Presence Of Morning Stiffness Research Articles

Impact of socio-demographic and clinical characteristics on functional disability and health-related quality of life in patients with rheumatoid arthritis: a cross-sectional study from Palestine

BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disorder, which has a significant impact on patients' health-related quality of life (HRQoL), and limits physical function as well as increases pain and fatigue. Therefore, this study aimed to evaluate the HRQoL and functional disability profile of patients with RA in Palestine to determine the socio-demographic and clinical features associated with low HRQoL and functional disability in patients with RA and to investigate the impact of drugs used on functional disability and HRQoL.MethodologyA cross-sectional, observational study conducted at rheumatology clinics in Northern West-Bank, Palestine (Alwatani Hospital—Nablus, Khalil Suleiman Hospital—Jenin, Thabet Thatbet Hospital-Tulkarem, and Darweesh Nazzal Hospital—Qalqilia). EuroQoL-5 Dimension scale (EQ-5D-5L) was used to evaluate HRQoL, Health Assessment Questionnaire, Disability Index (HAQ-DI) to evaluate the functional disability, and the Health Assessment Questionnaire pain visual analog scale (HAQ-VAS) to evaluate pain.Results300 patients were included in the study, 229(76.3%) were females, the mean ± standard deviation age was 49 ± 13.10 years, and the median RA duration (lower–upper quartiles) was 6 (4–12) years. The median EQ-5D-5L index value and Euro QOL visual analogue scale (EQ-VAS) scores were 0.56 and 60, respectively. There was a significant strong positive correlation (R = 0.773; p < 0.001) between the EQ-5D-5L index values and the reported EQ-VAS scores. The median HAQ-DI and HAQ-VAS were 0.94 and 40, respectively. The results of multiple linear regression showed that treatment with biological DMARD (Etanercept), having work, higher income, absence of night pain, and absence of comorbid diseases were significantly associated with higher EQ-5D-5L index score (better HRQoL) and lower HAQ-DI scores (less disability). On the other hand, older age and the presence of morning stiffness were significantly associated with higher HAQ-DI scores (more disability).ConclusionsThis study revealed the impact of treatment, clinical variables, and socio-demographic factors on disability and HRQoL in RA patients. Healthcare providers should be aware of the association between treatment with biological DMARD and improved HRQoL and functional status to make early interventions that reduce disability and improve HRQoL in susceptible patients.

Initial visit symptoms in probable Behçet's syndrome is predictive of ISG criteria fulfillment in Behçet's syndrome: data from New York and Amsterdam cohorts.

Behçet's syndrome (BS) is a systemic vasculitis with heterogeneous clinical presentation and a relapsing disease course. The International Study Group (ISG) criteria are most often used for classification. A significant proportion of patients is classified as probable BS because they do not fulfil the criteria at initial presentation. The aim of this study is to explore clinical BS symptoms present at initial patient visit predictive of ISG criteria diagnosis during follow-up. Patients classified as probable BS at initial visit were included. Follow-up ISG status (defined as meeting criteria ISG+ vs. not meeting criteria ISG-) was abstracted from last visit. Univariable logistic regression was used to screen initial visit clinical features and symptoms with follow-up ISG status. All variables that passed screening at p<0.10 were included in the final multivariable model, which was then used to create a probability risk score. 189 patients were included (169 from New York and 20 from Amsterdam). 71 (37.6%) patients were classified as ISG+ during follow-up. In the final model, presence of morning stiffness, genital ulcers, skin lesions, and eye disease were associated with increased odds of ISG+, adjusting for age, symptom duration and family history. This was used to create a probability risk score. Over a third of patients with suspected or probable BS developed new manifestations over time that led to classification as ISG+ BS. The presence of morning stiffness, genital ulcers, skin lesions and eye disease at initial visit were independently associated with significantly higher odds for developing ISG+ Behçet's during follow-up.

Validation of the HAQ-UP-A (Health Assessment Questionnaire-Upper Limbs-Argentine Version) in Patients With Rheumatoid Arthritis.

