The evaluation of quality of life in fibromyalgia syndrome: a comparison with rheumatoid arthritis by using SF-36 Health Survey

Musculoskeletal disorders are the most common causes of deterioration in quality of life (QOL). We in this study aimed to assess (1) the impact of fibromyalgia syndrome (FS) on QOL comparing with that of rheumatoid arthritis (RA) patients and control subjects and (2) the impact of these two musculoskeletal disorders on various components of QOL using SF-36 Health Survey. Thirty-five patients with RA, 30 patients with FS, and 30 voluntary control subjects were included in the study. The groups were comparable in terms of demographic characteristics. QOL was evaluated by using Short-Form (SF)-36 Health Survey in all study participants, and Fibromyalgia Impact Questionnaire (FIQ), which is a specific health-status instrument for FS, was used in FS patients. Physical functioning, physical role, social functioning, bodily pain, general health, vitality, emotional role, and mental health scores were significantly lower in RA and FS patients than in control subjects (p<0.05). The between-groups comparisons revealed that FS patients had significantly lower mental health scores than RA patients (49.87 vs 62.51, respectively), (p<0.001). Total FIQ score correlated significantly with physical functioning, physical role, and bodily pain in FS patients. All parameters of SF-36 Health Survey except for social functioning correlated significantly with some of the variables of FIQ. FS has a negative impact on QOL, like RA. Furthermore, mental health was more severely affected in FS patients when compared with RA patients.     

The relationship between disease activity and depression in patients with Behcet disease and rheumatoid arthritis

Disease activity may be questioned as a possible related factor to depression in patients with rheumatoid arthritis (RA) and Behcet disease (BD). Our aims were to determine and compare the depression levels of patients with RA and BD and to investigate a possible association between disease activity and depression scores of the patients. A total of 30 RA and 30 BD patients were included in this study. In RA patients; pain, morning stiffness duration, systemic involvement, tender–swollen joints, the physician–patient global assessments and DAS28 scores were determined. In patients with BD, the BD Current Activity Form was assessed for disease activity. Beck depression inventory (BDI) was used for the evaluation of patient groups. BDI score above 13 was considered as cut-off point for depression. Pearson’s correlation and Mann–Whitney U tests were used for statistical analysis. In RA patients, in spite of no correlation between disease activity and depression, a significant correlation between BDI scores and pain was determined (p < 0.000; r = 0.615). In BD group; positive correlations between BDI scores and patient’s impression of disease activity and arthralgia were determined (p < 0.014 and p < 0.001, respectively). Number of BD patients with higher BDI scores than cut-off point was significantly more than those in RA group (p < 0.039). Pain in RA patients, and patient’s impression of disease activity and joint involvement in BD patients were found as related factors to the depression scores. The greater ratio of BD patients with higher depression score than those in RA indicates the need for increased awareness of depressive symptoms in patients with BD.     

Measuring utilities by the time trade-off method in Tunisian rheumatoid arthritis patients

The objective of this study was to determine the feasibility, reliability and validity of the time trade-off (TTO) in Tunisian rheumatoid arthritis (RA) patients. The TTO was used to measure the utility in 122 RA patients with increasing difficulty in performing activities of daily living. The 1-week test–retest reproducibility was studied in 57 patients using the intraclass correlation coefficient (ICC). Validity was evaluated by comparison with other outcome measures: utility rating scale (RS), quality of life (QOL) [arthritis impact measurement scale 2 (AIMS2), rheumatoid arthritis quality of life (RAQOL)], functional status [health assessment questionnaire (HAQ), Lee index] and disease activity score (DAS). Eight patients (6.6%) did not complete the TTO. The median value of the TTO score was 0.655 (0.019–1.000). The ICC for reliability of the TTO was 0.89 (p<0.001). The TTO showed poor to moderate correlation (Spearmans correlation coefficients between 0.2 and 0.409, p<0.01) with AIMS2, RAQOL, HAQ and Lee index. We did not find any correlation between TTO and DAS. Multiple regression analysis showed that only 32% of TTO scores could be explained. The TTO method appeared to be reliable in a group of Tunisian RA patients, but TTO values were poorly to moderately related to measures of QOL, functional ability, and disease activity. We think that TTO and RS are not feasible for use in RA patients.     

