Modified Health Assessment Questionnaire Score Research Articles

Comparison of creatine kinase elevation caused by Janus kinase inhibitors and interleukin-6 inhibitors in patients with rheumatoid arthritis: A propensity score-matched study.

This study aimed to examine whether creatine kinase (CK) elevation occurs with interleukin (IL)-6 inhibitors, as in Janus kinase (JAK) inhibitors, which are reported to increase CK levels in rheumatoid arthritis. A multicenter database of JAK inhibitor and IL-6 inhibitor treatment was retrospectively searched between January 2016 to December 2022; 142 cases (117 females, 25 males, mean age: 63.8±13.0 years; range, 20 to 85 years), with 71 cases in each group, were extracted by propensity score matching using age, sex, body mass index, and CK at 0 weeks. The outlier rate was compared. Patients' background characteristics related to elevated CK levels at 24 weeks were investigated by univariate and multivariate analyses. Creatine kinase levels at 4 and 12 weeks were significantly higher with JAK inhibitors than with IL-6 inhibitors (four weeks, 72 vs. 87.5 IU/mL, p=0.016; 12 weeks, 71 vs. 95.5 IU/mL, p=0.028). The outlier rate (Grade 1) with JAK inhibitors increased significantly over time (0 weeks, 4.2%; four weeks, 18.1%; 12 weeks, 21.7%; 24 weeks, 18.3%; p=0.015), whereas that with IL-6 inhibitors increased slightly (0 weeks, 5.6%; four weeks, 9.2%; 12 weeks, 8.6%; 24 weeks, 8.5%; p=0.745), with a significant difference between the groups (p=0.035). No patients discontinued treatment due to myalgia or renal dysfunction. The factors significantly positively related to elevated CK levels at 24 weeks were male sex and creatinine. Those significantly negatively related were Steinbrocker stage and class, modified health assessment questionnaire scores, estimated glomerular filtration rate, and glucocorticoid dose. Mild CK elevations with JAK inhibitors are not a particular clinical problem. CK elevation might be specific to JAK inhibitors.

The relationship of vitamin D to the MHAQ index, activity disease, and inflammation in a sample of Syrian rheumatoid disease patients

Background: Vitamin D has an immunomodulatory and anti-inflammatory role, and its deficiency has been linked with many autoimmune disorders, including rheumatoid arthritis (RA). The correlation ship between the severity of RA and serum levels of vitamin D is a subject of immense interest and therapeutic implications. Patients and Methods: A total of 100 patients previously diagnosed with RA were collected from visitors to the rheumatology clinic at the university hospital and their ages were over 18 years. The serum vitamin D value and the C-reactive protein (CRP) value were measured, and the Disease Activity Score CRP28 (DAS28CRP) and Modified Health Assessment Questionnaire (MHAQ) score were calculated to determine the severity and effectiveness of the disease and its relationship to vitamin D deficiency. Results: The average age of the patients ranged according to the patient’s age (46.03±11.291), we note that individuals whose ages ranged from 26 to 65 accounted for the largest percentage (94%), 83% of women (83) and 17% men (17), and the mean score for sun exposure was 15.80±5.446. Patients were individuals diagnosed with the disease between 5 and 10 years were the highest group, with a percentage of 31%. A total of 72% of the patients were not treated with corticosteroids, and 43% of the patients were treated with vitamin D. We found that the number of patients using biologic medications was 18%, and the number of patients using disease-modifying anti-rheumatic drugs was 88%. The mean of DAS28 was moderate in 63% of patients, and the average of the MHAQ score was 0.80±0.334. We found that there is no statically significant correlation between the serum vitamin D level and DAS28/CRP (P=0.733), and there is also no statically significant correlation between the serum value of vitamin D and the medications used, whether biological or disease-modifying anti-rheumatic drugs (P=0.361). In addition, there is also no significant correlation between the serum vitamin D level and MHAQ score (P=0.100). Conclusion: There was no significant relationship between vitamin D deficiency and the disease activity or severity in a sample of patients with RA.

Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study.

musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population. a cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ). among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score. this Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being.

