Non-inflammatory Rheumatic Diseases Research Articles

Clinical and laboratory profiles of systemic lupus erythematosus patients in a new rheumatology clinic in southwestern Nigeria.

The aims were to study the sociodemographic characteristics of patients presenting to the clinic and to study the clinical and serological pattern of systemic lupus erythematosus (SLE) in a new rheumatology clinic of a predominantly Yoruba population. This was a retrospective, cross-sectional study conducted over 7 years (January 2017 - December 2023). Patients who satisfied the 1997 American College of Rheumatology (ACR) and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were enrolled using their medical records. Patients with overlap syndromes and other inflammatory or noninflammatory rheumatic diseases were excluded from the study. Their sociodemographic, clinical, laboratory, and treatment data were retrieved from their medical records and analysed using IBM SPSS version 23.0 software. A total of 65 patients were diagnosed with SLE with a frequency of 15.8%. The mean age ±SD of the patients at presentation was 33.85 years ±11.01 and the female to male ratio was 9.8 : 1. The median (IQR) duration of symptoms at presentation was 7.0 months (3-24). The common clinical presentations included synovitis (86.2%), acute cutaneous rash (53.8%), oral ulcers (52.3%), nonscarring alopecia (50.8%), and serositis (47.7%). Proteinuria was seen in 37.7% of the patients and the predominant renal histopathological feature was Class IV. Antinuclear antibody was 100% positive with 50.94% of the patients having a titre of 1 : 5,120 and above. Anti-double-stranded deoxyribonucleic acid and anti-Smith antibodies each had 50% prevalence. Dyslipidaemia was found in 76.7% of the patients. The study's findings are largely consistent with similar studies done in Africa. Further prospective multi-centred studies are needed to further determine the epidemiological characteristics of the disease in Nigeria with a multi-ethnic population.

Physical activity assessment with wearable devices in rheumatic diseases: a systematic review and meta-analysis.

In the management of rheumatic musculoskeletal disorders (RMDs), regular physical activity (PA) is an important recognized non-pharmacological intervention. This systematic review and meta-analysis aims to evaluate how the use of wearable devices (WDs) impacts physical activity in patients with noninflammatory and inflammatory rheumatic diseases. A comprehensive search of articles was performed in PubMed, Embase, CINAHL and Scopus. A random-effect meta-analysis was carried out on the number of steps and moderate-vigorous physical activity (MVPA). Univariable meta-regression models were computed to assess the possibility that the study characteristics may act as modifiers on the final meta-analysis estimate. In the analysis, 51 articles were included, with a total of 7488 participants. Twenty-two studies considered MVPA outcome alone, 16 studies considered the number of steps alone, and 13 studies reported information on both outcomes. The recommended PA threshold was reached for MVPA (36.35, 95% CI 29.39, 43.31) but not for daily steps (-1092.60, -1640.42 to -544.77). Studies on patients with fibromyalgia report a higher number (6290, 5198.65-7381.62) of daily steps compared with other RMDs. Patients affected by chronic inflammatory arthropathies seemed to fare better in terms of daily steps than the other categories. Patients of younger age reported a higher overall level of PA than elderly individuals for both the number of steps and MVPA. Physical activity can be lower than the recommended threshold in patients with RMDs when objectively measured using WD. WDs could be a useful and affordable instrument for daily monitoring physical activity in RMDs and may support an increase in activity levels. CRD42021227681, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227681.

Digitally supported rheumatological screening consultation : How useful is a questionnaire scoring system (RhePort)?

Regarding scarce capacities an early detection consultation (EDC) was established to discriminate patients in an outpatient setting with inflammatory from non-inflammatory rheumatic diseases. A total of 500patients suspected of having a rheumatic disease received an appointment within 2weeks. They were interviewed with the help of adigital questionnaire (RhePort), briefly physically examined followed by adetermination of CRP. The questionnaire answers were scored using an algorithm within RhePort (from 0 = non-inflammatory to 4 = highly probably inflammatory). Likewise, after completion of the EDC, the rheumatologists scored the overall assessment. The RhePort score and EDC score were compared with the "true" diagnosis made in adetailed second examination after an average of 10weeks. In 490 evaluable patients 133 inflammatory (27%) and 357 noninflammatory rheumatic diseases (73%) were diagnosed. Aclassification based solely on the RhePort questionnaire (score > 1) identified 103 out of 129 as inflammatory (sens. 80%) and 125 out of 355 as non-inflammatory (spec. 35%) resulting in an AUC of 0.62 after ROC analysis. With ascore > 1, the rheumatological assessment after EDC classified 130 out of 133patients as inflammatory (sensitivity 98%) and 261 out of 357 as non-inflammatory (specificity 73%). The combined EDC can decisively increase the sensitivity and specificity compared to an "automated" survey by means of adigital questionnaire alone. In addition to the early identification and treatment of inflammatory patients, rapid identification of patients who are not in need of rheumatological treatment can create capacities for care.