Health-related quality of life in ankylosing spondylitis,fibromyalgia syndrome,and rheumatoid arthritis: a comparison with a selected sample of healthy ındividuals

In this study, we compared health-related quality of life (HRQoL) scores of patients with rheumatoid arthritis (RA), fibromyalgia syndrome (FS), or ankylosing spondylitis (AS), with those of a selected sample of healthy individuals. The study group comprised 530 patients (264 with RA, 149 with FS, and 117 with AS). Three hundred fifteen healthy controls were used for comparison. HRQoL scores were obtained using the Short-Form (SF)-36 Health Survey. Frequency, mean, correlation, and multiple regression analyses were performed; in addition to the Student's t test, one-way ANOVA test, Kruskal–Wallis test, and chi-square test. The average physical component summary (PCS) and mental component summary (MCS) scores of patients in the RA, FS, and AS groups were much lower than those in the control group (p < 0.05). In all three patient groups, the lowest PCS score was found in the RA group, and the lowest MCS score was found in the FS group. The PCS scores of RA patients with disease-related changes in daily activities and the MCS scores of FS patients were lower (p < 0.05). In the three patient groups, the quality of life (QoL) of university graduates and those with a high level of income was good, whereas the QoL of patients who lacked information about the disease was poor. This study shows that AS, FS, and RA have a negative impact on HRQoL. Evaluating the HRQoL of patients with these conditions may provide guidance on their treatment and care.     

A comparative evaluation of quality of life and life satisfaction in patients with psoriatic and rheumatoid arthritis

Both rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have a negative impact on patients’ quality of life (QOL). The aim of this study was to compare QOL and life satisfaction in patients with RA and PsA. Forty patients with PsA, 40 patients with RA, and 40 healthy control subjects were included in the study. Demographic data and clinical characteristics including age, sex, disease duration, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), peripheral pain assessed by visual analog scale (VAS) and Larsen scores of hand X-rays were recorded. Nottingham Health Profile (NHP) was used to evaluate QOL, and Life satisfaction index (LSI) was used to measure psychological well-being in both groups. The demographic data of the subjects were similar between the groups. The scores of all NHP subscales were significantly higher and the scores of LSI were significantly lower in PsA and RA patients than in control subjects. The inflammation markers including ESR, CRP, pain by VAS and Larsen scores were found to be significantly higher in RA patients. The scores of LSI were similar between the groups. Although the scores of physical domains of NHP (pain and physical disability) were statistically higher in RA patients (p<0.05), the scores of psychosocial subgroups of NHP were similar between RA and PsA patients (p>0.05). Both PsA and RA patients had disturbed QoL and decreased life satisfaction. In conclusion, peripheral joint damage, inflammation, and physical disability are significantly greater in RA but psychosocial reflection of QOL and life satisfaction are the same for both groups which can be explained by the additional impact of skin disease in patients with PsA.     

Impaired bone formation and osteoporosis in postmenopausal elderly onset rheumatoid arthritis patients

Introduction

Bone metabolism may be uncoupled in postmenopausal rheumatoid arthritis (RA). Osteoporotic fracture in RA is highest for the hip especially in elderly women.

Aim of the work

To detect the bone mineral density (BMD) and markers of bone turnover in postmenopausal RA patients and study the influence of age at disease onset. Correlation with clinical and laboratory manifestations and disease activity were considered.

Patients and methods

Sixty postmenopausal RA patients were recruited into two groups, group I: 30 elderly onset (EORA) and group II: 30 young onset (YORA) patients. Thirty age and sex matched healthy subjects served as control. Full history taking, clinical examination, relevant investigations including calcium, phosphorus, total alkaline phosphatase (ALP), bone specific alkaline phosphatase (BALP), osteocalcin (OC), and N-terminal cross-linked telopeptides of type I collagen (NTX) were measured and BMD assessed by DEXA in all patients and control. Disease activity score in 28 joints (DAS-28) was calculated.

Results

The NTX was remarkably increased and the BMD decreased in RA patients. Osteocalcin in RA was 3.87 ± 1.15 ng/ml being obviously lower in EORA patients compared to YORA and control. In EORA, a significant correlation was present between the ALP and OC (r 0.41, p 0.025) and the NTX and BALP (r 0.46, p 0.011) and a negative correlation between the hip BMD and DAS-28 (r −0.43, p 0.019).