The study of serum muscarinic acetylcholine receptor subtype 3 (m3AChR)-Specific autoantibodies level in rheumatoid arthritis patients with secondary sjogren syndrome

BackgroundDry eyes and mouth are symptoms of Sjogren syndrome, which can occur on its own and be referred to as primary Sjogren syndrome or in conjunction with other rheumatic diseases like rheumatoid arthritis and be referred to as secondary Sjogren syndrome. Anti-muscarinic type 3 receptors have been linked to neurological issues as well as secretory dysfunction in Sjogren patients. Consequently, the purpose of this study is to determine the serum level of muscarinic acetylcholine receptor subtype 3 (m3AChR)-specific autoantibodies in rheumatoid arthritis (RA) patients and evaluate its relationship to disease activity, functional disability, and to study its role in the development of secondary Sjogren syndrome manifestations in those patients.MethodsIn this cross-sectional study, 30 RA patients with secondary Sjogren syndrome signs and 30 RA patients without secondary Sjogren syndrome manifestations were included, along with 30 healthy volunteers who were aged, and sex matched as controls. All participants underwent thorough clinical examination, evaluation of disease activity using the DAS28 score, assessment of functional status using the modified health assessment questionnaire (MHAQ), and evaluation of the serum level of (m3AChR) by (ELISA).ResultsWhen compared to RA patients without secondary Sjogren syndrome and healthy controls (20.09 ± 4.24, 18.36 ± 3.59 ng/ml respectively), the serum level of m3AChR antibodies among 30 RA patients with secondary Sjogren syndrome considerably increased (mean 25.98 ± 4.81 ng/ml).Analysis of the m3AChR’s (ROC)-curve revealed that the three groups under study differed significantly (P < 0.001), with the AUC (0.806), cutoff (> 22.63ng/ml), sensitivity (73.33%), and specificity (86.67%) all exceeding the threshold. Additionally, there was a significant positive connection between the serum level of m3AChR and the following variables (P < 0.05): DAS scores, MHAQ score, number of tender & swollen joints, and acute phase reactants.ConclusionAutoantibodies against m3AChR may be one of the serum components involved in the pathophysiology of secondary Sjogren syndrome in RA patients, and because of their high sensitivity and specificity, they can be utilized as a diagnostic marker in these individuals.

The burden of musculoskeletal pain, associated sociodemographic factors, and disability in Pakistan.

The objective of this survey was to determine the burden of musculoskeletal (MSK) pain, its association with sociodemographic factors and disability in the semi-urban community of Nain-Sukh, Lahore. The current article's data is taken from the COPCORD survey conducted in the community of Nain-Sukh. After formal IRB approval, data collection was done via interview by a trained team using validated Urdu translation of COPCORD core questionnaires. Participants of both genders, >16 years, were enrolled through a random walk and quota sampling. In phase 1, sociodemographic factors were recorded. In phase 2, the impact of MSK pain on functional disability was assessed by the Modified Health Assessment Questionnaire (MHAQ). The data was compiled and analyzed using software SPSS version 25. The Chi-square test was applied to determine association while generalized linear regression models to see the dependence of sociodemographic factors and MSK pain. Out of 4922 participants, 1425 (28.9%) had MSK pain, with a mean age of 35 ± 14 years, with female predominance. Illiteracy, marital status, and household work with moderate intensity were significantly associated with MSK pain. Based on the MHAQ score, the majority 769 (82.9%) had a mild disability. Odds of advancing age, illiteracy, and moderate intensity of work were statistically significant for MSK pain. Every fourth subject in the surveyed population had MSK pain. Musculoskeletal pain was found to be significantly associated with female gender, advancing age, household work, illiteracy, married status, and moderate nature of work. More than two-thirds of the subjects with MSK pain had some degree of disability.

