Evaluation of cardiovascular risk in patients with rheumatoid arthritis: Do cardiovascular biomarkers offer added predictive ability over established clinical risk scores?

Objective

To determine whether adding C‐reactive protein, anti–cyclic citrullinated peptide antibodies, rheumatoid factor, N‐terminal pro–brain natriuretic peptide (NT‐proBNP), oxidized low‐density lipoprotein (ox‐LDL), or anti–apolipoprotein A‐I (anti–Apo A‐I) IgG to the Framingham 10‐year cardiovascular (CV) risk score (FRS) could improve its CV prognostic accuracy in rheumatoid arthritis (RA).

Methods

We performed an ancillary study derived from a prospective single‐center cohort consisting of 118 RA patients without CV disease at baseline. The FRS and the various biomarkers were assessed at enrollment and their prognostic accuracy was determined using receiver operating characteristic (ROC) curve analysis. The incremental predictive ability of biomarkers was assessed using the integrated discrimination improvement (IDI) statistics.

Results

During a median followup period of 9 years, the incidence of CV events was 16%. Both the FRS and 3 of the biomarkers (NT‐proBNP, ox‐LDL, and anti–Apo A‐I) were significant predictors of subsequent CV events (area under the ROC curve [AUC] between 0.68 and 0.73). Anti–Apo A‐I was the only biomarker to significantly improve the prognostic ability of the FRS, with AUCs increasing from 0.72 to 0.81 and the IDI improving by 175% (P < 0.001).

Conclusion

Among the biomarkers tested, only anti–Apo A‐I significantly improved the FRS predictive ability.     

Do patients with older-onset rheumatoid arthritis receive less aggressive treatment?

Rheumatoid arthritis among elderly people is an increasingly important health concern. Despite several cross-sectional studies, it has not been clearly established whether there are important clinical differences between elderly-onset rheumatoid arthritis (EORA) and younger-onset rheumatoid arthritis (YORA). The aim of this study was to compare disease activity and treatment in EORA and YORA, using the Consortium of Rheumatology Researchers of North America (CORRONA) registry, a database generated by rheumatologist investigators across the USA. From the CORRONA registry database of 9381 patients with rheumatoid arthritis, 2101 patients with disease onset after the age of 60 years (EORA) were matched, on the basis of disease duration, with 2101 patients with disease onset between the ages of 40 and 60 years (YORA). The primary outcome measures were the proportion of patients on methotrexate, multiple disease-modifying antirheumatic drugs (DMARD) and biological agents (etanercept, infliximab, adalimumab and kineret) in each group. Disease activity and severity differed slightly between the EORA and YORA groups: Disability Index of the Health Assessment Questionnaire: 0.30 v 0.35; tender joint count: 3.7 v 4.7; swollen joint count: 5.3 v 5.2; Disease Activity Score 28: 3.8 v 3.6; patient global assessment: 29.1 v 30.9; physician global assessment: 24.9 v 26.3; patient pain assessment: 31.4 v 34.9. Regarding treatment, the use of methotrexate use was slightly more common among patients with EORA (63.9%) than among those with YORA (59.6%), although the mean methotrexate dose among the YORA group was higher than that in the EORA group. The percentage of patients with EORA who were on multiple DMARD treatment (30.9%) or on biological agents (25%) was considerably lower than that of patients with YORA (40.5% and 33.1%, respectively; p<0.0001). Toxicity related to treatment was very minimal in both groups, whereas toxicities related to methotrexate were more common in the YORA group. Patients with EORA receive biological treatment and combination DMARD treatment less frequently than those with YORA, despite identical disease duration and comparable disease severity and activity.     

HLA-DRB1 alleles genotyping in patients with rheumatoid arthritis in Chinese.

Objective: To explore the role of HLA-DRB_1 genes in the development of rheumatoid arthritis (RA) and the correlations between HLA-DR alleles and clinical manifestations of patients with RA. Methods: 86 patients and 106 race matched controls in whom HLADR typing was performed by the method of DNA amplification with sequence-specific primers (PCR-SSP)     

Are useful prognostic factors in rheumatoid arthritis?

Rheumatoid arthritis (RA) is an inflammatory disease of unknown etiology, which predominantly affects joints and that confers poor functional and vital outcome. In many patients the inflammatory process is maintained for years, and results in joint destruction and long-term functional disability. Prognostic factors (PF) are demographic, clinical, laboratory and/or radiographic and should be evaluated at the onset of the disease, providing the physician prospective information on patient outcome. The challenge for the rheumatologist is to identify patients who present a poor prognosis in early rheumatoid arthritis and formulate treatment accordingly.     

Outcomes generated by patients with rheumatoid arthritis: how important are they?