Conclusion

Impaired bone formation and uncoupling of bone turnover are more evident in postmenopausal EORA patients which form a risk predictor of fracture hip in this subgroup of patients.     

Influence of serum folic acid levels on plasma homocysteine concentrations in patients with rheumatoid arthritis

The purpose of this study was to investigate whether negative effects of methotrexate (mtx) on blood homocysteine (hmc) levels can be prevented with the replacement of folic acid. 42 female patients with rheumatoid arthritis (RA) were studied. Patients were separated into two groups according to their treatment status with mtx (group I: 27 patients taking mtx and folic acid; group II: 15 patients not using mtx). The level of hmc was found to be 6.3±2.4 µmol/l in group I and 7.87±3.2 µmol/l in group II (p>0.05). Folic acid levels of group I and II were found to be 21.3±15.9 ng/ml and 8.41±2.86 ng/ml respectively (p<0.001). There was a statistically-significant correlation between age and hmc levels (r=0.386, p=0.012). Negative statistically-significant correlations were observed between folic acid and hmc levels. The effects of mtx on hmc can be prevented with the replacement of folic acid.This revised version was published in February 2005 with corrections to the authors affiliations and the abstract.     

Quality of life and physical functioning of relativesof fibromyalgia patients

Objectives:

The quality of life (QOL) and health status of fibromyalgia syndrome (FS) patients is impaired, and may adversely affect their close relatives. The aim of this study was to assess the QOL and physical functioning of relatives of FS patients.

Methods:

A total of 118 relatives (parents, husbands, siblings, and offspring) of30 FS female patients were evaluated using a QOL scale and the Fibromyalgia Impact Questionnaire (FIQ) and were compared with 124 healthy controls. These measures of functioning and QOL were further studied in relatives with and without FS.

Results:

Although the QOL of the relatives was better than that of the FS indexwomen, they were significantly less satisfied than the controls with functioning-related aspects, namely work (job or home), independence, and health (P < .05). Relatives with FS (n = 29) and female relatives (n = 40) reported lower QOL than relatives without FS (n = 89) and male relatives (n = 78), respectively. Similarly, physical functioning of relatives, though better than in FS index cases, was significantly worse than in healthy controls. Furthermore, the health status of female relatives and relatives with FS was significantly worse than that of male relatives and relatives without FS, respectively.

Conclusions:

The quality of life and physical functioning of relatives of FS patients were found to be impaired, especially in female relatives and those with undiagnosed FS. This finding may be attributed to the psychological distress in families of FS patients and to the high prevalence (25%) of undiagnosed FS among the relatives.     

What is the factor that most influences QOL among rheumatoid arthritis patients?

We attempted to elucidate the factors which affect the quality of life (QOL) among patients with rheumatoid arthritis (RA). Ninety-five patients who satisfied the American Rheumatism Association criteria for RA were asked to fill in a modified arthritis impact measurement scale, version 2 (AIMS2) and complete a Lorish's face scale (FS) test. The same questionnaire and FS test were completed by 75 healthy persons as controls. We used Lorish's FS for our assessment of QOL. The investigation was undertaken to analyze the relationship between FS and each item on the questionnaire. For average FS score, there was no significant difference between the RA group and the controls. However, RA group scores covered a wider range than those of the controls. From the correlation analysis, physical stress, pain factors, and some of the activities of daily living (ADL) factors showed a strong correlation with FS. ADL factors which strongly correlated with FS were those related to activities of the lower limbs. Other ADL factors were moderately correlated with FS. Socioeconomic factors were not significantly correlated with FS. There was no significant difference between the QOL of RA patients and that of healthy controls. The QOL was correlated with pain and stress factors rather than with ADL factors among patients with RA. Received: June 9, 2000 / Accepted: October 23, 2000     

