Autonomic nerve function in rheumatoid arthritis of varying severity

Autonomic nerve function was evaluated by deep breathing and tilt table tests in 17 patients with rheumatoid arthritis (RA) and in 24 healthy control subjects. The results showed that all RA patients had increased heart rates at rest, irrespective of the severity of the disease. Patients with severe RA had increased systolic and diastolic blood pressures before and after tilting. Pronounced abnormalities in the immediate heart rate reaction to tilting indicating autonomic neuropathy (AN) were also demonstrated in patients with severe RA. The abnormal immediate reaction to tilting was mainly the result of vagal neuropathy. From the present study it is evident that severe RA may be accompanied by AN and the consequences need to be elucidated.     

Atorvastatin reduces arterial stiffness in patients with rheumatoid arthritis

BACKGROUND: Chronic systemic inflammation may contribute to accelerated atherosclerosis and increased arterial stiffness in patients with rheumatoid arthritis (RA). In addition to lowering cholesterol, statins have immunomodulatory effects which may be especially beneficial in patients with RA who have systemic immune activation. OBJECTIVE: To investigate the effect of atorvastatin on the augmentation index (AIx: a measure of arterial stiffness) and systemic inflammation in RA. METHODS: 29 patients with RA (mean (SD) age 55 (13) years) with moderately active disease of long duration were studied. AIx, lipid levels, serum inflammatory markers, and disease activity score were measured before and after 12 weeks of atorvastatin 20 mg daily. RESULTS: AIx improved significantly from 34.1 (11.6)% to 29.9 (11)% (p = 0.0002), with the greatest improvements in AIx occurring in those subjects with the highest disease activity scores (r = -0.5, p = 0.007). Total and LDL cholesterol were reduced from 5.5 (0.9) to 3.9 (0.7) mmol/l and 3.3 (0.8) to 1.9 (0.6) mmol/l, respectively (p = 0.0001). Serum inflammatory markers remained unchanged during the study. CONCLUSIONS: Atorvastatin significantly reduced arterial stiffness in patients with RA. The greatest improvements were seen in patients with more active disease, suggesting that, in addition to the beneficial effects of cholesterol reduction, immune modulation may contribute to the cardioprotective effect of statins.     

Monocyte receptor function in patients with rheumatoid arthritis

Monocytes from patients with rheumatoid arthritis (RA), osteoarthritis (OA), and normal volunteers were studied for abnormalities of Fc and C3 receptor function. Monocytes from the majority of 22 patients with active RA showed enhanced EA-rosette formation and EA phagocytosis compared to monocytes from 20 normal volunteers and 10 OA patients. However, no significant differences in binding of EAC or uptake of iodinated aggregated gamma globulin were found among the 3 groups. Corticosteroid-treated RA patients exhibited significant depression of EA-rosette formation and phagocytosis. These results suggest that there is modulation of EA receptor function in monocytes from RA patients.     

Influence of sex on disease severity in patients with rheumatoid arthritis

OBJECTIVE: To determine whether patient's sex influences the severity of rheumatoid arthritis (RA) in terms of clinical severity or need for treatments. METHODS: This was a retrospective, single-center study. We compared 133 male patients with 133 female patients presenting with RA and matched for disease duration. Data collection included demographic characteristics, pattern of joint involvement, extraarticular manifestations, medical treatment, and joint surgery. Biological measures, HLA genotypes, Larsen radiological scores on radiographs of hands and feet, and Health Assessment Questionnaire (HAQ) results were obtained. RESULTS: Mean disease duration was 7.4 +/- 6.9 years. Concerning clinical pattern of involvement, sicca syndrome was more frequent in women than in men (p = 0.0003). There were no significant differences concerning absence or presence of at least one disease associated gene (HLA-DRB1*01 or *04) in our patients; however, women more often carried 2 disease associated genes (21% vs 11%). No other difference in clinical, biological, or radiological indicators was noted between the 2 populations. Concerning treatment, there was no difference for large joint arthroplasties; female patients underwent significantly more distal joint arthrodesis, 6.7% vs 1.5% (p = 0.03); they were prescribed slightly more disease modifying drugs, 3.33 vs 2.83 (p = 0.04); and showed a trend toward more large joint arthrodesis, 15% vs 7.5% (p = 0.05), and metacarpophalangeal joint arthroplasties, 5.2% vs 0.7% (p = 0.08). CONCLUSION: When patients are matched for RA duration, sex has little effect on the disease pattern and severity, yet women undergo more distal joint surgery.     

