Rheumatoid Arthritis Research Today is a free monthly online journal that collates and summarizes the latest research about Rheumatoid Arthritis, including details on treatment, symptoms, causes, medication.

Disease activity level, remission and response in established rheumatoid arthritis: performance of various criteria sets in an observational cohort, treated with anti-TNF agents.

Gülfe A, Aletaha D, Saxne T, Geborek P

Dept of Rheumatology, Lund University Hospital, Lund, Sweden. anders.gulfe@med.lu.se

BACKGROUND: Most composite indices of disease activity and response criteria in RA have been validated and compared in clinical trials rather than routine care. We therefore wanted to compare the performance of the DAS28, SDAI and CDAI activity indices, their activity states, their response criteria, and also compare with the ACR response criteria in an observational clinical setting. METHODS: Agreement between the criteria sets was investigated using kappa statistics in a non-randomized cohort of 1789 RA patients from southern Sweden, starting their first course of anti-TNF-treatment. Mean disease duration was 12 years. Completer analysis was used. RESULTS: Agreement between high, moderate and low activity states was moderate or substantial, with kappa = 0.5 or better for all criteria. Agreement between SDAI and CDAI disease states was > 90% in these categories with kappa > 0.8. DAS28 original and modified cut point remission had good agreement (kappa = 0.91). Agreement between responses was substantial at the overall/ACR20 level (about 95%, kappa = 0.7 or better) for all criteria. By contrast, agreement was poor between moderate and high level responses. CONCLUSION: Disease activity states according to the various indices perform similarly and show substantial agreement at all levels except remission. Agreement between SDAI and CDAI states is excellent. Response criteria, applied at the individual patient level, are hard to interpret and show poor agreement, except at the lowest level of response. Thus, they should not be applied uncritically in clinical practice.

Published 8 May 2009 in BMC Musculoskelet Disord, 10: 41.
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Articles on Rheumatoid Arthritis published 27 April 2009:

Anti-Ro/SSA autoantibody-mediated regulation of extracellular matrix fibulins in human epithelial cells of the salivary gland.   Scand J Rheumatol, 38(3): 198-206.

OBJECTIVES: The fibulins are a family of extracellular matrix (ECM) molecules that regulate the organ shape along with other growth factors and stromal cells and have recently been shown to be involved in a variety of cellular functions including proliferation, migration, differentiation, and survival. Important changes in acinar and ductal morphology and function, together with pronounced ECM remodelling, are detectable in the labial salivary glands (LSGs) of patients with Sjögren's syndrome ... [Abstract] [Full-text]

Interleukin-18 gene (IL18) promoter polymorphisms in patients with rheumatoid arthritis.   Scand J Rheumatol, 38(3): 159-65.

OBJECTIVE: Rheumatoid arthritis (RA) is a complex autoimmune disease with a strong genetic contribution to its pathogenesis. Proinflammatory cytokines play an important role in the inflammatory process in RA patients. The synthesis of cytokines is genetically determined. Cytokine gene polymorphisms have been implicated in a number of diseases, including RA. Interleukin-18 (IL-18) is a proinflammatory cytokine involved in the pathogenesis of RA. There are, however, controversial reports that the ... [Abstract] [Full-text]

Predictors of remission, normalized physical function, and changes in the working situation during follow-up of patients with early rheumatoid arthritis: an observational study.   Scand J Rheumatol, 38(3): 166-72.

OBJECTIVES: To evaluate possible predictors of remission, normalized physical function, and work change in rheumatoid arthritis (RA). METHODS: We determined in our early RA cohort the proportion of patients in remission [Disease Activity Score (DAS28)<2.6], with normalized function [Health Assessment Questionnaire (HAQ) = 0], and with changed working situation since disease onset. Candidate predictors of remission, normalized function, and work change were studied by subgroup comparison and ... [Abstract] [Full-text]

Rheumatoid arthritis in UK primary care: incidence and prior morbidity.   Scand J Rheumatol, 38(3): 173-7.

OBJECTIVES: To estimate the incidence of rheumatoid arthritis (RA) in primary care and to investigate associations with consultation behaviour, risk factors, and comorbidities, using the UK General Practice Research Database (GPRD). METHODS: Subjects with a first-ever diagnosis of RA between 1 January 1996 and 31 December 1997 (n = 579) were identified from a cohort of 1 206 918 subjects aged 20-79 years without cancer. Controls from the same cohort were frequency-matched to the RA group by ... [Abstract] [Full-text]

Comparison of work disability and health-related quality of life between males and females with rheumatoid arthritis below the age of 45 years.   Scand J Rheumatol, 38(3): 178-83.

OBJECTIVES: To compare work disability (WD) and health status between males and females with rheumatoid arthritis (RA) in the age group 18-45 years, and to compare health status between patients with and without WD within each gender, and finally to identify factors independently associated with WD in this age group. METHODS: A cross-sectional study of RA patients at the time starting with disease-modifying antirheumatic drug (DMARD) therapy and/or biological treatment. Patients receiving a ... [Abstract] [Full-text]

Articles on Rheumatoid Arthritis published 21 April 2009:

Evidence-based outcomes of studies addressing diagnostic accuracy of MRI of juvenile idiopathic arthritis.   AJR Am J Roentgenol, 192(5): 1209-18.

OBJECTIVE: Our objective was to semiquantitatively evaluate the diagnostic accuracy of MRI for evaluation of synovium and cartilage of peripheral joints in juvenile idiopathic arthritis (JIA) according to the levels of evidence and recommendations of the Canadian Task Force on Periodic Health Examination guidelines. CONCLUSION: Articles were screened using MEDLINE, EMBASE, DARE, and the Cochrane Library. Two independent reviewers assessed whether the currently available MRI techniques are ... [Abstract] [Full-text]

Articles on Rheumatoid Arthritis published 20 April 2009:

Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis.   Clin Infect Dis, 48(10): 1364-71.

BACKGROUND: Herpes zoster occurs more commonly in patients taking immunosuppressive medications, although the risk associated with different medications is poorly understood. METHODS: We conducted a retrospective cohort study involving 20,357 patients who were followed in the Veterans Affairs healthcare system and treated for rheumatoid arthritis from October 1998 through June 2005. Cox proportional hazards regression was used to determine risk factors for herpes zoster and herpes zoster-free ... [Abstract] [Full-text]

Articles on Rheumatoid Arthritis published 15 April 2009:

Multiple antibody reactivities to citrullinated antigens in sera from patients with rheumatoid arthritis: association with HLA-DRB1 alleles.   Ann Rheum Dis, 68(5): 736-43.

BACKGROUND: Autoantibodies to cyclic citrullinated peptides (anti-CCP) are present in most patients with rheumatoid arthritis (RA), and associate with HLA-DRB1 shared epitope (SE) alleles. OBJECTIVE: To investigate reactivities of anti-CCP to various citrullinated proteins/peptides, which represent potential autoantigens in RA, and to examine the relationship between such antibodies, and their association with genetic variants within HLA-DRB1 SE alleles. METHODS: Serum samples from 291 patients ... [Abstract] [Full-text]

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