Recent-onset Rheumatoid Arthritis Research Articles

SAT0087 Is the Extent of Atherosclerosis in Patients with Rheumatoid Arthritis After Five Years of Follow-Up Associated with Markers of Inflammation?

BackgroundIn the general population several inflammatory cytokines, for example pentraxin3 (ptx3), monocyte chemoattractant protein 1 (MCP-1), interleukin 6 (IL-6), TNF-receptor 1 (TNFR1), TNFR2, endoglin, VCAM and ICAM, have been found...

SAT0086 Extent of Atherosclerosis is Associated with Biomarkers for Unstable Plaques: A Prospective Study Over Five Years in Rheumatoid Arthritis Patients and Matched Controls

BackgroundIn the general population several serological biomarkers, for example phospholipase A2 group 7 (PLA2G7), macrophage inhibitory cytokine 1 (MIC-1), soluble CD40 ligand (sCD40L), myeloperoxidase (MPO) and interleukin 18 (IL-18), have...

OP0145 Induction therapy with adalimumab plus methotrexate versus methotrexate monotherapy in recent onset rheumatoid arthritis (RA) – an investigator initiated randomized controlled trial

BackgroundTo study the prolonged effect on disease activity by an early induction therapy with adalimumab (ADA) plus methotrexate (MTX) versus MTX alone in DMARD naïve patients (pts) with early RA...

OP0154 Clinical and radiological outcomes of four disease activity driven treatment strategies: 8-year results of the best study

ObjectivesTo compare clinical and radiological outcomes of 8 years targeted treatment with four treatment strategies in recent onset rheumatoid arthritis (RA) patients.MethodsPatients (n=508) with recent onset RA were randomized to...

FRI0069 Impact assessment of smoking in disease activity in a cohort of recent onset rheumatoid arthritis

BackgroundThere is wide scientific evidence about the involvement of smoking in the susceptibility to rheumatoid arthritis. However, the effect of smoking on the activity of the disease and its clinical...

SAT0097 Changes In Bone Mineral Density in Patients with Recent-Onset Rheumatoid Arthritis

BackgroundGeneralized bone loss and an increased risk of fractures are regarded as complications in rheumatoid arthritis. Variable clinical factors, inflammatory activity, and treatment regimens may contribute to the development of...

THU0220 Establishment of a Prediction Model for Hepatotoxicity of Methotrexate by Using Dmet Microarray Profiling in Japanese Patients with Rheumatoid Arthritis

BackgroundEfficacy and toxicity of methotrexate (MTX) differs among individual patients, suggesting the influence of genetic variations in enzymes associated with MTX metabolism and folate metabolic pathway. Recent advances in pharmacogenetics...

THU0524 Antidepressant use among Persons with Recent-Onset Rheumatoid Arthritis: A Nationwide Register-Based Study in Finland

BackgroundDepression is a sizeable problem in rheumatoid arthritis (RA) but data on the antidepressant use is sparse.ObjectivesTo investigate antidepressant initiations and the prevalence of antidepressant use among persons with recent-onset...

AB0189 Polymorphisms in genes involved in the metotrexate action mechanism. are they associated with response/toxicity of the drug?

BackgroundRheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease of unknown etiology. Methotrexate (MTX) is the first-line treatment option for newly diagnosed RA patients. However, only 50–70% of the...

FRI0113 Rheumatoid arthritis and eosinophilia: the risk of lymphoproliferative malignancies and solid cancers. a study based on the copenhagen primary care differential count (copdiff) database

BackgroundCohort and population studies have indicated an association between rheumatoid arthritis (RA) and malignancies. Several mechanisms have been suggested; i) extrinsic pro-oncogenic effects of disease-modifying antirheumatic drugs, ii) intrinsic pro-oncogenic...

AB0410 Use of disease-modifying treatment (dmard) in patients with rheumatoid arthritis: clinical aspects

BackgroundRheumatoid arthritis (RA) is one of the most common occurrence diseases with a high frequency (about 1%) in the general population. More the 4500 patients with rheumatoid arthritis registered in...

AB0829-HPR Influence of ra patient personality for more aggressive therapies

BackgroundActually, patients with rheumatoid arthritis (RA) play a more active role in relation to his illness, and the choice of treatment. The patient’s personality can be an important part in...

