Correlations between coping styles and symptom expectation for whiplash injury

In pain conditions, active coping has been found to be associated with less severe depression, increased activity level, and less functional impairment. Studies indicate that Canadians have a high expectation for chronic pain following whiplash injury. Expectation of recovery has been shown to predict recovery in whiplash victims. The objective of this study was to compare both the expectations and the coping style for whiplash injury in injury-naive subjects. The Vanderbilt Pain Management Inventory was administered to university students. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviors indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Subjects (57%) held an expectation of chronic pain after whiplash injury. The mean active coping style score was 28.5 ± 6.6 (40 is the maximum score for active coping). The mean passive coping style score was 28.5 ± 6.6 (50 is the maximum score for passive coping). Those with high passive coping styles had a higher mean expectation score. The correlation between passive coping style score and expectation score was 0.62, while the correlation between active coping style score and expectation was −0.48. Both expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in whiplash victims. Further studies of coping style as an etiologic factor in the chronic whiplash syndrome are needed.     

Treatment and nontreatment predictors of health assessment questionnaire disability progression in rheumatoid arthritis: a longitudinal study of 18,485 patients

Objective

To examine predictors of progression of disability in rheumatoid arthritis (RA), as measured by the Health Assessment Questionnaire disability index (HAQ), and to determine rates of progression during biologic treatment.

Methods

We followed 18,485 RA patients for up to 11 years (mean 3.7 years) in a longitudinal study of RA outcomes. Patients were characterized as having moderate or severe RA versus less severe RA at study entry. Annualized progression rates were determined in multivariable analyses using generalized estimating equations.

Results

Although all of the demographic and severity characteristics were associated with baseline differences in HAQ score, progression was only associated with age, comorbidity, initial severity, and treatment. HAQ score increased fastest in patients ages >65 years (0.031; 95% confidence interval [95% CI] 0.028, 0.034). HAQ progression was independently associated with the presence of baseline cardiovascular disease, hypertension, diabetes mellitus, and the number of comorbid conditions. Annualized progression rates were greater in patients with mild to inactive RA (0.021; 95% CI 0.019, 0.023) than in moderate to severe RA (0.003; 95% CI 0.001, 0.006). The overall progression rate during biologic treatment was 0.008 (95% CI 0.005, 0.011); for patients with moderate to severe RA, the rate was 0.001 (95% CI ?0.005, 0.003).

Conclusion

Age and comorbidity are important predictors of the rate of loss of functional status, and have a stronger effect on HAQ progression than does biologic treatment. There is little difference in progression rates among biologics. Patients with more severe RA progress less than those with less severe RA, a possible function of regression to the mean.

     

Effectiveness of a clinical practice intervention in early rheumatoid arthritis

Objective

To compare the outcome of early rheumatoid arthritis (RA) patients in a country where early clinics were established versus the outcome of patients in nonprotocolized clinics.

Methods

We compared 2 multicenter cohorts: an RA cohort derived from an early arthritis registry set in 36 reference hospitals in which a specific intervention was established (Evaluation of a Model for Arthritis Care in Spain [SERAP]), and a historical control cohort of patients with early RA attending 34 rheumatology departments (Prognosis in Rheumatoid Arthritis [PROAR] cohort). Effectiveness was tested by comparing the change in the Disease Activity Score in 28 joints (DAS28), the change in the Health Assessment Questionnaire (HAQ), and the change in the Sharp/van der Heijde radiologic score using marginal structural models.

Results

A total of 161 early RA patients were recruited in the PROAR cohort and 447 in the SERAP cohort. Being a SERAP patient was inversely correlated with activity, resulting in a decrease of ?0.24 (95% confidence interval [95% CI] ?0.39, ?0.08) units in the population average of the DAS28 after adjustment was made. Moreover, intervention may be seen as a protective factor of radiologic damage, with a decrease of ?0.05 (95% CI ?0.09, ?0.01) units in the logarithm of the total Sharp/van der Heijde score. On the other hand, a decrease in functional impairment was detected, but intervention was not statistically associated with HAQ changes.