To validate HAQ-UP-Argentine version in patients with RA. Cross-sectional study. Consecutive patients ≥18years with diagnosis of RA (ACR/EULAR 2010) were included. Socio-demographic data and RA characteristics were recorded. Questionnaires were administered: HAQ-A, HAQ-UP-A, FIHOA, Quick-DASH. The reproducibility of the questionnaire was assessed. A total of 100 patients were included, 83% women, mean age 57.9years (SD 11.6). Cronbach's alpha test was 0.94. The intra-item correlation did not show redundant questions. HAQ-UP-A showed excellent correlation with HAQ-A (r=.93); FIHOA (r=.89) and Quick-DASH (r=.91). It also showed good correlation with DAS28-ESR (r=.68) and other composite disease activity indices as well as with other parameters of the disease. There was no correlation between HAQ-UP-A and disease duration. The reproducibility of the questionnaire was 0.82. Multiple linear regression adjusted for age and sex showed patient global VAS as the main determinant of HAQ-UP-A, followed by the presence of morning stiffness. HAQ-UP-A was found to be reliable, valid and reproducible in patients with RA, representing a useful tool for the evaluation of the functional capacity of the upper limbs in these patients.

Older adults with back pain and spinal morning stiffness longer than 30 minutes are more at risk of developing long-term physical functioning limitations

Purpose: Spinal osteoarthritis (OA) is related to various signs and symptoms such as back pain, spinal morning stiffness, restricted/painful spinal range of motion (ROM) and lumbar disc degeneration (LDD). However, it is not known if patients with these signs and symptoms experience more limitations in physical functioning, and if these features are prognostic for long-term physical functioning limitations. Therefore, the aims of this study were to assess the following associations in older patients with back pain: 1) Morning stiffness, spinal ROM, and radiographic LDD with physical functioning at baseline, and 2) Morning stiffness, spinal ROM, and radiographic LDD with physical functioning after 1 year. Methods: For this prospective observational study data from the BACE cohort was used. Patients aged >55 years visiting a general practitioner with a new episode of back pain were included. Presence and duration of spinal morning stiffness were assessed with single-item patient-reported questions. Low back ROM was investigated through physical examination by an experienced research assistant, evaluating limitations and pain during lateroflexion, rotations and anteflexion of the spine. Osteophytes and disc space narrowing were considered LDD features, and they were investigated with lumbar lateral X-rays. The 4-grade Lane Atlas classification was used (i.e. grade 0= none, grade 1= mild, grade 2= moderate, grade 3= severe); osteophytes grade 2 or higher at two or more levels for L1-2 to L5-S1 and disc space narrowing grade 1 or higher at two or more levels from L1-2 to L5-S1 were defined as LDD presence. Outcomes were physical functioning limitations at baseline and physical functioning limitations at 1-year follow-up; physical functioning was measured with the Roland Morris Disability Questionnaire (RMDQ, range 0-24, 0 = no physical functioning limitation, 24 = maximum physical functioning limitation). The associations between morning stiffness, spinal ROM and radiographic features of LDD and back-related physical functioning at baseline and 1-year follow-up were assessed with multivariable linear regression models. Adjustments were made for age, sex, BMI, back pain severity, recent episodes of back pain, kinesiophobia and depressive symptoms. Results: This study included 543 patients, with mean age 67 years (SD 8), and 59% female. In multivariable adjusted analyses, presence of spinal morning stiffness (β=1.78, 95%CI 0.93-2.63), morning stiffness longer than 30 minutes (β=1.04, 95%CI 0.04-2.02), and pain during anteflexion (β=1.54, 95%CI 0.71-2.37) were independently associated with worse physical functioning at baseline. Morning stiffness longer than 30 minutes (β=1.54, 95%CI 0.22-2.86) was the only spinal OA feature independently associated with worse physical functioning at 1-year follow-up. Conclusions: Presence of morning stiffness, morning stiffness longer than 30 minutes and pain with anteflexion are associated with the level of physical functioning. Additionally, morning stiffness longer than 30 minutes is a prognostic factor for worse physical functioning at 1 year follow-up, independently of other already known prognostic factors (e.g. previous back pain episodes, physical functioning at baseline, and depression). Hence, older patients with back pain and spinal morning stiffness longer than 30 minutes are more at risk of having future back-related physical activity limitations.