Hypermobility in women with fibromyalgia syndrome

The purpose of this study was to evaluate the relationship between hypermobility and fibromyalgia syndrome (FS) in women. Ninety-three women with FS who met the American College of Rheumatology criteria for FS and 58 healthy women without FS were included in this study. All women were examined for hypermobility by blinded observers using the Beighton criteria. The mean age was 43.5±9.9 (21–68) and 40.2±11.1 (21–63) years in the FS and control groups, respectively, and the two groups were statistically similar (p>0.05). The mean Beighton total score was 4.7±2.1 and 2.9±2.4 in the FS and control groups, respectively (p<0.0001). The frequency of joint hypermobility was 64.2% in the FS group and 22% in the control group. In accordance with the Beighton criteria (p<0.05), we found that the joint hypermobility ratio was significantly higher in patients with FS than in subjects without FS. Additionally, we evaluated the correlation between the total Beighton score and the age and number of trigger points. There were negative correlations between the total Beighton score and the age (r=−0.42, p<0.001) and number of trigger points (r=−0.24, p=0.03) in all patients. Hypermobility syndrome is more common in women with FS than in those in the control group. Therefore, the relationship between hypermobility and FS should be taken into consideration in the diagnosis and follow-up of women, especially those with widespread pain.     

Serum substance P: an indicator of disease activity and subclinical inflammation in rheumatoid arthritis

The aim of the is study is to examine the role of serum substance P (SP) levels as a simple biomarker for rheumatoid arthritis (RA) disease activity, its correlation with other markers of disease activity, and with selected clinical parameters. The study comprised 90 RA patients and 24 healthy controls. RA activity was assessed by means of the disease activity 28-C-reactive protein (DAS28-CRP) index and ultrasound power Doppler (USPD) by the German ultrasound score based on seven joints. SP serum values were obtained by means of an ELISA commercial kit. Statistics were achieved by the Student’s t test and Spearman correlation analysis with Bonferroni correction. As a group, RA patients had significantly increased levels of SP compared with healthy controls (p?<?0.0001). SP levels correlated with DAS28-CRP (r =?0.5050, p?<?0.0001), number of tender joints (NTJ, r =?0.4668, p?<?0.0001), number of swollen joints (NSJ, r?=?0.4439, p?<?0.0001), visual analogue scale (VAS, r?=?0.5131, p?<?0.0001). However, SP did not correlate with CRP levels (r?=?0.0468, p?=?0.6613), nor with the USPD (r?=?0.1740, p?=?0.1009). Elevated serum SP is a common feature of RA patients, which also appears to correlate with clinical measurements of disease activity and with subjective clinical data (NTJ and VAS). Thus, although SP is higher in RA patients with high disease activity, it also detects subtle RA disease activity even in patients in apparent remission, which suggests its usefulness for therapeutic decisions.     

Characteristics of rheumatoid arthritis patients with concomitant hepatitis C virus infection

Introduction

Hepatitis C virus (HCV) is frequently associated with rheumatic autoimmune manifestations including rheumatoid-like arthritis.

Aim of the work

This work is aimed to study the impact of concomitant HCV infection on rheumatoid arthritis (RA) patients.

Patients and methods

110 RA patients (mean age 44.6 ± 12.7, disease duration 7.92 ± 6.56 years) were included. HCV infection was diagnosed by HCV-antibody (HCV-Ab) and polymerase chain reaction. Disease activity was assessed using the disease activity score 28 (DAS28) and radiological damage by a modified Larsen method. Functional disability was assessed by the Modified Health Assessment Questionnaire (MHAQ).

Results

HCV-Ab was detected in 20% and viremia in 12.7% of RA patients. HCV-Ab positive patients were significantly older (p < 0.001) and had a longer disease duration (p = 0.02). No differences were found between HCV-Ab positive and -negative patients in DAS28 and modified Larsen’s scores, however, HCV-Ab positive patients had a higher frequency of deformities (p < 0.005) associated with older age (p < 0.001) and higher MHAQ scores (p = 0.002), independent of age and disease duration. They also had a higher frequency of hepatomegaly (p < 0.001) and vasculitis (p < 0.001). Hepatomegaly was associated with older age (p = 0.004) and longer disease duration (p = 0.003) while vasculitis was associated with older age (p = 0.02).

Conclusion

Concomitant HCV infection in RA patients is associated with significant disability and comorbidities in the form of hepatomegaly and vasculitis. Hepatomegaly and vasculitis were associated with older age. Hepatomegaly was also associated with longer disease duration. Screening for HCV infection is recommended in Egyptian RA patients.     

