Modified Health Assessment Questionnaire Research Articles

Prognostic modeling in early rheumatoid arthritis: reconsidering the predictive role of disease activity scores.

In this prospective cohort study, we provide several prognostic models to predict functional status as measured by the modified Health Assessment Questionnaire (mHAQ). The early adoption of the treat-to-target strategy in this cohort offered a unique opportunity to identify predictive factors using longitudinal data across 20years. A cohort of 397 patients with early RA was used to develop statistical models to predict mHAQ score measured at baseline, 12months, and 18months post diagnosis, as well as serially measured mHAQ. Demographic data, clinical measures, autoantibodies, medication use, comorbid conditions, and baseline mHAQ were considered as predictors. The discriminative performance of models was comparable to previous work, with an area under the receiver operator curve ranging from 0.64 to 0.88. The most consistent predictive variable was baseline mHAQ. Patient-reported outcomes including early morning stiffness, tender joint count (TJC), fatigue, pain, and patient global assessment were positively predictive of a higher mHAQ at baseline and longitudinally, as was the physician global assessment and C-reactive protein. When considering future function, a higher TJC predicted persistent disability while a higher swollen joint count predicted functional improvements with treatment. In our study of mHAQ prediction in RA patients receiving treat-to-target therapy, patient-reported outcomes were most consistently predictive of function. Patients with high disease activity due predominantly to tenderness scores rather than swelling may benefit from less aggressive treatment escalation and an emphasis on non-pharmacological therapies, allowing for a more personalized approach to treatment. Key Points •Long-term use of the treat-to-target strategy in this patient cohort offers a unique opportunity to develop prognostic models for functional outcomes using extensive longitudinal data. •Patient reported outcomes were more consistent predictors of function than traditional prognostic markers. •Tender joint count and swollen joint count had discordant relationships with future function, adding weight to the possibility that disease activity may better guide treatment when the components are considered separately.

Demographic, Clinical Profile of Rheumatoid Arthritis Patients and Their Association with Disease Severity in Ghana.

Rheumatoid arthritis (RA) is one of the frequent chronic, systemic, inflammatory autoimmune disorders with an estimated global prevalence of 1%. RA leads to joint destruction and disability if left untreated. Ghana has seen very few studies on RA, and little is known about the disease's severity and related variables. This study sought to characterize the clinical presentation and determine disease severity and associated risk factors with disease severity among RA patients in a tertiary hospital in Ghana. This cross-sectional study was conducted between September 2020 and August 2021. This study included 56 consecutively consenting RA patients from the Komfo Anokye Teaching Hospital orthopaedic unit. Diagnosis of RA was based on the updated American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2022 rheumatoid arthritis classification criteria by a rheumatologist. A study questionnaire was used to gather participant demographics and clinical features, and results from the laboratory were taken from the patients' charts and medical records. The patients' disease severity was evaluated based on the rheumatoid arthritis disease activity score, which is based on a 28-joint count (DAS28), and their functioning was evaluated using the modified health assessment questionnaire. The participants' mean age was 51.25 ± 13.22 years. Out of the total participants, 46 were females, and 10 were males (female-to-male ratio 4.6 : 1). Moreover, 37.50% had arthritis of the hand; 5.30% had severe disease, and 94.60% were not severe. A majority (76.80%) were on methotrexate medication. The most frequently involved joints were the knee (42.90%), wrist (32.10%), and elbow (12.50%). There was no statistically significant association with disease severity and a functional status score of >0.5 (cOR: 10.60, 95% CI (0.52-217.30); p = 0.124). In addition, marital status (p = 0.04), disease duration (p = 0.04), family complaints (p = 0.02), and ESR (p = 0.03) were significantly associated with disease severity. RA is predominant among elder populations and females. Disease duration, family complaints, and ESR are associated with disease severity. The findings of this study call for interventions towards ensuring early diagnosis of RA among high-risk populations to enhance good management practices.

Patterns of comorbidities differentially affect long-term functional evolution and disease activity in patients with ‘difficult to treat’ rheumatoid arthritis

BackgroundCharacterisation of the long-term outcome of patients with ‘difficult to treat’ (D2T) rheumatoid arthritis and factors contributing to its evolution are unknown. Herein, we explored the heterogeneity and contributing factors...