Validation of the HAQ-UP-A (Health Assessment Questionnaire-Upper Limbs-Argentine Version) in patients with rheumatoid arthritis

HAQ is considered the gold standard for the evaluation of functional capacity in patients with rheumatoid arthritis (RA), even though it does not focus in any particular anatomical region. With the objective of assessing functional disability of the hand in elderly patients with osteoarthritis, Baron et al. used a modified version of the HAQ which was calculated as the mean value for those categories involving mostly upper extremities and named it ‘HAQ-UP’. This instrument has not been validated in patients with RA. ObjetiveTo valídate HAQ-UP argentine version in patients with RA. MethodsCross-sectional study. Consecutive patients ≥ 18 years with diagnosis of RA (ACR/EULAR 2010) were included. Socio-demographic data and RA characteristics were recorded. Questionnaires were administered: HAQ-A, HAQ-UP-A, FIHOA, Quick DASH. The reproducibility of the questionnaire was assessed. ResultsA total of 100 patients were included, 83% women, mean age 57.9 years (SD 11.6). Cronbach's alpha test was 0.94. The intra-item correlation did not show redundant questions. HAQ-UP-A showed excellent correlation with HAQ-A (r=0.93); FIHOA (r=0.89) and Quick DASH (r=0.91). It also showed good correlation with DAS28-ESR (r=0.68) and other composite disease activity indices as well as with other parameters of the disease. There was no correlation between HAQ-UP-A and disease duration. The reproducibility of the questionnaire was 0.82. Multiple linear regression adjusted for age and sex showed patient global VAS as the main determinant of HAQ-UP-A, followed by the presence of morning stiffness. ConclusionHAQ-UP-A was found to be reliable, valid and reproducible in patients with RA, representing a useful tool for the evaluation of the functional capacity of the upper limbs in these patients.

Prevalence and impact of knee osteoarthritis in runners

Purpose: The aim of this study was to investigate the prevalence and impact of knee osteoarthritis among recreational runners. Methods: This study is part of a randomized-controlled trial that investigated the effectiveness of an evidence-based online injury prevention program on running injuries, in preparation for a running event (from 5 km up to marathon) in recreational runners (N=2378). After registration, a baseline questionnaire informed on demographics, lifestyle characteristics, running characteristics and injury history. All participants received three follow-up questionnaires during the study period; two weeks before the running event they registered for, one day after the running event and one month after the running event. The follow-up questionnaires informed on running related injuries (RRIs) during follow-up. Participants that reported a new running related knee injury (RRKI) during the study period (N=277)were sent a knee-specific questionnaire after a mean of 16-months (range 11.7-18.6) follow-up. This questionnaire informed on the type of knee complaints, morning stiffness, activity related knee pain and self-reported diagnosis. In addition, the National Institute for Health and Care Excellence (NICE) guideline was followed to diagnose clinical knee osteoarthritis (OA).Participants were asked if they were recovered from their RRKI (yes/no) and time to recovery(weeks) was questioned. Information on medical consumption was obtained and all were asked whether the RRKI restricted their running in terms of running speed, duration and/or frequency. The subscales symptoms and sports of the Knee injury and Osteoarthritis Outcome Score (KOOS/100) and the Anterior Knee Pain Score (AKPS/100) were used to administer OA and patellofemoral specific outcomes at follow-up. T-tests and chi-square tests were used to describe differences between runners with and without knee OA. With cox regression analysis, the association between time-to-recovery and potential prognostic factors was determined. Results: Of the 277 runners that reported a new RRKI (11.6%) during follow-up, a total of 138 (49.8%) responded to the knee-specific follow-up questionnaire and were consequently included in the current study. Responders were on average significantly older (42.3 vs. 39.3 years, p=0.04). No other differences between responders and non-responders were observed. At baseline, study participants (N=138) were on average 42.3 (SD 12.2) years old, had an average BMI of 23.3 (SD 3.0) kg/m2 and the majority was male (59.4%). Participants trained on average 2.2 (SD 0.9) times a week, spend 2.6 (SD 1.5) hours a week on training with an average running speed of 6.0 (SD 0.9) min/km. At baseline, 36.2% of the participants reported an RRKI in the previous 12 months. At 16 month follow-up, 71.0% of the runners were recovered from their knee injury, with a mean recovery time of 10.5 (SD 9.9) weeks. Non-recovered participants had complaints for 54.4 (SD 4.8) weeks up to follow-up. Following self-diagnosis, most participants suffered from knee OA/degenerative meniscus lesions (23.2%)and iliotibial band syndrome (23.2%). Morning stiffness was reported by 26.0% of the participants. Following the NICE guidelines, 13.8% of the runners with incident knee injuries were diagnosed with knee OA at follow-up. Within the group of participants that had clinical knee OA following the NICE guideline, 5.1% was recovered and 35% was not-recovered from their knee injury (p<0.001). The presence of morning stiffness was associated with recovery rate (83.3% versus 36.1%, p<0.001). Runners with clinical knee OA had a significantly lower KOOS symptom score (65.3(20.0) vs 84.8(20.0), p<0.001) and AKPS (80.9(10.7) vs. 93.3(9.6), p<0.001) compared to runners with other types of RRKIs. Runners with a self-reported diagnosis of knee OA more frequently visited a health care professional (78.1% vs. 43.4%, p<0.001) compared to runners with other types of RRKIs, with especially a high percentage of visits to the physiotherapist (80%). The results of the COX regression for time to recovery shows that male sex (HR 1.90; 95%CI 1.17-3.09) was associated with a shorter time to recover from RRKIs, while participants diagnosed with knee OA following the NICE guideline (HR 0.18; 95%CI 0.06-0.53) had a longer time to recovery. Conclusions: Time-to-recovery from RRKIs is relatively long, which emphasizes the need for optimal treatment, education and injury prevention programs in recreational runners, especially in female runners. Furthermore, more knowledge on the impact of running with knee OA is important, given the high number of runners with knee OA symptoms and the longer time-to-recovery of RRKI in runners with knee OA.