AB0343 A high serum level of haptoglobin is associated with the response of 12 weeks methotrexate therapy in recent-onset rheumatoid arthritis patients

BackgroundAmong the several available DMARDs, Methotrexate (MTX) is currently the most widely used drug in clinical practice. About 30-40% of the patients could experience an adequate response to MTX alone;...

AB0430 Fulfillment of some GUIPCAR-2007 recommendations for the care of patients with recent-onset reumatoid arthritis in spanish rheumatology centres. EMAR-II study

BackgroundThe emAR study was developed to determine variations in the management of socio-sanitary resources, including drugs use, in patients with rheumatoid arthritis (RA) and Spondyloarthritis (Spa).ObjectivesTo evaluate the fulfillment degree...

Peripheral joint inflammation in early onset spondyloarthritis is not specifically related to enthesitis

ObjectivesA pivotal MRI study of knee arthritis indicated that enthesitis was more frequently observed in established spondyloartritis (SpA) than rheumatoid arthritis (RA). Subsequent MRI and ultrasound studies, however, failed to...

Early Local Swelling and Tenderness Are Associated with Large-joint Damage After 8 Years of Treatment to Target in Patients with Recent-onset Rheumatoid Arthritis

To assess whether early swelling and tenderness in large joints in patients with rheumatoid arthritis (RA) is predictive of later local damage and whether this leads to functional disability. Two-year clinical and 8-year radiological followup data from the BeSt study (trial numbers NTR262 and NTR265), a randomized controlled treat-to-target trial, were used. The association between early local joint swelling and/or tenderness (at least once, or for ≥ 2 consecutive visits) and later large-joint damage (Larsen score ≥ 1) was assessed using generalized estimating equations. The association between large-joint damage and functional ability [by Health Assessment Questionnaire (HAQ)] was assessed using logistic and linear regression analysis. Clinical and 8-year radiological data were available for 290 patients. Concomitant local joint swelling and tenderness at least once in the first 2 years was independently associated with damage of the large joints (OR 2.5, 95% CI 1.7-3.6), as was swelling without tenderness (OR 2.0, 95% CI 1.1-3.6). Stronger effects were seen for persistent swelling and/or tenderness. Other independent predictors for joint damage were baseline erythrocyte sedimentation rate (OR 1.01, 95% CI 1.01-1.02) and the presence of rheumatoid factor and/or anticitrullinated protein antibodies (OR 2.5, 95% CI 1.5-4.1; and OR 2.2, 95% CI 1.3-3.8, respectively). Patients with large-joint damage had a higher HAQ score after 8 years than patients without (difference 0.15). Early local swelling and tenderness are independent predictors of later joint damage in these joints after 8 years of Disease Activity Score-guided treatment in patients with RA. This suggests that suppression of local inflammation could help prevent local damage and functional disability.

Foot‐related health care use in patients with rheumatoid arthritis in an outpatient secondary care center for rheumatology and rehabilitation in The Netherlands: A cohort study with a maximum of fifteen years of followup

To describe foot-related health care use over time in a cohort of rheumatoid arthritis (RA) patients in an outpatient secondary care center for rheumatology and rehabilitation in The Netherlands. A total of 1,087 patients with recent-onset RA from 1995 to September 2010 were included in the study. All foot-related visits to the podiatrist, rehabilitation physician, orthopedic surgeon, and the multidisciplinary foot-care clinic were registered and described. Logistic regression techniques for longitudinal data were used to analyze the course of foot-related health care use. A total of 32.9% of patients visited a podiatrist in secondary care during the course of their disease. For most patients, a visit to the podiatrist took place during the first year after diagnosis. This was followed by a significant decrease in visits in the ensuing years. Nine percent of patients visited the rehabilitation physician with foot symptoms, with peak prevalences between year 10 and 11 and during year 14 of followup. The orthopedic surgeon was visited by 5.3% of patients with foot symptoms, with a significant increase in visits over time. The multidisciplinary foot-care clinic was visited by 7.5% of patients. This was significantly associated with visits to the rehabilitation physician. In an outpatient secondary care center in The Netherlands, RA patients with foot symptoms visited the podiatrist in an early stage of the disease. When foot symptoms worsened, patients visited the rehabilitation physician, who subsequently referred patients to the multidisciplinary foot-care clinic for therapeutic footwear. The orthopedic surgeon was the final step in the management of foot symptoms.

