Arthritis and rheumatism最新文献

Objective: To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic Lyme disease (CLD).

Methods: We assessed 159 patients drawn from a cohort of 240 patients evaluated at an academic Lyme disease referral center. Patients were screened for common axis I psychiatric disorders (e.g., depressive and anxiety disorders); structured clinical interviews confirmed diagnoses. Axis II personality disorders, functional status, and traits like negative and positive affect and pain catastrophizing were also evaluated. A physician blind to psychiatric assessment results performed a medical evaluation. Two groups of CLD patients (those with post-Lyme disease syndrome and those with medically unexplained symptoms attributed to Lyme disease but without Borrelia burgdorferi infection) were compared with 2 groups of patients without CLD (patients recovered from Lyme disease and those with an identifiable medical condition explaining symptoms attributed to Lyme disease).

Results: After adjusting for age and sex, axis I psychiatric disorders were more common in CLD patients than in comparison patients (P = 0.02, odds ratio 2.64, 95% confidence interval 1.30-5.35), but personality disorders were not. Patients with CLD had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain (P < 0.001) than comparison patients. All psychological factors except personality disorders were related to level of functioning. A predictive model based on these psychological variables was confirmed. Fibromyalgia was diagnosed in 46.8% of CLD patients.

Conclusion: Psychiatric comorbidity and other psychological factors distinguished CLD patients from other patients commonly seen in Lyme disease referral centers, and were related to poor functional outcomes.

Objective: To estimate health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus (SLE) in the US.

Methods: Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants provided information on their health care resource use and employment. Cost estimates were derived for both direct health care costs and costs related to changes in work productivity. Direct health care costs included costs for hospitalizations, emergency department services, physician visits, outpatient surgical procedures, dialysis, and medications. Productivity costs were estimated by measuring changes in hours of work productivity since diagnosis of SLE; these estimates were also compared with normal US population data.

Results: For the total population of participants, the mean annual direct cost was $12,643 (2004 US dollars). The mean annual productivity cost for subjects of employment age (>or=18 and <65 years) was $8,659. The mean annual total cost (direct and productivity) for subjects of employment age was $20,924. Regression results showed that greater disease activity, longer disease duration, and worse physical and mental health were significant predictors of higher direct costs; older age predicted lower direct costs. Older age, greater disease activity, and worse physical and mental health status were significant predictors of higher costs due to changes in work productivity.

Conclusion: Both direct health care costs and costs associated with changes in work productivity are substantial and both represent important contributors to the total costs associated with SLE.

Objective: To compare magnetic resonance imaging (MRI), conventional radiography, and ultrasonography in identifying bone erosions in patients with juvenile idiopathic arthritis (JIA), and to determine the validity and reliability of an MRI scale in detecting and grading joint damage.

Methods: In 26 JIA patients, the clinically more affected wrist was studied with MRI, radiography, and ultrasonography, coupled with standard clinical assessment and biochemical analysis. MR images were assessed independently by 2 readers according to an apposite devised scoring system.

Results: Of 26 patients, 25 (96.1%) had 1 or more erosions as detected by MRI, whereas conventional radiography and ultrasonography revealed erosions in 13 (50%) of 26 and 12 (50%) of 24 patients, respectively. The ability of MRI to detect erosive changes was significantly higher with respect to conventional radiography (P = 0.002 with Bonferroni correction [P(B)]) and ultrasonography (P(B) = 0.0002) in the group of patients with <3 years' disease duration. Ultrasonography and conventional radiography were of equivalent value for the detection of destructive changes. Wrist MRI score correlated highly with radiographic erosion score (r(s) = 0.82) and with wrist limited range of motion score (r(s) = 0.69). The interreader intraclass correlation coefficient (ICC) for MRI score was excellent (0.97); intrareader ICCs were good for both investigators (0.97 and 0.79).

Conclusion: MRI seems to be a powerful tool to detect early structural damage in JIA. The proposed MRI scale for bone erosions appears promising in terms of reliability and construct validity. The pathophysiologic meaning and the prognostic value of bone erosions revealed only by MRI remain to be established in longitudinal studies.

Objective: Cardiovascular disease is the major cause of excessive mortality in rheumatoid arthritis (RA) and endothelial dysfunction plays a key role in atherosclerosis. The aim of the present study was to assess whether rituximab therapy was able to improve endothelial function in RA patients refractory to tumor necrosis factor alpha (TNFalpha) blockers.