Validity and reliability of the Persian version of illness invalidation inventory (3*I) among patients with non-inflammatory rheumatic painful disorders

BackgroundThe Invalidation Illness Inventory (3*I) is an instrument that assesses invalidation (including discounting and lack of understanding dimensions) experienced by patients with rheumatic disorders. This study aimed to translate and validate the 3*I in Iran.MethodsFollowing translation of the 3*I into the Iranian language (Persian), a cross-sectional study was conducted. A consecutive sample of females with chronic non-inflammatory rheumatic painful diseases completed the questionnaire. Patients also completed the Revised Symptom Impact Questionnaire (SIQR) and the Short Form Health Survey-12 (SF-12). To examine convergent validity, the correlation between the 3*I, the SIQR, and the SF-12 was assessed. The reliability of the 3*I was examined by internal consistency (the Cronbach's alpha coefficient) and intraclass correlation coefficient (ICC).ResultsIn all 196 patients participated in the study. The mean (SD) age of patients was 45.62 ± 10.70 years. Several significant correlations between the Invalidation Illness Inventory (discounting/lack of understanding) with the symptom impact (SIQR) and the short form health survey (SF-12) were observed lending support to the convergent validity of the 3*I. The Cronbach’s alpha coefficients were acceptable for most dimensions and sources, ranging from 0.52 to 0.88. Most ICC values for the dimensions of 3*I were above 0.75.ConclusionsThe findings indicated that the Persian version of Illness Invalidation Inventory (3*I) is a valid instrument for invalidation assessment in patients with chronic pain. Given the high frequency of perceived invalidation among patients with rheumatic painful disorders, serious attention is needed to the issue in clinical and research settings.

Investigation of asymptomatic intestinal inflammation in ankylosing spondylitis by fecal calprotectin

Background and Study AimsThis study aimed to investigate the prevalence of intestinal inflammation in patients with ankylosing spondylitis (AS) by assessing fecal calprotectin (FC) levels and comparing them with those in patients with rheumatoid arthritis (RA) and non-inflammatory rheumatic diseases. Our secondary aim was to correlate FC levels with antirheumatic treatment, nonsteroidal anti-inflammatory drug (NSAID) usage, and disease activity measures. Patients and MethodsThis cross-sectional study included 97 patients with AS fulfilling the modified New York criteria, 48 patients with RA fulfilling the American College of Rheumatology criteria, and 49 patients with non-inflammatory rheumatic diseases. All patients were questioned about intestinal complaints, and symptomatic patients were excluded. Disease activity was measured in the AS and RA patient groups. ResultsThe AS group had a significantly higher FC test positivity rate than the RA group (p = 0.016). Furthermore, the AS group had FC levels that were negatively correlated with disease duration (p = 0.04). FC levels were not correlated with any disease activity index, erythrocyte sedimentation rate, C-reactive protein, uveitis, or peripheral arthritis. Patients with AS who used NSAIDs had significantly higher FC levels than nonusers (p = 0.001). ConclusionsThis study revealed that 11% of patients with AS without intestinal complaints had elevated FC levels. FC levels were not correlated with disease activity in AS. Subclinical intestinal inflammation was higher in the early stages of AS. The AS group had a significantly higher FC test positivity than the RA group. In the AS group, NSAID users had significantly higher FC levels than nonusers; thus, no statistically significant difference was observed between biological agent users and nonusers.

Immediate effect of the COVID-19 pandemic on patient health, health-care use, and behaviours: results from an international survey of people with rheumatic diseases.