Diagnosis delay in Egyptian rheumatoid-arthritis patients: underlying factors and outcomes – retrospective observational study

Background. Early initiation of rheumatoid arthritis (RA) treatment leads to better outcomes and low disease activity. In spite of these, there is a significant delay between symptom onset and the initiation of therapy. Objective. This study aimed to investigate this diagnostic delay and to analyze its associated factors and outcomes. Patients and method. This cross-sectional study included 167 RA patients fulfilling the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) classification criteria. All patients were subjected to full clinical, laboratory and radiological assessment and treatment was also received; Disease Activity Score (DAS-28) functional disability evaluation using Modified Health Assessment Questionnaire (MHAQ) MHAQ were reported. Diagnostic delay was assessed regarding duration, associated factors and outcomes. Furthermore, RA patients were divided into early and late diagnosis group with a cutoff of one year and were compared regarding different disease parameters. Results. The median (IQR) lag in diagnosis of RA patients was 12 months (4 24), MHAQ score was significantly positively correlated with delay in diagnosis (p = 0.02). Early diagnosis group patients were statistically significant urban residents (p = 0.01), employed (p = 0.02), with higher educational level (p = 0.02), lower functional index MHAQ (p = 0.02), and were significantly visiting rheumatology specialists early in the disease compared to the late diagnosis group (p =&lt;0.0001). Conclusion. Early diagnosis is still suboptimal. Unemployment, specialist visits other than rheumatology, female gender, rural residence, and lower educational level were associated with the delay in diagnosis in RA patients. Patients with delayed diagnosis showed worse functional disability index.

Predictors of Perceived Functional Status in Early Systemic Sclerosis: A Prospective Longitudinal Study of an Early Disease Cohort.

The modified Health Assessment Questionnaire (M-HAQ) is a well-established patient-reported outcome measure in systemic sclerosis (SSc) studies that reflects how a patient functions in several categories of activities of daily living. This study analyzed clinical, demographic, and socioeconomic factors that predict M-HAQ scores over time. This study included 388 patients with baseline M-HAQ scores from the Genetics versus Environment in Scleroderma Outcome Study (GENISOS) early disease cohort with a mean disease duration of 2.5 years, mean follow-up time of 3.9 years, and median follow-up of 7.2 years. A total of 1,950 M-HAQ measurements were analyzed. Baseline disease characteristics were recorded, and the association of these characteristics with the M-HAQ score was analyzed at baseline and longitudinally. Lower income and education levels, older age, and more severe skin involvement at enrollment were independent predictors of worse perceived functional disability over time (i.e., higher longitudinal M-HAQ levels). Higher longitudinal modified Rodnan skin scores correlated with higher M-HAQ scores, whereas higher longitudinal forced vital capacity percentage predicted values correlated with lower M-HAQ scores over time (P < 0.001 for both univariable and multivariable analyses). Moreover, higher baseline M-HAQ scores predicted higher mortality (hazard ratio 1.29, 95% confidence interval 1.09-1.52, P=0.003). This large, longitudinal study of early disease SSc demonstrates that severity of skin disease and socioeconomic factors such as educational level and income are important predictors of perceived functional disability in SSc.

Disease characteristics in high versus low titers of rheumatoid factor or anti-citrullinated peptide antibody in rheumatoid arthritis patients

Aim of the workTo evaluate the impact of the level of rheumatoid factor (RF) or anti-citrullinated peptide antibody (ACPA) positivity on the clinical manifestations, disease activity, functional status, and treatment strategy among rheumatoid arthritis (RA) patients. Patients and methodsIn this study, 120 consecutive RA patients were grouped according to the level of RF or ACPA positivity. Group 1: patients with low positive RF or ACPA and Group 2: those with high titer. Disease activity score (DAS28) and functional status using modified health assessment questionnaire (MHAQ) were assessed ResultsThe patients mean age was 46.9 ± 10.9 years and female to male ratio was 7:1. 44 (36.7%) patients had low positive RF/ACPA titers, 59 (49.2%) had high titers and 17 (14.2%) had negative RF/ACPA and were excluded. Patients' global assessment of disease activity was significantly higher among patients with high RF/ACPA titer compared to those with low titer (p = 0.04) and MHAQ tended to be higher (p = 0.058). Subcutaneous nodules (p = 0.037) were more frequent among those with high RF/ACPA titer. The cumulative (p = 0.012) and the current (p = 0.006) steroid doses administered both turned out to be significantly higher in the high positive RF/ACPA patient group. ConclusionPatients with high titer RF and\\or ACPA have factors that may contribute to poor outcome as the presence of reduced functional status which indicated by the higher MHAQ score, the need for higher daily and cumulative steroid doses as an indirect indicator of increased disease activity and in turn poor outcome.