Fatigue and severity of rheumatoid arthritis in Moroccan patients

The aim of this study was to assess fatigue aspects in Moroccan patients with rheumatoid arthritis (RA) and its relationships with disease-specific variables especially parameters of functional and structural severity. A total of 248 patients with RA were included. Patients’ and disease characteristics were identified. Disease activity was measured clinically using physical examination, biologically and by the disease activity scores (DAS28). Radiographs were evaluated by using Sharp’s method as modified by van der Heijde. Functional disability was measured by using the Moroccan version of Health Assessment Questionnaire (HAQ). Immunological abnormalities and treatment (doses and duration) were identified. Fatigue was evaluated by using a 0–100 visual analogue scale (VAS fatigue) and the multidimensional assessment of fatigue (MAF). Quality of life (QoL) was assessed using the Arabic version of the generic instrument SF-36. The mean age of patients was 47.5?±?11.7?years [25–72]; 37.5% of patients had a high activity of disease and 11.3% were in remission. The mean Sharp score was 107.13?±?91, and the mean score of HAQ was 1.40?±?0.63. All domains of QoL were deteriorated; 89.51% of our patients experienced fatigue. The mean total score of MAF was 30.21?±?11.32. A low level of education, low socioeconomic status, atlantoaxial subluxation, hip involvement, the presence of a Sj?gren syndrome, and cigarette smoking had a negative impact on fatigue scores. The severity of fatigue was correlated with the duration of RA, the intensity of joint pain, the activity of disease, the importance of structural damage, the degree of functional impairment, and the rate of anti-cyclic citrullinated protein (CCP) antibodies (P?<?0.05). Patients receiving methotrexate had better scores of fatigue. Also, severity of fatigue was correlated with the deterioration of all domains of QoL. Fatigue is a major issue for our patients with RA and must be included in the routine assessment of patients. In our sample, fatigue appears to be related to disease activity, functional disability, structural damage, and immunological status and had a negative impact on QoL.     

Impaired arterial function associated with thinning of cortical bone in rheumatoid arthritis

OBJECTIVE: To evaluate the association between peripheral arterial function and cortical bone thickness in rheumatoid arthritis (RA). METHODS: In a cross-sectional study, we measured the combined cortical thickness (CCT) of the second metacarpal bone from hand radiographs, and the ankle-to-arm systolic blood pressure ratio, also known as ankle-brachial index (ABI), in RA patients. We evaluated the association between the 2 using multinomial logistic regression. RESULTS: We obtained CCT and ABI measurements in 588 RA patients. The mean +/- SD CCT was 3.62 +/- 1.16 mm. The proportion of patients with > or =1 ABI value < or =0.9, indicating obstructed lower limb arteries, increased from 18 (9.2%) of 191 patients in the highest CCT tertile to 25 (12.5%) of 200 in the middle CCT tertile to 38 (19.2%) of 198 in the lowest CCT tertile (P for trend 0.005). We noted a similar pattern for ABI values >1.3, indicative of arterial incompressibility (frequencies in high, middle, and low CCT tertiles were 4.7%, 9.5%, and 19.9%, respectively; P for trend < or =0.001). These trends remained significant after multivariable adjustment for potential confounders. After adjustment for the manifestations of RA and cumulative glucocorticoid dose, the association between CCT and arterial obstruction remained significant, but that with arterial incompressibility weakened considerably. CONCLUSION: There is an association between metacarpal cortical bone thinning and obstruction or incompressibility of the peripheral arteries in RA. The association with incompressibility may be mediated by systemic inflammation and/or glucocorticoids, but that with obstruction is independent of a wide array of potential confounders. Clinicians should be alert to the possibility of impaired arterial function RA patients with thinned metacarpal cortical bone.     

Predictors of hand function in patients with rheumatoid arthritis

Objectives. The aims of this study were to determine: (1) what factors predict patient self-estimated hand function; (2) what factors predict actual hand function; and (3) the relationship among actual hand function, patient estimates of hand function, and self-assessed activities of daily living (ADL). Methods. Fifty-two patients with rheumatoid arthritis completed wrist and hand mobility measures, grip strength, pain, stiffness, and estimated hand function tests, along with the Sollerman Grip Function Test (actual hand function), Health Assessment Questionnaire (HAQ), and subscales of the Arthritis Impact Measurement Scales (AIMS). Results. Grip strength and stiffness were the strongest predictors of self-estimated hand function. Flexion and extension deficits in digits II through V were the strongest predictors of actual hand function. Actual hand function and self-estimated hand function were significantly correlated with each other and with the HAQ and AIMS subscales. Conclusions. Measures of deficit are the most useful in predicting actual hand function, whereas measures of strength and flexibility are most useful for estimated hand function.     

