Number Of Painful Joints Research Articles

AB0698 Sleep and its relationship to pain, dysfunction, and disease activity in juvenile rheumatoid arthritis.

ObjectivesTo determine what sleep abnormalities may exist in children with juvenile rheumatoid arthritis (JRA), and their relationship to pain, dysfunction, and disease activityMethodsCase control study including 47 patients diagnosed with...

Sleep Loss Exacerbates Fatigue, Depression, and Pain in Rheumatoid Arthritis

Disturbances of sleep are hypothesized to contribute to pain. However, experimental data are limited to healthy pain-free individuals. This study evaluated the effect of sleep loss during part of the night on daytime mood symptoms and pain perceptions in patients with rheumatoid arthritis in comparison with control subjects. A between-groups laboratory study with assessment of mood symptoms and pain perception before and after partial night sleep deprivation (PSD; awake 23:00 hr to 03:00 hr). General clinical research center. Patients with rheumatoid arthritis (n = 27) and volunteer comparison control subjects (n = 27). Subjective reports of sleep, mood symptoms and pain, polysomnographic assessment of sleep continuity, and subjective and objective assessment of rheumatoid arthritis-specific joint pain. PSD induced differential increases in self-reported fatigue (P < 0.09), depression (P < 0.04), anxiety (P < 0.04), and pain (P < 0.01) in patients with rheumatoid arthritis compared with responses in control subjects, in whom differential increases of self-reported pain were independent of changes in mood symptoms, subjective sleep quality, and objective measures of sleep fragmentation. In the patients with rheumatoid arthritis, PSD also induced increases in disease-specific activity as indexed by self-reported pain severity (P < 0.01) and number of painful joints (P < 0.02) as well as clinician-rated joint counts (P < 0.03). This study provides the first evidence of an exaggerated increase in symptoms of mood and pain in patients with rheumatoid arthritis after sleep loss, along with an activation of rheumatoid arthritis-related joint pain. Given the reciprocal relationship between sleep disturbances and pain, clinical management of pain in patients with rheumatoid arthritis should include an increased focus on the prevention and treatment of sleep disturbance in this clinical population.

Evaluation of a Community Health Practitioner Self-care Program for Rural Korean Patients with Osteoarthritis

The purpose of this study was to evaluate a self-care program for elders with osteoarthritis managed by primary health care workers, Community Health Practitioners (CHPs), in rural Korea. The self-care program, consisting of 7 areas, was evaluated with a randomized experimental study for patients over age 60 with osteoarthritis in which 150 participants in the experimental group and 140 in the control group were compared. The self-care program was implemented for six weeks, 2 hours per week, at community health posts by CHPs. Data were collected using an interview questionnaire given by the CHPs and laboratory tests before and after the intervention for both groups. Propensity score matching analysis was done to test effectiveness after controlling for confounding variables. The intervention group showed a significant decrease in the number of painful joints (p<.001) and a significant increase in self-care ability (p<.05) compared to the control group. Study results indicate that training and utilizing primary health care workers in rural areas is valuable in increasing the generalization and continuity of intervention programs. As arthritis should be managed life-long, CHP directed self-care programs are useful interventions for rural elders with arthritis to learn self-care management.

P10 Vitamin D level in rheumatoid arthritis: correlation with the disease activity

Patients with rheumatoid arthritis have low plasma vitamin B6 levels and elevated plasma homocysteine responses to a methionine load. We examined whether these abnormalities are associated with clinical and biochemical indicators of disease status.We performed a cross-sectional study in 37 patients who met the American College of Rheumatology criteria for rheumatoid arthritis. Vitamin B6 status was assessed by the plasma pyridoxal 5′-phosphate level and with the homocysteine response to a methionine load test. Clinical disease activity was assessed by joint counts, the Health Assessment Questionnaire disability score, and biochemical markers of the acute phase response.Plasma pyridoxal 5′-phosphate levels were inversely correlated with the erythrocyte sedimentation rate (r = −0.37, P = 0.02), C-reactive protein level (r = −0.52, P = 0.002), disability score (r = −0.37, P = 0.02), morning stiffness (r = −0.38, P = 0.02), and degree of pain (r = −0.33, P = 0.04). The increase in homocysteine levels after a methionine load correlated with the erythrocyte sedimentation rate (r = 0.39, P = 0.02), C-reactive protein level (r = 0.37, P = 0.03), disability score (r = 0.37, P = 0.04), degree of pain (r = 0.38, P = 0.02) and fatigue (r = 0.42, P = 0.01), number of painful joints (r = 0.43, P = 0.007), and number of swollen joints (r = 0.32, P = 0.05).Markers of vitamin B6 status are associated with disease activity and severity, synovial burden, and pain in patients with rheumatoid arthritis, raising the possibility that impaired vitamin B6 status in these patients is a result of inflammation.