P098 Estimating the prevalence and predictors of musculoskeletal disability in Tanzania: a pilot study

Abstract Background/Aims Musculoskeletal (MSK) disorders are among the major causes of disability worldwide, accounting for 20% of all years lived with disability. MSK disorders are linked to other non-communicable diseases (NCDs) as their adverse impact on mobility may promote the development of other NCDs. Prevalence studies of MSK disorders in Africa are limited with most coming from South Africa, while none have been previously performed in Tanzania. Screening for MSK disorders is not routinely conducted in health care facilities and there are no registered consultants working in this field in Tanzania. This pilot study aimed to provide an initial estimate of the prevalence and predictors of MSK disability to inform the design of a more detailed study of MSK disorders in Tanzania. Methods A cross-sectional pilot study was conducted in Kirima village, Hai District, Kilimanjaro region which has a total population of 1,911 people. We obtained ethical approval to invite each eligible individual to consent to supervised examination using the Gait, Arms, Legs and Spine (GALS) assessment tool (adults aged 18 years and over) or the paediatric GALS (pGALS) assessment tool (children aged 5 to 17 years old). In those where these screening tools detected an abnormality, we then performed a full Regional Examination of Musculoskeletal System (REMS). We also assessed functional status and physical disability in all GALS positive subjects using the Modified Health Assessment Questionnaire (MHAQ) tool. All adults were assessed during planned accompanied household visits, while a substantial number of the children were assessed while at school. Multivariable logistic regression analyses were carried out to assess the influence of demographic variables on GALS, REMS and MHAQ outcomes. Results A substantial number of adults (270) and children (491) could not be contacted or declined to consent to examination. Among the 1150 people who did consent, the prevalence of GALS/pGALS positivity was 8.2% (95% CI: 6.6-9.8), while REMS was positive in 3.5% (95% CI: 2.4-4.5). Female gender and increasing age were both significantly associated with each of GALS and REMS positivity. The MHAQ score was strongly associated with REMS positivity and significantly associated with GALS positivity, equating to worse function and greater disability. Conclusion These initial prevalence estimates and predictors of MSK disability are comparable to those seen elsewhere in the world. Greater detail on the prevalence of specific MSK disorders in Tanzania will require larger and more detailed studies. Disclosure N.M. Yongolo: None. C. Bunn: None. J. Halliday: None. B. Mtesha: None. C. Kelly: None. A. Mwingwa: None. S. Biswaro: None. S. Siebert: None. A. Hemed: None. R. Walker: None. E. McIntosh: None. B. Mmbaga: None.

Translation and validation of Modified Health Assessment Questionnaire score in local language Urdu in patients with rheumatoid arthritis presenting in a tertiary care center of Pakistan.

To translate and validate the Modified Health Assessment Questionnaire from English to Urdu. The validation study was conducted at the Rheumatology outpatient department of Fauji Foundation Hospital, Rawalpindi, Pakistan, from July 1 to September 30, 2019. Two translators were given the modified health assessment questionnaire for translation from English to Urdu. It was then back-translated by two independent translators. The translated version of the tool was applied to rheumatoid arthritis patients to check for reliability, test-retest and internal consistency. It was applied to another group of patients to check for criterion validity. Reliability analysis was checked by applying Cronbach alpha. Criterion validity was checked by assessing disease activity score-28 and its correlation with Modified Health Assessment Questionnaire. Data was analysed using SPSS 23. Of the 30 patients in the initial testing, 28(93%) were females and 2(6.6%) were males, with an overall mean age of 38±13.2 years. Of the 100 patients in the second group, 97(97%) were women and 3(3%) were men, with an overall mean age of 42±12.37 years. The mean disease duration of the cohort was 8.4±4.8 years. The Cronbach alpha value was 0.797 and interclass coefficient was 0.7, reflecting good reliability. A significantly high correlation between Modified Health Assessment Questionnaire and disease activity score-28 was noted along with pain, tenderness, swollen joints, patient global assessment, age and erythrocyte sedimentation rate (p<0.05), while poor correlation was found with gender, disease duration, rheumatoid arthritis factor and anti-cyclic citrullinated peptide antibody (p>0.05). The Urdu version of the Modified Health Assessment Questionnaire was found to be a reliable tool for the indigenous population.