Anemia and renal function in patients with rheumatoid arthritis

OBJECTIVE: Treatments are now available that can improve the anemia of chronic illnesses such as rheumatoid arthritis (RA). Despite recognition that anemia is common in RA and that renal function may be impaired and affect hemoglobin levels, there are almost no quantitative comparative data regarding the prevalence of anemia or decreased renal function in RA. METHODS: We studied a prospectively acquired clinical database of 2,120 patients with RA who had 26,221 hemoglobin determinations, and a control population of 7,124 patients with noninflammatory rheumatic disorders (NIRD) who had 12,086 determinations. RESULTS: Using the World Health Organization definition, anemia occurred in 31.5% of patients with RA, and followed a U-shaped distribution that had minimal prevalence around 60 years of age. Anemia prevalence in men was 30.4% and in women 32.0%. Anemia occurred in 11.1% at hemoglobin < 11 g/dl and 3.4% at hemoglobin < 10 g/dl. After erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) was the strongest predictor of anemia, followed by estimated creatinine clearance. Adjusted for age and sex, estimated creatinine clearance was 9.8 (95% CI 7.5 to 12.1) ml/min lower in patients with RA than in those with NIRD. CONCLUSION: Anemia occurs in 31.5% of RA patients, 3 times the rate in the general population. However, severe chronic anemia (hemoglobin < 10 g/dl) is rare (3.4%). In addition, renal function is impaired in patients with RA compared with NIRD. Renal function has a small effect on the anemia of RA, and ESR and CRP have slightly greater effects.     

类风湿关节炎引起肺功能损害的早期研究

目的 研究类风湿关节炎导致肺功能损害的早期变化。方法 采用肺功能检查仪检测３２例朊呼吸道症状的类风湿关节炎患者及３５例健康成人的肺功能。结果 １２例类风湿关节炎病人有肺功能改变,主要表现为弥散功能受损,与正常对照组相比,差异显著（Ｐ〈０．０１）。结论 类风湿关节炎患者引起肺功能的早期改变以弥散功能损害为主。     

Disease activity and biologic use in patients with psoriatic arthritis or rheumatoid arthritis

Clinical Rheumatology - To compare disease burden and biologic use among psoriatic arthritis (PsA) or rheumatoid arthritis (RA) patients recruited to the Corrona registry. Retrospective study of...     

The relationship between bristol rheumatoid arthritis fatigue scales and disease activity of patients with rheumatoid arthritis

Fatigue is a symptom that affects the 40–80% of patients with rheumatoid arthritis (RA) and impairs the quality of life. The aim of this study was to assess multidimensional fatigue scales, the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ) and the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS) and to evaluate their relationship with disease activity in Turkish RA patients. The study included 180 patients with RA. The Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI) were used to evaluate disease activity. The participants comprised of 142 females and 38 males. The mean ± standard deviations of DAS28, CDAI, and SDAI were 3?±?1.24, 9.51?±?7.96, and 10.5?±?8.38 respectively. All scales except the emotional subscale were correlated with disease activity. The emotional subscale correlated with CDAI and SDAI but not with DAS28. The results of the study indicated that fatigue and disease activity were correlated. Fatigue is a symptom that impairs the quality of life but it can be easily coped with by controlling disease activity. Thus, it should be assessed in a multidimensional perspective.     

Foot deformities in patients with rheumatoid arthritis: the relationship with foot functions

Aim: The aim of this study was to investigate foot deformities in patients with rheumatoid arthritis (RA), to detect frequency of deformities and to assess the relationship between foot deformities and foot functions. Methods: Anteroposterior and lateral radiographs of 40 patients and 40 control subjects were studied. The hallux valgus (HV) angle, intermetatarsal angle between first and second metatarsals, intermetatarsal angle between first and fifth metatarsals, and calcaneal pitch were measured on radiographs. Foot functions were measured by the Foot and Ankle Outcome Score (FAOS). Results: The frequency of foot deformities in RA patients was determined as 78.8%. The most frequent foot deformity in RA patients was HV (62.5%), followed by metatarsus primus varus (MPV) (41.3%). MPV and splaying of the forefoot deformities were significantly more frequent in RA patients than the control group (P < 0.05). Mild to moderate effect on FAOS subscales was observed in RA patients. There was a slight, but significant correlation between the foot deformities and the FAOS subscales except for quality of life subscale. Conclusions: In this study, it has been shown that foot deformities are frequent in patients with RA and that there is slight deterioration in foot functions related to RA. Our results indicated that foot deformities have small, but clinically important changes on foot functions. There is a need for more studies, which evaluates the foot deformities, to further explore the relationship between the foot deformities and foot function in patients with RA.     

