Positive Rheumatoid Factor Test Research Articles

Influencers of Achievement of Remission and Low Disease Activity in Response to Disease-Modifying Antirheumatic Drugs (DMARDs) in Patients With Rheumatoid Arthritis.

In this prospective cohort study the objective was to identify the socio-demographic and clinical factors that influence treatment response to disease-modifying antirheumatic drugs (DMARDs) at ambulatory multicenter rheumatology outpatient clinics. The subjects were patients with rheumatoid arthritis satisfying the American College of Rheumatology/European Alliance of Associations for Rheumatology criteriawith informed consent. Pre-coded data sheets were used to capture socio-demographicand clinical characteristics. Baseline data was collected at time of patient recruitment.Only patients who had complete data at three-month follow-up were included in the study analysis. The study's outcome was achievement of remissionor low disease activity. The study used the adherence in chronic disease scale and European Task Force for Patient Evaluation of General Practicetools to evaluate patient adherence and assessments of health care received. Data analysis was carried out using Prism 7 and SPSS. Categorical data were regulated as percentages, while continuous data were regulated as means and standard deviation.Prevalence (at 95% CIs) of various socio-demographic and clinical characteristics were calculated comparisons of socio-demographic characteristics, clinical characteristics between patients into achieved primary/secondary outcomes and those who didn't were carried out using the chi-square statistic (for categorical variables) and independent student T-test (for continuous variables). Logistic regression was performed to estimate the impact of moderator variables on study outcomes and to calculate adjusted odds ratio (OR) with corresponding 95% CI. Throughout analysis α < 0.05 was considered statistically significant. A total of 206 patients were included. The mean age was 51.2 ± 15.1 years; mostly females (n=188 patients, 91.3%). Majority had attained post-primary education (n=172 patients, 83.5%). Only 74 patients (35.9%) had formal professional employment, while only six patients (3%) paid for healthcare via government-funded/private insurance. At recruitment, nearly half of the included patients had moderate to severe disability. Majority of patients had elevated baseline erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Most of the patients (90.3%) had a positive rheumatoid factortest at recruitment, while 58% had a positive anti-cyclic citrullinated peptidetest. Majority had moderate diseaseactivity. Thirty-three patientswere in remission, 9.7% had low disease activity while 12.6% had high disease activity. Majority of patients (94.2%) were on non-steroidal anti-inflammatory drugs, non-biological DMARDs (80.6%) and systemic corticosteroids (54.9%).Mean duration of follow-up was 4.6 months. At follow-up, 37.9% found the system to be acceptable, 63.6% found the system to be problematic. Majority of the patients reported to have been adherent to therapy (high adherence:7.8%; moderate adherence: 86.9%). The proportion of patients who achieved remission or low disease activity increased significantly at three-month follow-up. Having shorter disease duration, lower unemployment rates, higher income, lower non-adherence rates, having a positive outlook towards the healthcare system, normal CRP baseline, normal ESR baseline, and lower baseline of functional disabilitywere significantly associated with increased chances of low disease activity/remission.

The assessment of rheumatoid factor levels and hemogram parameters as predictors for rheumatologic disease.