BackgroundThe impact and consequences of the COVID-19 pandemic on people with rheumatic disease are unclear. We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effects of the COVID-19 pandemic on people with rheumatic disease worldwide.MethodsSurvey questions were developed by key stakeholder groups and disseminated worldwide through social media, websites, and patient support organisations. Questions included demographics, rheumatic disease diagnosis, COVID-19 diagnosis, adoption of protective behaviours to mitigate COVID-19 exposure, medication access and changes, health-care access and communication with rheumatologists, and changes in employment or schooling. Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible for inclusion. We included participants with and without a COVID-19 diagnosis. We excluded participants reporting only non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis.Findings12 117 responses to the survey were received between April 3 and May 8, 2020, and of these, 10 407 respondents had included appropriate age data. We included complete responses from 9300 adults with rheumatic disease (mean age 46·1 years; 8375 [90·1%] women, 893 [9·6%] men, and 32 [0·3%] participants who identified as non-binary). 6273 (67·5%) of respondents identified as White, 1565 (16·8%) as Latin American, 198 (2·1%) as Black, 190 (2·0%) as Asian, and 42 (0·5%) as Native American or Aboriginal or First Nation. The most common rheumatic disease diagnoses included rheumatoid arthritis (3636 [39·1%] of 9300), systemic lupus erythematosus (2882 [31·0%]), and Sjögren's syndrome (1290 [13·9%]). Most respondents (6921 [82·0%] of 8441) continued their antirheumatic medications as prescribed. Almost all (9266 [99·7%] of 9297) respondents adopted protective behaviours to limit SARS-CoV-2 exposure. A change in employment status occurred in 2524 (27·1%) of 9300) of respondents, with a 13·6% decrease in the number in full-time employment (from 4066 to 3514).InterpretationPeople with rheumatic disease maintained therapy and followed public health advice to mitigate the risks of COVID-19. Substantial employment status changes occurred, with potential implications for health-care access, medication affordability, mental health, and rheumatic disease activity.FundingAmerican College of Rheumatology.

Antirheumatic drugs in older adults and polypharmacy issues.

Older individuals experience various noninflammatory and autoimmune inflammatory rheumatic diseases. Given the increased incidence of rheumatic conditions in older adults, it is of great importance for healthcare providers to be aware of the potential benefits and risks of antirheumatic drugs. The present article aims to provide acomprehensive review regarding antirheumatic drug use in older patients, particularly by focusing on safety issues and polypharmacy. Antirheumatic medications include nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and disease-modifying antirheumatic drugs (DMARDs), which comprise conventional synthetic DMARDs, targeted synthetic DMARDs and biological DMARDs. Due to the alteration in drug pharmacokinetics and pharmacodynamics in old people, antirheumatic drug efficiency and safety may be different than in the younger population. Polypharmacy and multimorbidity are other potential challenges to be faced during the treatment of older patients with rheumatic diseases. The current review also discusses the strategies to minimize adverse reactions due to antirheumatic drugs.

Association of Rural Setting With Poorer Disease Outcomes for Patients With Rheumatic Diseases: Results From a Systematic Review of the Literature.

To assess whether clinical and patient-reported outcomes are poorer for individuals with inflammatory and noninflammatory rheumatic diseases living in rural locations. We searched 6 databases for articles that reported on primary peer-reviewed research, published in English between 1990 and 2019, that focused on selected rheumatic diseases (rheumatoid arthritis [RA], psoriatic arthritis, axial spondyloarthritis, or osteoarthritis [OA]) and quantified either patient-reported or clinically measured outcomes by a measure of rurality or remoteness. Selected articles were synthesized narratively. Eight eligible publications, including 753 rural and 929 urban patients, evaluated outcomes in RA (5 studies) and OA (3 studies). Studies were small, single center, and rarely provided a definition of rurality. Aspects relating to rurality, such as access to services, were not measured. In RA, some studies suggested greater functional disability and disease activity in rural dwellers. In OA, there was some evidence to suggest that rural dwellers presented with more advanced degenerative hip changes, and that illness perceptions and coping differed between rural and urban dwellers. No studies examined work outcomes. Potentially important confounding factors such as socioeconomic status were rarely considered. There remains considerable uncertainty whether outcomes differ for patients with rheumatic disease in rural settings. There is a need for larger scale studies characterizing participants in relation to place of residence in order to determine whether rurality is an independent predictor of outcome or a surrogate marker for socioeconomic factors.