The relation of serum vascular endothelial growth factor level with disease duration and activity in patients with rheumatoid arthritis

Vascular endothelial growth factor (VEGF) is known to be involved in the pathogenesis of rheumatoid arthritis (RA). In order to elucidate the association between VEGF levels and RA disease activity, VEGF concentrations were measured in RA patients at different phases and severity levels. Thirty-eight healthy subjects and 40 patients with RA were prospectively included in the study. Subjects were further categorized into four subgroups (high, moderate, low, or remission) using the disease activity score-28 (DAS28) scoring system. VEGF levels were significantly higher in patients than controls (p < 0.001). VEGF levels differed significantly in controls, early and late-phase RA patients (p = 0.002). A significant difference was found between controls and patients with high RA disease activity scores (p < 0.0001). VEGF levels were not correlated with age (r = −0.016; p = 0.921) or sex (r = 0.209; p = 0.921). VEGF values were correlated with erythrocyte sedimentation rate (r = 0.445; p = 0.004), but was not correlated with serum rheumatoid factor levels (r = −0.130; p = 0.424) in the patient group. In conclusion, higher VEGF levels are associated with late phase and high disease activity in RA, independent of age and sex.     

Factor analysis of the questionnaire of olfactory disorders in patients with chronic rhinosinusitis

Background

Olfactory‐specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders–Negative Statements (QOD‐NS), which examines various aspects of olfactory dysfunction. It is unknown if certain factors of the QOD‐NS differentially impact QOL.

Methods

Patients with chronic rhinosinusitis (CRS) completed the QOD‐NS, 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Medical Outcomes Study Short Form 6‐D (SF‐6D) health utility measure, and Patient Health Questionnaire‐2 (PHQ‐2) depression screen. Exploratory factor analysis of the QOD‐NS was performed. Associations between QOD‐NS factors and other QOL metrics were analyzed before and after endoscopic sinus surgery (ESS).

Results

Outcomes were examined on 132 patients. The QOD‐NS contains 4 distinct factors. There was no difference in associations between the different factors and baseline clinical characteristics. ESS had greatest effect size (d) on factors 2 and 4 (d = 0.29 and 0.27, respectively, p < 0.05). Postsurgical changes in the SF‐6D and SNOT‐22 had the strongest correlation with factor 2 scores (r = 0.29 and 0.34, respectively, p < 0.05), and changes in the PHQ‐2 had the strongest correlation to factor 3 (r = 0.24, p < 0.05). Abnormal QOD‐NS scores at baseline were associated with effect size increases of 50% to 100% (p < 0.05).

Conclusion

The QOD‐NS measures 4 distinct factors. Eating‐related questions had the greatest improvement after ESS. Health utility and CRS‐specific QOL improvement most strongly associated with factor 2, while PHQ‐2 changes are most highly associated with factor 3, suggesting a differential impact of the factors of the QOD‐NS on varying aspects of QOL.

     

Taste impairment in chronic rhinosinusitis

Background

Though many patients with chronic rhinosinusitis (CRS) describe disturbances in smell and taste, there have been no studies specifically assessing taste impairment in CRS. This study sought to objectively assess taste dysfunction in CRS patients and determine whether taste impairment correlates with olfactory dysfunction. Additionally, this investigation sought to determine the impact of taste dysfunction on quality of life (QOL) in CRS and identify the clinical factors that influence taste.

Methods

Sixty‐eight CRS patients were prospectively enrolled and completed several QOL surveys in relation to taste, smell, overall sinus‐specific QOL, and depression. Validated taste strips were used to determine gustatory dysfunction pertaining to sweet, sour, salty, and bitter. Olfactory testing was assessed using the Sniffin’ Sticks Test while both Lund‐Kennedy and Olfactory Cleft Endoscopy Scoring (OCES) systems were used for endoscopic evaluation.

Results

The overall prevalence of dysgeusia was 28%, with scores significantly lower for sour compared to other subgroups. No correlation was observed between taste scores and objective olfactory metrics including olfaction tests and OCES. Taste scores were better in younger patients (r = 0.28, p = 0.02), female patients (p = 0.004), and never smokers compared to former smokers (p = 0.01). Taste scores did not correlate with patient‐reported outcome measures or CRS disease severity metrics.

Conclusion

Taste dysfunction is a common complaint in CRS. This cohort shows prevalence of gustatory loss to be about 28% using ideal normative values. This dysfunction correlated with male gender, smoking history, and older age. Taste dysfunction did not correlate with measured olfactory outcomes.

