Years Of Rheumatoid Arthritis Research Articles

Malignancy in the Upadacitinib Clinical Trials for Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, and Non-radiographic Axial Spondyloarthritis.

This article aims to describe malignancies in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), or non-radiographic axial spondyloarthritis (nr-axSpA) treated with upadacitinib (UPA) or active comparators. This integrated safety analysis includes data from 11 phase3 UPA trials across RA (6 trials), PsA (2 trials), AS (2 trials; one phase2b/3), and nr-axSpA (1 trial). Treatment-emergent adverse events (TEAEs) were summarized for RA (pooled UPA 15mg [UPA15], pooled UPA 30mg [UPA30], adalimumab 40mg [ADA], methotrexate monotherapy [MTX]), PsA (pooled UPA15, pooled UPA30, ADA), AS (pooled UPA15), and nr-axSpA (UPA15). TEAEs were reported as exposure-adjusted event rates (events/100 patient-years). Median treatment duration ranged from 1.0 to 4.0years (with a maximum of 6.6years in RA). Across treatments and indications, rates of malignancy excluding nonmelanoma skin cancer (NMSC) ranged from 0.2 to 1.1, while NMSC ranged from 0.0 to 1.4. In RA, rates of malignancy excluding NMSC were generally similar between UPA15, UPA30, ADA, and MTX (breast and lung cancer were the most common). In RA and PsA, Kaplan-Meier analyses revealed no differences in event onset of malignancy excluding NMSC with UPA15 versus UPA30 over time. In RA, NMSC rates were higher with UPA30 than UPA15; both UPA15 and UPA30 were higher than ADA and MTX. In PsA, rates of malignancy excluding NMSC and NMSC were generally similar between UPA15, UPA30, and ADA. In AS and nr-axSpA, malignancies were reported infrequently. Few events of lymphoma were reported across the clinical programs. Rates of malignancy excluding NMSC were generally similar between UPA15, UPA30, ADA, and MTX and were consistent across RA, PsA, AS, and nr-axSpA. A dose-dependent increased rate of NMSC was observed with UPA in RA. ClinicaTrials.gov identifier: NCT02706873, NCT02675426, NCT02629159, NCT02706951, NCT02706847, NCT03086343, NCT03104400, NCT03104374, NCT03178487, and NCT04169373.

EVALUATION OF PERIPHERAL AND CENTRAL ANALGESIC EFFICACIES OF AYURVEDIC NEW FORMULATION FOR AMAVATA DISEASE IN ANIMAL MODEL THROUGH WRITHING TEST AND TAIL -FLICK IMMERSION TEST IN MICEMODEL- AN ANIMAL EXPERIMENTAL STUDY.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder, it is the most common persistent inflammatory arthritis, occurring throughout the world and in all ethnic groups. This is the most marked in those with severe diseases, with a reduction in expected lifespan by 8-15 years. Around 40% of RA pa-tients are registered disable within 3 years, around 80% are moderately to severely disables within 20 years, and 25% will require a large joint replacement. Functional capacity decreases most rapidly at the beginning of disease and the functional status of patients within their 1st year of RA is often predictive of long-term out-come(1). Aim: In research field RA need more attention for deep research due to, firstly its unbearable symptoms and secondary complication and secondly in modern science there are medicines available for temporary manage-ment purpose but with lot of adverse reaction. RA is a non-curable disease, in Ayurveda, RA can be corelated with Amavata disease (Rheumatoid arthritis). Methodology: In this present study It has been taken up to see the efficacy of new combined Ayurvedic formu-lation i,e combination of Stem of Asthishrinkhala (Cissus quadrangularis L), bulb of Sunthi (Zingiber offici-nale Roscoe) and bulb of Rasona (Allium sativum L) with (1:1:1) ration for better management with less side effects. This research firstly done on animal to evaluate central and peripheral activity of research drug, through Writhing Test and Tail -flick immersion test in Mice model.

Hydroxychloroquine retinopathy: The importance of timely screening

Hydroxychloroquine (HCQ) is a drug being increasingly used in the treatment of various autoimmune disorders. Retinal toxicity is a complication of prolonged use causing permanent visual loss in patients receiving HCQ. We report a case of HCQ retinopathy who received the drug for 35 years for rheumatoid arthritis. She had never been advised for ophthalmologic evaluation before. Interprofessional collaboration will help in the early detection of retinal damage, treatment with alternate drugs, and prevention of permanent retinal damage.