Conclusion

Preventing major radiographic progression in a 2‐year term inside structured and organized special programs for the management of disease, such as early arthritis clinics, are effective compared to nonprotocolized referrals, treatment, and followup.

     

An examination of coping styles and expectations for whiplash injury in Germany: comparison with Canadian data

Cross-sectional cohort study: to examine concurrent expectations and coping style for whiplash injury in injury-naive subjects in Germany. Studies suggest the recovery rate from whiplash injury may be faster in Germany than in Canada. Canadians have a high expectation for chronic pain following whiplash injury and Germans do not. Expectation of recovery not only predicts recovery in whiplash victims but is also known to correlate with coping style. The Vanderbilt Pain Management Inventory was administered to university students and staff in Germany. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviours indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Sixteen percent of subjects held an expectation of chronic neck or back pain after whiplash injury. The mean active coping style score was 27.4 ± 3.6 (40 is the maximum score for active coping). The mean passive coping style score was 27.0 ± 6.3 (50 is the maximum score for passive coping). Coping style scores and patterns were not different from those previously observed in Canadian studies, but there was no correlation between expectations and coping style among German subjects, a finding that differs from Canadian studies. Although expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in Canadian whiplash victims, in Germany, despite having similar coping styles to Canadians, the lack of expectation for chronic pain may be protective from the effect of passive coping styles. Further studies of coping style as an aetiologic factor in the chronic whiplash syndrome are needed.     

Resistin in inflammatory and degenerative rheumatologic diseases

Aims of the study

To assess and compare resistin levels in the serum and synovial fluid of patients with rheumatoid arthritis (RA; an inflammatory rheumatologic disease) and osteoarthritis (OA; a degenerative rheumatologic disease) and to study the relationship between resistin levels and prognostic factors of RA disease progression.

Patients and methods

This study included a total of 50 patients: 25 with RA and 25 with OA. Full case history was documented for all patients and all underwent a thorough clinical examination and laboratory testing. Body mass index (BMI) values were also calculated. Radiographs were made of OA patients’ knees and RA patients’ hands. Disease Activity Score 28 (DAS28) was calculated for RA patients. Serum and synovial fluid samples were obtained from the effused knees of all patients and tested for resistin level.

Results

Serum resistin levels were higher in RA patients than in those with OA (p?<?0.01). Synovial fluid resistin levels were also higher in RA than OA patients (p?<?0.001). While serum resistin levels correlated with Larsen score and total leukocyte count (TLC), synovial fluid resistin levels correlated with rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) levels in addition to Larsen score and TLC.

Conclusion

Resistin levels were found to be higher in the serum and synovial fluid of RA patients than in those with OA. This may suggest a role for resistin in inflammatory rheumatologic diseases. The observed statistically significant correlation between synovial fluid resistin levels and RF, ACPA and Larsen score may suggest that high synovial fluid resistin levels can be considered a poor prognostic factor for RA progression. However, further studies employing a larger cohort of patients are needed to confirm the relevance of resistin as a prognostic marker in RA patients.     

Influence of age and sex on functional outcome over time in a cohort of patients with recent-onset inflammatory polyarthritis: results from the Norfolk Arthritis Register

Objective

It has been found that women with rheumatoid arthritis (RA) have a poorer prognosis than men. However, the impact of age at symptom onset is unclear. We investigated the relationship between these factors and functional disability in patients with recent‐onset inflammatory polyarthritis (IP).

Methods

A total of 3,666 patients (66% women) were registered with the Norfolk Arthritis Register between 1990 and 2008. Functional disability was assessed using the Health Assessment Questionnaire (HAQ), adjusted for age at HAQ completion. Linear random‐effects models were used to examine HAQ score over time, by sex and age at symptom onset (early = age <55 years, late = age 55–74 years, very late = age ≥75 years).