Many markers are used for clinical diagnosis in rheumatic diseases; rheumatoid factor (RF) is the most frequently used marker. However, RF is not specific to rheumatoid arthritis (RA). RF positivity is widely observed in patients with advanced age, infectious, autoimmune, and lymphoproliferative diseases. In this context, the objective of this study is to investigate the demographic characteristics, frequency of antinuclear antibody (ANA) and anti-cyclic citrullinated peptide (anti-CCP) positivity, hemogram parameters and distribution of the diagnoses in RF-positive patients followed at the rheumatology clinic. The population of this retrospective study consisted of patients above 18 years of age who were referred to have RF positivity by nephelometric method at Kahramanmaraş Necip Fazıl City Hospital Rheumatology Clinic between January 2020 and June 2022. The mean age of the 230 patients with a positive RF test result, 155 (76%) male and 55 (24%) female, was 52.7 ± 15.5 years. There were 81 (35.2%), 54 (23.5%), 73 (31.7%) and 22 (9.6%) patients with RF levels between 20 and 50 IU/mL, 50 and 100 IU/mL, 100 and 500 IU/mL, and above 500 IU/mL, respectively. There was no significant difference detected between the groups that were created based on the RF titers regarding demographic characteristics (P > 0.05). The rate of being diagnosed with any rheumatic disease was significantly lower in the group with RF levels between 20 and 50 IU/mL compared to other groups (P = 0.001). The distribution of rheumatic and non-rheumatic disease diagnoses according to RF levels did not reveal any significant difference between the groups (P = 0.369 and P = 0.147, respectively). RA was the most common (62.2%) rheumatic disease diagnosis among the patients included in the study. The leukocyte count was significantly higher in the group with RF levels above 500 IU/mL compared to the group with RF levels between 20 and 50 IU/mL (P = 0.024). There was no significant difference between the groups in other laboratory results, that is, hemogram, sedimentation, C-reactive protein, platelet, and lymphocyte/monocyte ratio (P > 0.05). The study findings indicate that RF positivity can be seen in the context of different rheumatological diseases; hence RF levels alone may not predict rheumatological disease. There was also no significant relationship between RF levels and ANA and anti-CCP positivity. The most common diagnosis in patients presenting with elevated RF levels was RA. Nevertheless, it should be noted that RF can be found asymptomatically in the general population.

Management of simultaneous bilateral immune-mediated peripheral ulcerative keratitis.

Peripheral ulcerative keratitis (PUK) is a sight threatening disease, often immune mediated and can rapidly progress to corneal perforation. Here we report the successful management of simultaneous bilateral peripheral ulcerative keratitis presenting with corneal perforation with surgical intervention and systemic immunosuppression. A 41-year-old female presented with similarly located super-nasal peripheral ulcerative keratitis (PUK) in both eyes and focal area of adjoining scleritis in the left eye. Serological investigations for systemic immune-mediated conditions showed positive rheumatoid factor test. She underwent cyanoacrylate glue application in both eyes, and was started on topical and oral corticosteroids and oral immunomodulators, and the right eye stabilized. The left eye required a second surgical intervention with a corneal patch graft following which the condition stabilized. This case highlights the importance of investigating for an underlying systemic etiology in PUK and the role of systemic immunosuppression prior to and after surgical intervention in order to arrest the disease and prevent recurrences.

Drug-induced Rowell syndrome, a rare and difficult to manage disease: A case report.

Rowell syndrome is defined as the association between lupus erythematosus, erythema multiforme-like lesions and characteristic immunological changes including positive tests for rheumatoid factor, speckled antinuclear antibody, positive anti-Ro or anti-La antibodies. The present report presents the case of a 45-year-old female patient who was previously diagnosed in January 2010 with terbinafine-induced subacute cutaneous lupus erythematosus and was admitted for a skin eruption consisting of erythematous-papular erythema multiforme-like lesions, primarily on the trunk and limbs. The associated symptoms consisted of fatigability, myalgia and gonalgia. In October 2015, the illness reoccurred ~1 week after the initiation of Helicobacter pylori eradication treatment. Anti-Ro antibodies, rheumatoid factor and antinuclear antibody tests were positive. Given the patient's medical history, clinical manifestations, and laboratory, histopathological and immunofluorescence microscopy findings, a diagnosis of Rowell syndrome was made. Systemic corticosteroids (methylprednisolone; 0.5 mg/kg/day) and immunomodulatory therapy (azathioprine; 50 mg/day) were administered with the associated medication (omeprazole, 20 mg/day; KCl, 1 g/day) and topical dermocorticoids (fluticasone propionate 0.05% cream; 1 application/day), with a favorable outcome. The major diagnostic criteria for Rowell syndrome are the presence of lupus erythematosus (acute, subacute or systemic), erythema multiforme-like lesions and positive testing for antinuclear antibodies. The minor diagnostic criteria for Rowell syndrome are chilblains, the presence of anti-Ro antibodies and positive testing for rheumatoid factor. A diagnosis of Rowell syndrome is made if the patient exhibits all major criteria and at least one minor criterion. The present case met all diagnostic criteria, excluding the presence of chilblains. Notably, in this case there was a co-occurrence of subacute lupus erythematosus and Rowell syndrome lesions, which was drug-induced.

