scholarly journals Risk of the high-riding variant of vertebral arteries at C2 is increased over twofold in rheumatoid arthritis: a meta-analysis

2020 ◽  
Author(s):  
Tomasz Klepinowski ◽  
Jagoda Cembik ◽  
Leszek Sagan
Keyword(s):  
Rheumatoid Arthritis ◽  
Relative Risk ◽  
Vertebral Artery ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Atlantoaxial Instability ◽  
Vertebral Arteries ◽  
Group A ◽  
Group B

Abstract Rheumatoid arthritis (RA) might lead to atlantoaxial instability requiring transpedicular or transarticular fusion. High-riding vertebral artery (HRVA) puts patients at risk of injuring the vessel. RA is hypothesized to increase a risk of HRVA. However, to date, no relative risk (RR) has been calculated in order to quantitatively determine a true impact of RA as its risk factor. To the best of our knowledge, this is the first attempt to do so. All major databases were scanned for cohort studies combining words “rheumatoid arthritis” and “high-riding vertebral artery” or synonyms. RA patients were qualified into the exposed group (group A), whereas non-RA subjects into the unexposed group (group B). Risk of bias was explored by means of Newcastle-Ottawa Scale. MOOSE checklist was followed to ensure correct structure. Fixed-effects model (inverse variance) was employed. Four studies with a total of 308 subjects were included in meta-analysis. One hundred twenty-five subjects were in group A; 183 subjects were in group B. Mean age in group A was 62,1 years, whereas in group B 59,9 years. The highest risk of bias regarded “comparability” domain, whereas the lowest pertained to “selection” domain. The mean relative risk of HRVA in group A (RA) as compared with group B (non-RA) was as follows: RR = 2,11 (95% CI 1,47–3,05), I2 = 15,19%, Cochrane Q = 3,54 with overall estimate significance of p < 0,001. Rheumatoid arthritis is associated with over twofold risk of developing HRVA, and therefore, vertebral arteries should be meticulously examined preoperatively before performing craniocervical fusion in every RA patient.

scholarly journals Therapeutic efficacy of alternative primaquine regimens to standard treatment in preventing relapses by Plasmodium vivax: A systematic review and meta-analysis

2015 ◽  
pp. 183-191 ◽  
Author(s):  
Lina Marcela Zuluaga Idarraga ◽  
Maria Eulalia Tamayo Perez ◽  
Daniel Camilo Aguirre Acevedo
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Relative Risk ◽  
Fixed Effects ◽  
Standard Treatment ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Efficacy And Safety ◽  
Standard Regimen

Objective: To compare efficacy and safety of primaquine regimens currently used to prevent relapses by P. vivax. Methods: A systematic review was carried out to identify clinical trials evaluating efficacy and safety to prevent malaria recurrences by P. vivax of primaquine regimen 0.5 mg / kg / day for 7 or 14 days compared to standard regimen of 0.25 mg/kg/day for 14 days. Efficacy of primaquine according to cumulative incidence of recurrences after 28 days was determined. The overall relative risk with fixed-effects meta-analysis was estimated. Results: For the regimen 0.5 mg/kg/day/7 days were identified 7 studies, which showed an incidence of recurrence between 0% and 20% with follow-up 60-210 days; only 4 studies comparing with the standard regimen 0.25 mg/kg/day/14 days and no difference in recurrences between both regimens (RR= 0.977, 95% CI= 0.670 to 1.423) were found. 3 clinical trials using regimen 0.5 mg/kg/day/14 days with an incidence of recurrences between 1.8% and 18.0% during 330-365 days were identified; only one study comparing with the standard regimen (RR= 0.846, 95% CI= 0.484 to 1.477). High risk of bias and differences in handling of included studies were found. Conclusion: Available evidence is insufficient to determine whether currently PQ regimens used as alternative rather than standard treatment have better efficacy and safety in preventing relapse of P. vivax. Clinical trials are required to guide changes in treatment regimen of malaria vivax.

scholarly journals Multiple intravenous tranexamic acid doses in total knee arthroplasty in patients with rheumatoid arthritis: a randomized controlled study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bing-xin Kang ◽  
Hui Xu ◽  
Chen-xin Gao ◽  
Sheng Zhong ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trial ◽  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Randomized Controlled ◽  
Group A ◽  
Total Knee ◽  
Group B ◽  
D Dimer

