scholarly journals POS0499 WORK ABSENCE DUE TO MUSCULOSKELETAL SYMPTOMS IN PATIENTS AT-RISK OF RHEUMATOID ARTHRITIS IS COMPARABLE TO THOSE WITH ESTABLISHED DISEASE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 482.1-482
Author(s):  
L. Garcia-Montoya ◽  
K. Mankia ◽  
L. Duquenne ◽  
J. Nam ◽  
A. Di Matteo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
Sick Leave ◽  
Clinical Intervention ◽  
Musculoskeletal Symptoms ◽  
Full Time ◽  
Work Absence ◽  
Ultrasound Scan ◽  
Patients At Risk ◽  
Employment Rates

Background:Rheumatoid arthritis (RA) is an established cause of disability and work absence; however, little is known about the impact of musculoskeletal (MSK) symptoms on sick leave in patients at-risk of developing the disease.Objectives:To describe the sick leave of individuals at-risk of RA, compared to patients who had recently been diagnosed with RA, over a 12-month period. Additionally, to investigate baseline predictors for sick leave within the first 12 months.Methods:A prospective observational cohort for individuals at-risk of RA was conducted. A total of 591 consecutive anti-citrullinated protein antibodie positive (ACPA+) individuals, with no clinical synovitis were recruited. A MSK ultrasound scan and a blood test were performed at baseline, and information about employment regime (retired, not in a paid job, part time and full time), days of sick leave and reasons for absences within the previous months were collected every 3 months and analysed at baseline, 6 months, 12 months and at the moment of diagnosis of an inflammatory arthritis (IA) (if the patient had progressed). Subjects who had retired (n=80) were excluded from the analysis.A comparison was made with 114 RA patients from an observational study. Employment information was collected at pre-treatment, 6 months and 1 year after diagnosis.Univariable and logistic regression analyses were performed to assess predictors of work absence due to MSK reasons in the next 12 months from baseline for at-risk individuals.Results:Even though the reasons for unemployment were not available, there were no statistically significant differences between employment rates across the timepoints of the study for the at-risk individuals’ group (p=0.778). A similar pattern was observed in the RA patient group; which also maintained the same employment rates throughout the study (p=0.311) and these were comparable to the at-risk individuals’ (p=0.480).Over 35% of at-risk individuals in paid employment had work absences in the 3 months prior to the baseline visit. Of these 65.5% were due to MSK related issues, meaning 23.2% of the total absences were MSK related. The other reasons for work absence can be seen in table 1. This fell to 12.9% of the total absences at 6 months (which probably reflects clinical intervention) and increased to 38% if the patient progressed to an IA (graph 1).Table 1.REASONS FOR SICK LEAVE AT BASELINE IN INDIVIDUALS AT-RISK OF RA (%)MSK related issues65.5Flu-like symptoms20.1Gastrointestinal issues19.4Stress/anxiety14.4Headaches11.5Infection3.6Fatigue1.4Other3.6The percentage of individuals who took absence from work due to MSK related issues, was similar in both the at risk and RA group, including an initial reduction possibly due to drug intervention (graph 1). However, the median number of days off work 3 months prior baseline, 6 months and 1 year in RA patients tended to be higher than those in the at-risk group (10, 2 and 6 versus 5, 4 and 3 respectively).Several factors were assessed to predict sick leave within 12 months in at-risk individuals: age, gender, smoking status, ACPA, rheumatoid factor (RF), anti-nuclear antibodies (ANA), C-reactive protein (CRP), early morning stiffness, shared epitope, joint pain, joint tenderness and abnormal findings in the ultrasound scan (erosions or power doppler); however, only RF [OR 0.18; p=0.018; 95% CI (0.04-0.84)] and CRP [OR 1.3; p=0.021; 95%CI (1.04-1.60)] were statistically significant in the multivariable analysis.Conclusion:Even though being at-risk of RA is not considered a potential cause of disability, results show that the burden on the workplace, due to MSK related absences, was comparable to subjects diagnosed with RA. Although further investigation is required, initial data suggests that clinical intervention may reduce this burden; which tends to be higher in at-risk individuals with a negative RF and a high CRP.Graph 1.Percentage of individuals who had work absences related to MSK issues 3 months prior to each timepoint.Acknowledgements:H. SinghT. HullandG. John- Leeds Cares -Disclosure of Interests:None declared

scholarly journals EULAR points to consider for conducting clinical trials and observational studies in individuals at risk of rheumatoid arthritis