Differences in activity limitation, pain intensity, and global health in patients with rheumatoid arthritis in Sweden and the USA: a 5-year follow-up

Objective: In this study we compared activity limitations, pain intensity, and global health in patients with rheumatoid arthritis (RA) in Sweden and the USA and aimed to determine whether nationality is associated with these outcomes.Methods: We used longitudinal data from the ‘Swedish TIRA project’ (n = 149) and the University of California, San Francisco (UCSF) RA panel study (n = 85). Data were collected annually concerning use of medications [disease-modifying anti-rheumatic drugs (DMARDs), biologics, and corticosteroids], morning stiffness, number of swollen joints, and number of painful joints. Three self-reported outcome measures were examined: pain intensity measured on a 0–100 visual analogue scale (VAS), activity limitation according to the Health Assessment Questionnaire (HAQ), and global health. To analyse the data, the Student’s t-test, the χ2-test, and the generalized estimating equation (GEE) method were used.Results: Nationality was significantly related to HAQ score and pain intensity, even after adjustment for covariates. The patients in the TIRA cohort reported a lower HAQ score and a higher pain intensity than the patients in the UCSF cohort. Nationality was not related to global health.Conclusion: Patients with RA should be assessed with awareness of the psychosocial and cultural context because disability seems to be affected by nationality. Further knowledge to clarify how a multinational setting affects disability could improve the translation of interventions for patients with RA across nationalities.

Neuropathic pain symptoms in a community knee OA cohort

A neuropathic pain (NP) questionnaire may facilitate the identification of a neuropathic component to osteoarthritis (OA) pain. An existing questionnaire, the painDETECT, was modified for use in knee OA and administered to measure the prevalence and correlates of NP symptoms among adults with this condition. Sensibility of the modified painDETECT (mPD-Q) was assessed in 20 OA subjects followed by mail administration in an established knee OA cohort. NP symptoms were defined using a previously established, painDETECT cut-point. Correlates of NP symptoms, including OA severity (Western Ontario and McMaster Universities Osteoarthritis Index, Von Korff Chronic Pain Grade pain subscale score), psychological factors (Centre for Epidemiological Studies Depression Scale, Pain Catastrophizing Scale), and concomitant medical conditions, were evaluated using logistic regression. Construct validity of the mPD-Q was evaluated through co-administration with another NP questionnaire (S-LANSS). The mPD-Q had face and content validity. Of 259 eligible cohort members, 171 (66%) completed the questionnaire; 28% had NP symptoms on the mPD-Q (19% among those without neurological conditions). Independent correlates of NP symptoms were: pain intensity (adjusted odds ratio [OR]=2.1 per 10 unit increase, P<0.0001), the presence of referred back/hip pain (adjusted OR=2.9, P=0.024), number of painful joints (OR=1.2, P=0.20) and one or more self-reported neurological condition (OR=3.0, P=0.026). Among older adults with chronic symptomatic knee OA, over one-quarter had NP symptoms localized to their knees using the mPD-Q. The mPD-Q may facilitate the identification of a neuropathic component to pain in adults with knee OA who may benefit from further evaluation and/or treatment for NP.