     

Reliability,validity, and cross-cultural adaptation of the Turkish version of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire

Up to 98% of rheumatoid arthritis (RA) patients experienced fatigue. It is an important physical and cognitive symptom which has overwhelming, uncontrollable, and unpredictable affects throughout their whole life. RA fatigue composes of complex and multi-dimensional components which are pain, stress, depression, inflammation, and disability. The acknowledgement of fatigue is important, and fatigue should be measured in all RA trials alongside the core set. The aim of this study was to determine reliability and validity of Turkish version of Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire in RA patients. One hundred RA patients were evaluated in the study. Exclusion criteria were determined as patients with cognitive impairment, illiterate patients, unable to understand and speak Turkish, under the age of 18, and over the age of 75. To validate Turkish version of Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) (BRAF-MDQ-T), all participants answered BRAF-MDQ-T, Multidimensional Assessment of Fatigue (MAF) scale, and Short Form-36 vitality (SF-36 VT). BRAF-MDQ-T was applied again 7 days later for test–retest reliability. Validity, internal consistency, and test–retest results were based on a sample of 100 patients. Internal consistency reliability of BRAF-MDQ-T was Cronbach α?=?0.95 which was excellent. The correlation between the total scores of the BRAF-MDQ-T scale and the total scores of MAF-T was statistically significant (r?=?0.82, p?<?0.001). The correlation between the total scores of the BRAF-MDQ-T scale and the subscale scores of SF–36 VT was statistically significant (r?=???0.64, p?<?0.001). The BRAF-MDQ-T is a valid and reliable scale for the assessment of fatigue in Turkish rheumatoid arthritis patients.     

A study on vascular endothelial growth factor and endothelin-1 in patients with extra-articular involvement of rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease associated with a wide range of extra-articular manifestations. Recent studies emphasise a key inflammatory role of the endothelial cells, either by overexpression of inflammatory mediators or by the proliferation of new blood vessels, in the disease process leading to the systemic organ involvement. To evaluate the relationship between internal organ manifestations and immunological markers of endothelial activation, serum levels of vascular endothelial growth factor (VEGF) and endothelin-1 (ET-1) were determined by an enzyme-linked immunosorbent assay in 64 RA patients and in 32 healthy controls. In comparison with a control group, higher serum concentrations of VEGF and ET-1 (p<0.001) in RA patients were demonstrated. A comparison between both RA groups with (20 patients) and without systemic involvement (44 patients) showed significantly higher concentrations of VEGF (p<0.05) and ET-1 (p<0.01) in the sera of patients with systemic manifestation. Moreover, a significant positive correlation between VEGF and ET-1 (r=0.475, p<0.001) in RA patients was found. A positive correlation between VEGF and Disease Activity Score (DAS) 28 index (r=0.39, p<0.005) as well as erythrocyte sedimentation rate (ESR) (r=0.564, p<0.0001) and C-reactive protein was found. ET-1 serum level correlated significantly with ESR (r=0.326, p<0.05) and DAS 28 index (r=0.307, p<0.05). These results suggest that the elevated serum levels of VEGF and ET-1 are associated with systemic organ involvement in RA patients and may play a key role in the pathogenesis of extra-articular manifestation of the disease.     