2021 ◽  
pp. annrheumdis-2021-220884
Author(s):  
Kulveer Mankia ◽  
Heidi J Siddle ◽  
Andreas Kerschbaumer ◽  
Deshire Alpizar Rodriguez ◽  
Anca Irinel Catrina ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
At Risk ◽  
Clinical Trials ◽  
Observational Studies ◽  
Task Force ◽  
Musculoskeletal Symptoms ◽  
Subclinical Inflammation ◽  
Consensus Statements ◽  
Clinical Arthritis

BackgroundDespite growing interest, there is no guidance or consensus on how to conduct clinical trials and observational studies in populations at risk of rheumatoid arthritis (RA).MethodsAn European League Against Rheumatism (EULAR) task force formulated four research questions to be addressed by systematic literature review (SLR). The SLR results informed consensus statements. One overarching principle, 10 points to consider (PTC) and a research agenda were proposed. Task force members rated their level of agreement (1–10) for each PTC.ResultsEpidemiological and demographic characteristics should be measured in all clinical trials and studies in at-risk individuals. Different at-risk populations, identified according to clinical presentation, were defined: asymptomatic, musculoskeletal symptoms without arthritis and early clinical arthritis. Study end-points should include the development of subclinical inflammation on imaging, clinical arthritis, RA and subsequent achievement of arthritis remission. Risk factors should be assessed at baseline and re-evaluated where appropriate; they include genetic markers and autoantibody profiling and additionally clinical symptoms and subclinical inflammation on imaging in those with symptoms and/or clinical arthritis. Trials should address the effect of the intervention on risk factors, as well as progression to clinical arthritis or RA. In patients with early clinical arthritis, pharmacological intervention has the potential to prevent RA development. Participants’ knowledge of their RA risk may inform their decision to participate; information should be provided using an individually tailored approach.ConclusionThese consensus statements provide data-driven guidance for rheumatologists, health professionals and investigators conducting clinical trials and observational studies in individuals at risk of RA.

A3.10 Serum calprotectinis elevated in patients with early rheumatoid arthritis but not in patients at risk of developing rheumatoid arthritis

2016 ◽  
Vol 75 (Suppl 1) ◽  
pp. A36.1-A36
Author(s):  
K Prajzlerová ◽  
L Andrés Cerezo ◽  
P Hánová ◽  
H Mann ◽  
K Pavelka ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
Early Rheumatoid Arthritis ◽  
Patients At Risk

scholarly journals Should We Be Screening for and Treating Periodontal Disease in Individuals Who Are at Risk of Rheumatoid Arthritis?

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1326
Author(s):  
Zhain Mustufvi ◽  
Stefan Serban ◽  
James Chesterman ◽  
Kulveer Mankia
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
Periodontal Disease ◽  
Disease Activity ◽  
Joint Inflammation ◽  
Disease Association ◽  
Musculoskeletal Symptoms ◽  
Future Research ◽  
Periodontal Inflammation ◽  
Citrullinated Protein

There is increasing evidence supporting an association between periodontal disease (PD) and rheumatoid arthritis (RA), both mechanistically and clinically. Trials have shown that treating PD in people with RA may improve RA disease activity. Patients with musculoskeletal symptoms without arthritis, who test positive for cyclic-citrullinated protein antibodies, are at risk of RA (CCP+ at-risk), with seropositivity preceding arthritis onset by months or years. Importantly, there is evidence to suggest that periodontal inflammation may precede joint inflammation in CCP+ at-risk and, therefore, this could be a trigger for RA. There has been increased research interest in RA prevention and the phenotyping of the pre-RA disease phase. This review will examine the merits of identifying individuals who are CCP+ at-risk and performing screening for PD. In addition, we discuss how PD should be treated once identified. Finally, the review will consider future research needed to advance our understanding of this disease association.

FRI0239 Subclinical Inflammation on MRI of Hand and Foot of Acpa-Negative Arthralgia Patients at Risk for Rheumatoid Arthritis

2014 ◽  
Vol 73 (Suppl 2) ◽  
pp. 469.2-469
Author(s):  
H.W. Van Steenbergen ◽  
J.A. van Nies ◽  
T.W. Huizinga ◽  
M. Reijnierse ◽  
A.H. van der Helm-van Mil
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
Subclinical Inflammation ◽  
Patients At Risk

scholarly journals POS0434 CLINICAL UTILITY OF SCREENING TOOLS IN REFERRAL OF PATIENTS WITH HAND ARTHRALGIA TO RHEUMATOLOGISTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 445.1-445
Author(s):  
G. Figueroa-Parra ◽  
D. Vega-Morales ◽  
P. Herrera-Sandate ◽  
J. A. Esquivel Valerio ◽  
B. R. Vázquez Fuentes ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
Clinical Utility ◽  
Screening Tools ◽  
Categorical Variables ◽  
Left Hand ◽  
Right Hand ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
Patients At Risk