76-Year-Old Man With New Bilateral Shoulder Pain

76-Year-Old Man With New Bilateral Shoulder Pain

Is it worth allowing the presence of morning stiffness in the definition of inactive disease in juvenile idiopathic arthritis?

Morning stiffness is a major symptom of juvenile idiopathic arthritis (JIA) and it is usually associated with active disease. However, it is common view that children with disease quiescence may have some degrees of residual morning stiffness. The 2004 preliminary criteria for inactive disease (ID) in JIA did not include the assessment of morning stiffness, whereas the 2011 revision of the criteria has allowed the presence of morning stiffness lasting ≤ 15 minutes. However, it is still unknown whether the disease status of children with ID who have or do not have morning stiffness is comparable.

FRI0511 Detection of Anti-Th/To Antibodies in Patients with Various Rheumatic Diseases and their Clinical Features

BackgroundAnti-Th/To were initially reported to be specific for SSc or Raynaud's disease with a short duration. Clinically, anti-Th/To were associated with features like puffy fingers, hypothyroidism and a significantly lower...

The value of referral letter information in predicting inflammatory arthritis—factors important for effective triaging

The aim of this study is to identify factors from referral information predictive of patients with inflammatory arthritis (IA) requiring early review. Four hundred twenty-six consecutive rheumatologist-triaged referrals from February to June 2012 were retrospectively reviewed to identify patients with rheumatologist-diagnosed IA correctly triaged for review within 2 weeks from referral date. Information from referral was analyzed descriptively followed by univariate logistic regression adjusted for age and sex to identify predictors of IA. Of the 108 patients with rheumatologist-confirmed diagnoses seen within 2 weeks, 76 patients (70.4%) were correctly triaged with 44.7% having rheumatoid arthritis (RA); 9.2%, psoriatic arthritis; 9.2%, spondyloarthritis; and 18.4%, undifferentiated inflammatory arthritis. The majority were females (63.2%), with median age of 52.8 years (Q1; Q3 38.4; 61.3) with referrers indicating presence of morning stiffness in 71.4% and symmetrical distribution in 74.6%. Five or more joints were involved in 65.7% with suspected metacarpophalangeal joint (MCPJ) (44.7%) or proximal interphalangeal joint (PIPJ) (59.6%) involvement. Of the referrals with laboratory results, erythrocyte sedimentation rate (ESR) was raised with median 43.5 mm/h (Q1; Q3 24.8; 77.5) and normal median uric acid of 312.5 μmol/L (Q1; Q3 249.5; 363.5). Univariate analysis revealed that presence of ≥5 joints affected (p = 0.001), symmetrical distribution (p = 0.006), MCPJ (p = 0.003), PIPJ (p = 0.003), and elevated ESR (p = 0.001) were predictive of IA after adjustment for age and sex. Specific information including number, pattern, and location of joint involvement with relevant laboratory investigations should be included in referral letters to assist with effective triaging of patients with IA.