Evaluation of the efficacy of standard basic anti-inflammatory drugs and the time to start basictherapy for rheumatoid arthritis

Objective: to evaluate the efficiency of basic therapy for rheumatoid arthritis (RA) depending on the time of its start and the choice of a starting regimen. Subjects and methods. The study included 258 patients with verified RA, who were divided into groups by the time of basic therapy initiation. All the patients were estimated for changes in the articular syndrome (Ritchie articular index, the number of painful joints, that of inflamed joints, pain and total disease activity assessment by the visual analogue scale, morning stiffness in minutes, and the number of erosions by hand and foot X-ray films). Therapeutic effectiveness was evaluated by the EULAR criteria on the basis of DAS 4 changes and the number of erosions. Results. The study group showed significant clinical and laboratory improvements at the early start of basic therapy as compared with the controls. Assessment using the EURLAR criteria indicated better short-term results in leflunomide-treated patients; overall, a greater percentage of improvements were noted in the study group than in the control one. The study group exhibited a total significantly less increase in the number of erosions as did subgroups with different basic therapy options, but not the sulfasalazine subgroup. Conclusion. Basic therapy initiated at the time of diagnosis of RA permits disease activity and progression to be more effectively controlled than delayed therapy

A comparative study of the effects of bucillamine and salazosulfapyridine in the treatment of rheumatoid arthritis

Bucillamine (Buc), developed in Japan, is a disease-modifying antirheumatic drug (DMARD) which has been used to treat numerous patients with rheumatoid arthritis (RA) in Japan and Korea with favorable results. However, it has not been used globally. In the present study, we compared the timing of onset of efficacy and the usefulness of this drug with that of the globally accepted agent salazosulfapyridine (SASP). There were 26 patients in the Buc group and 23 in the SASP group. We compared changes in the number of swollen joints, number of painful joints, duration of morning stiffness, grip strength, levels of inflammatory marker [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)], rheumatoid factor (RF), physician’s rating by visual analogue scale (VAS), patient’s rating of pain, patient’s overall rating (VAS), and improvement according to European League against Rheumatism (EULAR) criteria (DAS28-CRP, DAS28-ESR) in these two groups of patients. Both Buc and SASP were shown to be efficacious within 3 months after the start of treatment. Both drugs were found to be suitable as first-line treatment of early RA. Signs of efficacy tended to occur earlier with Buc than with SASP, and Buc also tended to have higher efficacy than SASP.

Palindromic Rheumatism: Longterm Outcomes of 60 Patients Diagnosed in 1967–84

To study longterm outcomes of 60 patients with palindromic rheumatism (PR) diagnosed in 1967-1984. A cohort of patients with PR was identified in Jyväskylä Central Hospital in 1967-84, and reexamined in 1984-86. In 2006, medical records of the patients were reviewed to analyze the proportion of patients who had developed chronic rheumatoid arthritis (RA), had joint replacement surgery, or had died. Patients' health status was reviewed by mail questionnaires including functional status on the Health Assessment Questionnaire (HAQ), pain, and the number of painful joints. Forty patients developed chronic RA over the observation period of over 20 years, among whom 38 patients within 10 years and 2 patients after 10 years. Twenty-four patients had died by 2006, 17 (42%) in the RA group and 7 (35%) in the non-RA group. Nine patients, all in the RA group (23%), had received 1 or more joint replacements. The mean HAQ score was 0.57 in the non-RA survivors (mean age 70 yrs), compared to 0.89 in the RA group (mean age 66 yrs) (p = 0.020, adjusted for age). Pain scores and the number of painful joints were similar between the groups. Two-thirds of the patients with PR developed chronic arthritis. The risk to develop chronic arthritis remained over 10 years. The RA group was characterized with functional declines and having joint replacements as longterm outcomes of the disease.

A comparative study of the effects of bucillamine and salazosulfapyridine in the treatment of rheumatoid arthritis

Bucillamine (Buc), developed in Japan, is a disease-modifying antirheumatic drug (DMARD) which has been used to treat numerous patients with rheumatoid arthritis (RA) in Japan and Korea with favorable results. However, it has not been used globally. In the present study, we compared the timing of onset of efficacy and the usefulness of this drug with that of the globally accepted agent salazosulfapyridine (SASP). There were 26 patients in the Buc group and 23 in the SASP group. We compared changes in the number of swollen joints, number of painful joints, duration of morning stiffness, grip strength, levels of inflammatory marker [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)], rheumatoid factor (RF), physician's rating by visual analogue scale (VAS), patient's rating of pain, patient's overall rating (VAS), and improvement according to European League against Rheumatism (EULAR) criteria (DAS28-CRP, DAS28-ESR) in these two groups of patients. Both Buc and SASP were shown to be efficacious within 3 months after the start of treatment. Both drugs were found to be suitable as first-line treatment of early RA. Signs of efficacy tended to occur earlier with Buc than with SASP, and Buc also tended to have higher efficacy than SASP.