P203 Prevalence of lower limb disease activity and walking disability in the first two years of rheumatoid arthritis: results from the Scottish Early Rheumatoid Arthritis inception cohort

Abstract Background/Aims Lower limb synovitis and walking disability are reported as common in rheumatoid arthritis (RA), however there is a paucity of contemporary longitudinal studies reporting prevalence rates from disease onset. The aims of this study were to determine i) the prevalence of lower limb synovitis and walking disability from first presentation to 2 years, and ii) the prevalence of active foot/ankle disease amongst participants in Disease Activity Score-28 (DAS28)-remission. Methods The Scottish Early Rheumatoid Arthritis (SERA) study is an inception cohort of newly diagnosed inflammatory arthritis patients attending rheumatology units across Scotland. SERA data included demographics and 6-monthly clinical outcome data. Data from participants diagnosed with RA were included. Synovitis was determined using tender and swollen joint counts recorded at hips, knees, ankles and metatarsophalangeal (MTP) joints 2-5, and dichotomised as present (≥1) or absent (0). Walking disability was measured using the Health Assessment Questionnaire (HAQ) walking subscale (range 0-3) and dichotomised at present (≥1) or absent (0). Prevalence rates are expressed as percentages of participants. Subgroup analysis was performed to estimate the prevalence of foot/ankle joint swelling in participants who were in DAS28-remission (<2.6). Results A total of 932 participants (65.9% female) with a median (interquartile range [IQR]) age 59.5 years (49.5-68.1) were included, dropping to 391 at 2 years. Prevalence rates for lower limb synovitis and walking disability are reported in table 1. At 6 months, 138/816 (28.6%) participants met DAS28-remission criteria, followed by 124/691 (31.9%) at 1 year, 118/522 (39.2%) at 18 months, and 88/391 (39.5%) at 2 years. For those in DAS28-remission the prevalence of foot/ankle joint swelling was 10.3% at 6 months, 13.5% at 1 year, 17.6% at 18 months and 12% at 2 years. Conclusion Prevalence rates for knee, ankle and MTP joint swelling are initially high then stabilise, with largest reductions observed at 6 months. Joint tenderness prevalence rates follow a similar course but are consistently higher than joint swelling. Walking disability affects a significant proportion of patients throughout the first 2 years of RA. Clinically important rates of active foot/ankle disease are present amongst those classed in DAS28-remission. Disclosure N. Kelleher: None. G.J. Hendry: None.

Subclinical Atherosclerosis Measure by Carotid Ultrasound and Inflammatory Activity in Patients with Rheumatoid Arthritis and Spondylarthritis

Objective: To compare the effect of inflammation on subclinical atherosclerosis using carotid ultrasound in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Methods: Cross-sectional study including 347 participants (148 RA, 159 SpA, and 40 controls). We measured the carotid intima media thickness (cIMT) and detection of atheromatous plaques using carotid ultrasound. We recorded disease activity (DAS28-CRP/ASDAS-CRP) and traditional cardiovascular risk factors. We performed descriptive, bivariate, and linear multivariate analyses (dependent variable: cIMT) to evaluate the influence of diagnosis on cIMT in all patients. Two additional multivariate analyses were performed by stratifying patients according to their inflammatory activity. Results: cIMT correlated with the mean CRP during the previous 5 years in RA, but not with CRP at the cut-off date. We did not find such differences in patients with SpA. The first multivariate model revealed that increased cIMT was more common in patients with RA than in those with SpA (β coefficient, 0.045; 95% confidence interval (95% CI), 0.0002–0.09; p = 0.048) after adjusting for age, sex, disease course, and differential cardiovascular risk factors (arterial hypertension, smoking, statins, and corticosteroids). The second model revealed no differences in cIMT between the 2 groups of patients classified as remission–low activity (β coefficient, 0.020; 95% CI, −0.03 to 0.080; p = 0.500). However, when only patients with moderate–high disease activity were analysed, the cIMT was 0.112 mm greater in those with RA (95% CI, 0.013–0.212; p = 0.026) than in those with SpA after adjusting for the same variables. Conclusions: Subclinical atherosclerosis measured by carotid ultrasound in patients with RA and SpA is comparable when the disease is well controlled. However, when patients have moderate–high disease activity, cIMT is greater in patients with RA than in those with SpA after adjusting for age, sex, disease course, and cardiovascular risk factors. Our results point to greater involvement of disease activity in subclinical atherosclerosis in patients with RA than in those with SpA.