Study of correlation of level of expression of Wnt signaling pathway inhibitors sclerostin and dickkopf-1 with disease activity and severity in rheumatoid arthritis patients.

This study was done with aim to assess the serum sclerostin and dickkopf-1 (DKK-1) level in patients of rheumatoid arthritis (RA) and to correlate their level with disease activity and bone mineral density. Fifty patients of RA and equal age and sex matched healthy controls were included in the study. Patients were evaluated clinically and investigated with routine blood tests along with rheumatoid factor (RF), anti-citrullinated protein antibody (anti-CCP2), radiographs and bone mineral density (BMD). Serum sclerostin and DKK-1 levels of both cases and controls was assayed by using enzyme-linked immunosorbent assay (ELISA) assay [RayBio®, Georgia, USA with coefficient of variation percent (CV %), < 10%] and compared with disease activity and bone mineral density. Disease activity was measured by Disease Activity Score 28 (DAS28) along with Modified Health Assessment Questionnaire (MHAQ) score. Mean serum sclerostin and DKK-1 was significantly higher in study group as compared to control group. Serum sclerostin showed significant correlation with disease activity scores (DAS score and MHAQ score), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level. Serum sclerostin at level of 394 pg/mL was found to have diagnostic significance with sensitivity of 100% and specificity of 90%. DKK-1 level shows significantly positive correlation with larson score which denotes radiological progression (r value 0.468; p value 0.001). More studies with larger sample size of RA patients are needed for better determination of the role of sclerostin and DKK-1 in RA. Also, the correlation of these and other bone turn over markers will help decipher their role with disease progression in RA patients.

Predictors of Hand Contracture in Early Systemic Sclerosis and the Effect on Function: A Prospective Study of the GENISOS Cohort.

To identify baseline features that predict progression of hand contractures and to assess the effect of contractures on functional status in the prospective GENISOS cohort. Rate of decline in hand extension, as an indicator of hand contracture, was the primary outcome. We assessed longitudinal hand extension measurements, modified Health Assessment Questionnaire (MHAQ) score, Medical Outcomes Study Short Form-36 (SF-36) physical function score, and demographic, clinical, and serological variables. Subjects with ≥ 2 hand measurements at least 6 months apart were included. A total of 1087 hand measurements for 219 patients were available over an average of 8.1 ± 4.8 years. Hand extension decreased on average by 0.11 cm/year. Antitopoisomerase I antibody (ATA) positivity and higher modified Rodnan Skin Score (mRSS) were predictive of faster decline in hand extension (p = 0.009 and p = 0.046, respectively). In a subgroup analysis of 62 patients with ≤ 2 years from SSc onset, ATA and diffuse disease type were associated with faster decline in hand extension; anticentromere positivity was associated with slower rate of decline. Although the rate of decline in patients with disease duration ≤ 2 years was numerically higher, the difference was not statistically significant. Hand extension continued to decline in a linear fashion over time and was inversely related to overall functional status. ATA was predictive of contracture development in both early disease (≤ 2 yrs) and in the overall cohort. Hand extension declined linearly over time and was inversely associated with MHAQ and SF-36 scores. ATA positivity and higher baseline mRSS were predictive of faster decline in hand extension.

Long-term patient reported outcomes of elbow, wrist and hand surgery for rheumatoid arthritis.

A retrospective questionnaire survey was conducted to investigate the long-term outcomes of elbow, wrist and hand surgery for rheumatoid arthritis (RA). One hundred and thirteen RA patients underwent primary elective elbow, wrist or hand surgery at our hospital between January 2002 and December 2003. To evaluate the outcomes at 10years after surgery, the patient-reported outcomes were assessed using an original questionnaire that inquired about the site of treatment; the modified Stanford Health Assessment Questionnaire (mHAQ) was also used. Responses were obtained from 67 patients (98 sites). In the 10years after surgery, the Disease Activity Score of 28 joint - erythrocyte sedimentation rate (4) and the modified Health Assessment Questionnaire scores of the patients showed significant improvement. Nearly 85% of patients were satisfied with the outcome at the surgical site. The most frequent reason for perceived improvement was 'pain relief' (all surgical sites). An 'improved appearance' was frequently reported after finger surgery and 'increased power' was frequently reported after wrist and thumb surgeries. With regard to elbow surgery, 30% of the patients were satisfied with the increase in motion and power. In contrast, approximately 20% of patients complained of decreased power around the surgical site after elbow and thumb surgeries. Our original patient-reported outcome assessment tool revealed that elbow, wrist and hand surgery provided long-lasting benefits in RA patients. While the efficacy differed in some of the surgical sites, pain relief was the most favorable effect. Altered medical therapy may also have impacted the patient-perceived outcomes of surgery at 10years.