CXCL10 as a biomarker of interstitial lung disease in patients with rheumatoid arthritis

IntroductionPulmonary involvement is a frequent and serious rheumatoid arthritis (RA) manifestation that affects 60%–80% of patients. CXCL10 is an inflammatory chemokine that regulates different biological responses, such as chemotaxis, angiogenesis, and inflammation. AimThis study aimed to identify the role of CXCL10 as a peripheral blood marker of RA-ILD and its correlation with disease activity. Patients and methodsThis cross-sectional study included 73 patients with RA (33 with ILD and 40 without ILD). Pulmonary function tests and high-resolution computed tomography were performed. Blood samples were taken for complete blood count and blood chemistry analysis, and human interferon-inducible protein 10 (IP-10/CXCL10) level. Statistical Package for the Social Sciences (version 22) was used for all statistical calculations. ResultsThe serum CXCL10 level and patient age (r=.393, p=.024), disease duration (r=.756, p<0.001), erythrocyte sedimentation rate (r=.516, p=.002), C-reactive protein (r=.539, p=.001), and rheumatoid factor (r=.663, p<.001) revealed a significant positive correlation. Furthermore, the Modified Health Assessment Questionnaire (r=−.418, p=.015) revealed a significant negative correlation. Patients with RA-ILD show significantly higher CXCL10 than those without ILD (p<.001). ConclusionCXCL10 is a useful RA disease activity biomarker and is an RA-ILD-sensitive biomarker, also CXCL10 is a significant predictor for development of RA-ILD.

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.

Comprehensive relationship between disease activity indices, mTSS, and mHAQ and physical function evaluation and QOL in females with rheumatoid arthritis

Rheumatoid arthritis (RA) causes significant physical disability. We comprehensively investigated the relationship between RA disease activity (Disease Activity Score 28-C-reactive protein [DAS28-CRP], Simplified Disease Activity Index [SDAI], and Clinical Disease Activity Index [CDAI]), physical function (10-Meter Walk Test [10 MWT], Timed Up and Go test [TUG], Functional Reach Test [FRT], and Disabilities of the Arm, Shoulder, and Hand [DASH]), and quality of life (QOL) (Short-Form 36 [SF-36®]). We also investigated the relationship between van der Heijde’s modified Total Sharp Score (mTSS), modified Health Assessment Questionnaire (mHAQ), and physical function and QOL assessments. Among 35 female patients with RA, DAS28-CRP correlated solely with DASH (r = 0.376), while SDAI and CDAI did not correlate with physical function. The mTSS-hand roentgenographic evaluation correlated with TUG (r = 0.359), FRT (r = − 0.415), and DASH (r = 0.533) among physical function assessments. The mHAQ correlated with 10 MWT (r = 0.347), TUG (r = 0.356), FRT (r = − 0.420), and DASH (r = 0.646). DAS28-CRP correlated with six of the eight subscales of SF-36®, and mTSS and mHAQ correlated with only one subscale. RA disease activity assessments may not reflect all physical functions and QOL domains of female patients with RA. Evaluating physical function and QOL in female patients with RA is essential.

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.

Real-world comparative study of the efficacy of Janus kinase inhibitors in patients with rheumatoid arthritis: the ANSWER cohort study.

This multicentre, retrospective study compared the efficacy and safety of tofacitinib, baricitinib, peficitinib and upadacitinib in real-world clinical settings after minimizing selection bias and adjusting the confounding patient characteristics. The 622 patients were selected from the ANSWER cohort database and treated with tofacitinib (TOF), baricitinib (BAR), peficitinib (PEF) or upadacitinib (UPA). The patient's background was matched using propensity score-based inverse probability of treatment weighting (IPTW) among four treatment groups. The values of Clinical Disease Activity Index (CDAI), C-reactive protein (CRP), and modified Health Assessment Questionnaire (mHAQ) after drug initiation and the remission or low disease activity (LDA) rates of CDAI at 6 months after drug initiation were compared among the four groups. Further, the predictive factor for TOF and BAR efficacy was analysed. The retention and discontinuation rates until 6 months after drug initiations were not significantly different among the four JAK inhibitors treatment groups. Mean CDAI value, CDAI remission rate, and CDAI-LDA rate at 6 months after drug initiation were not significantly different among treatment groups. Baseline CDAI (TOFA: OR 1.09, P < 0.001; BARI: OR 1.07, P < 0.001), baseline CRP (TOFA: OR 1.32, P = 0.049), baseline glucocorticoid dose (BARI: OR 1.18, 95% CI 1.01-1.38, P = 0.035), a number of previous biological or targeted synthetic disease-modifying antirheumatic drugs (biological/targeted synthetic DMARDs) (BARI: OR 1.36, P = 0.004) were predictive factors for resistance to CDAI-LDA achievement to JAK inhibitor treatment. The efficacy and safety of TOF, BAR, PEF and UPA were not significantly different for the treatment of patients with rheumatoid arthritis.

