Clinical and experimental rheumatology (CLIN EXP RHEUMATOL )


Clinical and Experimental Rheumatology is a bi-monthly journal which publishes original papers on clinical or experimental research pertinent to the rheumatic diseases; work on connective tissue diseases and other immune disorders also are within the journal's scope.

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    Clinical & Experimental Rheumatology website
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    Clinical and experimental rheumatology, Rheumatology
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Publications in this journal

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    ABSTRACT: OBJECTIVES: Circulating proangiogenic haematopoietic cells (PHCs), including CD34+ cells, play an important role in endothelial homeostasis. Among PHCs, CD34+ cells are the largest cell population, thus, much of the regenerative/reparative potential of PHCs may be attributed to CD34+ cells. Our aim was to determine the association between inflammation and CD34+ cell number, intracellular levels of reactive oxygen species (ROS) and expression of Toll-like receptor 3 (TLR3) and interleukin 1β (IL-1β), arterial stiffness (AS) indices, and carotid intima-media thickness (cIMT) in patients affected by rheumatoid arthritis (RA). METHODS: CD34+ cells were isolated from 24 RA patients and 26 matched controls. ROS levels, TLR3 and IL-1β expression were measured. C-reactive protein (CRP), fibrinogen, AS, and cIMT were also evaluated. RESULTS: CD34+ count was lower in RA patients as compared to controls. In CD34+ cells from RA patients, ROS, TLR3 and IL-1β expressions were increased compared to controls. In RA patients, we found higher CRP and fibrinogen levels, and higher values of Pulse Wave Velocity (PWV) and Augmentation Index (AIx), both AS indices, and of cIMT. CD34+ cell numbers were inversely correlated with CRP, TLR3, IL-1β, ROS, and AS indices. TLR3 levels were related to CRP, IL-1β, fibrinogen and ROS. IL-1β levels were correlated with expression of CRP, ROS, and PWV. CONCLUSIONS: Inflammatory status in RA is associated with an increased expression of TLR3 and of IL-1β in CD34+ cells, which appear to affect cell number. These new findings suggest a perspective on accelerated atherosclerosis and vascular damage in RA.
    Clinical and experimental rheumatology 11/2014;
  • Clinical and experimental rheumatology 11/2014; 32 Suppl 86(6):233.
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    ABSTRACT: Comorbidities are conditions that coexist with a disease of interest, and may lead to a delayed diagnosis, be confounders in analysis of clinical status and course, and increase morbidity and mortality. Therefore, it appears desirable to summarise efficiently one or multiple comorbidities into a single score in an efficient manner, using comorbidity indices and self-administered comorbidity questionnaires. The two most commonly used comorbidity indices are the Charlson Comorbidity Index (CCI) and the Elixhauser et al. comorbidity measure (ECM). The CCI was constructed based on the mortality rates of 607 patients admitted to the general internal medicine service over 1 month; sixteen diseases were included in this index, with different weights, and were selected and weighted based on the strength of their association with mortality. Elixhauser et al. used administrative data to identify the 30 comorbidities that had a major impact on short-term outcomes in acutely hospitalised patients. Although ECM appeared to have better performance in all aspects of validity, difficulty in terms of feasibility in collecting 30 comorbidities may encourage investigators to use the CCI. Self-administered questionnaires could be a valid and reliable alternative approach to assess comorbidities, and a tool to be included in prospective studies.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):131-134.
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    ABSTRACT: Gastroesophageal reflux disease (GERD) is clinically-identified in patients with systemic sclerosis (SSc). The GERD-questionnaire (GERD-Q) score is a sensitive, non-invasive, diagnostic screening tool for diagnosis of GERD in general patients, but it has been not investigated for use in SSc. Our aim was to evaluate the proper cut-off GERD-Q score, sensitivity and specificity for a diagnosis of GERD in SSc patients.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 86(6):98-102.