Assessment of long-term articular damage and function in rheumatoid arthritis patients

Aim of the workThis study aimed to assess long-term articular damage and function in rheumatoid arthritis (RA) patients in relation to the type of treatment. Early disease modifying anti-rheumatic drug (DMARD) therapy has not been evaluated in this study. Patients and methodsOne hundred and fifty RA patients (141 females and 9 males) with disease duration more than five years and disease activity score-28 (DAS-28) <3.2 were included in this study. Sixty patients received disease modifying anti-rheumatic drugs (DMARDs) (group A), 60 received DMARDs and corticosteroids (CS) (group B), and 30 patients received CS only (group C). The functional outcome was assessed using the Modified Health Assessment Questionnaire (MHAQ). The articular damage was measured by using Rheumatoid Arthritis Articular Damage (RAAD) Score. The van der Heijde modification of the Sharp erosion score was used to define the plain X-ray of both hands and feet. ResultsThe mean age of the patients was 49.3 ± 11.5 years, and disease duration was 12 ± 7.9 years. There was a significant difference between the RAAD, visual analogue scale and MHAQ scores among the three groups (p = 0.001), with higher score in group C followed by B. By using Multiple regression analysis to examine the relationship between RAAD score and other independent variables there was a significant association of the RAAD score with higher X-ray score (p < 0.001) and with patients taking steroids only (p = 0.001). ConclusionAlthough, use of corticosteroids may help to control the disease activity, but it increases the risk of overall joint damage.

Association between Bone Mineral Density of Femoral Neck and Geriatric Nutritional Risk Index in Rheumatoid Arthritis Patients Treated with Biological Disease-Modifying Anti-Rheumatic Drugs.

Treatment of rheumatoid arthritis (RA) with biological disease-modifying anti-rheumatic drugs (bDMARDs) induces rapid remission. However, osteoporosis and its management remains a problem. The Geriatric Nutritional Risk Index (GNRI) evaluates the risk of malnutrition-related complications in elderly patients and has been shown to be a significant predictor of many diseases. We evaluated the correlation between GNRI and RA activity. In addition, risk factors for femoral neck bone loss were evaluated in RA patients treated with bDMARDs. We retrospectively examined the medical records of 146 patients with RA, collecting and recording the patients’ demographic and clinical characteristics. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Inverse correlations were observed between GNRI and disease duration, disease activity score-28 joint count serum C-reactive protein (CRP), simple disease activity index, modified health assessment questionnaire score and CRP. GNRI showed correlation with femoral neck BMD and femoral neck BMD ≤ 70% of young adult men (YAM). Multiple regression analysis showed that female sex, increased age and lower GNRI were risk factors for lower BMD of the femoral neck. Multivariate binomial logistic regression analysis showed that female sex (odd ratio: 3.67) and lower GNRI (odd ratio: 0.87) were risk factors for BMD ≤ 70% of YAM. Because the GNRI is a simple method, it might be a simple predictor for RA activity and BMD status in RA patients. Complementary nutritional therapies might improve RA activity and osteoporosis in RA patients who have undergone treatment with bDMARDs.

Discontinuation of Biologic Therapy in Rheumatoid Arthritis: Analysis from the Corrona RA Registry.