Results

Women had higher HAQ scores over time than men (mean difference 0.29; 95% confidence interval [95% CI] 0.25, 0.34). Men with late‐onset IP had lower baseline HAQ scores than men with early onset (mean difference ?0.14; 95% CI ?0.29, ?0.001). Women had comparable baseline HAQ scores at all ages of onset. Both sexes showed the greatest rate of disability progression in patients with very late onset. Those with early onset had a steady level of disability over time. Adjustment for treatment received, comorbidities, and RA subgroup analysis produced results that were largely similar to the initial analysis.

Conclusion

Female patients have higher HAQ scores than male patients; patients with early symptom onset show the smallest sex difference. Older age at symptom onset is associated with an increasingly steep trajectory of disability progression. The impact of sex on outcome is evident at baseline, whereas the impact of age at symptom onset becomes apparent during long‐term followup.

     

Association of functional outcome with both personal‐ and area‐level socioeconomic inequalities in patients with inflammatory polyarthritis

Objective

To describe the relationship between baseline area‐ and person‐level social inequalities and functional disability at 3 years in patients with early inflammatory polyarthritis (IP).

Methods

A total of 1,393 patients with new‐onset IP were recruited and allocated an Index of Multiple Deprivation (IMD) 2004 score based on their area of residence, and a social class based on baseline self‐reported occupation. Differences in the Health Assessment Questionnaire (HAQ) score at baseline and 3 years by IMD or social class were tested. The mean 3‐year change in HAQ score was compared by IMD and social class, and interactions between these measures examined.

Results

Patients from more deprived areas had poorer 3‐year HAQ outcome than those from less deprived areas (P = 0.019, adjusted for baseline HAQ score, age, sex, and symptom duration). The mean difference in HAQ change was most notable between the most deprived (IMD4) and least deprived areas (IMD1) (0.22; 95% confidence interval [95% CI] 0.11, 0.34). There was also a significant difference in HAQ score change between patients of the highest (SCI and II) and lowest social class (SCIV and V) (0.11; 95% CI 0.02, 0.20). For the mean (95% CI) 3‐year change in HAQ score, a significant interaction exists between IMD score and social class and their association with HAQ scores (P = 0.001) to modify outcome: IMD1/SC I and II ?0.23 (95% CI ?0.40, ?0.06) versus IMD 4/SC IV and V 0.15 (95% CI ?0.05, 0.34).

Conclusion

Person‐ and area‐level inequalities combine to modify outcome for rheumatoid arthritis. A person's social circumstance and residential environment have independent effects on outcome and are not just alternative measures of the same exposure.

     

Validation of single‐factor structure and scoring protocol for the health assessment questionnaire‐disability index

Objective

The extensively used Health Assessment Questionnaire Disability Index (HAQ‐DI) has been well received by the research and clinical community, notably because of its measurement strengths including reliability and stability of scores over time, utility in observational studies and clinical trials, predictive relationship with morbidity and mortality in rheumatoid arthritis (RA), and its translation for use in different countries. However, HAQ‐DI scoring has not been validated. The purpose of this study was to examine the structural validity of the HAQ‐DI and evaluate the latent factors underlying HAQ‐DI scoring.

Methods

This study used a cross‐validation approach on a total of 278 patients with RA. Exploratory and confirmatory factor analyses were performed.

Results

Results yielded a single‐factor HAQ‐DI score, which favored the current scoring system of the HAQ‐DI. Additionally, modification indices suggested improved model fit with the secondary inclusion of correlated residual scores from a motor skills subdomain.

Conclusion

The current study provides the first validation of the HAQ‐DI scoring system as determined by its latent factor structure. In addition, the findings suggest some benefit from a secondary interpretation of the scores based on domains that measure motor skills.

     

Assessment of the treat-to-target strategy in patients with refractory rheumatoid arthritis

Aim

The goal of the present study was to prospectively assess the long-term clinical outcome of biologic modifying drug therapy in a population of Saudi rheumatoid arthritis (RA) patients.