Determining early referral criteria for patients with suspected inflammatory arthritis presenting to primary care physicians: a cross-sectional study.

ObjectiveEarly diagnosis and initiation of treatment for inflammatory arthritis can greatly improve patient outcome. We aimed to provide standardized and validated criteria for use by primary care physicians (PCPs) in the identification of individuals requiring referral to a rheumatologist.Patients and methodsWe analyzed the predictive value of a wide variety of demographic variables, patient-reported complaints, physical examination results, and biomarkers in order to identify the most useful factors for indicating a requirement for referral. Patients for this cross-sectional study were enrolled from various centers of the city of Jeddah, Saudi Arabia, if they were ≥18 years of age and presented to a PCP with small joint pain that had been present for more than 6 weeks. A total of 203 patients were enrolled, as indicated by the sample size calculation. Each patient underwent a standardized physical examination, which was subsequently compared to ultrasound findings. Biomarker analysis and a patient interview were also carried out. Results were then correlated with the final diagnosis made by a rheumatologist.ResultsA total of 9 variables were identified as having high specificity and good predictive value: loss of appetite, swelling of metacarpophalangeal joint 2 or 5, swelling of proximal inter-phalangeal joint 2 or 3, wrist swelling, wrist tenderness, a positive test for rheumatoid factor, and a positive test for anti-citrullinated protein antibodies.ConclusionNine variables should be the basis of early referral criteria. It should aid PCPs in making appropriate early referrals of patients with suspected inflammatory arthritis, accelerating diagnosis and initiation of treatment.

Phenotypic Characterization of Juvenile Idiopathic Arthritis in African American Children.

Juvenile idiopathic arthritis (JIA) affects children of all races. Prior studies suggest that phenotypic features of JIA in African American (AA) children differ from those of non-Hispanic white (NHW) children. We evaluated the phenotypic differences at presentation between AA and NHW children enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, and replicated the findings in a JIA cohort from a large center in the southeastern United States. Children with JIA enrolled in the multicenter CARRA Registry and from Emory University formed the study and replication cohorts. Phenotypic data on non-Hispanic AA children were compared with NHW children with JIA using the chi-square test, Fisher's exact test, and the Wilcoxon signed-rank test. In all, 4177 NHW and 292 AA JIA cases from the CARRA Registry and 212 NHW and 71 AA cases from Emory were analyzed. AA subjects more often had rheumatoid factor (RF)-positive polyarthritis in both the CARRA (13.4% vs 4.7%, p = 5.3 × 10(-7)) and the Emory (26.8% vs 6.1%, p = 1.1 × 10(-5)) cohorts. AA children had positive tests for RF and cyclic citrullinated peptide antibodies (CCP) more frequently, but oligoarticular or early onset antinuclear antibody (ANA)-positive JIA less frequently in both cohorts. AA children were older at onset in both cohorts and this difference persisted after excluding RF-positive polyarthritis in the CARRA Registry (median age 8.5 vs 5.0 yrs, p = 1.4 × 10(-8)). Compared with NHW children, AA children with JIA are more likely to have RF/CCP-positive polyarthritis, are older at disease onset, and less likely to have oligoarticular or ANA-positive, early-onset JIA, suggesting that the JIA phenotype is different in AA children.

Anti- Cyclic Citrullinated Peptide Antibodies: Clinical utility and their role as early prognostic markers in Erosive Rheumatoid Arthritis.