Comparison of vitamin D profile between patients with inflammatory and non-inflammatory rheumatic diseases

Comparison of vitamin D profile between patients with inflammatory and non-inflammatory rheumatic diseases

Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study

ObjectivesTo identify serious infection (SI) risk by aetiology and site in patients with rheumatoid arthritis (RA) compared with those with non-inflammatory rheumatic and musculoskeletal diseases (NIRMD).MethodsPatients participating in FORWARD from...

Burden of Rheumatic Diseases in A Rural Community of Bangladesh

Objective: To estimate the magnitude, burden of illness and help-seeking behavior of patients with musculoskeletal complaints and to provide incidence of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis, gout, and other inflammatory and non-inflammatory rheumatic diseases in a rural community of Bangladesh. Methods: The study was conducted in a few villages near Dhaka city which were considered to be a fairly representative sample of Bangladeshi rural population. Data were collected with the help of modified Community Oriented Program for Control of Rheumatic Diseases (COPCORD) questionnaire and a diagnosis using American College of Rheumatology (ACR) criteria was established. Results: During the 18 months study period, 2685 adults (15 years and above) were included. A total of 441 (M=163, F=278) developed new musculoskeletal (MSK) pain. The incidence rates were 10.9/100 person-years (PY) for the whole population, 8.2/100 PY for males and 13.6/100 PY for females. Nonspecific low back pain (NSLBP), fibromyalgia and osteoarthritis of knee were common MSK problems. A total of 302 patients had complaints of low back pain, of them 204 persons had noninflammatory low back pain; 262 respondents had complaints of knee pain, 38 had satisfied the criteria of knee OA; a total of 116 respondents suffered from fibromyalgia during the study period. Of the respondents (M=17, F=24) 41 had inflammatory arthropathy. Among the incidences of inflammatory arthritis, rheumatoid arthritis 120 (M=101, F=147), spondyloarthropathies 150 (M=252, F=49), ankylosing spondylitis 75 (M=151, F=0), reactive arthritis 50 (M=101, F=0), and psoriatic arthritis 256 (M=0, F=49) per 100,000 / PY respectively were observed, Conclusions: Rheumatic diseases are common in the rural community of Bangladesh, affecting nearly a quarter of adult population. Non-specific low back pain (NSLBP), fibromyalgia and osteoarthritis of knee joints are common joint disorders; point prevalence estimates of most common diagnoses were similar to other community surveys using COPCORD methodology.DOI: http://dx.doi.org/10.3329/jom.v15i2.20685 J MEDICINE 2014; 15 : 125-130

AB0108 Increased Expression of GM-CSF Secreting Peripheral B Cells in Patients with Rheumatoid Arthritis

BackgroundB cells secreting GM-CSF have been recently identified to participate in innate immunity against bacteria. GM-CSF is known also to play a key role in rheumatoid arthritis (RA) pathogenesis and...

Peripheral and Central Mechanisms of Fatigue in Inflammatory and Noninflammatory Rheumatic Diseases

Fatigue is a common symptom in a large number of medical and psychological disorders, including many rheumatologic illnesses. A frequent question for health care providers is related to whether reported fatigue is "in the mind" or "in the body"-that is, central or peripheral. If fatigue occurs at rest without any exertion, this suggests psychological or central origins. If patients relate their fatigue mostly to physical activities, including exercise, their symptoms can be considered peripheral. However, most syndromes of fatigue seem to depend on both peripheral and central mechanisms. Sometimes, muscle biopsy with histochemistry may be necessary for the appropriate tissue diagnosis, whereas serological tests generally provide little reliable information about the origin of muscle fatigue. Muscle function and peripheral fatigue can be quantified by contractile force and action potential measurements, whereas validated questionnaires are frequently used for assessment of mental fatigue. Fatigue is a hallmark of many rheumatologic conditions, including fibromyalgia, myalgic encephalitis/chronic fatigue syndrome, rheumatoid arthritis, systemic lupus, Sjogren's syndrome, and ankylosing spondylitis. Whereas many studies have focused on disease activity as a correlate to these patients' fatigue, it has become apparent that other factors, including negative affect and pain, are some of the most powerful predictors for fatigue. Conversely, sleep problems, including insomnia, seem to be less important for fatigue. There are several effective treatment strategies available for fatigued patients with rheumatologic disorders, including pharmacological and nonpharmacological therapies.