Patients and methods

This is the first prospective, long-term report on the efficacy and safety of biologic therapy in Saudi RA patients. It is a single center, observational study with a follow-up period of 3 years. Enrolled were 120 biologic naïve patients (94 women, 78.3?%; mean age 48.4?±?17.9 years, mean disease duration 7.3?±?3.9 years) with the diagnosis of RA (ACR/EULAR, 2010 criteria) who were inadequate responders to methotrexate and synthetic DMARDs.

Results

After 3 years, the mean Disease Activity Index-28 (DAS-28), Health Assessment Questionnaire (HAQ), Pain Score, ESR, and CRP values improved significantly. Of the 99 patients completing the 3-year follow-up, 35.3?% of patients achieved DAS-28 remission and 53.5?% achieved low disease activity, and 11.1?% of patients had moderate to high activity scores. At the 3-year follow-up, 80?% of patients had no evidence of significant radiographic progression (achieved Conclusion The results of this study can be understood as real-life clinical experience displaying the incremental benefit of biologic therapy in refractory disease when it is added to other optimal strategies. The study showed satisfying clinical and functional benefit with considerable safety.     

Ultrasonography is a potent tool for the prediction of progressive joint destruction during clinical remission of rheumatoid arthritis

Objectives

Although “clinical remission” has been a realistic goal of treatment in rheumatoid arthritis (RA), there is evidence that subclinical synovitis is associated with ongoing structural damage even after clinical remission is achieved. In the study reported here, we assessed whether ultrasonography (US) can predict progressive joint destruction during clinical remission of RA.

Methods

Thirty-one patients with RA in clinical remission based on the disease activity score in 28 joints were recruited for this study. Bilateral wrists and all of the metacarpophalangeal and proximal interphalangeal (PIP) joints were examined by power Doppler (PD) ultrasonography (US), and the PD signals were scored semiquantitatively in each joint. The total PD score was calculated as the sum of individual scores for each joint.

Results

Among 22 RA patients who maintained clinical remission during the 2-year follow-up period, seven showed radiographic progression. Radiographic progression was strongly associated with total PD score at entry, with all patients showing radiographic progression having a total PD score of ≥2 at entry and none of the patients with a total PD score of ≤1 showing any radiographic progression. There was no significant association of therapeutic agents with progressing or non-progressing cases.

Conclusions

PD-US detects synovitis causing joint destruction even when the patient is in clinical remission. Thus, remission visible on US is essential to reach “true remission” of RA.     

Health‐related quality of life of patients with psoriatic arthritis: A comparison with patients with rheumatoid arthritis

Objective

To compare health‐related quality of life (QOL) between patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA), using the Medical Outcomes Study Short Form health survey (SF‐36) and the Health Assessment Questionnaire (HAQ).

Methods

Both the SF‐36 and the HAQ were administered to 107 PsA patients attending the University of Toronto Psoriatic Arthritis Clinic between January 1 and December 31, 1994, and to 43 RA patients attending a University of Toronto–affiliated RA clinic during the same period. Standardized assessments of disease activity and severity were also performed at each clinic visit. Logistic regression analysis was used to compare health‐related QOL between PsA and RA.

Results

Both patient populations experienced lower physical health compared with that of a general population sample. The RA patients demonstrated more active inflammatory disease at the time of assessment than the PsA patients. The PsA patients were younger, and more were men. Logistic regression analyses showed that patients with PsA reported higher levels of vitality than patients with RA, even after adjusting for the observed differences in clinical and demographic characteristics. PsA patients, however, reported more role limitations due to emotional problems and more bodily pain after adjusting for the difference in vitality and other covariates.

Conclusions

Although both patient populations experienced reduced QOL, there were some meaningful differences in how the 2 conditions affect health‐related QOL. Further, it appeared that there may be unique disabilities associated with the psoriasis dimension of PsA.

     

An investigation of the correlation between blood concentration of mizoribine and its efficacy in treatment of rheumatoid arthritis based on indices of drug survival and improvement in DAS28-CRP

Objectives

The efficacy of mizoribine (MZR) in treatment of rheumatoid arthritis (RA) was retrospectively investigated in terms of drug survival, improvement in Disease Activity Score-28 (DAS28)-C-reactive protein (CRP), and blood MZR concentration obtained 3?h after dosing (MZR-C3).