Objectives: To assess the diagnosticutilityofanti- cyclic citrullinated protein antibody (anti-CCP) in comparison to rheumatoid factor (RF) in diagnosis of rheumatoid arthritis (RA) and to determine its prognostic value in erosive rheumatoid arthritis.Materials and Methods: The study included 60 patients with clinically suspected RA. Anti-CCPwas measured by enzyme-linked immunosorbent assay (ELISA) and rheumatoid factor (RF) by nephalometry. The seropositivity with RF and ACCP antibodies were studied in comparison with radiographic changes and joint symptoms which included presence and duration of joint involvement- multiple joints, small joints, symmetric joints, stiffness or swelling of joints.Results: Among the 60 patients, the mean age for RA was found to be 43 years. A higher seropositivity was found among the females. The sensitivity and specificity ofanti-CCPreactivity for the diagnosis of RAwere 38.3 and 100 respectively. Among the symptoms studied, small joint involvement and involvement of multiple joints showed a positive association with serologically positive individuals. Patients with high anti-CCP antibody titres showed higher RF titres and severe radiographic erosions.Conclusion: Anti CCP antibodies are a highly specific for rheumatoid arthritis. A combined diagnosis using both high titers ofanti-CCPantibodiesand a positive RF test markedly improvesRAdiagnostic specificity. ACCP antibody detection helps in early diagnosis as well as detection of progressive joint damage.

In antisynthetase syndrome, ACPA are associated with severe and erosive arthritis: an overlapping rheumatoid arthritis and antisynthetase syndrome.

Anticitrullinated peptide/protein antibodies (ACPA), which are highly specific for rheumatoid arthritis (RA), may be found in some patients with other systemic autoimmune diseases. The clinical significance of ACPA in patients with antisynthetase syndrome (ASS), a systemic disease characterized by the association of myositis, interstitial lung disease, polyarthralgia, and/or polyarthritis, has not yet been evaluated with regard to phenotype, prognosis, and response to treatment. ACPA-positive ASS patients were first identified among a French multicenter registry of patients with ASS. Additionally, all French rheumatology and internal medicine practitioners registered on the Club Rhumatismes et Inflammation web site were asked to report their observations of ASS patients with ACPA. The 17 collected patients were retrospectively studied using a standardized questionnaire and compared with 34 unselected ACPA-negative ASS patients in a case–control study. All ACPA-positive ASS patients suffered from arthritis versus 41% in the control group (P < 0.0001). The number of swollen joints was significantly higher (7.0 ± 5.0 vs 2.9 ± 3.9, P < 0.005), with a distribution resembling that of RA. Radiographic damages were also more frequent in ACPA-positive ASS patients (87% vs 11%, P < 0.0001). Aside from a significantly higher transfer factor for carbon monoxide in ACPA–ASS patients, lung, muscle, and skin involvements had similar incidences, patterns, and severity in both groups. Although Nonbiologic treatments were similarly used in both groups, ACPA-positive patients received biologics more frequently (59% vs 12%, P < 0.0008), mostly due to refractory arthritis (n = 9). Eight patients received anti-Cluster of differentiation 20 (CD20) monoclonal antibodies (mAbs) with good efficacy and tolerance, whereas 2 of the 5 patients treated with antitumor necrosis factor drugs had worsened myositis and/or interstitial lung disease. After a >7-year mean follow-up, extra-articular outcomes and survival were not different. ACPA-positive ASS patients showed an overlapping RA–ASS syndrome, were at high risk of refractory erosive arthritis, and might experience ASS flare when treated with antitumor necrosis factor drugs. In contrast, other biologics such as anti-CD20 mAb were effective in this context, without worsening systemic involvements.

Optimising the use of electronic health records to estimate the incidence of rheumatoid arthritis in primary care: what information is hidden in free text?