CXCL10 as a biomarker of interstitial lung disease in patients with rheumatoid arthritis

IntroductionPulmonary involvement is a frequent and serious rheumatoid arthritis (RA) manifestation that affects 60%–80% of patients. CXCL10 is an inflammatory chemokine that regulates different biological responses, such as chemotaxis, angiogenesis, and inflammation. AimThis study aimed to identify the role of CXCL10 as a peripheral blood marker of RA-ILD and its correlation with disease activity. Patients and methodsThis cross-sectional study included 73 patients with RA (33 with ILD and 40 without ILD). Pulmonary function tests and high-resolution computed tomography were performed. Blood samples were taken for complete blood count and blood chemistry analysis, and human interferon-inducible protein 10 (IP-10/CXCL10) level. Statistical Package for the Social Sciences (version 22) was used for all statistical calculations. ResultsThe serum CXCL10 level and patient age (r=.393, p=.024), disease duration (r=.756, p<0.001), erythrocyte sedimentation rate (r=.516, p=.002), C-reactive protein (r=.539, p=.001), and rheumatoid factor (r=.663, p<.001) revealed a significant positive correlation. Furthermore, the Modified Health Assessment Questionnaire (r=−.418, p=.015) revealed a significant negative correlation. Patients with RA-ILD show significantly higher CXCL10 than those without ILD (p<.001). ConclusionCXCL10 is a useful RA disease activity biomarker and is an RA-ILD-sensitive biomarker, also CXCL10 is a significant predictor for development of RA-ILD.

The role of the Beclin-1: a gene related to autophagy in rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disorder. Autophagy, a regulator of cell homeostasis, can impact innate and adaptive immune cells activation and contribute to the pathogenesis of RA. The purpose of this study was to assess the significance of autophagy in RA, by investigating the autophagy signaling Beclin-1 in RA patients.ResultsIn RA patients, the Beclin-1 gene expression level was higher than the healthy controls with a statistically highly significant difference (P < 0. 001) where the gene expression mean was 3.33 ± 0.45 in patients and 0.98 ± 0.070 in controls. There was a significant positive correlation between Beclin-1 gene expression and disease duration (p = 0.013*), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF) titer (P = 0.018*, 0.027*, and 0.023* respectively). Beclin-1 gene overexpression is significantly correlated with disease activity parameters (DAS 28, patient and physician global health assessment). Furthermore, the Beclin-1 gene overexpression is highly correlated with the disability index, Modified Health Assessment Questionnaire (MHAQ) (P < 0.001).ConclusionThe elevated autophagy-related gene Beclin-1 expression in RA patients can contribute to RA probability, high disease activity, and severity. Therefore, suppressing autophagy may be a therapeutic target for RA.

Test-retest reliability of pain VAS/NRS, stiffness VAS/NRS, HAQ-DI and mHAQ in polymyalgia rheumatica: An OMERACT study

ObjectiveTo examine the test-retest reliability of four measurement instruments in polymyalgia rheumatica (PMR): pain severity visual analogue scale (VAS) / numerical rating score (NRS), stiffness severity VAS/NRS, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the modified Health Assessment Questionnaire (mHAQ). MethodTwo prospectively collected datasets were used. All participants had a diagnosis of PMR and only those with stable disease were included in analyses. Measurement instruments were administered twice, with a testing interval of two to six weeks. The intra-class correlation coefficient (ICC) was calculated using a two-way mixed effects model looking for absolute agreement. ICC values of 0.8-0.9 were deemed representative of good test-retest reliability, whilst values >0.9 were representative of excellent test-retest reliability. ResultsFrom the first dataset, 38 participants were analysed. The ICC between baseline and 2 weeks for pain VAS, stiffness VAS, HAQ-DI and mHAQ were 0.84, 0.82, 0.92 and 0.92 respectively.From the second dataset, 58 participants were included in the analysis for pain NRS, 59 for stiffness NRS and 78 for mHAQ. The ICC between baseline and follow-up for pain NRS, stiffness NRS and mHAQ were 0.80, 0.83 and 0.87 respectively. ConclusionPain severity VAS/NRS, stiffness severity VAS/NRS, HAQ-DI and mHAQ all demonstrate good to excellent test-retest reliability in a PMR patient population.

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 received, also; Disease Activity Score (DAS-28) &amp;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 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 significantly urban resident (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 specialty early in the disease compared to late diagnosis group (P= &lt;0.0001). Conclusion. Early diagnosis is still suboptimal. Unemployment, specialty visited first other than rheumatology, female gender, rural residence, and lower educational level was associated with the delay in diagnosis in RA patients. Patients with delayed diagnosis showed worse functional disability index.