Methods

To compare the efficacy of MZR administered via different regimens, the subjects were divided into 2 groups: those receiving a single dose of MZR at 100–150?mg every other day (group?A) and those receiving 2 or 3 divided doses of the drug on consecutive days, which is the usual dosing method of the drug (group?B).

Results

Group?A had significantly higher MZR-C3 levels compared with group?B, as well as significantly greater improvement in DAS28-CRP. Moreover, drug survival was significantly longer in group?A. The primary regression equation suggested that the effective blood MZR concentration in RA treatment is MZR-C3 of 1.47?μg/mL or more.

Conclusions

The results of the present study indicate that it is possible to increase the efficacy of MZR in a blood concentration-dependent manner, and also to control RA over a prolonged period, using single administration of MZR on alternate days at an increased dose.     

Increased thickness of the arterial intima‐media detected by ultrasonography in patients with rheumatoid arthritis

Objective

To determine whether arterial wall thickening is advanced in rheumatoid arthritis (RA) patients compared with healthy controls by measuring the intima‐media thickness (IMT) of the common carotid and femoral arteries, and to evaluate the factors associated with arterial IMT in patients with RA.

Methods

We studied 138 RA patients and 94 healthy controls (matched for age, sex, and other major risk factors for atherosclerosis). IMT was measured on digitized still images of the common carotid and femoral arteries obtained by high‐resolution ultrasonography (10‐MHz in‐line Sectascanner). Laboratory variables relevant to RA activity were measured by routine methods. The degree of RA progression was assessed by scoring (Larsen method) metacarpophalangeal (MCP) joints on hand radiographs. Activities of daily living were determined by a modified Health Assessment Questionnaire (M‐HAQ) score, and physical activity levels were assessed by ultrasound measurement of the calcaneus (expressed as the osteo‐sono assessment index [OSI] Z score).

Results

Common carotid and femoral artery IMTs were significantly higher (P < 0.05) in RA patients (mean ± SD 0.641 ± 0.127 and 0.632 ± 0.125 mm, respectively) compared with controls (0.576 ± 0.115 and 0.593 ± 0.141 mm, respectively). Multiple regression analysis revealed a significant association between RA and the common carotid artery IMT. Moreover, the common carotid artery IMT in RA patients was positively associated with disease duration, the MCP joint Larsen score, and the M‐HAQ score, and was negatively associated with the calcaneus OSI Z score. No significant association was found between corticosteroid treatment and common carotid artery IMT.

Conclusion

RA patients exhibited greater thickness of the common carotid and femoral arteries than healthy controls. The duration and severity of RA and decreased activities of daily living, but not corticosteroid treatment, were independently associated with the increased arterial wall thickness.

     

Non traditional risk factors of carotid atherosclerosis in rheumatoid arthritis

Introduction

Cardiovascular events are markedly increased in rheumatoid arthritis, and they remain poorly understood.

Aim of work

To investigate inflammatory markers, markers of endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis-related factors as non traditional risk factors for occurrence of carotid atherosclerosis in rheumatoid arthritis patients.

Patients and methods

Thirty RA patients were included in this study. All of them were females and their ages ranged from 23 to 62 years with a mean of 43.95 ± 7.2 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment, bone erosion assessment by Modified Larsen score and functional assessment by health assessment questionnaire (HAQ) score. Carotid Duplex was done to measure the intima-media thickness (IMT) and carotid plaques. The patients who proved to have carotid atherosclerosis by ultrasound were subjected to ultrasound examination of brachial artery flow mediated dilatation (FMD) to confirm presence of endothelial dysfunction in those patients.