Measuring pain in older adults: new considerations about the Fifth Vital Sign

We evaluated measures of pain location and severity in relation to mobility in the MOBILIZE Boston Study which enrolled 749 participants aged 70 and older. Pain location was measured by the McGill Pain Map (MPM) and a questionnaire on chronic joint and back pain (JPQ). Pain severity was measured using the 4-item Brief Pain Inventory (BPI) severity subscale and the JPQ pain severity scale; both scales used the 0-10 rating scales. Self-reported mobility difficulty was defined as a lot of difficulty or inability in walking 1/4 mile or climbing stairs. In one model predicting mobility difficulty, we compared the 2 pain location measures; in the second model we compared the pain severity measures, using multivariable logistic regression. Standard errors showed no evidence of collinearity. On the BPI, 62% of elders rated their pain "now" as 0, on the 0-10 rating scale. However, 45% of the same elders reported pain in the previous week that interfered with their daily activities (BPI). For pain "on average", only 26% of all participants rated their pain as 0 on the 0-10 scale. In the pain location model, number of painful joints (JPQ) was independently associated with mobility difficulty (p < 0.007); number of sites on the MPM was weakly associated (p = 0.07). In the second model, the JPQ severity scale (p = 0.0006) and the BPI severity subscale (p = 0.02) were each independently associated with mobility difficulty. Modest differences in wording of pain assessment items using the 0-10 pain severity rating led to differing conclusions regarding the burden of pain in older adults. Summary measures of chronic joint pain location and severity may offer the most relevant assessments related to functional burden of pain in older adults. (Supported by National Institute on Aging Grant #P01AG004390.)

Targeted Assessment of the Temporomandibular Joint in Patients With Rheumatoid Arthritis

This observational study was done to identify the signs and symptoms of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis (RA) and to assess the association between these and quantitative measurements for the evaluation of rheumatologic disease. The sample comprised 61 patients suffering from RA whose signs and symptoms of TMJ were recorded by means of a questionnaire (scale of limited mandibular function) and clinical measurements (pain during jaw movement, limitation of maximal mouth opening, joint sounds, tenderness on TMJ palpation, tenderness on masticatory muscle palpation). These findings were correlated with the quantitative measurements for evaluating RA: duration of the disease, positivity for rheumatoid factor, Health Assessment Questionnaire (HAQ) score, number of edematous and painful joints, and overall assessment of functional status. In terms of overall figures, 70.5% of the patients presented with at least 1 sign or symptom, 49.2% had at least 1 symptom, and 54.1% had at least 1 sign. The variable pain on movement was associated with the number of painful joints and the overall assessment findings (P < .05). Sound on movement was positively associated with the number of edematous joints (P = .0291). The scale of limited mandibular function was statistically significantly correlated with 4 quantitative measurements (P = .0283 to .0448). The variable pain on palpation of the masticatory muscles was associated with the number of painful joints (P = .0023). Pain on palpation of the TMJ was statistically significantly associated with the HAQ score (P = .0344) and with the number of painful joints (P = .0006). A significant percentage of the patients with RA have signs and symptoms of TMJ involvement, and the scale of limited mandibular function proved to be an important measurement tool.