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    ABSTRACT: A vast amount of important information on the various rheumatic diseases that the rheumatologist treats is available in the medical records derived from the patient consultation. Until recently, it has been difficult to assemble and interpret this data. Moreover, the 'everyday' rheumatologist seeing the 'everyday' patient often does not contribute data to better understanding of 'everyday' clinical issues. We discuss an approach to this problem by describing a blending of a customised electronic medical record with a consortium of like-minded clinicians. We feel that this approach demonstrates the powerful potential for targeted point of care data collection in rheumatology research and patient management.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):150-152.
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    ABSTRACT: The assessment of disease in rheumatological diseases is rather complicated, because it may involve different contexts (clinical practice, clinical trials, observational studies, registries, etc.) as well as different domains (disease activity, physical function, radiographic damage, quality of life, etc.). Furthermore, available tools can be comprehensive but also rather condense, may be patient-oriented or rather physician-oriented, and so on. In this article all these levels that may matter in case of a choice of disease assessment tool are discussed, arriving at a conclusion that choosing the appropriate tool for the assessment of disease is not 'cookbook medicine'.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):2-6.
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    ABSTRACT: To date, the diagnostic utility of anti-SSA/Ro52 autoantibodies in scleroderma and the association of them with certain clinical manifestations, particularly inflammatory myositis, are still controversial. This paper aims to assess the correlation between the presence of anti-SSA/Ro52 antibodies and the demographic, clinical and prognosis characteristics of patients with systemic sclerosis (SSc).
    Clinical and experimental rheumatology 11/2014; 32 Suppl 86(6):177-82.
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    ABSTRACT: 14-3-3 proteins are a conserved family of 7 isoforms with diverse cellular functions found predominantly intracellularly. The 14-3-3η isoform is expressed extracellularly in the joints of patients with rheumatoid arthritis (RA) and expression in both serum and joint fluid correlates strongly with expression of metalloproteinases. 14-3-3η activates proinflammatory signalling cascades and inflammatory mediators relevant to the pathogenesis of RA. A new ELISA based assay has diagnostic utility for RA with sensitivity of 63.6% and specificity of 92.6% using the optimal cut-off from ROC analysis of 0.19ng/ml. Adding 14-3-3η to anti-cyclic citrullinated peptide antibodies (ACPA) resulted in an identification rate of 72% compared to 59% for ACPA alone. Adding rheumatoid factor (RF) to ACPA increased diagnostic capture from 59% to 72% and this increased further to 78% when 14-3-3η was added. Positive 14-3-3η status is also significantly associated with radiographic progression in early RA at years 1, 3 and 5 indicating prognostic utility. Extracellular 14-3-3η elicits the production of autoantibodies to the native protein, which also possess diagnostic utility. These do not correlate with expression of the protein and have complementary diagnostic utility. The presence of either the protein or its autoantibodies is observed in 90% of patients with early RA. Together with RF and/or ACPA this may result in identification of 95% of patients with early RA.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):35-39.
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    ABSTRACT: The 7 Core Data Set measures to assess rheumatoid arthritis (RA) were analysed for their relative efficiencies to distinguish active from control treatments in 9 comparisons of 5 agents, methotrexate, leflunomide, infliximab, adalimumab, and abatacept, in 8 clinical trials. Among the 7 measures, levels of relative efficiencies were in a similar range, highest for the physician global estimate, followed by, in order, patient global estimate, physical function on a health assessment questionnaire (HAQ), pain, swollen joint count (SJC), an acute phase reactant laboratory test - erythrocyte sedimentation (ESR) or C-reactive protein (CRP), and tender joint count (TJC). Comparisons of only 3 measures, SJC and ESR/CRP (regarded as optimal indicators of inflammation) and HAQ function (regarded as most likely to be affected by joint damage and therefore least reversible) indicated relative efficiencies for HAQ function at least as great as for SJC or ESR/CRP, although 8 of the nine comparisons involved patients with disease duration >6.9 years. The findings indicate a strong rationale for a Core Data Set of 7 measures, as no single measure was clearly superior in relative efficiency in all clinical trials. At the same time, 'objective' laboratory ESR/CRP, TJC and SJC were not superior to 'subjective' global estimates of the physician or patient or patient self-report measures of physical function or pain, to differentiate active from control treatments. The findings challenge a traditional view that laboratory and clinical examination findings are more robust than patient self-report scores and physician global estimates to assess and monitor RA patients.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):47-54.