Eosinofilia sinovial

Synovial fluid eosinophilia is defined as the presence of eosinophils, irrespective of quantity, in the synovial fluid and is a rare finding that is probably underestimated. The pathogenesis of this entity remains incompletely understood. Secondary and idiopathic forms have been described. Idiopathic forms are those not associated with systemic or rheumatic inflammatory disease or associated with chronic non-inflammatory rheumatic diseases. Idiopathic forms can be divided into pure or pseudoallergic forms when they occur in patients with an atopic background and/or intensely positive dermographism. Both forms are usually monoarthritis of the large joints with a substantial component of joint effusion but few inflammatory signs. Synovial fluid usually contains between 2,000 and 10,000leukocytes/mm3, with a variable percentage of eosinophils. Although a major form (>10% eosinophils) and a minor form (<10% eosinophils) have been distinguished, both seem to have the same significance in terms of clinical manifestations and prognosis. Peripheral eosinophilia (>600eosinophils/mm3) is a rare association and is not usually severe. Symptoms resolve within a few days without specific therapy and recurrences occur in approximately half of patients. Non-steroidal anti-inflammatory drugs are usually sufficient to control symptoms. Synovial fluid eosinophilia has not been associated with the development of new joint deformities nor has it been described as a chronic form of arthritis.

Subclinical atherosclerosis in young patients with rheumatoid arthritis and low disease activity

There is an increasing body of evidence suggesting that subjects with rheumatoid arthritis (RA) are characterized by acceleration of atherosclerotic process of arterial wall. However, all investigations performed so far to evaluate subclinical atherosclerosis in RA included subjects without selection for age and degree of disease activity that may represent confounding factors in such an evaluation. To verify signs of accelerated subclinical atherosclerosis in young subject suffering from RA but with low disease activity. Thirty-two patients with RA and 28 age- and sex-matched control subjects with non-inflammatory rheumatic diseases were enrolled. Inclusion criteria were age less than 60 and low disease activity with score < or =3.2 according to DAS28, while subjects with traditional risk factors for and/or overt cardiovascular disease were ruled out from the study. Both patients and controls underwent evaluation of carotid and femoral artery intima-media thickness by ultrasounds. Patients had higher intima-media thickness than controls of all the sites evaluated at carotid artery level, whereas there were no differences at the comparison of the superficial and common femoral artery wall. At the univariate analysis, a positive correlation between LDL cholesterol levels and intima-media thickness at the carotid bifurcation was found. Young patients with RA and low disease activity have acceleration of atherosclerosis development as shown by increased intima-media thickness of carotid artery with respect to subjects without inflammatory rheumatic disease. It is conceivable that the organic damage of arterial wall could be the result of persistent endothelial dysfunction induced by chronic inflammation and immune dysregulation which characterize RA.

Quality of life at the dead sea region: the lower the better? an observational study

BackgroundThe Dead Sea region, the lowest in the world at 410 meters below sea level, is considered a potent climatotherapy center for the treatment of different chronic diseases.ObjectiveTo assess the prevalence of chronic diseases and the quality of life of residents of the Dead Sea region compared with residents of the Ramat Negev region, which has a similar climate, but is situated 600 meters above sea level.MethodsAn observational study based on a self-administered questionnaire. Data were collected from kibbutz (communal settlement) members in both regions. Residents of the Dead Sea were the study group and of Ramat Negev were the control group. We compared demographic characteristics, the prevalence of different chronic diseases and health-related quality of life (HRQOL) using the SF-36 questionnaire.ResultsThere was a higher prevalence of skin nevi and non-inflammatory rheumatic diseases (NIRD) among Dead Sea residents, but they had significantly higher HRQOL mean scores in general health (68.7 ± 21 vs. 64.4 ± 22, p = 0.023) and vitality (64.7 ± 17.9 vs. 59.6 ± 17.3, p = 0.001), as well as significantly higher summary scores: physical component score (80.7 ± 18.2 vs. 78 ± 18.6, p = 0.042), and mental component score (79 ± 16.4 vs. 77.2 ± 15, p = 0.02). These results did not change after adjusting for social-demographic characteristics, health-related habits, and chronic diseases.ConclusionsNo significant difference between the groups was found in the prevalence of most chronic diseases, except for higher rates of skin nevi and NIRD among Dead Sea residents. HRQOL was significantly higher among Dead Sea residents, both healthy or with chronic disease.