Abstract Background We aimed to determine the efficacy and safety of multiple doses of intravenous tranexamic acid (IV-TXA) on perioperative blood loss in patients with rheumatoid arthritis (RA) who had undergone primary unilateral total knee arthroplasty (TKA). Methods For this single-center, single-blind randomized controlled clinical trial, 10 male and 87 female participants with RA, aged 50–75 years, who underwent unilateral primary TKA were recruited. The patients received one dose of 1 g IV-TXA 10 min before skin incision, followed by articular injection of 1.5 g tranexamic acid after cavity suture during the surgery. The patients were randomly assigned (1:1) into two groups and received an additional single dose of IV-TXA (1 g) for 3 h (group A) or three doses of IV-TXA (1 g) for 3, 6, and 12 h (group B) postoperatively. Primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum hemoglobin (Hb) level decrease. Secondary outcomes were transfusion rate and D-dimer levels. All parameters were measured postoperatively during inpatient hospital stay. Results The mean TBL, HBL, and maximum Hb level decrease in group B (506.1 ± 227.0 mL, 471.6 ± 224.0 mL, and 17.5 ± 7.7 g/L, respectively) were significantly lower than those in group A (608.8 ± 244.8 mL, P = 0.035; 574.0 ± 242.3 mL, P = 0.033; and 23.42 ± 9.2 g/L, P = 0.001, respectively). No episode of transfusion occurred. The D-dimer level was lower in group B than in group A on postoperative day 1 (P <  0.001), and the incidence of thromboembolic events was similar between the groups (P > 0.05). Conclusion In patients with RA, three doses of postoperative IV-TXA further facilitated HBL and Hb level decrease without increasing the incidence of adverse events in a short period after TKA. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR1900025013).

scholarly journals POS0563 THE NATURAL COURSE OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE FOCUSING ON LUNG PHYSIOLOGY AND DISEASE ACTIVITY: A PROSPECTIVE COHORT STUDY (PART 2)

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 516.1-516
Author(s):  
S. H. Chang ◽  
J. S. Lee ◽  
J. S. Lee ◽  
C. H. Park ◽  
M. U. Kim ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Natural Course ◽  
Annual Change ◽  
Low Disease Activity ◽  
Activity Group ◽  
Lung Physiology ◽  
Group A ◽  
Group B ◽  
Group D

Background:Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). However, the effect of RA disease activity on the course of ILD is not yet known.Objectives:To assess the natural course of lung physiology of RA-ILD and the relation between arthritis activity and pulmonary physiology in patients with RA-ILD.Methods:The Korean Rheumatoid Arthritis ILd (KORAIL) cohort is the prospective observational cohort and aims to investigate the natural course of RAILD. Based on either 1987 or 2020 ACR criteria, patients diagnosed with RA and ILD based on CT scan were recruited from six tertiary medical hospitals in Korea since January 2015. RA disease activity was assessed using disease activity (DAS)28-ESR and CRP, annually. Pulmonary function tests (PFT), including FVC and DLCO were conducted annually. According to the transition of DAS28-ESR status, we classified patients into four groups: Group A. persistent remission or low disease activity, Group B. improvement, Group C. worsening, Group D. persistent moderate to high disease activity.Results:We analyzed 143 patients who completed a 2-year follow-up (visit 2) or had died with available PFT results at least twice. Mean duration since RA diagnosis and since ILD diagnosis was 7.6±8.0 and 2.7±3.1 years, respectively. Twenty-four patients were Group A, 33 Group B, 10 Group C and 30 Group D. The mean of FVC (mL) and % of the predicted value in FVC was significantly lower in Group D than in other groups (Table 1). The annual rate of decline in FVC was -42 (95% CI -93~10) mL·year-1 in Group B while -113 (95% CI -206~-21) mL·year-1 in Group C (Figure 1A). The annual decline rate in Group C was further exaggerated in patients with ≥ 80% of FVC predicted (-141, 95% CI -251~-32 mL·year-1). During two years of follow-up, patients ever experienced a relative decline of ≥10% from the enrollment in FVC predicted was 27.3%(n-9/33) in Group B whereas 30.0% (3/10) in Group C. The annual rate of decline in % of DLco predicted value was also the largest in Group C (-4.6 %·year-1, 95%CI -8.5~-0.7), which further exaggerated in patients with ≥ 80% of FVC predicted (-4.9%·year-1, 95 %CI -8.3~-1.5, Figure 1B). Of note, about half of patients with maintained not only low disease activity (Group A) but also moderate to severe disease activity (Group D) improved in DLco at least 10% or more from the enrollment of DLco predicted value (Group A: 54.2%, n=13/24, Group D: 46.7%, n=14/30).Conclusion:RA disease activity is associated with the change of lung physiology in patients with RA-ILD; worsening disease activity associated with a further decrease of annual change in FVC and maintaining low disease activity associated with a further increase of annual change in % of DLco predicted value.Table 1.The analysis of forced vital capacity (FVC) according to disease activity transition group.Group AGroup BGroup CGroup DFVC (mL), mean±SD2810.0±771.12528.8±735.32801.0±952.72048.3±575.7FVC % of predicted, mean±SD87.5±14.586.5±16.693.0±15.677.2±17.3Rate of FVC decline, mL·year-1 (95% CI)-52 (-112,7)-42 (-93,10)-113 (-206, -21)1 (-52, 54)A 10-point decline from V1 in predicted FVC value, n (%)29 (20.3)6 (25.0)6 (18.2)3 (30.0)Relative decline of 10% from the enrollment in predicted FVC value, n (%)35 (24.5)5 (20.8)9 (27.3)3 (30.0)Figure 1.The annual change of pulmonary physiology according to disease activity transition group.Acknowledgements:This work was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (grant no.HI14C1277).Disclosure of Interests:None declared