Background:Clinically Suspect Arthralgia (CSA) was defined by European League Against Rheumatism to identify a combination of clinical features that best characterise patients with arthralgia who are at risk of progression to rheumatoid arthritis (RA) (1). A specificity >90% is obtained with the presence of ≥4 parameters. Another clinical feature useful to identify patients at risk is the squeeze test (ST). Recently, we have identified the necessary strength to screen the patient with arthralgia through ST, with a median squeeze force of 3 kg and 2.78 kg to evoke pain in the right and left hand of the RA patient, respectively (2). Primary care physicians (PCP), the first contact of patients at risk, could benefit from these screening tools, prompting early referral, diagnosis, and treatment of these individuals.Objectives:To identify the clinical utility of CSA and ST in the referral of patients with hand arthralgia from PCP to rheumatologists.Methods:We conducted a cohort study from October 2018 to December 2020 in 110 patients who attended a Family Medicine clinic at University Hospital “Dr. Jose Eleuterio Gonzalez” in Monterrey, Mexico. We recruited patients with hand arthralgia with no history of previous trauma or autoimmune rheumatic diseases. A questionnaire assessing CSA criteria was employed, and an ST maneuver was performed through an automated compressor with quantitative measures of applied force. Patients were grouped based on referral to Rheumatology consultation and variables categorized according to clinically relevant thresholds. Chi square test was performed in categorical variables, t-student test was performed in normal, continuous variables and Spearman’s rho correlation was utilized between CSA number of criteria and quantitative ST force using SPSS v25.Results:Out of 110 patients, 49 (44.5%) were referred to a rheumatologist. A non-significant association was found across assessed variables in referred and non-referred patients as seen in Table 1. Spearman’s rho found a moderate correlation between the number of CSA criteria and quantitative force in right (r=-.445) and left (r=-.382) hand as seen in Figure 1. Evaluation of CSA cutoffs other than ≥4 did not yield a significant association in referral of patients to the rheumatologist (data not shown).Conclusion:The clinical utility of CSA criteria and ST in referral of patients with hand arthralgia from PCP to rheumatologists is currently limited. More research is needed to elucidate the clinical utility of these screening tools.References:[1]van Steenbergen HW, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Ann Rheum Dis. 2017;76(3):491-496.[2]Vega-Morales D, et al. Automated squeeze test (Gaenslen’s manoeuvre) to identify patients with arthralgia suspicious for progression to RA: improving time delay to rheumatology consultation. Ann Rheum Dis. 2017;76(10):e40.Table 1.Demographic characteristics and clinical performance of CSA and ST in referral of patients with hand arthralgia from PCP to rheumatologists.Referred patients,n = 49Non-referred patients, n = 61pFemale, n (%)40 (81.6)50 (82.0)0.964Age in years, mean ± SD46.76 ± 14.4352.05 ± 15.000.064Patients with ≥4 CSA criteria, n (%)23 (46.9)19 (31.1)0.090Right hand positive ST patients, n (%)21 (42.9)22 (36.1)0.468Left hand positive ST patients, n (%)26 (53.1)28 (45.9)0.455Force in right hand ST, mean kg ± SD4.19 ± 2.923.86 ± 3.070.571Force in left hand ST, mean kg ± SD4.25 ± 3.043.54 ± 2.740.198CSA, Clinically Suspect Arthralgia; ST, Squeeze Test; SD, Standard Deviation.Disclosure of Interests:None declared

scholarly journals Expression of Prostaglandin E2 Enzymes in the Synovium of Arthralgia Patients at Risk of Developing Rheumatoid Arthritis and in Early Arthritis Patients

PLoS ONE ◽  
2015 ◽  
Vol 10 (7) ◽  
pp. e0133669 ◽  
Author(s):  
Maria J. H. de Hair ◽  
Patrick Leclerc ◽  
Elize C. Newsum ◽  
Karen I. Maijer ◽  
Marleen G. H. van de Sande ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
Prostaglandin E2 ◽  
Early Arthritis ◽  
Patients At Risk ◽  
E2 Enzymes