Periodontitis severity affects the clinical response to biological disease-modifying antirheumatic drugs in rheumatoid arthritis: A 1-year follow-up study.

To assess whether periodontitis severity affects the clinical response to biological disease-modifying antirheumatic drugs (bDMARDs) for 1 year in rheumatoid arthritis (RA) patients. Data were collected from 50 RA patients who had received corticosteroids, conventional synthetic DMARDs, or non-steroidal anti-inflammatory drugs before (baseline) and after 1 year of bDMARD therapy in a retrospective study. Rheumatologic conditions were compared between the two periodontitis severity groups according to the periodontal inflamed surface area (PISA) or Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) case definitions. Twenty-eight patients with no or mild periodontitis showed significantly greater decreases in changes in Clinical Disease Activity Index (CDAI) and tender and swollen joint count in comparison to 22 patients with moderate and severe periodontitis (p = .02, p = .01, and p = .03). Both bivariate and multivariate analyses revealed a significantly positive association between the baseline CDC/AAP definitions and CDAI changes (p = .005 and p = .0038). However, rheumatologic conditions were comparable between 25 patients each in the low and high PISA groups. Baseline periodontitis severity according to the CDC/AAP definitions is associated with the clinical response to bDMARDs for 1 year in RA patients.

Patient perspectives on biological treatments for inflammatory arthritis: A multi-center study in Korea.

Objectives The aim of this study was to evaluate the patient’s perception of the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) and provide a basis for physicians to understand the patient’s perspective.Patients and methods Between December 2018 and June 2019, a total of 307 patients (162 males, 145 females; mean age: 48 years; range, 18 to 81 years) were included in this investigator-initiated, multi-center, observational, and cross-sectional study in six rheumatology centers. We asked patients using bDMARDs to treat rheumatoid arthritis (RA) or ankylosing spondylitis (AS) to complete a questionnaire regarding major considerations and satisfaction with bDMARDs, preferred administration route, knowledge about bDMARDs, experiences of adverse events, non-adherence, and expectations of their healthcare provider. The satisfaction of physician and clinical information on the patient's disease and treatment were also collected.Results Of the patients, 139 had RA and 168 had AS. Median disease duration was six years in RA and five years in AS. A total of 80.1% of the patients and 77.1% of the physicians indicated being satisfied or very satisfied with the therapeutic effect of the current bDMARD. Most patients were open to intravenous or subcutaneous injection, with the most preferred route of administration being subcutaneous (41.3%), followed by intravenous (32.0%), and oral (26.7%). The patients considered therapeutic effect to be more important than cost or convenience while choosing a bDMARD (69.3%), and most were willing to be educated about therapeutic effects (46.1%). Only 35.2% of the patients reported well and/or very well knowledge about the therapeutic effects, side effects, and administration methods of their current bDMARD, and 86.6% cited their physician as the primary source of information about biological treatment.Conclusion Patients value therapeutic effect more than cost or convenience while selecting a bDMARD, and consider their physicians to be the primary information source. Therefore, it is important for physicians to provide appropriate education and encourage patients to cooperate actively with treatment.

Methotrexate-associated lymphoproliferative disorder with hypopituitarism and central diabetes insipidus.

