Active foot synovitis in patients with rheumatoid arthritis: Applying clinical criteria for disease activity and remission may result in underestimation of foot joint involvement

Objective.To determine the factors most strongly associated with an increase in therapy of early rheumatoid arthritis (ERA).Methods.Data from the Canadian Early Arthritis Cohort (CATCH) were included if the patient had ≥ 2 visits and baseline and 6 months data. A regression analysis was done to determine factors associated with treatment intensification.Results.Of 1145 patients with ERA, 790 met inclusion criteria; mean age was 53.4 years (SD 14.7), mean disease duration 6.1 months (SD 2.8), 75% were female, baseline Disease Activity Score-28 (DAS28) was 4.7 (SD 1.8) and 2.9 (SD 1.8) at 6 months for included patients. Univariate factors for intensifying treatment were physician global assessment (MDGA; OR 7.8 and OR 7.4 at 3 and 6 months, respectively, p < 0.0005), swollen joint count (SJC; OR 4.7 and OR 7.3 at 3 and 6 months, p < 0.0005), and DAS28 (OR 3.0 and OR 4.6 at 3 and 6 months, p < 0.0005). In the regression model only MDGA was strongly associated with treatment intensification (OR 1.5 and OR 1.2 at 3 and 6 months, p < 0.0005); DAS28 was not consistently predictive (OR 1.0, p = 0.987, and OR 1.2, p = 0.023, at 3 and 6 months). DAS28 was the reason for treatment intensification 2.3% of the time, compared to 51.7% for SJC, 49.9% for tender joint count, and 23.8% for MDGA. For the same SJC, larger joint involvement was more likely to influence treatment than small joints at 3 months (OR 1.4, p = 0.027).Conclusion.MDGA was strongly associated with an increase in treatment at 3 and 6 months in ERA, whereas DAS28 was not. Physicians rarely stated that DAS28 was the reason for increasing treatment.

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Study on the evaluation of rheumatoid arthritis via doppler ultrasonography and anti-cyclic citrullinated peptide antibody analysis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.3.1492 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Li-na Shang ◽

Gui-xin Di ◽

Feng-ju Wei ◽

Zheng Zhang

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Doppler Ultrasonography ◽

Severe Disease ◽

Joint Involvement ◽

Cyclic Citrullinated Peptide ◽

Mild Disease ◽

Number Of Patients ◽

Peptide Antibody ◽

Citrullinated Peptide

Objective: This study aims to discuss the value of ultrasonic analysis and anti-cyclic citrullinated peptide (CCP) antibody analysis in evaluating the state of rheumatoid arthritis (RA). Methods: This study was conducted during March 2016 to December 2016. Total 82 patients with RA who sought treatment in the Affiliated Hospital of Hebei University were included in this study. Data on ultrasonic and anti-CCP antibody, ESR, and RF were collected and compared. The RA patients were divided into two groups of mild disease activity (DAS28 ≤ 3.2) and moderate-severe disease activity (DAS28 > 3.2) to compare the changes in synovial thickness of joints. The changes of joint ultrasonography were also compared between positive and negative anti-CCP antibodies group. Results: It is found that the number of patients suffering from joint involvement in the negative anti-CCP antibody group was larger than that of the anti-CCP positive antibody group (P <0.05); the thickness of the synovium of joints of patients in the group with moderate-severe disease activity evaluated via ultrasonography was significantly larger than that of the group with mild disease activity (P <0.05). Conclusion: It is possible to observe the degree of disease activity dynamically by combining ultrasonography with anti-CCP antibody and make a better assessment of patients to facilitate treatment. doi: https://doi.org/10.12669/pjms.36.3.1492 How to cite this:Shang L, Di G, Wei F, Zhang Z. Study on the evaluation of rheumatoid arthritis via doppler ultrasonography and anti-cyclic citrullinated peptide antibody analysis. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1492 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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FRI0077 THE PREVALENCE OF DEPRESSION AND ANXIETY IN PATIENTS WITH RHEUMATOID AND PSORIATIC ARTHRITIS AND ITS CONTRIBUTORY FACTORS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5127 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 615.2-616

Author(s):