Sulfasalazine treatment and lymphocyte function in patients with rheumatoid arthritis

Sulfasalazine is now an established 2nd line agent in the treatment of rheumatoid arthritis (RA) but its mode of action is unknown. Two separate studies have investigated the possibility that it works in RA by influencing lymphocyte function. After 12 weeks of treatment with sulfasalazine, elevated levels of circulating activated lymphocytes and abnormal ex vivo mitogen response to concanavalin A (Con-A) in 11 patients with RA reverted to normal. An in vitro study investigated the effect of sulfasalazine and its metabolites on mitogen response by healthy and RA peripheral blood mononuclear cells (PBMC). Sulfapyridine (SP) and 5-hydroxy SP suppressed the response of RA PBMC to Con-A. Sulfasalazine, SP and N-acetyl SP suppressed the response of healthy PBMC to pokeweed mitogen. 5-aminosalicylic acid also affected mitogen response and cell viability, which may be relevant to actions of this metabolite within the gut.     

Responsiveness of the shoulder function assessment scale in patients with rheumatoid arthritis

OBJECTIVES: To investigate the responsiveness of the Shoulder Function Assessment scale (SFA) in patients with rheumatoid arthritis (RA). METHODS: In 35 patients with RA receiving a (peri-)articular injection because of local shoulder complaints the SFA, impact of shoulder function on activities of daily living, active shoulder range of motion (ROM), the 28 joint count Disease Activity Score (DAS28), and the Health Assessment Questionnaire (HAQ) were measured before and 4-6 weeks after treatment. Responsiveness was determined using the standardised response mean (SRM), effect size (ES), and responsiveness ratio (RR). RESULTS: Overall, significant improvement was seen according to the SFA (mean change 10.9 (95% confidence interval 6.5 to 15.3)), active shoulder ROM (except external rotation), and the impact of shoulder function on daily activities. In addition, the DAS28 and HAQ scores improved significantly. The responsiveness of the SFA was excellent, with the SRM, ES, and RR being -0.86, -1.16, and 1.28, respectively. CONCLUSIONS: In addition to its good validity and reliability, the SFA proved to have a high sensitivity to clinical changes in patients with RA who received local treatment for shoulder complaints.     

Relationship between arterial dysfunction and extra-articular features in patients with rheumatoid arthritis

Systemic inflammation may be a common process that underpins both atherosclerosis and extra-articular features (ExRA) of rheumatoid arthritis (RA). We evaluated the relationship between ExRA and arterial dysfunction in 114 consecutive patients with RA (82% women) without overt arterial disease aged 40–65?years. A trained research nurse undertook ‘SphygmoCor’ pulse wave analysis (PWA) using radial applanation tonometry to measure the extent (augmentation index, AIX%) and timing (reflected wave transit time, RWT, msec) of aortic wave reflection. Assessment included fasting blood sample, patient questionnaire and medical record review. Mean differences were adjusted for age, sex, mean blood pressure, smoking pack-years, fasting cholesterol, Stanford HAQ score and erythrocyte sedimentation rate. Mean age was 54 (SD 7) and median RA duration 10 (IQR 4–17) years. There was a trend for arterial dysfunction (higher AIX%; lower RWT) to increase as the number of ExRA features rose, but no difference in AIX% (?0.5, 95%CI ?2.8 to 1.8, P?=?0.65) or RWT (0.3?ms, 95%CI ?3.6 to 4.2, P?=?0.86) between ‘any ExRA’ and ‘no ExRA’. Arterial dysfunction was not associated with the presence of rheumatoid nodules, Sjogren’s syndrome or carpal tunnel syndrome. Our study was too small to determine whether severe (‘Malmo’) ExRA (vasculitis, pericarditis, episcleritis) was truly associated with a higher AIX% (3.8, 95%CI ?2.3 to 9.9, P?=?0.22) and lower RWT (?5.5?ms 95%CI ?13.1 to 2.1, P?=?0.16). While arterial dysfunction may be associated with the number of ExRA features and severe ExRA, it does not appear to be associated with other ExRA features.