Arthritis and rheumatism最新文献

Objective: To determine by magnetic resonance imaging (MRI), whether knees with advanced radiographic disease (medial joint space narrowing [mJSN]) encounter greater longitudinal cartilage loss than contralateral knees with earlier disease (no or less mJSN).

Methods: Participants were selected from 2,678 cases in the Osteoarthritis Initiative, based on exhibition of bilateral pain, body mass index >25 (kg/m(2)), mJSN in 1 knee, no or less mJSN in the contralateral knee, and no lateral JSN in both knees. Eighty participants (mean +/- SD age 60.6 +/- 9.1 years) fulfilled these criteria. Medial tibial and femoral cartilage morphology was analyzed from the baseline and the 1-year followup MRI (sagittal double echo at steady state by 3.0T) of both knees by experienced readers blinded to the time point and mJSN status.

Results: Knees with more radiographic mJSN displayed greater medial cartilage loss (-80 mum) assessed by MRI than contralateral knees with less mJSN (-57 mum). The difference reached statistical significance in participants with an mJSN grade of 2 or 3 (P = 0.005-0.08), but not in participants with an mJSN grade of 1 (P = 0.28-0.98). In knees with more mJSN, cartilage loss increased with higher grades of mJSN (P = 0.003 in the medial femur). Knees with an mJSN grade of 2 or 3 displayed greater cartilage loss in the weight-bearing medial femur than in the posterior femur or in the medial tibia (P = 0.048).

Conclusion: Knees with advanced mJSN displayed greater cartilage loss than contralateral knees with less mJSN. These data suggest that radiography can be used to stratify fast structural progressors, and that MRI cartilage thickness loss is more pronounced at advanced radiographic disease stage.

Objective: To introduce a new standardized ultrasound score based on 7 joints of the clinically dominant hand and foot (German US7 score) implemented in daily rheumatologic practice.

Methods: The ultrasound score included the following joints of the clinically dominant hand and foot: wrist, second and third metacarpophalangeal and proximal interphalangeal, and second and fifth metatarsophalangeal joints. Synovitis and synovial/tenosynovial vascularity were scored semiquantitatively (grade 0-3) by gray-scale (GS) and power Doppler (PD) ultrasound. Tenosynovitis and erosions were scored for presence. The scoring range was 0-27 for GS synovitis, 0-39 for PD synovitis, 0-7 for GS tenosynovitis, 0-21 for PD tenosynovitis, and 0-14 for erosions. Patients with arthritis were examined at baseline and after the start or change of disease-modifying antirheumatic drug (DMARD) and/or tumor necrosis factor alpha (TNFalpha) inhibitor therapy 3 and 6 months later. C-reactive protein level, erythrocyte sedimentation rate, rheumatoid factor, anti-cyclic citrullinated peptide, Disease Activity Score in 28 joints (DAS28), and radiographs of the hands and feet were performed.

Results: One hundred twenty patients (76% women) with rheumatoid arthritis (91%) and psoriatic arthritis (9%) were enrolled. In 52 cases (43%), erosions were seen in radiography at baseline. Patients received DMARDs (41%), DMARDs plus TNFalpha inhibitors (41%), or TNFalpha inhibitor monotherapy (18%). At baseline, the mean DAS28 was 5.0 and the synovitis scores were 8.1 in GS ultrasound and 3.3 in PD ultrasound. After 6 months of therapy, the DAS28 significantly decreased to 3.6 (Delta = 1.4), and the GS and PD ultrasound scores significantly decreased to 5.5 (-32%) and 2.0 (-39%), respectively.

Conclusion: The German US7 score is a viable tool for examining patients with arthritis in daily rheumatologic practice because it significantly reflects therapeutic response.

Objective: To explore how reported joint pain in patients with rheumatoid arthritis (RA) relates to weather and solar variables.

Methods: A prospective cohort study was conducted in Norway on 36 patients with stable RA. Daily reports of pain in the morning on a visual analog scale for 84 consecutive days were correlated (using time-series methodology) with records of atmospheric and solar variables for the same days.

Results: Pain was significantly associated with 3 or more external variables in 6 (17%) of the patients, with 1 or 2 external variables in 16 (44%) of the patients, and no associations were observed in 14 (39%) of the patients. The multivariate model explained between 19% and 64% of the variance in pain (R(2)) in the patients with associations to at least 3 weather/solar variables. The patients differed in the variables they responded to and in which direction, except for consistent negative associations between pain and ultraviolet light dose, and between pain and solar radio flux/sunspot count. The associations were mostly with same-day weather, but also lagged up to 3 days. We were not able to fit a statistically significant model at the group level.

Conclusion: Weather sensitivity seems to be a continuum and a highly individual phenomenon in patients with RA. In the present sample, pain was significantly associated with 3 or more weather variables in 1 out of 6 patients, for whom the magnitude of weather sensitivity might significantly influence pain reporting in clinical care and research.

Objective: To determine polymyalgia rheumatica (PMR) prevalence using population-based administrative data, and to estimate the error associated with case ascertainment approaches when using these databases.

Methods: Cases were ascertained using physician billing and hospitalization data from the province of Manitoba (population 1.1 million). Focusing on the population age >/=45 years, we compared 3 different case definition algorithms and also used statistical methods that accounted for imperfect case ascertainment to estimate the prevalence and the properties of the ascertainment algorithms. A hierarchical Bayesian latent class regression model was developed that also allowed us to assess differences across patient demographics (sex and region of residence).