Discordance of global assessment between the patients and physicians predicts 9-year pain-related outcomes in rheumatoid arthritis patients.

Perspectives regarding the disease state often differ between patients with rheumatoid arthritis (RA) and physicians. The aim of the present longitudinal cohort study was to investigate the impact of the discordance in global assessments between patients and physicians on 9-year pain-related outcomes in patients with rheumatoid arthritis. Sixty-eight consecutive outpatients with rheumatoid arthritis on their first visit to a tertiary center were included. Baseline measurements included demographic data, drugs used, disease activity, and a modified Health Assessment Questionnaire (mHAQ). Discordance in global assessment between patients and physicians at baseline was defined as 10 mm higher in the patient global assessment (PGA) than in the physician global assessment. A 9-year follow-up assessment included pain intensity, the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) scale, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and Pain Self-Efficacy Questionnaire (PSEQ). The number of patients with discordance was 26 (38%) in 68 patients. Patients with a 10 mm higher PGA than the physician global assessment at baseline measurements had significantly worse pain intensity, PCS score, PSEQ score, and EQ-5D-3L score measurements at the 9-year follow-up than those with concordance. A higher mHAQ score and 10 mm higher PGA at baseline were significantly independently associated with the EQ-5D-3L scale score and pain intensity at the 9-year follow-up. This longitudinal cohort study suggested that discordance in global assessment between patients and physicians modestly predicted worse 9-year pain-related outcomes in patients with rheumatoid arthritis.

Association between the Modified Health Assessment Questionnaire (MHAQ) and the Functional Status Scale (FSS) for Functional Status Measurement in Women with Rheumatoid Arthritis: A Descriptive Observational Study

Association between the Modified Health Assessment Questionnaire (MHAQ) and the Functional Status Scale (FSS) for Functional Status Measurement in Women with Rheumatoid Arthritis: A Descriptive Observational Study

Comparative Effectiveness of Abatacept vs. Tofacitinib in Rheumatoid Arthritis Patients who are CCP.

Currentlythere is limiteddata to drive clinical decision making regarding the choice of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARD); thus, head-to-head comparisons are needed to help guide prescribing.In recent years, significant advancements have helped clarify the mechanistic basis of the clinical associations of autoantibodies in rheumatoid arthritis (RA). This study evaluated the effectiveness of abatacept versus tofacitinib in anti-cyclic citrullinated peptide (CCP+) patients with rheumatoid arthritis (RA). CorEvitas (formerly known as CORRONA) Registry patients aged ≥ 18years, who were CCP+ before initiating abatacept or tofacitinib (December 2012 onwards through October 2019), had 6-month follow-up data (baseline and 6-month Clinical Disease Activity Index [CDAI]), and were not in remission at index were included. Patients were frequency matched 1:1 by prior biologic use before propensity score matching (PSM). Primary (mean change [D]in CDAI) and secondary outcomes 6 months after index were compared using mixed-effects models adjusted for variables that remained unbalanced after PSM. Following PSM, most baseline characteristics for 291 patient pairs were well balanced between treatments, although fewer patients initiating abatacept versus tofacitinib received prior non-TNFi biologic DMARDs, and patients initiating abatacept versus tofacitinib had a higher physician global assessment score, patient-reported fatigue, and modified Health Assessment Questionnaire (mHAQ). In adjusted analyses, there were no significant differences in mean [D]from baseline in CDAI at 6months with abatacept versus tofacitinib (P = 0.936). Patients naïve for b/tsDMARDs initiating abatacept had a numerically greater mean [D] in CDAI at 6months versus tofacitinib, although this difference was not statistically significant (P = 0.662). There were no significant differences for any secondary outcomes. In adjusted analyses, CCP+ patients with RA initiating treatment with abatacept versus tofacitinib did not show a statistically significant difference in reducing disease activity or improving patient-reported outcomes.

Smoking, but not use of complementary and alternative medicine predicts residual functional disability in patients with inflammatory arthritis on biologic disease‐modifying anti‐rheumatic drugs: Results from the Singapore National Biologics Register