scholarly journals Efficacy of Telmisartan in Pristane Induced Arthritis Rat Model

2021 ◽  
Vol 35 (3) ◽  
pp. 6-11
Author(s):  
Quratulain Mehdi
Keyword(s):  
Rheumatoid Arthritis ◽  
Rat Model ◽  
Leukocyte Count ◽  
Female Rats ◽  
Total Leukocyte Count ◽  
Standard Diet ◽  
Entire Study ◽  
Intergroup Comparison ◽  
Group A ◽  
Group B

Introduction: Rheumatoid arthritis is one of the most common systemic inflammatory diseases characterized by progressive damage to the joints. There is rising evidence that Renin Angiotensin Aldosterone System signaling is also involved in the inflammatory response in rheumatoid arthritis and its blockers possess anti-arthritic properties. Telmisartan is an angiotensin receptor blocker and PPAR-? agonist and its anti-arthritic effects were evaluated. Aims & Objectives: This experimental study was designed to evaluate the anti-arthritic efficacy of telmisartan in pristane induced rat model of arthritis in adult female rats. Place and duration of study: The study was conducted in the Department of Pharmacology, Army Medical College, Rawalpindi, in collaboration with National Institute of Health and Armed Forces Institute of Pathology from July 2020 to August 2020. Material & Methods: Twenty four (24) adult non-pregnant female Sprague Dawley rats were divided in three groups (n=8) designated as Group A (normal control), Group B (arthritic control) and Group C (telmisartan group) & maintained on standard diet and water adlibitum. Rheumatoid arthritis was induced in each rat of Groups B &C by a single intradermal injection of 0.5ml pristane at the base of its tail on day 0 and the disease developed in two weeks. All 3 groups were given distilled water 2.5 ml/kg from 2-4 weeks and Group C was additionally given dissolved telmisartan orally at 2 mg/kg/day. Anti-arthritic efficacy was determined by assessing arthrogram score and total leukocyte count on day 0, 14 and 28 along with histological examination done at the end of the study. Data analysis was done using SPSS version 25. Results: Healthy rats in group A maintained a unremarkable arthogram & histogram score & TLC count of 6675±350/?l during the entire study period. Telmisartan administration in Group C for two weeks after pristane induction resulted in significant reduction in arthrogram score (AS) 9.5±3.66, total leukocyte count (TLC) 7350±550/?l and histological score (HS) to 6.88±1.24 as compared to (AS) 14.50±2.07, WBC 10150±350/?L & (HS) 10.75±2.05 in Group B, left untreated with pristane alone. The intergroup comparison showed significant p value < 0.05 respectively. Conclusion: Anti-arthritic effect was shown by telmisartan as it was able to ameliorate the changes induced by pristane.