Associação do anticorpo anticitrulina e gravidade da artrite reumatóide

OBJETIVOS: Avaliar a associação do anticorpo antipeptídeo citrulinado cíclico (anti-CCP) com distintos parâmetros clínicos, sorológicos e radiológicos. MÉTODOS: Anti-CCP e fator reumatóide (FR) foram pesquisados no soro de 100 pacientes com artrite reumatóide (AR). A atividade da doença foi definida por meio de um índice combinado compreendendo cinco parâmetros: número de juntas inflamadas, número de juntas doloridas, rigidez matinal, escala visual analógica (EVA) de dor e velocidade de hemossedimentação (VHS). A capacidade funcional foi medida pelo índice HAQ (Health Assessment Questionnaire) e a classe funcional foi determinada mediante aplicação dos critérios revisados do American College of Rheumatology (ACR), de 1991. Erosão e pinçamento articular foram graduados pelo índice de Sharp modificado. A análise estatística empregou os testes do Qui-quadrado, Mann Whitney e Kruskal-Wallis. RESULTADOS: Nenhum dos dois anticorpos demonstrou associação significativa com atividade da doença, sexo, idade de início da doença, presença de nódulos subcutâneos e síndrome de Sjögren. A média de idade foi significativamente menor nos pacientes com AR anti-CCP positivos. A positividade para o FR e anti-CCP foi maior nos pacientes com AR com menos de 50 anos em comparação com os pacientes com mais de 50 anos. A AR de início recente (< 2 anos) não se associou a uma maior prevalência de soropositividade para o anti-CCP e FR. O anti-CCP apresentou uma correlação positiva moderada com o FR. Houve uma correlação direta entre o anti-CCP e a VHS e a proteína C reativa (PCR). Houve também uma correlação direta entre o FR, a VHS e a PCR. A classificação funcional dos critérios revisados do ACR de 1991 não se associou a qualquer dos dois auto-anticorpos. O índice de HAQ não se correlacionou com a atividade da doença, duração da doença, positividade do FR e atividade medida pela PCR, mas associou-se nitidamente à positividade do anti-CCP e à atividade medida pelo VHS. Os índices de Sharp para erosão e pinçamento se associaram à positividade do anti-CCP. Tal associação não foi evidenciada com a positividade do FR. CONCLUSÃO: Embora o anti-CCP apresente boas propriedades diagnósticas, ele não apresenta associação com a atividade da doença, sexo, idade de início da doença, tempo de evolução de doença, presença de nódulos subcutâneos, síndrome de Sjögren ou classificação funcional do ACR de 1991. Houve associação da positividade do anti-CCP com a menor idade dos pacientes, fator reumatóide, VHS, PCR, índice de HAQ e índices de Sharp para erosão e pinçamento.

Determinants of Self-Rated Health among Community-Dwelling Women Aged 40 Years and over in Japan

In developed countries, the elderly population is growing rapidly. Self-rated health is an important indicator of health and has been the focus of a number of aging studies. However, little is known about the possible differences in determinants of self-rated health according to age. Self-rated health and its possible determinants were examined in 542 community-dwelling Japanese women aged 40 to 91 years. The proportion of women with poor self-rated health increased with age. Approximately half of the women had poor self-rated health among women aged 80 years and over. We used multiple logistic regression analysis to examine the association with poor self-rated health in women aged 40 to 64 years (n = 248) and 65 years and over (n = 294). Lower physical activity and a greater number of comorbidities were associated with poor self-rated health for ages 40 to 64 and 65 years and over. Furthermore, the risk of poor self-rated health increased by 1.5-fold with every increase in the number of painful joints in the lower extremities for the 40- to 64-year-old age group, and increased by 2-fold with back pain for those 65 years and over. The determinants of self-rated health were similar in both middle-aged and elderly Japanese women. Our results could contribute to effective interventions to improve quality of life among Japanese women.

Abnormal vitamin B 6 status is associated with severity of symptoms in patients with rheumatoid arthritis