Background: It has been shown previously that patients with rheumatoid arthritis (RA) can generate a wide range of outcomes that they consider important in treatment. It is not known if these outcomes are generally important in the wider RA patient community. Objectives: (1) To examine whether recent patient‐generated outcomes are generalizable within a wider RA population; (2) to assess the relative importance of each outcome; and(3) to explore whether any important outcomes have been omitted. Methods: A questionnaire, listing 23 outcomes previously generated by RA patients, was distributed through three rheumatology centres in the UK. Patients gave an importance score to each outcome (0–3), selected their top three most important outcomes, and then listed any outcomes of personal importance that were missing. Results: 323 questionnaires were returned (65%). All outcomes were deemed important. Independence, pain, and mobility were most frequently selected by patients in their top three outcomes but were not chosen by 61–66% of patients. The next most commonly chosen outcomes related to feeling well and fatigue. Factor analysis revealed six reasonably distinct groupings: general well‐being (11.9% explained variance), day‐to‐day functioning(10.6%), emotional and psychological well‐being (10.6%), social role and confidence (10%), physical symptoms (9.5%) and medication issues (7.9%). Conclusion: Outcomes generated by patients as important in RA, are generalizable and inclusive. The most important (independence, pain and mobility) are routinely treated and measured. The next most important (feeling well, fatigue) are infrequently addressed and deserve urgent consideration for measurement, treatment and research. Copyright © 2005 John Wiley & Sons, Ltd.     

Quality of life and functional capacity in patients with rheumatoid arthritis – Cross-sectional study

Objectives

To analyze the Health related Quality of Life (HRQoL) and physical function in rheumatoid arthritis (RA) patients and compare it with the general population. We also intended to analyze about disease activity influence in HRQoL and functional capacity, as well as determine potential determinants for these outcomes.

Does healthcare regime affiliation influence the clinical outcomes of patients with rheumatoid arthritis?

Clinical Rheumatology - Adequate control of disease activity in rheumatoid arthritis (RA) depends, to a great extent, on the access to a rheumatologist. This study aimed to compare the disease...     

What factors affect discordance between physicians and patients in the global assessment of disease activity in rheumatoid arthritis?

Objective: To identify the level of agreement between patients with rheumatoid arthritis (RA) and physicians in the global assessment of disease activity and to explore factors influencing their discordance.

Methods: A total of 4368 patients with RA were analyzed from the KORean Observational study Network for Arthritis (KORONA) database. Patients were divided into four subgroups according to difference from their physicians in the assessment of disease activity by substracting physician’s visual analog scale (VAS) from patient’s VAS as follows: positive discordance group I (10?mm?≤?discordance <25?mm), positive discordance group II (≥25?mm), concordance (<|10| mm), and negative discordance (≤??10mm). Multinomial logistic regression analysis was performed to identify factors associated with discordance.

Results: Only 1350 (29.2%) patients were classified in the concordance group. Positive discordance was found in 52.3% of the patients (n?=?2425), with 33.7% (n?=?1563) showing marked discordance (≥25?mm). The high disease activity (OR =1.41), gastrointestinal (GI) disease (OR =1.28), pain (OR =1.12), fatigue (OR =1.07) were consistently associated with positive discordance.

Conclusion: More than half of patients with RA thought their disease more severe than their physicians. In addition to high disease activity, pain, fatigue, and sleep disturbance or GI disease were associated with the discordance between physicians and patients with RA.     

What do self-administered joint counts tell us about patients with rheumatoid arthritis?

Objective . This report presents data from two sources showing that a self-administered joint count (SAJC) suitable for use in clinical settings provides information comparable with that of observerassessed joint counts. Methods . Patients were tested with a 1-page form containing a 40-joint mannequin on which they could mark their painful or swollen joints. The first sample of 110 patients was used to compare the SAJC with the tender or swollen joint counts (TJC or SJC) performed by a rheumatologist and to a battery of clinical and laboratory measurements. The second sample consisted of 240 rheumatoid arthritis (RA) patients enrolled in a cohort study of RA outcomes, in whom the relationship between the SAJC and health-related quality of life measures was examined. Results . Test-retest reliability of the SAJC was excellent (r_i = 0.89), as was its agreement with the observer-assessed TJC (r_i = 0.78). The SAJC was significantly correlated (P ≤ 0.01) to pain on a 10-point scale (r = 0.33), the McGill Pain Questionnaire (r = 0.27), the pain subscale of the Arthritis Impact Measurement Scales (AIMS) (r = 0.32), the duration of morning stiffness (r = 0.27), and to the AIMS subscales of physical function (r = 0.20), impact (r = 0.31), and global health (r = 0.29). The SAJC was inversely related to formal education (r = −0.32), but did not correlate significantly with the modified Health Assessment Questionnaire, walking velocity, grip strength, or erythrocyte sedimentation rate. The responsiveness of the SAJC was comparable with that of other measures commonly employed to assess RA outcomes. Either the SAJC or the TJC could be included alternatively in multivariate models to explain 7 of the 8 subscales of the Medical Outcomes Study Short Form-36 (SF-36) questionnaire. Conclusion . The SAJC is a reliable and responsive measure that agrees highly with the observer-assessed TJC and is significantly associated to the health-related quality of life of patients with RA. Given its low cost and ease of administration, it is suggested that SAJC be included in future studies of RA outcome in routine clinical practice.