IntroductionDespite the availability of multiple effective therapies, discontinuation/switching of treatment is common for many patients with rheumatoid arthritis (RA). This study was designed to examine initiation of biologic disease-modifying anti-rheumatic drugs (bDMARDs) within the Consortium of Rheumatology Researchers of North America (Corrona) RA Registry, and characterize reasons for discontinuation.MethodsInclusion criteria were: Corrona-registered adults (≥18 years) with RA (2002–2011); age of RA onset: ≥16 years; ≥6 months’ follow-up after initiation of first/subsequent bDMARD. Patients receiving both tumor necrosis factor antagonists and non-TNF antagonists were included. Treatment discontinuation was defined as first report of stopping initial therapy or initiation of new bDMARD at/between visits, using a follow-up physician questionnaire.ResultsOverall, 6209 patients met inclusion criteria and 80.7% received TNF antagonists. Median time to discontinuation/change of therapy was 25.1 months (26.5 months with TNF antagonists vs. 20.5 months with non-TNF antagonists; log-rank p < 0.0001); 82.2, 67.3, and 51.1% of patients remained on therapy at 6, 12, and 24 months, respectively. Reasons for discontinuation were captured for 49.2% of patients, including: loss of efficacy (35.8%); physician preference (27.8%); safety (20.1%); patient preference (17.9%); and no access to treatment (9.0%). Baseline factors with greatest correlation to discontinuation were modified Health Assessment Questionnaire scores, patient-reported anxiety/depression, initiation of bDMARD treatment in 2007–2010 versus 2002–2003, and Clinical Disease Activity Index scores.ConclusionsAlmost one-third of patients in the US discontinue currently available bDMARD therapies for RA by 12 months and almost half by 24 months, most commonly due to loss of efficacy.FundingCorrona LLC and MedImmune.

Impact of hepatitis C virus infection on disease activity, functional status and ultrasonography findings in Egyptian rheumatoid arthritis patients

BackgroundHepatitis C virus (HCV) infection is one of the most frequently encountered public health problems in Egypt. It is associated with many autoimmune diseases such as rheumatoid arthritis. Aim of the workTo assess the impact of HCV infection in rheumatoid arthritis (RA) Egyptian patients; its relation to disease activity, functional status and ultrasonography findings. Patients and methodsThe study included 155 RA patients further classified according to the presence of concomitant HCV infection into 2 groups; rheumatoid arthritis (RA) and rheumatoid arthritis/hepatitis C virus (RA/HCV) groups. All patients were subjected to full history taking, thorough clinical examination, laboratory investigations, assessment of disease activity using the disease activity score 28 (DAS28) and assessment of functional status using the modified health assessment questionnaire (MHAQ). Ultrasonography (US) assessment was done using the German US7 score. ResultsBoth DAS28 and MHAQ scores showed significant differences between both the RA and the RA/HCV groups (p<0.001), with higher mean values observed in the RA/HCV group (5.4±1.1 and 1.05±0.79 respectively). Significantly higher US7 synovitis scores were found in the RA/HCV group compared to the RA group (p=0.03). US7 synovitis tenosynovitis scores revealed significant correlations with DAS28 and US7 synovitis scores correlated with MHAQ in both groups. ConclusionConcomitant HCV infection in RA patients had an impact on disease activity. RA patients with concomitant HCV infection (RA/HCV) had higher DAS28 and MHAQ scores, with higher US7 synovitis scores compared to RA patients. US7 score is a valuable objective tool for the assessment of RA disease activity.

The impact of joint disease on the Modified Health Assessment Questionnaire scores in rheumatoid arthritis patients: A cross-sectional study using the National Database of Rheumatic Diseases by iR-net in Japan

Objectives: To investigate the effect of bilateral and unilateral joint disease on the Modified Health Assessment Questionnaire (MHAQ) scores and the differences in joint weighting in rheumatoid arthritis patients.Methods: A total of 9212 subjects from the Japanese nationwide cohort database NinJa, 2011, were analyzed. The presence or absence of disease in each joint, including swelling and/or tenderness, was investigated. The correlations between bilateral and unilateral disease in each joint and MHAQ scores were investigated using multivariable logistic regression analysis.Results: The patients’ mean age and disease duration was 63.2 and 12.2 years, respectively. The Disease Activity Score-28 was 3.3. The odds ratios of physical impairment according to the MHAQ using multivariable logistic regression models for bilateral and unilateral joints, respectively, were: shoulder, 4.0 and 1.8; elbow, 2.6 and 1.8; wrist, 1.9 and 1.5; hip, 1.7 and 3.0; knee, 2.6 and 1.9; ankle, 2.3 and 2.0, finger, 1.4 and 1.2; and toe, 1.0 and 1.1. The shoulder, elbow, wrist, knee, and ankle had a significant effect on physical impairment.Conclusions: The MHAQ score was significantly affected by shoulder, elbow, wrist, knee, and ankle joint disease. Furthermore, bilateral disease tended to have a greater effect on physical impairment than unilateral disease.