scholarly journals Identification of Interorganellar Crosstalk Effect on Various Diseases, Including Kidney Disease: A Systematic Review and Meta-analysis

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Fateme Shamekhi Amiri
Keyword(s):  
Relative Risk ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Data Sources ◽  
Cellular Functions ◽  
Pubmed Central ◽  
Subcellular Organelles ◽  
Age Related ◽  
Health And Disease

Context: Subcellular organelles communicate with each other via their metabolites and maintain different cellular functions. They contain nucleus, mitochondria, endoplasmic reticulum, peroxisomes, and lysosomes. Objectives: This study aimed to identify interorganellar communication (crosstalk) in physiopathological states of cells in health and disease. Data Sources: The databases including PubMed Central, Embase, Scopus, and Google Scholar were searched to extract data. For statistical analyses, percentage, relative risk, and odds ratio were used. Moreover, the risk of bias was assessed by Cochrane collaboration’s tool. Results: Out of 20 studies included in this research, 12 (60%) studies included mitochondria-ER communication, 4 (20%) studies mitochondria-lysosome communication, 2 (10%) studies mitochondria-peroxisome, and 2 (10%) studies mitochondria-nucleus. Interorganellar crosstalk between mitochondria and peroxisome or lysosome had risk and odds of 1.5 (effect) on aging and age-related disorders. There were no effects of mitochondrial communication with other organelles on certain pathologies. The relative risk of mitochondria to nucleus crosstalk on apoptosis was assessed 1.13, and relative risk of mitochondria to lysosome crosstalk was assessed 2. In addition, the odds ratio of mitochondria to lysosome crosstalk on apoptosis was assessed 5, indicating a large effect on this crosstalk. Conclusions: Recent expansion of pharmacological, molecular, and genetic tools indicated these organelles have active intracellular and extracellular communications, which is important for cells and organ homeostasis. Disruption of such communication has been associated with aging and age-related disorders in this research.

A meta-analysis of biologic therapies on risk of new or recurrent cancer in patients with rheumatoid arthritis and a prior malignancy

Rheumatology ◽  
2019 ◽  
Vol 59 (5) ◽  
pp. 930-939 ◽  
Author(s):  
Wenhui Xie ◽  
Shiyu Xiao ◽  
Yanrong Huang ◽  
Xiaoying Sun ◽  
Dai Gao ◽  
...  
Keyword(s):  
Relative Risk ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Optimal Time ◽  
Biologic Therapies ◽  
Recurrent Cancer ◽  
Increased Risk ◽  
Risk Of Cancer ◽  
Prior Malignancy

Abstract Objectives To explore the risk of new and recurrent cancer in adult RA patients with prior malignancy and subsequently exposed to biologic therapies. Methods Separate searches were performed of PubMed, EMBASE and Cochrane Library and conference proceedings for observational studies reporting cancer incidence or recurrence in patients with RA and prior malignancy treated with biologics and conventional synthetic DMARDs (csDMARDs). Mantel-Haenszel fixed-effects method was conducted to calculate relative risk and 95% CI. Results A total of 12 studies involving 13 598 patients and 32 473 patient-years of follow-up were included (10, 3 and 1 studies for TNF inhibitors [TNFi], rituximab and anakinra, respectively). The crude incidence of new and recurrent cancer per 1000 patient-years were 34.4 for TNFi, 32.3 for rituximab, 32.3 for anakinra and 31.8 for csDMARDs. In the quantitative meta-analysis, biologics were not associated with an increased risk of new or recurrent cancer compared with csDMARDs in patients with RA and prior cancer (TNFi: relative risk = 0.95, 95% CI = 0.83, 1.09; rituximab: relative risk = 0.89, 95% CI = 0.52, 1.53). Secondary analyses of stratification of cancer types, the interval between initiation of TNFi and prior cancer diagnosis, and duration of TNFi exposure, found similar results. Conclusion Compared with csDMARDs, there is no increased risk of developing cancer overall or some specific subtypes in RA patients with a prior cancer receiving biologics. More investigations are warranted to explore the risk of cancer development in individual cancer as well as to determine optimal time to initiate biologic therapy after the diagnosis of cancer or completion of cancer treatment.