SummaryPatients treated with immunosuppressive drugs, especially methotrexate (MTX), rarely develop lymphoproliferative disorders (LPDs), known as MTX-related LPD (MTX–LPD). The primary site of MTX–LPD is often extranodal. This is the first reported case of MTX–LPD in the pituitary. A 65-year-old woman was admitted to our hospital with symptoms of oculomotor nerve palsy and multiple subcutaneous nodules. She had been treated with MTX for 11 years for rheumatoid arthritis. Computed tomography showed multiple masses in the orbit, sinuses, lung fields, anterior mediastinum, kidney, and subcutaneous tissue. Brain magnetic resonance imaging revealed a sellar mass. She was diagnosed with hypopituitarism and central diabetes insipidus based on endocrine examination. Although pituitary biopsy could not be performed, we concluded that the pituitary lesion was from MTX–LPD, similar to the lesions in the sinuses, anterior mediastinum, and subcutaneous tissue, which showed polymorphic LPD on biopsy. MTX was discontinued, and methylprednisolone was administered to improve the neurologic symptoms. After several weeks, there was marked improvement of all lesions, including the pituitary lesion, but the pituitary function did not improve. When pituitary lesions are caused by MTX–LPD, the possibility of anterior hypopituitarism and central diabetes insipidus needs to be considered. Further studies are needed to investigate the effectiveness of early diagnosis and treatment of MTX–LPD in restoring pituitary dysfunction.Learning pointsPituitary lesions from MTX–LPD may cause hypopituitarism and central diabetes insipidus.Pituitary metastasis of malignant lymphoma and primary pituitary lymphoma, which have the same tissue types with MTX–LPD, have poor prognosis, but the lesions of MTX–LPD can regress only after MTX discontinuation. In cases of pituitary lesions alone, a diagnosis of MTX–LPD may be difficult, unless pituitary biopsy is performed. This possibility should be considered in patients treated with immunosuppressive drugs.Pituitary hypofunction and diabetes insipidus may persist, even after regression of the lesions on imaging due to MTX discontinuation.

Quality of life in fibromyalgia, osteoarthritis and rheumatoid arthritis patients: Comparison of different scales

Aim of the workTo compare fibromyalgia syndrome (FMS), osteoarthritis (OA) and rheumatoid arthritis (RA) patients in terms of their measured quality of life (QoL). Patients and methodsFifty-nine FMS patients, 165 OA and 57 with RA were assessed. QoL Short Form (SF) scales, World Health Organization QoL (WHOQoL) Brief and Quick-Dash scales were measured. Covariance analysis was used for group comparisons. ResultsThe mean age of FMS patients was 40.4±10.9years; OA was 54.5±15.7years and RA 46.9±15years (p<0.001) mostly were females. The disease duration in FMS was 4±3.6years; in OA was 6±4.8years and 5.1±4.3years in RA. After effects of age, gender and educational level on scores were eliminated, at least one SF scale was found to be significantly higher in FMS and OA in terms of Physical and Role function, General health, Vitality, Social function, Emotional role, mean of Mental health subscale in addition to the physical (PCS) and mental (MCS) summary scales. The Quick-Dash score was higher in the RA group. Physical sub-dimension scores of WHOQoL Brief scale were significantly lower in RA group. In addition, social relations sub-dimension score was found to be higher in OA than RA group. MCS scores of SF-36, SF-12 and SF-6D were found higher than PCS scores in the three diseases. PCS score was found significantly higher only in FMS group. ConclusionsRA patients had worse QoL than FMS and OA according to PCS and MCS. SF-12 and SF-6D can be used instead of SF-36 or WHOQoL Brief scales for faster results.

Disease activity trajectories in early rheumatoid arthritis following intensive DMARD therapy over 3 years: association with persistence to therapy.

To identify the disease activity trajectories during intensive triple disease modifying anti-rheumatic drug (DMARD) therapy over 3 years in rheumatoid arthritis (RA) patients and to evaluate the association with treatment persistence. Disease Activity Score in 28 joints, baseline risk factors and medication usage were obtained from a longitudinal observational cohort of early RA patients, most of whom were treated with combination DMARD therapy consisting of methotrexate, sulfasalazine and hydroxychloroquine. Persistence of each DMARD was defined as the duration of time from initiation to cessation. A group-based trajectory modelling technique was used to identify disease activity trajectories. Three disease activity trajectories (good [43.8%], moderate [39.7%] and poor [16.5%]) were identified in a cohort of 297 patients. Most baseline risk factors, medication usage, the rate of treatment persistence and the effect of persistence on disease activity differed among patients in each of the three trajectories. Although the rate of persistence was higher in the trajectory with a good outcome, the association with persistence was more pronounced among patients who were in the poor outcome trajectory. Persistence with at least two or all three baseline DMARDs was associated with a decrease in disease activity to a broadly similar degree in all trajectories. After correction for other baseline prognostic factors, persistence with initial DMARDs contributes to heterogeneity in disease activity trajectory and there was an association between persistence with initial DMARD therapy and lower long-term disease activity.

Drug prescribing trends in adults with rheumatoid arthritis: a population-based comparative study from 2005 to 2014.