FRI0062 A prediction rule for the development of arthritis in seropositive arthralgia patients

BackgroundPatients presenting with arthralgia and a positive test for anti-cyclic citrullinated peptide antibodies (aCCP) and/or IgM rheumatoid factor (IgM-RF) (seropositive) are at risk for developing RA.ObjectivesTo predict the development of...

AB0250 The value of referral letter information in predicting inflammatory arthritis – factors important for effective triaging

BackgroundThe management of patients with inflammatory arthritis relies on the principle that patients are referred to and reviewed by rheumatologists as soon as possible. Success of this depends upon accurate...

A prediction rule for the development of arthritis in seropositive arthralgia patients

ObjectiveTo predict the development of arthritis in anticyclic citrullinated peptide antibodies and/or IgM rheumatoid factor positive (seropositive) arthralgia patients.MethodsA prediction rule was developed using a prospective cohort of 374 seropositive...

2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative

The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new...

2012 Provisional classification criteria for polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative

The objective of this study was to develop European League Against Rheumatism/American College of Rheumatology classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new-onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of rheumatoid factor and/or anti-citrullinated protein antibody (2 points), and absence of peripheral joint pain (1 point). A score ≥4 had 68% sensitivity and 78% specificity for discriminating all comparison subjects from PMR. The specificity was higher (88%) for discriminating shoulder conditions from PMR and lower (65%) for discriminating RA from PMR. Adding ultrasound, a score ≥5 had increased sensitivity to 66% and specificity to 81%. According to these provisional classification criteria, patients ≥50 years old presenting with bilateral shoulder pain, not better explained by an alternative pathology, can be classified as having PMR in the presence of morning stiffness >45 minutes, elevated C-reactive protein and/or erythrocyte sedimentation rate, and new hip pain. These criteria are not meant for diagnostic purposes.

Prevalence of Inflammatory Back Pain in a Cohort of Patients With Anterior Uveitis

To determine the prevalence of inflammatory back pain in an anterior uveitis cohort. Retrospective cohort study. Patients with anterior uveitis were recruited from the clinic of an ophthalmologist to complete a survey between March and December 2008. Patients were classified with inflammatory back pain if they had ≥2 positive responses to 4 validated inflammatory back pain questions: presence of morning stiffness >30 minutes in duration; improvement in back pain with exercise but not with rest; awakening from back pain during the second half of the night only; and presence of alternating buttock pain. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The impact of disease on quality of life was measured using the EuroQOL (EQ-5D) questionnaire. Twenty-five patients underwent further rheumatologic examination. One hundred forty-one of 167 patients (84.4%) completed the survey. Sixty-six of 141 patients (46.8%) were classified to have inflammatory back pain. Mean BASDAI (4.2, SD 2.41) and EQ-5D scores (0.73, SD 0.21) were lower than patients with no inflammatory back pain (0.82, SD 0.16, P = .0048). In the subgroup that underwent rheumatologic assessment, a classification of inflammatory back pain was 92% sensitive and 67% specific for a diagnosis of inflammatory back pain. The prevalence of inflammatory back pain in a cohort of anterior uveitis patients was found to be 46.8%. Patients with inflammatory back pain had worse quality of life than those without. Ophthalmologists may use these questions on back pain to select patients classified to have inflammatory back pain to refer for early rheumatologic assessment.

Articular manifestations of mixed connective tissue disease.

All but one of 28 patients with mixed connective tissue disease (MCTD) who were studied prospectively had arthralgia, and 15 of them had noticed joint swelling. Arthralgia was the first symptom in 14 patients and one of the first two symptoms in 24. Arthralgia was pauciaticular in 4 and polyarticular in 23. Presence of morning stiffness in 15 patients, symmetrical joint swelling in 16, joint deformity in 6, marginal erosions in roentgenograms of the hands of 12, rheumatoid factor in 25, and subcutaneous nodules in 5 caused 24 of the 28 patients with MCTD to fulfill criteria for definite or classic rheumatoid arthritis. All patients, however, also had prominent signs or symptoms of scleroderma, systemic lupus eruthematosus, or polymyositis.