Autoantibodies against myelin sheath and S100β are associated with cognitive dysfunction in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) has been associated with cognitive impairment and peripheral production of autoantibodies. Autoantibodies against central nervous system (CNS) proteins and S100 calcium-binding β (S100β) were found increased in diseases characterized by cognitive impairment like Alzheimer disease and Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). The aim of this study was to investigate the plasma levels of autoantibodies against myelin basic protein (anti-MBP), myelin oligodendrocyte glycoprotein (anti-MOG) and S100β, and their relationships with cognitive performance in RA patients. Twenty patients with active rheumatoid arthritis and 19 age-, sex-, and schooling-matched healthy controls were recruited. Multiple dimensions of cognitive function were evaluated by structured clinical questionnaires. Autoantibodies and S100β levels were assessed by ELISAs. Patients had significantly higher levels of anti-MBP IgG (17.51 ± 1.36 vs. 5.24 ± 0.53 ng/mL), anti-MOG IgG (5.68 ± 1.34 vs. 0.51 ± 0.49 ng/mL), and S100β protein (2.24 ± 0.50 vs. 0.47 ± 0.06) than controls (all p < 0.0001). After adjusting for potential confounders, RA group presented worse cognitive performance involving the working memory and executive functions such as inhibition, flexibility, and mental control in parallel to higher autoantibodies and S100β levels than healthy controls (all p < 0.001). Levels of anti-MBP were negatively associated with delayed verbal recall (DVR; r = ?0.42, p = 0.005), Stroop Color-Word (r = ?0.48, p = 0.004), and N-Back Total scores (r = ?0.59, p < 0.0001) and positively with Trail Making Test B (TMB, r = 0.53, p = 0.001). Negative correlation was found between levels of anti-MOG and DVR (r = ?0.64, p < 0.0001), N-Back Total scores (r = ?0.35, p = 0.03), Stroop Color-Word (r = ?0.51, p = 0.001), and positively with TMB (r = 0.50, p = 0.003). S100β levels were associated with DVR (r = ?0.51, p = 0.002), TMB (r = 0.46, p = 0.008), Stroop Color-Word (r = ?0.67, p < 0.0001), and N-Back Total (r = ?0.52, p = 0.003). RA is associated with impaired cognitive performance associated with higher levels of CNS-related autoantibodies and S100β levels. Given the importance of myelin integrity to cognition, our data indicate that these autoantibodies may be harmful to proper cognitive function.     

Ultrasound-detected joint inflammation and B cell count: related variables for rituximab-treated RA patients?

This cross-sectional observational study aimed to explore the relationship between B cell count and ultrasound (US)-detected synovitis, in patients with rheumatoid arthritis treated with rituximab. Thirty-seven consecutive RA patients treated with RTX were recruited for the study. The patients underwent clinical [i.e., Disease Activity Score 28 joints (DAS28)], laboratory, and US assessment of 12 joints. Each joint was semiquantitatively (0–3) scored on B-mode and power Doppler mode. The scores were summed, and a global index was created for BM (BMS) and PD scores (PDI) synovitis. BM subclinical synovitis was evident in all patients, with PD synovial signal detected in 16 patients (43.2 %). No correlation was found between DAS28 and US scores. B cells were detected in 27 (72.9 %) patients, but there was no association in the mean B cell count and disease activity as measured by DAS28 (DAS28 < 2.6 = 34.53, DAS28 > 2.6 = 49.45, p = 0.52) and PDI score (PDI < 1 = 49.48, PDI > 1 = 35.44, p = 0.54). There was no correlation between the B cell count and DAS28, BMS, and PDI (r = 0.020, p = 0.907; r = ?0.151, p = 0.371; r = ?0.099, p = 0.558, respectively). In RTX-treated RA patients, no relationship could be established between US-detected synovitis and peripheral blood B cell count.     

Depression, disability, and quality of life after off-pump coronary artery bypass grafting: A prospective 9-month follow-up study

Background

Several studies have looked at the effects on mood and quality of life (QOL) among patients who underwent on-pump coronary artery bypass grafting (CABG), but few have reported on off-pump CABG (OPCABG).

Methods

We recruited 50 patients undergoing OPCABG. The day before CABG, patients were interviewed using 4 questionnaires: the Beck Depression Index (BDI), Beck Anxiety Index (BAI), Sheehan Disability Scale (SDS), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). The process was repeated at 1, 3, 6, and 9 months.

Results

One month postoperatively, patients showed increased levels of depression (Δ 1.67 in the mean BDI score, P < .05) and disability (Δ 5.28 in the mean SDS score, P < .001) and decreases levels of anxiety (Δ 3.7 in the mean BAI score, P < .001) and QOL compared with baseline. When compared with the first month, at 9 months patients were significantly less depressed (Δ 3.58 in the mean BDI score, P < .001), were less disabled (Δ 5.34 in the mean SDS score, P < .001), and had better QOL (Δ 3.82 in the mean Q-LES-Q score, P = .014). At 9 months, 44% had some degree of depression and 48% had low QOL.

Conclusion

Despite that all scores returned to or below baseline at 9 months, a high percentage of patients still had depressive symptoms and overall poor quality of life (QOL). BDI scores at baseline are good predictors of QOL at all measured intervals. This should make physicians more prudent in diagnosing and observing these patients.