BackgroundPrimary care databases are a major source of data for epidemiological and health services research. However, most studies are based on coded information, ignoring information stored in free text. Using the early presentation of rheumatoid arthritis (RA) as an exemplar, our objective was to estimate the extent of data hidden within free text, using a keyword search.MethodsWe examined the electronic health records (EHRs) of 6,387 patients from the UK, aged 30 years and older, with a first coded diagnosis of RA between 2005 and 2008. We listed indicators for RA which were present in coded format and ran keyword searches for similar information held in free text. The frequency of indicator code groups and keywords from one year before to 14 days after RA diagnosis were compared, and temporal relationships examined.ResultsOne or more keyword for RA was found in the free text in 29% of patients prior to the RA diagnostic code. Keywords for inflammatory arthritis diagnoses were present for 14% of patients whereas only 11% had a diagnostic code. Codes for synovitis were found in 3% of patients, but keywords were identified in an additional 17%. In 13% of patients there was evidence of a positive rheumatoid factor test in text only, uncoded. No gender differences were found. Keywords generally occurred close in time to the coded diagnosis of rheumatoid arthritis. They were often found under codes indicating letters and communications.ConclusionsPotential cases may be missed or wrongly dated when coded data alone are used to identify patients with RA, as diagnostic suspicions are frequently confined to text. The use of EHRs to create disease registers or assess quality of care will be misleading if free text information is not taken into account. Methods to facilitate the automated processing of text need to be developed and implemented.

Unusual Draining Nodules in a Patient with Rheumatoid Nodulosis and Hepatitis C Virus Infection

To the Editor: Rheumatoid nodulosis is an uncommon condition with a combination of multiple rheumatoid nodules, recurrent joint symptoms, but without erosions, and usually positive tests for rheumatoid factor (RF). We describe a case of rheumatoid nodulosis with followup exceeding 10 years. The nodules first developed during treatment for hepatitis C virus (HCV) infection with interferon (IFN). A nodule biopsy confirmed the presence of a rheumatoid nodule. This association of draining nodules, rheumatoid nodulosis, and HCV is rare and raises the possibility that it might have been precipitated by the IFN therapy. A 53-year-old man presented with an 11-year history of hepatitis C and a 10-year history of poorly characterized asymmetrical arthritis and nodules. In February 1999, he was diagnosed elsewhere with hepatitis C based on laboratory tests and started therapy with ribavirin/α-IFN. After 1 year, he stopped ribavirin/α-IFN due to absence of effect on the viral load and did not follow up with his hepatologist. In August 1999, multiple subcutaneous nodules developed on his fingers. The nodules would gradually enlarge, discharge necrotic-appearing material, and then develop a central crater and at that time became painful. In January 2001, aspiration of one of the nodules was negative for crystals. A large finger nodule mass with dimensions 3.0 × 2.5 × 1.0 cm was excised for biopsy. Some individual nodules were injected with intralesional depot methylprednisolone, with complete resolution, but he continued to develop new nodules. Nonsteroidal antiinflammatory drugs (NSAID) helped his occasional pain from draining nodules, but did not change the shape or size of the nodules. Accompanying the nodules, he experienced intermittent joint pain and swelling that involved proximal interphalangeal joints, wrists, shoulders, and elbows. The joint pain improved under treatment with hydroxychloroquine but the nodules persisted. Due to anxiety over side effects he stopped hydroxychloroquine after 6 months. … Address correspondence to Dr. Schumacher; E-mail: schumacr{at}mail.med.upenn.edu

Web of Confusion

c t p m ( PRESENTATION The occurrence of a late-stage complication in a patient with early disease, reminds us that any illness can take an unpredictable course. A 63-year-old man presented with complaints of fatigue and rash. He had been in his usual state of health until approximately 2 months prior, when he developed decreased visual acuity in his right eye. He was seen by a local ophthalmologist, who diagnosed nonarteritic ischemic optic neuritis and prescribed a daily aspirin. Soon thereafter, the patient noticed that he was having trouble moving about his house and working, and he felt as if he needed to sit and rest often. Additionally, he admitted to night sweats and a 15-lb weight loss. Upon questioning, he also reported that he had developed a nonpruritic rash on his legs and torso. He denied headache, joint pain, myalgia, morning stiffness, jaw claudication, weakness, cough, or shortness of breath. He took no medications other than a daily adult aspirin. On examination, the patient exhibited livedo reticularis involving his lower limbs, buttocks, and lower torso circumferentially (Figures 1 and 2). He was normotensive, afebrile, and had no other rash, nodules or ulcers. His joints were normal, as were his heart, lungs, and abdomen. Peripheral pulses were present, and his temporal arteries appeared normal and were nontender.