The aim of this study was to examine drug prescribing trends for patients with rheumatoid arthritis (RA) over recent years and compare them to matched non-RA subjects. Retrospective prescription data were examined from 2005 to 2014 in a population-based incidence cohort of patients with RA and comparable non-RA subjects. Drugs for or related to the treatment of RA were excluded. Comparisons between cohorts of percentages of patients with at least one prescription in a specific drug category/class were performed using Poisson regression models adjusted for age and sex. The study included 497 RA (71% female) and 527 non-RA subjects (70% female). The overall observed percentage of subjects who were prescribed at least one drug over the 10-year period was somewhat higher among the RA compared to non-RA subjects (relative risk [RR], 1.04; 95% confidence interval [CI], 0.99, 1.08). Over the study period, both groups demonstrated significant increases in the percentages of patients with at least one prescription (age- and sex-adjusted 7% increase over 10years in RA, p < 0.001; 11% increase in non-RA, p < 0.001). Drugs that were more common among RA than non-RA included gastrointestinal drugs, antimicrobials, calcium metabolism modifiers, thyroid hormone replacement therapy, tricyclic antidepressants, antiasthma/inhaled corticosteroids, proton pump inhibitors, contraceptives, antihypertensives, and some others. Prescription drugs that were less common in RA than non-RA were statins and other antilipemic drugs. Excluding drug prescriptions specifically for treatment of RA, there was a marked overall increase in prescriptions for drugs for both RA and non-RA cohorts over the study period.

Early clinical response predicts low disease activity at one year in rheumatoid arthritis patients on treatment with certolizumab in real-life settings. An appraisal of the Italian registry GISEA

ObjectivesThe aim of this study was to assess whether good EULAR response assessed at 3months may predict the achievement of low disease activity (LDA) at 1year in rheumatoid arthritis (RA) patients on treatment with certolizumab pegol (CZP). MethodsFrom the nationwide Italian registry, we analysed 278 RA patients (age 54.8±12years, duration of disease 9.8±8years, female 84%) initiating CZP as first line (68%) or≥second line (32%) of biological treatment because of their active disease. Assessment of disease activity was based on 28 joint Disease Activity Score (DAS28). A reduction of DAS28>1.2 (good EULAR response) was assessed at 3months, and the achievement of LDA (DAS28≤3.2) was evaluated at 1year. Multiple regression models were used to estimate predictors of early good EULAR response or LDA. ResultsThe percentages of patients attaining good EULAR response were 52% at 3, 65% at 6, and 66% at 12months. Furthermore, 51.2% (98/192) of the patients reached LDA at 12months. Patients taking CZP as first biological treatment had adjusted odds ratios (OR) of good EULAR response at 3months 6 folds higher than in those with≥1 prior biological drug (OR 6.7, 95% CI 1.97–23.1). While, the strongest variable correlating with 12months LDA was the achievement of good EULAR response at 3months (OR 11.3, 95% CI 13.1–34.8). ConclusionsOur findings showed that attaining good EULAR response at 3months strongly predicted 1year LDA in RA patients treated with CZP in real-life settings.

A Strange Evolution of Rheumatoid Arthritis – Case Report

This paper brings in discussion a strange case evolution of rheumatoid arthritis in a female patient of 72 years old who was admitted in the Department of Plastic Surgery and Reconstructive Microsurgery for a tumoral structure of 4/8 cm in the right deltoid region, with incision marks on its surface, non-adherent with the surrounding tissues and no inflammatory sign locally. The patient has a history of more than 20 year of rheumatoid arthritis, for whom she had been treated whit immunosuppressors (Etanercept) for 10 years. Taking in consideration this fact, the most significant side effect of these medications is the increasing risk of all types of infections, including tuberculosis, especially skin tuberculosis or even an abscess due to a possible local skin reactions after injection of the anti-TNF agent. The deltoid region presented skin incisions, drainage and unsuccessful multiple antibiotic therapy, which led us to question marks regarding the origin of the collection. Rheumatoid involvement of the shoulder seems to be relatively not so common as the involvement of peripheral joints, but painful symptoms in this region are present.