FRI0041 ULTRASOUND-DETECTED SYNOVITIS AMONG INDIVIDUALS AT RISK OF RHEUMATOID ARTHRITIS INCREASES THE RISK OF DEVELOPING CLINICAL ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 595-596
Author(s):  
P. Hanova ◽  
K. Prajzlerová ◽  
N. Petrovská ◽  
M. Gregová ◽  
H. Mann ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
Rheumatic Diseases ◽  
Clinical Assessment ◽  
Palmar Approach ◽  
The Future ◽  
Clinical Arthritis ◽  
Risk Of Progression ◽  
Patients At Risk ◽  
Citrullinated Protein

Background:During the transition to rheumatoid arthritis (RA) patients pass through several phases. In the preclinical phase, the presence of anti citrullinated protein antibodies (ACPA) can be detected [1]. A set of clinical characteristics for patients with arthralgia who are at risk of progression to RA was established (clinically suspected arthralgia; CSA) [2]. Ultrasound (US) is more sensitive diagnostic tool in detecting synovitis than clinical assessment and was recommended to use in diagnostics of RA.Objectives:To test if ultrasound-detected synovitis among patients at risk of progression to RA increases the risk of developing clinical arthritis (CA) in the future.Methods:ACPA+ individuals with arthralgia and/or those fulfilling CSA criteria were enrolled into the study and were assessed in 3 months interval (routine clinical investigation with laboratory tests, 68-joint count, US assessment). Tender and swollen joint counts were provided by an independent investigator. Sonographer was blinded to all clinical and laboratory data. CA was defined as clinically swollen and tender joint. All US assessments were provided by a single experienced investigator. Thirty joints US score was assessed bilaterally in wrist, MCP I-V, PIP II-V (dorsal and palmar approach), MTP II-V (dorsal approach), ankle (dorsal, medial and lateral approach). US synovitis was defined according the EULAR-OMERACT and scored separately in gray-scale (GS) 0-3 (zero to severe synovitis) and Power Doppler (PD) 0-3 (zero to high activity). Scores were calculated as sum scores. For the statistical analysis, we used GraphPad Prism 8.0.0 software (Wilcoxon-Mann-Whitney test), and relative risk ratio (RR).Results:93 patients were enrolled into the study (95% female). 58 patients were ACPA+ (all of them RF+), 35 were ACPA- (10 of them RF+). Of ACPA+ individuals, 100% fulfilled the CSA criteria, all seronegative individuals met the CSA criteria. At baseline, GS≥1 was detected in 69 patients (74%), PD≥1 was in 26 (28 %) patients. Single erosion was found by US in 1 patient (0,9%) at baseline. 14 patients (15%) developed CA within 30 months, 77% of them till month 10 from the baseline. No statistical difference in US synovitis score was found between ACPA+ vs. ACPA- and CSA+ vs. CSA- groups at baseline. RR to develop CA at the joint level in patients with GS≥1 at baseline was 1.37 (95% CI 0.99-1.89; p<0.05), with PD≥1 the RR was 2.5 (95% CI 1.3-4.8; p<0.05), in GS≥2 RR was 3.8 (95% CI 2.6-5.6; p<0.0001), in PD≥2 RR was 5.3 (95% CI 2.4-11.7; p<0.0001). US-detected synovitis preceded clinical finding of arthritis by 3 months (SD 1.2).Conclusion:US-detected synovitis in patients at risk of RA further increases the risk of developing clinical arthritis in the future. US detected synovitis in joints appear about 3 months prior synovitis detected by routine clinical assessment.References:[1]Bos, W. H., Wolbink, G. J., Boers, et al. Arthritis development in patients with arthralgia is strongly associated with anti- citrullinated protein antibody status: a prospective cohort study. Annals of the Rheumatic Diseases, 2010;69(3):490-4.[2]van Steenbergen HW, Aletaha D, Beaart-van de Voorde LJJ, et al. EULAR definition of arthralgia suspicious for progression to rheumatoid arthritis. Annals of the Rheumatic Diseases 2017;76:491-6.Acknowledgments:Project AZV-17-32612ADisclosure of Interests:Petra Hanova: None declared, Klára Prajzlerová: None declared, Nora Petrovská: None declared, Monika Gregová Consultant of: Novartis, Abbvie, Paid instructor for: Novartis, Speakers bureau: Novartis, Abbvie, MSD, Heřman Mann: None declared, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Jiří Vencovský: None declared, Ladislav Šenolt: None declared, Mária Filková: None declared

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