Rheumatic manifestations among HIV positive adults attending the Infectious Disease Clinic at Mulago Hospital.

Rheumatic manifestations in HIV are common and sometimes the initial presentation of the disease. HIV is now a common infection at the Infectious Disease Clinic, Mulago. The spectrum of joint diseases seen depend on a number of factors such as, the CD4 count, HLA status and current therapy. This study included HIV patients from a heterogeneous population and was designed to determine the prevalence and clinical pattern of rheumatic manifestations among these HIV patients. Four hundred eighty seven patients were screened and 300 HIV positive patients were consecutively recruited into the study, evaluated for rheumatic manifestations and their clinical and laboratory findings documented. The prevalence of rheumatic manifestations was 27% (81 of 300). Arthralgias in 19.3% of the study population were commonest finding followed by HIV associated arthritis at 4.3%. The lower limbs were the most commonly affected with the knees (28.8%) and ankles (26.9%) contributing the highest. All patients had a negative anti-nuclear antibody test, with only two having a positive rheumatoid factor test. An association of antituberculosis drugs with joint disease was further highlighted in this study (OR 3.79 95% CI, 1.44 - 9.93). Septic arthritis due to Staphylococcus aureus was rarely observed except when the patients' level of CD4 + T cells dropped below 200 cells mm(3). The mean CD4+ count was 171 cells mm(3). Rheumatic manifestations should be considered among HIV positive adults. Arthralgias are common especially in patients using pyrazinamide.

Immunologic rheumatic disorders

We provide the basics for clinicians who might be called on to consider the diagnosis of diseases such as systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) in their practice. We will emphasize clinical recognition and first-line laboratory testing. Only characteristics of the classic rheumatic inflammatory diseases (ie, RA, seronegative spondyloarthropathy, SLE, antiphospholipid syndrome, Sjögren syndrome, scleroderma, and polymyositis/dermatomyositis) will be covered. In the past decade, treatment for RA and seronegative spondyloarthropathy has substantially improved. Their treatment has been revolutionized by the use of methotrexate and, more recently, TNF inhibitors, T-cell costimulation modulators, and B-cell depletion. The goal of RA treatment today is to induce a complete remission as early as possible in the disease process, with the mantra being "elimination of synovitis equals elimination of joint destruction." The hope is that if the major mediators of Sjögren syndrome, SLE, or scleroderma can be identified and then blocked, as in the example of TNF inhibitors in patients with RA, more specific treatments will become available. Thus RA has become an excellent model of this evolving paradigm. Through the identification of major mediators in its pathogenesis, novel and highly efficacious therapeutic agents have been developed.

Diagnostic value of anti-cyclic citrullinated peptide antibodies in northern Chinese Han patients with rheumatoid arthritis and its correlation with disease activity

This study was to evaluate the diagnostic value of anti-cyclic citrullinated peptide (CCP) antibodies in northern Chinese Han patients with rheumatoid arthritis (RA) and its correlation with disease activity. Clinical data and serum samples were collected from 112 RA patients and 55 non-RA patients. Statistical analyses of the correlations among anti-CCP antibodies, other serological markers, and the RA patients' clinical characteristics were performed using SPSS 11.5 software. Anti-CCP antibodies were detected in 77.7% of all RA patients and 80.4% of the RA patients with a disease duration of 3 years or less. The combined diagnosis using high titer anti-CCP antibodies (>or=100 RU/ml) with a concomitant positive rheumatoid factor (RF) test exhibited the greatest diagnostic specificity; it achieved 87.9% for all RA patients and 90.1% for the patients with disease duration of three years or less. Moreover, anti-CCP antibodies showed medium correlations to the RA patient's serum RF titer (r = 0.560, P < 0.001) and disease activity (DAS28 score; r = 0.404, P < 0.001). Compared with the patients with low anti-CCP antibody titers (<100 RU/ml), patients with high anti-CCP antibody titers showed higher RF titers, worse DAS28 scores, and severe morning stiffness (P < 0.01). This study suggests that anti-CCP antibodies can be used for RA diagnosis and disease activity evaluation for northern Han Chinese patients. A combined diagnosis using both high titers of anti-CCP antibodies (>or=100 RU/ml) and a positive RF test markedly improves RA diagnostic specificity. Patients' DAS28 scores rise and morning stiffness intensifies with increasing anti-CCP antibody titers.