A Study of Multiple Causes of Death in Rheumatoid Arthritis

To evaluate rheumatoid arthritis (RA)-related mortality in the state of São Paulo (Brazil). Data from all death certificates (DC) from 1996 to 2010 were analyzed using a multiple cause-of-death method. We compared the results from 2 subperiods (1996-2000 and 2006-2010). We found 3955 DC related to RA - 27.6% with RA as the underlying cause of death (UCD) and 72.4% with RA as the nonunderlying cause of death (NUCD). Ninety percent of RA-related deaths occurred at age ≥ 50 years. The mean ages at death were 67.1 ± 13.3 and 67.9 ± 13 years for RA as the UCD and NUCD, respectively. The most frequent NUCD associated with RA were pneumonia, sepsis, renal failure, interstitial lung disease, and heart failure. In the last subperiod, there was an increase in infectious causes. When RA was an NUCD, we observed a decrease in the mean age at death for the last subperiod (p = 0.021). The most common UCD were circulatory and respiratory system diseases. Comparing the mean age at death between RA-related deaths and the general population when deaths occurred at ages beyond 50 years, the linear regression analysis showed a downward curve for RA-related death (p < 0.001 and r = -0.795), while for the general population, as expected, the curve had an upward pattern (p < 0.001 and r = 0.993). Unexpectedly, RA-related deaths occurred at earlier ages in the more recent subperiod. Cardiovascular disease remained the most important cause, and infectious diseases are an increasing cause of death associated with RA, raising the question of whether infections were related to the more vigorous immunosuppressive treatment recommended by recent guidelines.

Significantly impaired shoulder function in the first years of rheumatoid arthritis: a controlled study.

IntroductionPatients with rheumatoid arthritis (RA) risk impaired shoulder function due to the inflammatory process. The knowledge of shoulder function in the early years of the disease is limited. The aim was to compare shoulder function and activity limitation related to the shoulder-arm-hand in women with RA in early disease course compared to age-matched healthy women.MethodThis controlled cross-sectional study included 103 women with rheumatoid arthritis and a reference group of 103 age-matched healthy women. The mean age was 47.1 (SD 10.0) years, the mean disease duration was 20.3 (SD 8.5) months and the mean DAS28 score was 3.8 (SD 1.4) among the patients. Participants were provided with self-reported questionnaires quantifying activity limitations. Shoulder function was assessed by isometric strength of the shoulder, shoulder-arm movement and shoulder pain. Hand-grip force was assessed and examination was made of tender and swollen joints among the patients.ResultsPatients showed significantly (p < 0.0001) impaired shoulder muscle strength, shoulder-arm movement, and shoulder pain compared to the reference group. Patients shoulder muscle strength was approximately 65 % of the results observed in the reference group. Activity limitations related to the shoulder-arm-hand (DASH) were significantly (p < 0.0001) higher in the patient group compared to the reference group and indicates limitations in daily activities for the patients.ConclusionPatients with RA were found to have significantly impaired shoulder function already 1.5 years after disease onset compared to age-matched subjects. Reduced shoulder muscle strength was found to be associated with activity limitations (DASH) implying that screening of the shoulder function, emphasising the shoulder muscle strength, should be initiated from disease onset.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0777-0) contains supplementary material, which is available to authorized users.

A Large-Scale Study Indicates Increase in the Risk of Epilepsy in Patients With Different Risk Factors, Including Rheumatoid Arthritis.

Peripheral neuropathy and inflammatory reactions of the central nervous system may accompany rheumatoid arthritis (RA). Inflammatory processes play a critical role in epilepsy. Therefore, we conducted this study to determine the risk of epilepsy in patients with RA.The RA cohort comprised patients ages 20 years and older who were newly diagnosed with RA between 2000 and 2011, with data obtained from the Registry of Catastrophic Illnesses Patient Database. Patients without RA were frequency matched with an RA cohort at a 1:1 ratio according to age, sex, and year of RA diagnosis.The overall crude hazard ratio (HR) for epilepsy was 1.27-fold higher in the RA cohort compared with that in the controls. After adjustment for age, sex, comorbidities, and medications, the patients with RA were associated with an increased risk of epilepsy compared with those without RA (adjusted HR [aHR] = 1.52, 95% confidence interval [CI] = 1.12–2.07). Compared with the RA patients with ≤ 560 days of nonsteroidal anti-inflammatory drug (NSAID) use, the RA patients with 1181 to 2145 and >2145 days of NSAID use had a significantly lower risk of epilepsy (aHR = 0.35, 95% CI = 0.24–0.52 and aHR = 0.15, 95% CI = 0.09–0.24, respectively).This study provides compelling evidence of an increased risk of epilepsy in patients with RA. The period of NSAID treatment is negatively associated with the risk of epilepsy in RA patients.