scholarly journals Large-scale meta-analysis across East Asian and European populations updated genetic architecture and variant-driven biology of rheumatoid arthritis, identifying 11 novel susceptibility loci

2020 ◽  
pp. annrheumdis-2020-219065
Author(s):  
Eunji Ha ◽  
Sang-Cheol Bae ◽  
Kwangwoo Kim
Keyword(s):  
Rheumatoid Arthritis ◽  
Transcription Factors ◽  
T Cell Activation ◽  
Fixed Effects ◽  
Genetic Architecture ◽  
Association Studies ◽  
Meta Analysis ◽  
Chromatin Interaction ◽  
Susceptibility Loci ◽  
European Populations

ObjectivesNearly 110 susceptibility loci for rheumatoid arthritis (RA) with modest effect sizes have been identified by population-based genetic association studies, suggesting a large number of undiscovered variants behind a highly polygenic genetic architecture of RA. Here, we performed the largest-ever trans-ancestral meta-analysis with the aim to identify new RA loci and to better understand RA biology underlying genetic associations.MethodsGenome-wide RA association summary statistics in three large case–control collections consisting of 311 292 individuals of Korean, Japanese and European populations were used in an inverse-variance-weighted fixed-effects meta-analysis. Several computational analyses using public omics resources were conducted to prioritise causal variants and genes, RA variant-implicating features (tissues, pathways and transcription factors) and potentially repurposable drugs for RA treatment.ResultsWe identified 11 new RA susceptibility loci that explained 6.9% and 1.8% of the single-nucleotide polymorphism-based heritability in East Asians and Europeans, respectively, and confirmed 71 known non-human leukocyte antigens (HLA) susceptibility loci, identifying 90 independent association signals. The RA variants were preferentially located in binding sites of various transcription factors and in cell type-specific transcription–activation histone marks that simultaneously highlighted the importance of CD4+ T-cell activation and the potential role of non-immune organs in RA pathogenesis. A total of 615 plausible effector genes, based on gene-based associations, expression-associated variants and chromatin interaction, included targets of drugs approved for RA treatments and potentially repurposable drugs approved for other indications.ConclusionOur findings provide useful insights regarding RA genetic aetiology and variant-driven RA pathogenesis.

A Meta-Analysis Study of the Effect of Chilling on Prevalence of Salmonella on Pig Carcasses

2008 ◽  
Vol 71 (7) ◽  
pp. 1330-1337 ◽  
Author(s):  
U. GONZALES BARRON ◽  
D. BERGIN ◽  
F. BUTLER
Keyword(s):  
Relative Risk ◽  
Effect Size ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Risk Difference ◽  
Detection Methods ◽  
Binary Outcomes ◽  
Production Chain ◽  
Prevalence Studies ◽  
Pig Carcasses

In the field of food safety, meta-analysis can be used to combine results of prevalence studies of pathogens at critical stages within the food processing chain so that policy makers can access reliable and concise information on the effectiveness of interventions for controlling and preventing foodborne illnesses in humans. The objective of this work was to demonstrate the applicability of a parametric approach of meta-analysis to the specific case of determining the overall effect of chilling on Salmonella prevalence on pig carcasses. A meta-analysis was performed on each of two parameters measuring effect size for binary outcomes (relative risk and risk difference). Both meta-analyses confirmed that the chilling operation has a significant beneficial effect (P &lt; 0.001) on the reduction of Salmonella prevalence on pig carcasses. Because risk difference is a parameter sensitive to the differences across studies in carcass swab areas and Salmonella detection methods, its meta-analysis highly reflected this heterogeneity (P &lt; 0.001). However, parameterization of relative risk, not being biased by the above sources of variability, did not give rise to heterogeneity among studies and produced a fixed-effects meta-analysis solution, which is deemed more suitable for compilations based on a small number of individual studies (n = 9). Because of the systematic approach of meta-analysis (i.e., individual studies are weighed according to precision) and its reliance for actual data, the output distribution of the relative risk effect size (~eN(−0.868,0.166)) merits consideration for inclusion in the chilling stage of quantitative risk assessments modeling the prevalence of this pathogen along the pork production chain.