Are plasma and synovial fluid leptin levels correlated with disease activity in rheumatoid arthritis ?

Leptin is an adypocyte derivated peptide hormone that plays a major role in preventing obesity development by the effects at the hypothalamic level. In our study leptin levels of 41 rheumatoid arthritis (RA) patients and 25 healthy subjects as control group were assessed. Synovial fluid from 21 RA patients were collected to detect leptin levels. Synovial fluid and plasma leptin levels were analysed and correlated with RA duration, ESR, CRP, X ray changes (erosive or non-erosive disease) and negative or positive test for rheumatoid factor. There wasn't any significant difference at plasma leptin levels between RA patients (3.91 +/- 6.15) and control group (4.94 +/- 6.44) (p > 0.05). Plasma leptin levels were correlated with body mass index (BMI) in both healthy subjects and RA patients (r = 0.37; p = 0.018). Therefore in RA patients, plasma and synovial fluid leptin levels were not correlated with disease duration, ESR, CRP, negative or positive test for rheumatoid factor and erosive or non-erosive disease (p > 0.05). In conclusion leptin is correlated with BMI both in RA patients and healthy individuals but no considerable relation with disease activity.

Development and evaluation of a patient self-report case-finding method for rheumatoid arthritis

Objective To describe the development and evaluation of a patient self-report case-finding method for rheumatoid arthritis (RA) not dependent on direct contact with the treating physicians. Methods The American College of Rheumatology criteria for RA diagnosis were adapted for patient self-report using a questionnaire, and alternative scoring algorithms were evaluated to balance case-finding sensitivity and specificity. Positive rheumatoid factor tests were used to identify 1053 individuals in 2 large healthcare organizations; 440 agreed to receive study materials. Case-finding results were validated by medical record review (MRR) for a random sample of 90 patients. Three scoring algorithms were compared with MRR for likelihood of RA diagnosis. Cases not classifiable by algorithm were flagged and reviewed by 2 expert physicians for likelihood of RA diagnosis. Results Pilot testing demonstrated that patients comprehended the questionnaire and were willing to answer the questions. Completed questionnaires were returned by 265 (60%) of the 440 patients contacted. Following expert physician review of 16 flagged cases in the 90-patient MRR subsample, the most accurate scoring algorithm demonstrated 80% sensitivity, 67% specificity, 74% accuracy, and 77% positive predictive value for detecting early RA. Conclusion The case-finding method represents a promising tool for identifying RA patients, with potential application in research and quality-assurance activities. Relevance This case-finding method should be useful in research and quality-assurance efforts requiring identification of RA patients treated by all types of providers in healthcare organizations in which centralized laboratory data are available.

Devenir des patients présentant un rhumatisme inflammatoire débutant non classable

Objective. To determine outcomes in patients with onset within the last year of peripheral inflammatory arthritis that does not meet classification criteria for any specific disease. Methods. Symptoms and laboratory tests were evaluated at baseline and 14 to 60 months later in 43 patients, 32 women and 11 men, with a mean age of 50 years. Results. At baseline, a presumptive clinical diagnosis was made in 16 of the 43 patients. Diagnoses at last follow-up were undifferentiated inflammatory arthritis in seven cases, mild rheumatoid arthritis in 18, psoriatic arthritis in two, Sjögren's syndrome in two, lupus in one, and paraneoplastic syndrome in one. The remaining 12 patients were free of inflammatory joint symptoms; three had symptoms of osteoarthritis and nine were asymptomatic. Factors present at baseline and predictive of progression to definite rheumatoid arthritis were a positive test for rheumatoid factor, presence of an HLA DRB1∗04 allele, and a presumptive clinical diagnosis of rheumatoid arthritis. Conclusion. 55% of our patients developed a specific inflammatory joint disease, and 42% developed rheumatoid arthritis, which was consistently mild. Resolution of all inflammatory joint symptoms occurred in 28% of cases. A number of clinical, laboratory, and genetic findings of use for predicting the outcome of undifferentiated arthritis were identified.