Alternative Use of Bisphosphonate Therapy for Rheumatic Disease

Bisphosphonates are widely use for pathologies such as osteoporosis, Paget's disease or bone metastasis. However, their potent antiresorptive properties open new therapeutic opportunities for other conditions associated with an increased focal or systemic bone remodelling. Moreover, apart from their antiresorptive activity, bisphosphonates could also have others properties through a specific analgesic or anti-inflammatory effect. Thus, rheumatic diseases like rheumatoid arthritis, spondylarthritis or SAPHO syndrome (acronym for synovitis, acne, pustulosis, hyperostosis and osteitis) that are associated with systemic and sometimes focal bone loss could be good candidates for bisphosphonate therapy. Other non-inflammatory rheumatic diseases like bone osteonecrosis, algodystrophy, fibrous dysplasia or neuropathic osteoarthropathy are also associated with pain and an increase of focal bone remodelling. Several studies have shown that bisphosphonate could have promising therapeutic potential in these inflammatory or non-inflammatory diseases where therapeutic options are usually few. This review will focus on the new potential alternative indications for bisphosphonate in rheumatic diseases.

Pain management in fibromyalgia

Pain is the primary presenting symptom in the vast majority of inflammatory and noninflammatory rheumatic diseases. Patients tell us that improved pain relief is a principal concern. Many pain complaints respond incompletely to the treatment of the primary rheumatic disorder and pain syndromes such as fibromyalgia do not respond to traditional analgesic medications. Therefore, proper management requires consideration of additional medications for symptomatic relief. This review addresses newer strategies for the treatment of pain in patients with fibromyalgia that may be also useful in patients with other rheumatic diseases. New medications have been developed with a better understanding of chronic pain mechanisms that principally address pain neurobiology at the levels of the spinal cord and the brain. Clinical studies demonstrate the effectiveness of the alpha-2-delta ligands (gabapentin and pregabalin) and the norepinephrine/serotonin reuptake inhibitors (duloxetine and milnacipran) in fibromyalgia. Patients with chronic pain, best classified as fibromyalgia, either primary or in association with other rheumatic disorders, may experience benefit from new therapies targeting central pain mechanisms.

Prevalence of Autoantibodies to Cyclic Citrullinated Peptide in Patients with Rheumatic Diseases other than Rheumatoid Arthritis: A French Multicenter Study

Our objective was to evaluate the prevalence of autoantibodies to cyclic citrullinated peptides (anti-CCP aAbs) in a cohort of patients with a variety of inflammatory or non-inflammatory rheumatic diseases other than rheumatoid arthritis (RA). Six hundred and nine serum samples were tested for anti-CCP aAbs and for rheumatoid factor (RF) using enzyme-linked immunosorbent assays and immunonephelometry. The prevalence of anti-CCP aAbs and RF reached 10% and 25%, respectively, using the positive cutoff value suggested by the manufacturers. Using a higher cutoff value (50 U/ml) for both aAbs, the prevalence was lower with 6% and 16%, respectively. The specificity of both markers for RA thus reached 94% and 84%, respectively. Anti-CCP aAbs were found to be elevated in inflammatory and also in non-inflammatory rheumatic diseases in the same proportion. Clinical data obtained for 36 positive patients showed that 17% developed RA within 5 years. In conclusion, anti-CCP aAbs are clearly more specific than RF for RA. Follow-up of anti-CCP aAbs-positive patients with inflammatory or non-inflammatory rheumatic diseases other than RA could be important considering the predictive value of these aAbs for the development of RA.

Pharmacogenetics/pharmacogenomics and antirheumatic drugs in rheumatology

Genomic medicine has raised many expectations with regard to individualized therapies. Drug response is a complex function of many genes interacting with environmental and behavioral factors. In addition, poor prescribing, interactions between drugs and an incomplete understanding of the metabolism of many drugs, which are administered simultaneously to treat concomitant morbidities, are leading causes of the occurrence of adverse drug reactions in chronic non-inflammatory and autoimmune rheumatic diseases. Symptomatic non-steroidal anti-inflammatory drugs, as well as disease-modifying drugs, are complicated by drop-outs (poor patient compliance) in a large percentage of patients. Even though intensive and careful monitoring is always clearly advisable, preliminary data suggest that typing of genes controlling the effects, metabolism and response of drugs might be of clinical utility to define the 'at-risk' genotype.