Results: Using methods that account for the imperfect nature of both billing and hospitalization databases, we estimated the prevalence of PMR in women age >/=45 years to be lower in urban areas (754.5 cases/100,000; 95% credible interval [95% CrI] 674.1-850.3) compared with rural areas (1,004 cases/100,000; 95% CrI 886.3-1,143). This regional trend was also seen in men age >/=45 years, where the prevalence was estimated at 273.6 cases/100,000 (95% CrI 219.8-347.6) in urban areas and 380.7 cases/100,000 (95% CrI 311.3-468.1) in rural areas. Billing data appeared more sensitive in ascertaining cases than hospitalization data, and a large proportion of diagnoses was made by physicians other than rheumatologists.

Conclusion: These data suggest a higher prevalence of PMR in rural versus urban regions. Our approach demonstrates the usefulness of methods that adjust for the imperfect nature of multiple information sources, which also allow for estimation of the sensitivity of different case ascertainment approaches.

Objective: To evaluate both direct and indirect costs of systemic lupus erythematosus (SLE) patients with and without flares from a societal perspective, and to investigate the impact of the severity and clinical manifestations of flares on direct/indirect costs.

Methods: A retrospective cost-of-illness study was performed on 306 SLE patients. Participants completed questionnaires on sociodemographics, employment status, and out-of-pocket expenses. Health resources consumption was recorded by chart review and patient self-reported questionnaire. The total number of flares and involved organs during the preceding 12 months were recorded. Multiple linear regression was performed to determine the cost predictors.

Results: Patients with flares were younger, had shorter disease duration, and had higher disease activity at the time of the assessment. The overall incidence of lupus flares was 0.24 episodes per patient-year. Patients with flares used more health care resources and incurred significantly higher annual direct and indirect costs. The mean total costs per patient-year were 2-fold higher for patients with flares ($22,580 versus $10,870 [2006 US dollars]; P < 0.0005). Multiple regression analysis showed that the number of flares was an independent explanatory variable associated with increased direct costs. Patients with multiorgan flares or renal/neuropsychiatric flares incurred higher direct costs compared with those with single-organ flares or with other organ flares.

Conclusion: Patients with flares incur higher direct and indirect costs compared with those without flares. Major organ flares incur higher disease costs than other organ flares. Treatments that effectively control disease activity and prevent flares, especially major organ flares, may reduce the high costs associated with flare in SLE.

Objective: To determine the factors associated with increased levels of fatigue over the course of the disease in systemic lupus erythematosus (SLE) patients from LUpus in MInorities: NAture versus nurture, a longitudinal multiethnic cohort.

Methods: Patients with SLE (according to the American College of Rheumatology revised and updated criteria) age >/=16 years with a disease duration

Results: A total of 515 patients ( approximately 91% female) contributed 2,609 visits to these analyses. Of these patients, 93 (18.1%) were Texan-Hispanic, 101 (19.6%) were Puerto Rican-Hispanic, 169 (32.8%) were African Americans, and 152 (29.5%) were Caucasian. The mean +/- SD patient age and followup time were 37.2 +/- 12.6 years and 4.7 +/- 3.2 years, respectively. Variables associated with increased levels of fatigue in the multivariable analyses were Caucasian ethnicity, the presence of constitutional symptoms (fever, weight loss), and higher levels of pain, abnormal illness-related behaviors, and helplessness (P values between 0.0018 and <0.0001).

Conclusion: The presence of pain, abnormal illness-related behaviors, helplessness, and constitutional manifestations were associated with increased levels of fatigue. However, SLE-specific measures, such as disease activity and damage, were not. Interventions aimed at decreasing fatigue need to take into account these findings.

Objective: To assess whether knee extensor strength or hamstring:quadriceps (H:Q) ratio predicts risk for incident radiographic tibiofemoral and incident symptomatic whole knee osteoarthritis (OA) in adults ages 50-79 years.

Methods: We followed 1,617 participants (2,519 knees) who, at the baseline visit of the Multicenter Osteoarthritis (MOST) Study, did not have radiographic tibiofemoral OA and 2,078 participants (3,392 knees) who did not have symptomatic whole knee OA (i.e., did not have the combination of radiographic OA and frequent knee symptoms). Isokinetic strength was measured at baseline, and participants were followed for development of incident radiographic tibiofemoral OA, or incident symptomatic whole knee OA at 30 months. Generalized estimating equations accounted for 2 knees per subject, and multivariable models adjusted for age, body mass index (BMI), hip bone mineral density, knee surgery or pain, and physical activity score.

Results: In the studies of incident radiographic and incident symptomatic knee OA, mean +/- SD ages were 62.4 +/- 8.0 years and 62.3 +/- 8.0 years, respectively, and mean +/- SD BMI scores were 30.6 +/- 5.8 kg/m(2) and 30.2 +/- 5.5 kg/m(2), respectively. Knee extensor strength and H:Q ratio at baseline significantly differed between men and women. Neither knee extensor strength nor the H:Q ratio was predictive of incident radiographic tibiofemoral OA. Compared with the lowest tertile, the highest tertile of knee extensor strength protected against development of incident symptomatic whole knee OA in both sexes (adjusted odds ratio 0.5-0.6). H:Q ratio was not predictive of incident symptomatic whole knee OA in either sex.

Conclusion: Thigh muscle strength does not appear to predict incident radiographic OA, but does seem to predict incident symptomatic knee OA.