Purpose Patients with rheumatoid arthritis have low plasma vitamin B 6 levels and elevated plasma homocysteine responses to a methionine load. We examined whether these abnormalities are associated with clinical and biochemical indicators of disease status. Methods We performed a cross-sectional study in 37 patients who met the American College of Rheumatology criteria for rheumatoid arthritis. Vitamin B 6 status was assessed by the plasma pyridoxal 5′-phosphate level and with the homocysteine response to a methionine load test. Clinical disease activity was assessed by joint counts, the Health Assessment Questionnaire disability score, and biochemical markers of the acute phase response. Results Plasma pyridoxal 5′-phosphate levels were inversely correlated with the erythrocyte sedimentation rate ( r = −0.37, P = 0.02), C-reactive protein level ( r = −0.52, P = 0.002), disability score ( r = −0.37, P = 0.02), morning stiffness ( r = −0.38, P = 0.02), and degree of pain ( r = −0.33, P = 0.04). The increase in homocysteine levels after a methionine load correlated with the erythrocyte sedimentation rate ( r = 0.39, P = 0.02), C-reactive protein level ( r = 0.37, P = 0.03), disability score ( r = 0.37, P = 0.04), degree of pain ( r = 0.38, P = 0.02) and fatigue ( r = 0.42, P = 0.01), number of painful joints ( r = 0.43, P = 0.007), and number of swollen joints ( r = 0.32, P = 0.05). Conclusion Markers of vitamin B 6 status are associated with disease activity and severity, synovial burden, and pain in patients with rheumatoid arthritis, raising the possibility that impaired vitamin B 6 status in these patients is a result of inflammation.

Prevalence of vertebral deformity and its associations with physical impairment among Japanese women: The Hizen-Oshima Study.

Vertebral fractures are a hallmark of postmenopausal osteoporosis and an important end point in trials of osteoporosis treatment, but the clinical significance of vertebral deformities remains uncertain. We examined the prevalence of vertebral deformity and associations of vertebral deformities and other characteristics with physical functioning among 584 Japanese women ages 40 to 89 years. Lateral spine radiographs were obtained and radiographic vertebral deformities were assessed by quantitative morphometry, defined as vertebral heights more than 3 SD below the normal mean. A self-administered questionnaire was used to survey participants about difficulty in performing selected basic and instrumental activities of daily living (ADL). Overall, 15% of women had at least one vertebral deformity, and 8% had 2 or more. The prevalence of vertebral deformities increased progressively with age. Half of women ages 80 and over had vertebral deformities. Impaired function was defined as difficulty performing 3 or more ADLs. After adjusting for age, the odds of impaired function were increased by 1.4 times (95% CI: 0.7, 2.9) in women with a single vertebral deformity, and 3.1 times (1.4, 6.8) in those with two or more deformities. Additional adjustment for number of painful joints, number of comorbidities, body mass index, and back pain did not materially alter these findings. In conclusion, women with multiple vertebral deformities had significantly greater impaired function. The association was independent of age, back pain and the number of painful joints, suggesting that deformities may impair function even when back pain is not present.

Soluble HLA class I antigens in serum and synovial fluid from patients with rheumatoid arthritis and other arthropathies.

To investigate the presence of soluble HLA class I (s-HLA) antigens in serum and synovial fluid (SF) from a large cohort of rheumatic patients. We studied clinical and analytical data and serum samples from 300 patients [122 patients with rheumatoid arthritis (RA), 38 with osteoarthritis or osteoporosis, 29 with seronegative spondyloarthropathies, 45 patients with other rheumatic diseases] and 66 healthy controls. In addition, we studied 25 paired samples of serum and SF from these groups of subjects. In RA patients, we examined whether the levels of s-HLA in serum and SF were related to the activity of the disease. The mean concentrations of s-HLA molecules in serum were slightly higher in RA patients (1.2 microg/ml) than in the other four groups (1.08, 1.01, 1.09 and 0.94 microg/ml respectively). We found no correlation between serum s-HLA levels and any variable of inflammatory disease activity in RA patients. s-HLA molecules were found in SF and at levels that correlated with those found in serum (P=0.04; r=0.4). Furthermore, s-HLA levels were higher in SF from patients with RA (1.3 microg/ml) or crystal-induced arthritis (0.98 microg/ml) than in SF from those with osteoarthritis (0.38 microg/ml) (P<0.05 and P<0.005 respectively), and these levels were correlated inversely and significantly with the score on the visual analogue scale of pain (P=0.02), the number of painful joints (P=0.05) and the level of C-reactive protein (P=0.03) in RA patients. This is the first report to demonstrate the presence of s-HLA molecules in SF at levels that correlate with serum levels. The mean levels of s-HLA molecules were significantly higher in SF from patients with RA and crystal-induced arthritis than in SF from cases of osteoarthritis, and correlated inversely with certain variables of disease activity in RA patients.