To describe inflammatory arthritis (IA) patients initiating biologic disease-modifying anti-rheumatic drugs (bDMARDs) who use complementary and alternative medicine (CAM), and determine the impact of CAM on predicting modified Health Assessment Questionnaire (mHAQ) at 6months. This was a prospective inception cohort study of patients ≥21 years old initiating a bDMARD for IA after July 2016. Data were obtained via questionnaires and abstraction from medical records. Baseline characteristics between ever-CAM and CAM non-users were compared. CAM as a predictor of mHAQ ≥1 at 6months after bDMARD initiation was analyzed using multivariate logistic regression, adjusting for other baseline characteristics. We recruited 299 patients (36.2% male, mean age 49.0 years). There were 45.8% who had rheumatoid arthritis, 54.2% had a spondyloarthropathy, median disease duration of 1.1 years and median mHAQ of 0.4. Compared to CAM non-users, ever-CAM users had a lower mean body mass index, were less likely to speak English, and more likely to smoke and drink alcohol. There was no association of CAM use with high mHAQ and no interaction with smoking. Smoking (odds ratio [OR] 938.9; 95% CI 3.20-275 884.1), baseline mHAQ (OR 252.2; 95% CI 5.34-11 899.2) and Charlson's Comorbidity Index score ≥4 (OR 237.4; 95% CI 1.22-46 184.4) independently predicted high mHAQ at 6months. CAM use was not associated with high mHAQ at 6months. Smoking was an independent predictor of residual functional disability at 6months, even after adjusting for age, comorbidity and baseline mHAQ. Greater emphasis on smoking cessation may improve long-term functional outcomes in IA patients on bDMARDs.

Association of New Generation Anti-CCP Antibodies with Disease Severity and Functional Status in Rheumatoid Arthritis Patients

Introduction: Detection of anti-cyclic citrullinated peptide (anti-CCP) antibodies in patients with rheumatoid arthritis (RA) is associated with higher disease activity and lower functional ability. This study investigated the presence of the new generation of anti-CCP antibodies (anti-CCP2 IgG, anti-CCP2 IgA and anti-CCP3.1 IgG/IgA) and their association with disease severity and functional status of RA patients. Methods: A total of 46 RA patients and 40 healthy controls participated in this cross-sectional study that was conducted at the Rheumatology Clinic, Hospital Universiti Sains Malaysia. Blood samples were taken from all participants for anti-CCP2 IgG, anti-CCP2 IgA, and anti-CCP3.1 IgG/IgA analysis. Disease severity and functional status of RA patients were measured using the Disease Activity Score-28 (DAS28) and the modified Health Assessment Questionnaire (mHAQ) respectively. Results: Significantly higher proportion of RA patients were found with positive anti-CCP2 IgG (63.0%), anti-CCP2 IgA (37.0%), and anti-CCP3.1 IgG/IgA antibodies (63.0%) than the healthy controls. No significant association was found between anti-CCP antibodies status and mean DAS28 score of the RA patients. However, RA patients with negative anti-CCP2 IgG status had higher mean mHAQ score than patients with positive anti-CCP2 IgG status. Conclusion: Our study has demonstrated detection of the new generation anti-CCP antibodies in RA patients, supporting the use of autoantibodies in RA diagnosis. While no significant association was found between the presence of anti-CCP antibodies and disease severity of RA patients, the absence of anti-CCP2 IgG was associated with worse function and greater disability of the patients.

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.

Clinical significance of Galectin-1 and Galectin-4 in rheumatoid arthritis patients and their potential role as diagnostic markers

Aim of the workTo investigate the utility of serum Galectin-1 (Gal-1) and Galectin-4 (Gal-4) as potential markers for diagnosis of rheumatoid arthritis (RA) and to explore their relationship with disease activity. Patients and methodsSerum Gal-1 and Gal-4 of 60 RA patients were compared to 30 age and sex-matched controls. Potential relationship of both markers with disease activity assessed using Disease activity score-28 joints (DAS-28), seropositivity (Rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA)), functional classification assessed using modified health assessment questionnaire (MHAQ), radiographic progression assessed using Larsen score and treatment was investigated. ResultsThe study included 60 patients; 54 (90 %) females and 6 (10 %) males with a mean age of 42.6 ± 10.1 years and disease duration of 7.5 ± 6.4 years. Their mean DAS-28 was 4.6 ± 1.0, their MHAQ was 1 ± 0.5 and their Larsen score was 41.3 ± 9.9. The mean of Gal-1 and Gal-4 were both significantly lower in RA patients in comparison to control group (4.4 ± 1.5 ng/ml vs 38.1 ± 25.5 ng/ml and 1.2 ± 0.7 ng/ml; p < 0.001vs 8.1 ± 7.0 ng/ml; p < 0.001 respectively. At a cut off value ≤7.7 for Gal-1 and ≤2.3 for Gal-4 was successfully able to differentiate between RA patients and control group. There was no correlation between both Gal-1 & Gal-4 and DAS-28, MHAQ, Larsen score, RF or ACPA titres. ConclusionGal-1 & 4 serum levels have a potential role as diagnostic markers in patients with RA. Both markers however cannot be regarded as disease activity or severity markers.