Assessment of fatigue in rheumatoid arthritis and its relation to pain and disease activity measures

Fatigue is a serious outcome of rheumatoid arthritis (RA). Inflammatory synovitis is potentially an important causal factor for RA fatigue. Other factors include psychosocial factors, health beliefs, illness perceptions, and poor social support. Fatigue also has strong relationships to pain and depression. The aim of the study was to define the amount of fatigue experienced by RA patients, and determine the relative contribution of RA disease activity to fatigue in comparison with factors such as pain and treatment in established RA cases using different instruments to assess fatigue [visual analog scale (VAS) fatigue and the vitality subscale of the Medical Outcomes Study Short Form 36 (SF-36) questionnaire]. A total of 50 adult patients diagnosed with RA according to the 1987 Revised American College of Rheumatology – 42 of them being female and the remaining eight being male, with a mean age of 45.36 ± 9.6 years and a mean disease duration of 7.78 ± 4.1 years – were included in the study. Fatigue was measured using a 100 mm VAS and the SF-36 vitality scores. We measured pain using 100 mm VAS, Disease Activity Score for 28 joint counts (DAS28), early morning stiffness, the modified Health Assessment Questionnaire score, and the physician global assessment score. Fatigue was common in RA patients. Out of 50 patients, 42 patients had fatigue (VAS ≥ 20 mm), and at the same time 26 had high fatigue scores (VAS350 mm). The mean SF-36 energy and vitality score was 60.5 ± 23.1. The VAS fatigue scores and the SF-36 vitality scores were significantly correlated with disease activity measures, including duration of morning stiffness (P = 0.001), articular index (P < 0.0001), VAS pain (P < 0.0001), DAS28 (P < 0.0001), C reactive protein (CRP) (P = 0.04 and 0.001, respectively), erythrocyte sedimentation rate (ESR) (P = 0.04), and rheumatoid factor positivity (P = 0.04 and 0.01, respectively). Pain had the strongest association with fatigue, followed by articular index, duration of morning stiffness, ESR, DAS28, and finally CRP in that order. High fatigue levels are common in RA and are mainly linked to pain. VAS fatigue scores are simple measurements that can be used for assessment of fatigue in patients with RA.

The impact of multimorbidity status on treatment response in rheumatoid arthritis patients initiating disease-modifying anti-rheumatic drugs.

When treating RA patients, remission (REM) or at least low disease activity (LDA) is the ultimate therapeutic goal. The aim of this study was to assess the impact of multimorbidity on achieving REM or LDA. In a prospective RA cohort, we identified patients initiating any DMARD with follow-up data 1 year after. Treatment effects were measured using the clinical disease activity index (CDAI) and the modified health assessment questionnaire (MHAQ); multimorbidity status was assessed using a counted multimorbidity index (cMMI). The proportion of patients reaching REM or LDA 1 year after DMARD commencement with respect to the cMMI was evaluated. In regression models, we calculated the odds ratio of achieving REM or LDA, and predicted CDAI and MHAQ 1 year after DMARD commencement for various levels of cMMI, adjusting for age, sex, disease duration, serostatus, disease activity at DMARD commencement, number of previous DMARDs, and type of DMARD, steroid and NSAID use. A total of 815 patients started DMARDs; 414 were on the same DMARD after 1 year. The proportion of these patients achieving REM or LDA after 1 year was significantly lower in the patients with higher cMMI, following a linear trend (P < 0.01). After accounting for covariates, the odds ratio for REM associated with each additional morbidity in the cMMI was 0.72 (95% CI 0.55, 0.97) and 0.81 (95% CI 0.70, 0.94) for LDA. One year after DMARD initiation, CDAI (+0.16 per additional morbidity) and MHAQ scores (+0.15 per additional morbidity) were significantly worse (both P < 0.05). Increased multimorbidity negatively affects the therapeutic goal of REM and LDA.