S. Selvadurai ◽

L. Mohamed Nor ◽

N. I. Redzuan ◽

L. Mohd Isa ◽

N. S. Shahril

Keyword(s):

Rheumatoid Arthritis ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Associated Factors ◽

Depression Scale ◽

Disease Assessment ◽

Joint Involvement ◽

Depression And Anxiety ◽

Prevalence Rates ◽

The Mean

Background:Rheumatoid Arthritis (RA) and Psoriatic arthritis (PsA) are both chronic, progressive inflammatory arthritis that can cause significant disability and morbidity. Depression in RA has been associated with higher levels of disease activity, pain, fatigue, work disability, lower treatment compliance and increased suicidal risk and mortality [1]. PsA patients suffer from psoriasis and joint involvement; hence have greater odds of depression by 2.1 times compared with RA [2].Objectives:To compare the prevalence rates of depression and anxiety and its associated factors between RA and PsA patients in Hospital Putrajaya.Methods:A cross sectional survey using the Hospital Anxiety and Depression Scale (HADS) questionnaire were distributed to 300 patients who attended rheumatology outpatient clinic from February – April 2019. The HADS was categorized into 3 groups based on their scores 0-7 (Normal); 8-10 (Borderline); and 11-21 (Abnormal). Data on patient demographics and components of disease assessment scores were recorded. Disease activity was assessed using DAS 28-CRP for all patients. Additional evaluation using Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and body surface area (BSA) were done for PsA patients. P value of < 0.05 was taken as significant.Results:In total, 205 RA and 73 PsA patients were eligible for analysis. Majority of the patients were female, Malay and married for both groups. The mean age group for RA and PsA were 56.2 ± 11.9 years and 51.0 ± 14.6 years. The mean duration of disease for RA were 8 ± 10 years; while for PsA were 6 ± 11 years. The prevalence rates of depression and anxiety for RA were 8.3% and 13.7%; and PsA were 9.6% and 17.8% respectively. Borderline scores for depression occurred in 16.1% of RA patients and 12.3% for PsA. Twenty percent of RA patients (n=41) and twenty-four percent of PsA patients (n=18) scored borderline for anxiety. The significant positive correlations with depression and anxiety in RA include high disease activity scores (r = 0.27; r = 0.31), number of tender joints (r = 0.26; r = 0.24) and pain (r = 0.29; r = 0.27). Higher number of swollen joints significantly correlated with depression (r = 0.16) but not with anxiety. RA patients with Ischaemic Heart Disease (IHD) ± heart failure have higher depression scores (p < 0.05). As for PsA group, high BASDAI score (anxiety: r = 0.34, depression: r = 0.26) and psoriasis involving head and neck region (p < 0.05) were significant associated factors. Age was inversely correlated with anxiety in the PsA group.Conclusion:There is higher prevalence of anxiety in both RA and PsA as compared to depression. Higher disease activity scores were associated with depression and anxiety in both RA and PsA with axial involvement.References:[1]Faith Matcham et al. “Are depression and anxiety associated with disease activity in rheumatoid arthritis? A prospective study” BMC Musculoskeletal Disorders (2016) 17:155.[2]Sinnathurai et al. “Comorbids in psoriatic arthritis and rheumatoid arthritis”. July 2018. Internal Medicine Journal.Available fromhttps://doi.org/10.1111/imj.14046[3]RA Rahim et al. “ Self-reported symptoms of depression, anxiety and stress among patients with Rheumatoid Arthritis in a Malaysian rheumatology centre – prevalence and correlates”. Med J Malaysia Vol 73 No 4 August 2018Disclosure of Interests:None declared

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Clinical Ankle Involvement and Ultrasound Synovial Hypertrophy are Significant Predictors of DAS28-Defined Rheumatoid Arthritis Disease Activity

Internal Medicine ◽

10.2478/inmed-2019-0057 ◽

2019 ◽

Vol 16 (2) ◽

pp. 19-33

Author(s):