Results

Ten out of 30 RA patients (33.3%) had carotid atherosclerosis in whom there was impaired FMD denoting endothelial dysfunction. Among those patients, the risk factors that associated with occurrence of carotid atherosclerosis included higher levels of inflammatory markers (CRP, ESR and IL-6) and VCAM-1 (a marker of endothelial dysfunction), lower levels of antioxidant vitamins A and E, and RA-related factors as longer duration of disease, increased RF titer, increased HAQ-score, bone erosion, duration of prednisone use and prednisone cumulative dose.

Conclusion

The prevalence of carotid atherosclerosis in rheumatoid arthritis patients was 33.3%. Among those patients, a statistically significant association was found between occurrence of carotid atherosclerosis and inflammatory markers, endothelial dysfunction, antioxidant vitamins and rheumatoid arthritis related factors.     

Clinical and radiographic results from a 2-year comparison of once-weekly versus twice-weekly administration of etanercept in biologics-naive patients with rheumatoid arthritis

Objectives

The twice-weekly administration of 25?mg of etanercept (TW) has been shown to be effective in patients with rheumatoid arthritis (RA). However, the once-weekly administration of 25?mg of etanercept (OW) was tried in order to address the economic burden of anti-rheumatic biologics. We evaluated the clinical and radiographic results from a 2-year follow-up study of patients receiving OW or TW.

Methods

Sixty-three biologics-naive patients with RA were randomly assigned to receive either OW (n?=?42) or TW (n?=?21).

Results

From baseline to year 2, rates of clinical remission, according to the Disease Activity Score of 28 joints (DAS-28) (based on C-reactive protein; CRP)–with clinical remission being regarded as a DAS-28 (CRP) score of <2.3–were significantly improved in the OW group (from 1.6 to 39.0%) and in the TW group (from 9.5 to 47.6%), but no significant between-group difference was observed at year 2. Radiographic joint damage, quantified with the modified Sharp score, was significantly progressive in the OW group in contrast to findings in the TW group. Thus, among patients receiving TW therapy, the progression of joint damage may have been inhibited or may have shown remission.

Conclusions

These results suggest that, in terms of DAS-28 remission, OW therapy can efficiently substitute for TW therapy in biologics-naive patients with RA. However, TW therapy was indispensable in preventing the worsening of joint damage.     

Development and validation of a short form of the valued life activities disability questionnaire for rheumatoid arthritis

Objective

To develop and validate a shortened version of the Valued Life Activities disability and accommodations scale (VLA) for individuals with rheumatoid arthritis (RA).

Methods

To shorten the existing VLA measure, item response theory analyses were conducted using data from 449 patients with RA. Next, the resulting 14‐item shortened version of the VLA scale (S‐VLA) was evaluated by structured interviews among 20 RA patients. Lastly, the S‐VLA was administered to 150 RA patients along with other measures, including the Health Assessment Questionnaire (HAQ) and Short Form 36 (SF‐36). A random sample of 50 patients completed the S‐VLA 2 weeks later to assess reliability. Item statistics were calculated to evaluate correlations between individual items and the S‐VLA total score. Correlations between the S‐VLA and other measures were used to evaluate validity.

Results

Test–retest reliability was 0.91, while Cronbach's alpha for the S‐VLA was 0.95. None of the 14 items was associated with improved alpha coefficients when omitted. All of the items were strongly correlated with the S‐VLA total score. S‐VLA scores were highly positively correlated with the HAQ (r = 0.81, P ≤ 0.001), patient‐reported disease activity (r = 0.71, P ≤ 0.001), satisfaction with abilities (r = 0.82, P ≤ 0.001), and number of days with activity limitations (r = 0.65, P ≤ 0.001). In addition, as hypothesized, the S‐VLA was inversely correlated with the SF‐36 physical component summary score (r = ?0.78, P ≤ 0.001) and the physical functioning (r = ?0.80, P ≤ 0.001), role physical (r = ?0.67, P ≤ 0.001), and social functioning (r = ?0.72, P ≤ 0.001) subscales.

Conclusion

The S‐VLA is a short, valid, and reliable instrument that may prove useful for monitoring disability among individuals with RA.