慢性関節リウマチにおける血清こう質反応（ＴＴＴ，ＺＴＴ）について

We studied the Thymol Turbidity test (TTT) and Zinc Sulfate Turbidity test (ZTT) in the serum of 83 patients with rheumatoid arthritis (RA). TTT or ZTT was high in 63 of 83 patients (75.9%) with RA. All patients were divided into two groups, according to high or low values for serum CRP, erythrocyte sedimentation reaction and Lansbury index. TTT and ZTT from the high group were higher compared to the low group. 21 or 27 patients. whose TTT or ZTT was not high, had a positive rheumatoid factor test. However TTT or ZTT were high in 7 patients, whose rheumatoid factors were negative. Most of these cases had high RA activity. It was suggested that TTT and ZTT are useful indices for RA activity although less significant compared to rheumatoid factor.

A simple algorithm to predict the development of radiological erosions in patients with early rheumatoid arthritis: prospective cohort study.

To produce a practical algorithm to predict which patients with early rheumatoid arthritis will develop radiological erosions. Primary care based prospective cohort study. All general practices in the Norwich Health Authority, Norfolk. 175 patients notified to the Norfolk Arthritis Register were visited by a metrologist soon after they had presented to their general practitioners with inflammatory polyarthritis, and again after a further 12 months. All the patients satisfied the American Rheumatism Association's 1987 criteria for rheumatoid arthritis and were seen by a metrologist within six months of the onset of symptoms. The study population was randomly split into a prediction sample (n = 105) for generating the algorithm and a validation sample (n = 70) for testing it. Predictor variables measured at baseline included rheumatoid factor status, swelling of specific joint areas, duration of morning stiffness, nodules, disability score, age, sex, and disease duration when the patient first presented. The outcome variable was the presence of radiological erosions in the hands or feet, or both, after 12 months. A simple algorithm based on a combination of three variables--a positive rheumatoid factor test, swelling of at least two large joints, and a disease duration of more than three months--was best able to predict erosions. When the accuracy of this algorithm was tested with the validation sample, the erosion status of 79% of patients was predicted correctly. A simple algorithm based on three easily measured items of information can predict which patients are at high risk and which are at low risk of developing radiological erosions.

Clinical and laboratory assessments in rheumatoid arthritis and osteoarthritis.

Clinical and laboratory assessments in rheumatoid arthritis and osteoarthritis precede imaging methods in both defining diagnosis and determining response to therapy. Some assessments are similar in both diseases, e.g. measuring joint pain, the number of involved joints and functional impairment. There are also areas of difference; for example, rheumatoid arthritis is a systemic disease with immune disturbance and positive tests for rheumatoid factor and elevated acute phase markers while osteoarthritis is a more local disease with little systemic upset. In both diseases pain and progressive joint damage result in increasing disability. There is agreement on a core data set in rheumatoid arthritis which comprises: swollen joint counts, tender joint counts, pain assessment, patient's global assessment, an acute phase marker such as the ESR and a self-administered functional questionnaire. There is less agreement on the core data set in osteoarthritis, though pain and functional impairment are both important. Combined or overall indices have been used in both rheumatoid arthritis (e.g. the disease activity score) and in osteoarthritis (e.g. the Lequesne functional index), but there is no general agreement on their value. In both diseases plain radiology is useful to define diagnostic groups and follow progression in long-term studies. Mortality is increased in rheumatoid arthritis and is useful for defining the long term effects of the disease; little is known about mortality in osteoarthritis. Standardizing clinical methods is important and much work is needed in this area.