PP.13.17

Objective: Patients with inflammatory arthritis have increased cardiovascular risk. The aim of this study was to assess large arterial stiffness and inflammatory markers in patients with short duration rheumatoid arthritis (RA) and ankylosing spondylitis (AS).Design and method: The 77 patients with RA and AS, and 29 healthy subjects were examined. Traditional cardiovascular risk factors, markers of inflammation and endothelial activation (IL-6, IL-18, TNF<alfa>, hsCRP, fibrinogen, sICAM) as well as carotid-femoral pulse wave velocity (PWV) were measured. The overall measure of inflammation based on the individual values of above-mentioned inflammatory markers were calculated. To compare differences between the groups the Mann-Whitney or Kruskal-Wallis tests were calculated. Results: There were no significant differences in traditional cardiovascular risk factors between examined groups with exception of HDL–cholesterol level (p < 0,05). The mean duration of disease symptoms was one and six years for RA and AS respectively. The results of inflammatory markers analysis are summarized in Table 1. The positive correlation (r = 0,23, p < 0,05) between TNF < alfa> and PWV was observed, but it was no longer significant after adjustment for age. Conclusions: In comparison to healthy subjects, patients with inflammatory arthritis of short duration were not presented increased arterial stiffness despite high grade systemic inflammation. Our findings do not support the hypothesis that systemic inflammation is involved in acceleration of atherosclerosis early in the course of the disease.

Development of functional impairment and disability in rheumatoid arthritis patients followed for 20 years: relation to disease activity, joint damage, and comorbidity.

To study the course of impairment measured by Signals of Functional Impairment (SOFI) and disability measured by the Health Assessment Questionnaire (HAQ) over 20 years in rheumatoid arthritis (RA) patients followed from the time of diagnosis, and to explore the contribution of disease activity, joint damage, and comorbidity to variation of SOFI and HAQ over time. Patients diagnosed with RA from 1985-1989 were prospectively monitored. There were 183 patients, 63% women, mean ± SD age 52 ± 12 years. Disease activity was measured by the 44-joint Disease Activity Score (DAS), joint damage by Larsen score, and comorbidity by the Charlson Comorbidity Index. The contribution of comorbidity, DAS, and joint damage on development of SOFI and HAQ was studied at 0, 5, 10, 15, and 20 years followup (hierarchical regression model) and over the total study period using a longitudinal regression model. SOFI progressed over 20 years while progression of HAQ levelled off after 10 years. For SOFI, DAS and joint damage contributed the most (2-28% and 3-31%, respectively). Over 20 years, SOFI was explained by DAS (20%), joint damage (20%), age (7%), and comorbidity (4%). For HAQ, DAS contributed the most (4-24%). Over 20 years, HAQ was explained by DAS (20%), joint damage (2%), sex (7%), comorbidity (6%), and age (4%). Over 20 years, 51% of the variation of SOFI and 39% of the variation of HAQ could be explained by age, sex, variations in comorbidity, disease activity, and joint damage. Over time, disease activity contributed significantly to both SOFI and HAQ. Joint damage contributed predominantly to SOFI.

The role of rheumatoid arthritis (RA) flare and cumulative burden of RA severity in the risk of cardiovascular disease

ObjectiveTo examine the role of rheumatoid arthritis (RA) flare, remission and RA severity burden in cardiovascular disease (CVD).MethodsIn a population-based cohort of patients with RA without CVD (age ≥30 years;...

Intertoe Squamous Cell Carcinoma Developed in a Patient with Rheumatoid Arthritis under Etanercept Therapy.

The use of tumor necrosis factor-α (TNF-α) inhibitors in the treatment of various inflammatory conditions has altered the field of medical therapeutics. Squamous cell carcinoma is the second most common cancer of the skin, usually affecting sun-exposed areas of the body. We present here the case of a 75-year-old woman with rheumatoid arthritis, who developed an intertoe squamous cell carcinoma (SCC) of the right foot. According to her history, she received etanercept and methotrexate for 5 years for rheumatoid arthritis. The rare localization of this cancer could suggest a possible linkage of the malignancy to the chronic intake of anti-TNF-α treatment. This is the first reported case of an interdigital SCC developed under the use of an anti-TNF-α agent.