Familial Mediterranean Fever Occurring in an Elderly Japanese Woman with Recent-onset Rheumatoid Arthritis

A 60-year-old woman with a two-year history of rheumatoid arthritis (RA) developed recurrent two- to three-day attacks of fever (>38 °C) accompanied by monoarthritis of the right hip joint. The first attack occurred two months after beginning anti-tumor necrosis factor-α therapy. Since a diagnosis of infectious arthritis was suspected, the therapy was discontinued. Thereafter, the patient repeated similar episodes; however, oral colchicine effectively controlled the attacks. The patient was diagnosed to have familial Mediterranean fever (FMF). The clinical manifestations of FMF mimic infectious complications during anti-RA therapy. Clinicians should therefore consider the possibility of FMF development in RA patients exhibiting recurrent febrile attacks.

Risk of alanine transferase (ALT) elevation in patients with rheumatoid arthritis treated with methotrexate in a DAS-steered strategy

To determine incidence of increased levels of alanine transferase (ALT) >2× upper limit of normal (ULN) in patients receiving methotrexate (MTX), treated according to a dynamic strategy, and to identify predictors of ALT of >2× ULN. Data of 508 recent-onset rheumatoid arthritis (RA) patients from the BeSt study, randomized to initial monotherapy or combination therapy, were used. Treatment was dynamic, aiming at a disease activity score = ≤ 2.4. ALT was measured every three months. With logistic regression analyses, baseline variables predictive of first ALT of >2× ULN were identified and the association between use of concomitant antirheumatic drugs, the actual and cumulative dose of MTX and ALT of >2× ULN was determined. In total, 498 patients ever initiated MTX, with a total duration on MTX of 1,416 patient-years. In 89 patients, a first incidence of ALT of >2× ULN occurred. Incidence rate was 6.3 per 100 patient-years and cumulative incidence 18 %. ACPA positivity and baseline ALT of >1× ULN were independent predictors of later ALT of >2× ULN (OR 1.8 (95 % CI, 1.1-3.1) and OR 3.1 (95 % CI, 1.6-6.2), respectively). Smoking showed a trend (OR 1.6 (95 % CI, 0.98-2.7)). Mean MTX dosage over time was higher in patients with an ALT of >2× ULN. Patients who did not have an ALT of >2× ULN used more concomitant disease-modifying antirheumatic drugs and longer. In RA patients treated with MTX according to a dynamic strategy resembling daily clinical practice, incidence of increased ALT of >2× ULN was lower than previously reported, and also without treatment adjustments, persistence was rare. The recommendations for ALT monitoring may be reevaluated.

Assessment of synovitis in early rheumatoid arthritis by CXCL13 serum levels and power Doppler ultrasonography: Correlation with disease activity

Aim of the workAssessment of synovitis in rheumatoid arthritis (RA) is a major issue for proper treatment; it has been proven that high resolution ultrasound (US) examination could be of valuable help. The B-cell chemokine, CXCL13, is a proposed serum biomarker of synovitis in RA. We aimed to find out the presence of synovitis in patients with recent-onset RA and its correlation with disease activity. Patients and methodsWe evaluated 30 patients with early RA for the presence and degree of synovitis by performing high resolution US and obtaining serum CXCL13 levels. In addition, we correlated these results with disease activity score 28 (DAS 28). Results of high resolution US and serum CXCL13 were also obtained for 20 healthy age- and sex-matched volunteers and served as controls. ResultsSerum CXCL13 level was significantly increased in early RA patients vs. controls (p<0.001). High resolution US revealed that RA patients had a significant increased synovial thickness and high power Doppler US score. In RA patients, DAS 28 had a significant correlation with serum CXCL13 (r=0.42, p=0.02), synovial thickness (r=0.39, p=0.03) and power Doppler US score (r=0.43, p=0.02). Serum CXCL13 level correlated with synovial thickness (r=0.63, p=0.001) and power Doppler US score (r=0.69, p=0.001). ConclusionRecent-onset RA patients suffer from synovitis as evidenced by significantly increased serum CXCL13 and by high resolution US. Serum CXCL13 is a reliable marker of synovial inflammation which correlates better with synovial thickening and power Doppler US scores than DAS28.