     

Der rheumatische Fuß als Focus bakterieller Infektionen

Background

A high incidence of infections has been reported in rheumatoid arthritis (RA) patients, either due to intrinsic factors or as a side effect of immunosuppressive agents used for treatment. The present article provides an overview of incidence and distribution patterns of septic complications in RA.

Materials and Methods

We prospectively assessed all data from RA patients who underwent in-patient treatment for septic complications in the 3-year period from 01.01.2006 to 31.12.2009. All disease- and infection-specific data were gathered and analysed.

Results

Of the 36 cases in total, infection was localized in the rheumatoid foot in 23 patients (64%) and at the lower extremities in 32 (89%). The bacterial spectrum was heterogenous, with Staphylococcus aureus representing the most frequent causative agent. In total, 34 of 36 cases were cured.

Conclusions

Since approximately 2/3 of all infections occur in the rheumatoid foot, regular foot examinations to identify predisposing deformities and/or ensure early diagnosis of existing infections are recommended.     

Prospective study of reactivation of hepatitis B virus in patients with rheumatoid arthritis who received immunosuppressive therapy: evaluation of both HBsAg-positive and HBsAg-negative cohorts

Background

Screening and prophylactic treatment for hepatitis B virus (HBV) reactivation is recommended for patients who receive immunosuppressive or cytotoxic therapy. The aim of this study was to clarify the prevalence of HBV reactivation in rheumatoid arthritis (RA) patients who had received more than 1?year of immunosuppressive therapy. This study also evaluated guidelines for determining HBV reactivation in patients with RA.

Methods

This was a prospective non-randomized, non-controlled study. We enrolled 50 patients with RA who had antibodies against hepatitis B core antigen (anti-HBc) and who had started treatment with disease-modifying anti-rheumatic drugs, including those who had additionally received anti-tumor necrosis factor-?? (anti-TNF-??). HBV DNA levels were measured every 2?C3?months by a real-time, polymerase chain reaction-based method. Entecavir was administered to patients with HBV DNA levels >2.1 log/ml.

Results

The mean observation period was 23?months (range 12?C32?months). HBV reactivation occurred in 2 of 5 patients with HBV surface antigen (HBsAg) and in 1 of 45 patients without HBsAg. In patients who received anti-TNF-?? therapy, antibodies against HBsAg decreased significantly. Entecavir therapy inhibited HBV amplification and prevented HBV-associated flares of hepatitis.

Conclusions

The incidence of HBV reactivation was low in RA patients in whom HBV infection had been resolved. Screening for HBV reactivation and prophylactic therapy with entecavir were effective means of preventing HBV-associated hepatic failure in patients with HBsAg, as well as in those with only anti-HBc who received immunosuppressive therapy for RA.     

Musculoskeletal ultrasonography assists the diagnostic performance of the 2010 classification criteria for rheumatoid arthritis

Objective

We investigated whether musculoskeletal ultrasonography (MSKUS) assists the diagnostic performance of the 2010 rheumatoid arthritis (RA) classification criteria.

Methods

Sixty-nine early arthritis patients were consecutively enrolled. None of the patients had been treated. In MSKUS of bilateral wrist and finger joints from 22 sites, the findings obtained by gray-scale and power Doppler (PD) assessment were graded on a semiquantitative scale from 0 to 3. Plain magnetic resonance imaging (MRI) of both wrist and finger joints was also examined. Diagnosis of RA was defined by the initiation of disease-modifying antirheumatic drugs within the first 3 months. The diagnostic performance of the patients was evaluated at entry using 2010 RA classification criteria in conjunction with MSKUS.

Results

The indispensable MSKUS finding for differentiating RA was the presence of a PD grade 2 or 3 that was superior to 2010 RA classification criteria or MRI-proven bone edema. We propose that the decision tree algorithm of 2010 RA classification criteria with PD grade 2 or 3 reveals the best discriminative ability.

Conclusion

MSKUS, especially with a strong PD signal, is very useful to assist the diagnostic performance of the 2010 RA classification criteria in the early recognition of RA.