A 15-year follow-up study on the outcome in patients with early rheumatoid arthritis

This study aimed to investigate the natural course of early rheumatoid arthritis (RA) after treatment for 15 years based on the present data of patients who had been enrolled in a 1 year study of early RA conducted by the Japan Rheumatism Foundation in 1981 and 1982. An examination form was mailed to each doctor who had participated in the previous study requesting them to record the present data of the patients. The patients were requested to fill out the AIMS2 questionnaire. Patients had been randomly assigned into three treatment groups: those treated with gold, with d-penicillamine and without slow acting antirheumatic drugs (SAARDs). Information was obtained concerning 74 of 161 patients who had completed the previous 1 year study. Clinical remission was observed in 20 of 74 patients. The current status of RA by physician’s assessment was reported to be well controlled in 32 of 48 cases (66.7%); however, no remarkable improvement was seen in erythrocyte sedimentation rate (ESR, and the number of painful joints compared with the values at entry 15 years previously. Radiographical stages showed progression and the average score of AIMS2 had deteriorated in most cases. High ESR, progression of joint damage and positive rheumatoid factors at the early stage of RA were suggested to be factors relating to QOL deterioration. These results suggest that it would be difficult to modify the natural course of RA by currently used treatment strategies with SAARDs.

Prospective study of the clinical value of determining circulating IgA-alpha 1-antitrypsin complex using a prototype ELISA kit in patients with rheumatoid arthritis.

To evaluate the clinical value of determining circulating IgA-alpha 1-antitrypsin (IgA-AT) complex in rheumatoid arthritis. The IgA-AT complex was assayed by a prototype ELISA kit using a specific monoclonal antibody against the complex. The median level of serum IgA-AT complex in rheumatoid patients (2.26 AU ml-1) was significantly higher than in osteoarthritis patients (1.37 AU ml-1, P < 0.05) and healthy volunteers (1.03 AU ml-1, P < 0.001). The concentration of IgA-AT complex in rheumatoid arthritis patients at baseline was correlated with the number of painful joints (P < 0.05), number of swollen joints (P < 0.01), erythrocyte sedimentation rate (P < 0.05), and modified Lansbury index (P < 0.01). The median serum level of IgA-AT complex in rheumatoid patients at baseline was higher than that at three months (P < 0.01), six months (P < 0.01), and 12 months (P < 0.01) after the start of treatment. The difference and ratio of IgA-AT complex levels before and after treatment were significantly associated with radiographic progression. The findings validate the usefulness of determining IgA-AT complex using ELISA in the management of rheumatoid arthritis.

Scintigraphic evaluation of the severity of inflammation of the joints with 99TCm-HIG in rheumatoid arthritis.

A prospective study was carried out to determine the usefulness of 99TCm-human immunoglobulin G (HIG) scintigraphy in the assessment of the severity of joint inflammation. Twenty-four patients with rheumatoid arthritis were studied. The presence or absence of pain and/or swelling was evaluated in 34 joints and a clinical index taking into account the surface area of each joint was calculated. We measured the following biological markers of inflammation activity: erythrocyte sedimentation rate, C-reactive protein, haemoglobin, platelet count, serum levels of IL-6, TNF-alpha and soluble receptors of IL-2. Scintigraphic was performed 4 h after the injection of 740 MBq 99Tcm-HIG. The scans were evaluated by visual and quantitative analysis and the scores in each joint were weighted for joint size. Pathological uptake of the radiopharmaceutical was noted in 46% (24/52) of joints evaluated as painful, 89% (146/164) of swollen joints and 94% (78/83) of both painful and swollen joints. Both the visual and the quantitative scintigraphic indices correlated significantly with the clinical index, the number of painful joints, the number of swollen joints and several biological markers of inflammation. A very high correlation was also found between the visual and the quantitative scintigraphic indices (r = 0.91, P < 0.0001). In conclusion, 99Tcm-HIG scintigraphy is an objective test to detect synovitis and to assess the severity of inflammation. A careful visual analysis of scans is good enough for routine evaluations and computer quantitative analysis should be used when more accurate intra-individual variation is required.