Methods: Six consecutive RA patients (5 women; age range 55-79 years) with active disease refractory to TNFalpha inhibitor therapy were studied. Patients received intravenous rituximab (1 course, consisting of 2 infusions of 1,000 mg each separated by 2 weeks). Flow-mediated endothelium-dependent vasodilatation (FMD%) and endothelium-independent vasodilatation (postnitroglycerin) were measured at day 0 prior to the first rituximab infusion, at week 2 (before the second infusion), and at month 6.

Results: At week 2, a dramatic increase in FMD% values was observed in all patients (mean +/- SD 7.02 +/- 2.31%, median 7.29%, range 3.2-9.75%) compared with those observed before the first infusion (mean +/- SD 3.35 +/- 1.58%, median 3.04%, range 1.69-5.89%). In addition, at month 6, FMD% values in all patients (mean +/- SD 7.66 +/- 1.73%, median 7.64%, range 5.61-9.98%) were greater than those found before the first infusion (P = 0.03). The dramatic improvement of FMD% was associated with a significant decrease in C-reactive protein level and Disease Activity Score in 28 joints.

Conclusion: Our study demonstrates an active effect of rituximab on endothelial function in RA patients refractory to TNFalpha blockers.

Objective: To assess the usefulness of using oblique foot radiographs in addition to posteroanterior radiographs of the hands and feet for detecting erosions in patients with recent-onset arthritis.

Methods: We included 813 patients from the prospective French ESPOIR cohort with arthritis of <6 months' duration and >or=2 swollen joints. Baseline standardized posteroanterior radiographs of the hands and feet and oblique radiographs of the feet were assessed by 2 blinded readers for erosions typical for rheumatoid arthritis (ETRA) and the Sharp score as modified by van der Heijde.

Results: A total of 715 complete sets were available. Mean +/- SD total Sharp scores were 3.6 +/- 6.6, 2.5 +/- 6.3, and 1.8 +/- 5 for the hand and wrist, foot, and oblique foot, respectively. ETRA were visible in 160 (22.4%) of 715 patients (95% confidence interval [95% CI] 19.4-25.6). They were seen on hand radiographs in 86 (53.7%) of 160 patients (95% CI 45.7-61.6), on posteroanterior foot radiographs in 91 (56.9%) of 160 patients (95% CI 48.8-64.6), and on oblique foot radiographs in 84 (52.5%) of 160 patients (95% CI 44.5-60.4). ETRA were visible at the feet, but not at the hands, in 74 (46%) of 160 patients (95% CI 38.4-54.3), among whom 22 (30%) had erosions only on the posteroanterior view, 16 (21%) only on the oblique view, and 36 (48.6%) on both.

Conclusion: ETRA were found in 22.4% of patients. Adding an oblique foot radiograph identified 16 (10%) of 160 additional patients (95% CI 6-16), compared with 27.5% and 13.8% identified by adding posteroanterior radiographs of the hands and feet, respectively.

Objective: Few studies have examined hand osteoarthritis (OA) pathology using sensitive imaging techniques. The aim of this study was to determine the extent of ultrasound (US)-detected pathology and investigate its relationship with symptoms in hand OA.

Methods: Subjects with symptomatic hand OA and controls were recruited. All underwent clinical and US examination of the small joints of both hands and completed a range of measures of hand pain, stiffness, and function.

Results: Thirty-six subjects with symptomatic OA and 19 control subjects with similar demographics were recruited. US-detected pathology (osteophytes, joint space narrowing, gray-scale synovitis, and power Doppler signal) occurred frequently in symptomatic hand OA (41%, 40%, 46%, and 7% of joints, respectively), and significantly less often in controls (P < 0.001 for all comparisons). Symptomatic joints were more likely to demonstrate US-detected changes of gray-scale synovitis, power Doppler signal, or osteophytes (P < 0.001, P = 0.002, and P < 0.001, respectively). Neither the number of affected joints per individual nor the summative semiquantitative scores for synovitis per individual correlated with symptoms (pain visual analog scale [VAS], global VAS, or Australian/Canadian Osteoarthritis Hand Index).

Conclusion: This study demonstrated extensive synovitis changes as well as the traditional structural radiographic findings of hand OA. Symptomatic joints were significantly more likely to demonstrate US-detected structural changes or inflammation in symptomatic hand OA; however, the extent of changes in individual joints or in individuals did not correlate with the degree of symptoms, which may relate to both the assessment tools and the complex nature of pain.