Luminiţa Enache ◽

Claudiu C. Popescu ◽

Cătălin Codreanu ◽

Maria Șuţa

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Ankle Joint ◽

Clinical Examination ◽

Power Doppler ◽

Independent Effect ◽

Joint Involvement ◽

Synovial Hypertrophy ◽

Rheumatoid Arthritis Disease ◽

Patient Reported

AbstractObjective. The study aimed to investigate the relationship between ankle involvement and disease activity in rheumatoid arthritis (RA), from clinical and ultrasound perspectives.Methods. RA patients were recruited in 2018 in the random order of presentation from the out-patient clinic. On the same day of inclusion, all patients underwent clinical examination, laboratory tests (inflammatory markers), ankle ultrasound and patient-reported outcomes.Results. The study included 183 patients with established RA, mostly women (86.3%), with mean age of 57.3 years. Clinical examination revealed 101 (55.2%) patients with at least one tender ankle and 56 (30.6%) patients with at least one swollen ankle. Regression analysis revealed that both clinically tender and swollen ankles were 2.8 and respectively 3.4 times more likely to reveal ultrasound ankle joint synovial hypertrophy (SH). The presence of ankle SH was associated with higher disease activity: for example, compared to patients without ankle SH, patients with ultrasound-detected SH in any ankle joint had significantly higher median DAS28CRP (4.60 compared to 2.73, p<0.001). Power Doppler (PD) activity of ankle SH produced similar results: PD signal presence (p<0.001) and PD grade (p = 0.009) were associated with higher median DAS28CRP. Ankle joint involvement had an independent effect on DAS28CRP-defined disease activity: for example, the absence of ankle SH independently and significantly decreased DAS28CRP with 0.985 points (p<0.001).Conclusion. Clinical ankle involvement and ultrasound-detected ankle SH have a directly proportional relationship with disease activity in RA.

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Metabolic Syndrome Among Patients with Rheumatoid Arthritis and the Correlation with Disease Activity

Revista de Chimie ◽

10.37358/rc.19.6.7285 ◽

2019 ◽

Vol 70 (6) ◽

pp. 2108-2111

Author(s):

Cristina Gabriela Ene ◽

Mihaela Mitroi ◽

Ionela Mihaela Vladu ◽

Lucretiu Radu ◽

Tiberiu Stefanita Tenea Cojan ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Metabolic Syndrome ◽

Disease Activity ◽

Joint Involvement ◽

Control Group ◽

Cvd Risk ◽

Systemic Involvement ◽

The Metabolic Syndrome ◽

Cardio Vascular

Rheumatoid arthritis is a systemic inflamatory disease that affects primarily the synovial joints and it is associated with a progressive disability and a important socio-economic burden. [1] Although the main characteristic is the joint involvement, it is important to remember that RA is a disorder with systemic involvement mainly due to it�s chronic inflamation. Patients with RA have a higher risk of cardio-vascular mortality that in general population. There are numerous studies that sugest that inflamation plays a key�role in the develompent of aterosclerosis and heart disease, therefore a better understanding of the inflamatory response in RA may lead to better outcomes for patients with RA. Metabolic Syndrome is described as a congregate of major risk factors for cardiovascular diseases (CVD): Diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol and high blood presure[2]. The clustering of CVD risk factors that typifies the metabolic syndrome is now considered to be the driving force for a new CVD epidemic [3]. The conducted study aims to assess and evaluate the presence of metabolic syndrome (MetS) in RA patients. 120 patients with RA (89 women and 31 men) and 120 (85 women and 35 men) patients without RA were included in the study. The prevalence of MetS in RA patients was 39.16% and 22.5% for the control group. RA patients with MetS had significantly higher disease activity score of 28 joints index (DAS28-ESR) than patients without MetS ( 3.70 � 0.644 vs. 3.35 �0.725; p=0.006).

