were not significantly different between DR and UC. For tocilizumab, DAS28 was significantly higher in the DR compared with the UC group at 6 months. Adverse events were comparable between groups.ConclusionAbatacept and tocilizumab DR appears to be feasible and safe in clinical practice. No benefits in terms of fewer adverse events in the DR group were observed. Furthermore, DR was suboptimal, because all patients were eligible for DR, but in a substantial number of patients no DR was attempted.

Clinical and radiological outcomes of 5-year drug-free remission-steered treatment in patients with early arthritis: IMPROVED study.

To determine the 5-year outcomes of early remission induction therapy followed by targeted treatment aimed at drug-free remission (DFR) in patients with early arthritis. In 12 hospitals, 610 patients with early (<2 years) rheumatoid arthritis (RA) or undifferentiated arthritis (UA) started on methotrexate (MTX) 25 mg/week and prednisone (60 mg/day tapered to 7.5 mg/day). Patients not in early remission (Disease Activity Score <1.6 after 4 months) were randomised (single blind) to arm 1, adding hydroxychloroquine 400 mg/day and sulfasalazine 2000 mg/day, or arm 2, switching to MTX plus adalimumab 40 mg/2 weeks. Treatment adjustments over time aimed at DFR. Outcomes were remission percentages, functional ability, toxicity and radiological damage progression after 5 years. After 4 months, 387 patients were in early remission, 83 were randomised to arm 1 and 78 to arm 2. After 5 years, 295/610 (48%) patients were in remission, 26% in sustained DFR (SDFR) (≥1 year) (220/387 (57%) remission and 135/387 (35%) SDFR in the early remission group, 50% remission, 11% SDFR in the randomisation arms without differences between the arms). More patients with UA (37% vs 23% RA, p=0.001) and more anticitrullinated protein antibody (ACPA)-negative patients (37% vs 18% ACPA-positive, p<0.001) achieved SDFR.Overall, mean Health Assessment Questionnaire was 0.6 (0.5), and median (IQR) damage progression was 0.5 (0-2.7) Sharp/van der Heijde points, with only five patients showing progression >25 points in 5 years. Five years of DFR-steered treatment in patients with early RA resulted in almost normal functional ability without clinically relevant joint damage across treatment groups. Patients who achieved early remission had the best clinical outcomes. There were no differences between the randomisation arms. SDFR is a realistic treatment goal.