Systemic therapy for nonmetastatic castrate-resistant prostate cancer (M0 CRPC): A systematic review and network meta-analysis (NMA).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 113-113
Author(s):  
Ellen Cusano ◽  
Richard M. Lee-Ying ◽  
Devon J. Boyne ◽  
Darren Brenner ◽  
Marcus Vaska
Keyword(s):  
Fixed Effects ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Similar Efficacy ◽  
Risk Of Bias ◽  
Fixed Effects Model ◽  
Castrate Resistant Prostate Cancer ◽  
Grade 3 ◽  
Castrate Resistant ◽  
The Cochrane Collaboration

113 Background: The treatment landscape for M0 CRPC has changed following the demonstrated efficacy of new agents in recent randomized control trials (RCT). However, the comparative effectiveness of these novel agents is unknown. This NMA indirectly compared the efficacy and safety of available therapies for M0 CRPC. Methods: A literature search of MEDLINE (Ovid), EBM Reviews, HealthSTAR, PubMed, PubMed Central, CINAHL, and TRIP Database was performed. Studies were screened by two independent reviewers. Hazard ratios (HR) and confidence intervals were extracted for the primary outcome metastasis-free survival (MFS) and the secondary outcomes overall survival (OS) and grade 3 or higher adverse events (AE). Bone MFS was used as a surrogate for MFS when MFS was not reported. Risk of bias was assessed using the Cochrane Collaboration tool. A Bayesian NMA was performed using a fixed-effects model. Results: Four RCT were analyzed (n=5549). Each trial compared either apalutamide (APA), enzalutamide (ENZA), darolutamide (DARO), or denosumab (DENO) plus androgen deprivation therapy (ADT) to placebo plus ADT. Risk of bias was low. For MFS, APA and ENZA had similar efficacy (Table), and Surface Under the Cumulative Ranking Analysis demonstrated a 59% probability that APA was preferred for MFS, followed by ENZA (41%). There was a trend for improved OS for APA, DARO and ENZA, but no meaningful differences between these agents. APA, ENZA, and DARO had a similar risk of AEs and all had a greater risk of AEs compared to DENO. Conclusions: APA and ENZA appear to be the most efficacious treatments for MFS in M0 CRPC, though more data for OS is required. Compared to DARO, APA and ENZA’s demonstrated efficacy is not at the expense of added toxicity.[Table: see text]

DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis

2009 ◽  
Vol 69 (01) ◽  
pp. 65-69 ◽  
Author(s):  
Y P M Goekoop-Ruiterman ◽  
J K de Vries-Bouwstra ◽  
P J S M Kerstens ◽  
M M J Nielen ◽  
K Vos ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Controlled Trial ◽  
Joint Damage ◽  
Routine Care ◽  
Activity Score ◽  
Recent Onset ◽  
Group A ◽  
Group B

Objectives:To compare the efficacy of Disease Activity Score (DAS)-driven therapy and routine care in patients with recent-onset rheumatoid arthritis.Methods:Patients with recent-onset rheumatoid arthritis receiving traditional antirheumatic therapy from either the BeSt study, a randomised controlled trial comparing different treatment strategies (group A), or two Early Arthritis Clinics (group B) were included. In group A, systematic DAS-driven treatment adjustments aimed to achieve low disease activity (DAS ⩽2.4). In group B, treatment was left to the discretion of the treating doctor. Functional ability (Health Assessment Questionnaire (HAQ)), Disease Activity Score in 28 joints (DAS28) and Sharp/van der Heijde radiographic score (SHS) were evaluated.Results:At baseline, patients in group A (n = 234) and group B (n = 201) had comparable demographic characteristics and a mean HAQ of 1.4. Group A had a longer median disease duration than group B (0.5 vs 0.4 years, p = 0.016), a higher mean DAS28 (6.1 vs 5.7, p<0.001), more rheumatoid factor-positive patients (66% vs 42%, p<0.001) and more patients with erosions (71% vs 53%, p<0.001). After 1 year, the HAQ improvement was 0.7 vs 0.5 (p = 0.029), and the percentage in remission (DAS28 <2.6) 31% vs 18% (p<0.005) in groups A and B, respectively. In group A, the median SHS progression was 2.0 (expected progression 7.0), in group B, the SHS progression was 1.0 (expected progression 4.4).Conclusions:In patients with recent-onset rheumatoid arthritis receiving traditional treatment, systematic DAS-driven therapy results in significantly better clinical improvement and possibly improves the suppression of joint damage progression.

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