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The correlation between ultrasound-detected synovitis of small joints and the clinical disease activity in patients with rheumatoid arthritis

10.21203/rs.3.rs-17385/v1 ◽

2020 ◽

Author(s):

Xuerong Deng ◽

Xiaoying Sun ◽

Wenhui Xie ◽

Yu Wang ◽

Zhuoli Zhang

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Activity Index ◽

Power Doppler ◽

Disease Activity Index ◽

Clinical Disease ◽

Joint Involvement ◽

Clinical Disease Activity ◽

Hands And Feet ◽

Activity Indices

Abstract Background: Rheumatoid arthritis (RA) is chronic inflammatory arthritis with multi-joint involvement, especially small synovial joints in hands and feet. So far, the synovitis of which joint in hands or feet is better correlated with clinical disease activity indices is unknown; the correlation of synovitis detected by ultrasound in an individual joint with global disease activity is unclear either.Objectives: To explore the correlation between the ultrasound-detected synovitis in metacarpophalangeal (MCP), metatarsophalangeal (MTP), proximal interphalangeal (PIP) joints and the clinical disease activity indices in patients with RA.Methods: 30 joints, including bilateral MCP, PIP and MTP, were scanned for synovitis by ultrasound, semi-quantitatively scored for gray scale(GS) and power Doppler(PD). The correlation between Disease Activity Score-28 joints(DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI) and ultrasound-detected synovitis score in each joint was assessed using Spearman’s rank correlation test. Results: 211 RA patients were included in this study. The whole GS scores of all MCP joints showed highest correlation with all clinical disease activity indices (r=0.403-0.452, p<0.01), followed by PIPs (r=0.318-0.331, p<0.01) and MTPs (r=0.277-0.301, p<0.01). Likewise, the whole PD scores of all MCP joints also showed highest correlation with the disease activity (r=0.332-0.396, p<0.01), followed by PIPs (r=0.211-0.242, p<0.01), and MTPs (r=0.198-0.222, p<0.01). The highest correlation of GS score with DAS28-ESR (r=0.411, p<0.01), DAS28-CRP (r=0.459, p<0.01), SDAI (r=0.444, p<0.01) was observed in MCP3 joint, while with CDAI (r=0.421, p<0.01) in MCP2 joint. The highest correlation of PD score with DAS28-ESR (r=0.353, p<0.01), DAS28-CRP (r=0.399, p<0.01), CDAI (r=0.368, p<0.01), SDAI (r=0.377, p<0.01) was in MCP5 joint. Conclusions: The ultrasound-detected synovitis at MCP joints, especially MCP2, MCP3, and MCP5 joints, was best correlated with composite disease activity of RA, in contrast to PIP and MTP joints. MCP joints should take greater weight in clinical disease activity assessment.

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Clinical Significance of Anti-Modified Citrullinated Vimentin Antibodies in Palindromic Rheumatism

Laboratory Medicine ◽

10.1093/labmed/lmaa095 ◽

2020 ◽

Author(s):

Aida Malek Mahdavi ◽

Nadereh Rashtchizadeh ◽

Mahsanam Khaknejad ◽

Ebrahim Sakhinia ◽

Alireza Khabbazi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Ankle Joint ◽

Clinical Picture ◽

Joint Involvement ◽

Palindromic Rheumatism ◽

Clinical Criteria ◽

Disease Prognosis ◽

Significant Difference ◽

Citrullinated Vimentin

Abstract Objective This study evaluated anti-modified citrullinated vimentin (anti-MCV) performance in determining the clinical picture and outcomes of palindromic rheumatism (PR). Methods In a retrospective study, patients with PR with at least 1 year of follow-up diagnosed according to clinical criteria were enrolled. Anti-MCV antibodies were measured, and levels >20 IU/mL were considered positive. Disease prognosis was assessed according to patients acquiring remission and preventing PR from developing into rheumatoid arthritis (RA) or other diseases. Results Seventy-six patients with PR with a mean follow-up of 30.57 months (median = 21 months; minimum = 12 months; maximum = 48 months) were included in the study. Anti-MCV antibodies were positive in 69.7% of patients. Metacarpophalangeal (MCP) joint involvement and positive anti-cyclic citrullinated peptides were significantly higher in patients who were anti-MCV-positive, whereas ankle joint involvement was significantly lower. No significant correlation was observed between the anti-MCV titer and the severity of attacks. Remission in patients who were anti-MCV-positive and negative was 75.5% and 78.3%, respectively, with no significant difference. Evolution to RA was observed in only 3.8% of patients who were anti-MCV-positive. No patients who were anti-MCV-negative developed RA. Conclusion Except for MCP and ankle joint involvement, anti-MCV was not helpful in determining the clinical picture and outcome of PR.

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