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    ABSTRACT: New therapeutic options are constantly emerging for the treatment of rheumatic diseases. To evaluate the safety and efficacy of newly introduced anti-rheumatic treatment alternatives, registers are an important source of information. The Swedish Rheumatology Quality Register (SRQ) collects clinical data on patients with rheumatoid arthritis, as well as other rheumatic diseases, and may be enriched with data on comorbid conditions, prescription drug dispensings, and mortality from national data sources in Sweden. In this setting, many different outcomes can be investigated over a long period of time in a diverse population of patients recruited in daily clinical practice.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):147-149.
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    ABSTRACT: There is a paucity of data available on small intestinal bacterial overgrowth (SIBO) in systemic sclerosis (SSc). The objectives of the study were to estimate the prevalence of SIBO in SSc patients exhibiting intestinal symptoms and identify patients at risk of SIBO regarding clinical and biological presentations and gastrointestinal symptoms captured by standardized questionnaires.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 86(6):82-7.
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    ABSTRACT: The METEOR (Measurement of Efficacy of Treatment in the 'Era of Outcome' in Rheumatology) initiative aims at improving care for RA patients by assisting rheumatologists in strict monitoring and tight control of disease activity. The state of the art of the METEOR initiative, the technical organisation of the database and future perspectives are described.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):135-140.
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    ABSTRACT: Missing data are found in nearly all clinical trials and it is important to use appropriate statistical techniques to analyse clinical trials with missing data. We discuss common statistical methods for tackling missing data and how to handle results when the analyses give different results.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 86(6):122-6.
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    ABSTRACT: This review summarises most currently used indices to assess and monitor patients with systemic lupus erythematosus (SLE) in clinical trials, long-term observational studies, and clinical care. Six SLE disease activity indices include the British Isles Lupus Assessment Group Index (BILAG), European Consensus Lupus Activity Measurement (ECLAM), Systemic Lupus Activity Measure (SLAM), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Lupus Activity Index (LAI), and Systemic Lupus Erythematosus Activity Questionnaire (SLAQ). Three SLE responder indices include Responder Index for Lupus Erythematosus (RIFLE), SLE Responder Index (SRI), and BILAG Based Combined Lupus Assessment (BICLA). Three SLE damage indices include the Systemic Lupus International Collaborating Clinics/American College of Rheumatology-Damage Index (SLICC/ACE-DI), Lupus Damage Index Questionnaire (LDIQ), and Brief Index of Lupus Damage (BILD). The SLAQ, LDIQ and the BILD are patient self-report questionnaires, which appear to give similar information to physician-completed indices, but are pragmatically more easily completed as patients do almost all the work. Additional self-report indices which have been used to assess and monitor patients with in SLE include a generic general health short form 36 (SF36), a SLE-specific Lupus Patient Reported Outcome (LupusPRO), and a generic rheumatology index, Routine Assessment of Patient Index Data 3 (RAPID3). These activity, response, damage and patient self-report indices have been validated at different levels with no consensus about what it is the most appropriate for every setting. Sensitive and feasible assessment of SLE in clinical trials, observational studies, and busy clinical settings remains a challenge to the rheumatology community.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):85-95.
  • Clinical and experimental rheumatology 11/2014; 32 Suppl 86(6):234-235.
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    ABSTRACT: The spondyloarthritides (SpA) are currently differentiated into axial and peripheral SpA. Patients with axial SpA (axSpA) may be further classified into the classical form ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA). The SpA are genetically linked, and the subtypes including psoriatic arthritis (PsA) share characteristic clinical symptoms such as inflammatory back pain (IBP) and enthesitis. IMP can be due to sacroiliitis and spondylitis, enthesitis may occur with or without arthritis, and anterior uveitis, as well as other extraarticular manifestations such as psoriasis and chronic inflammatory bowel disease (IBD). In addition to clinical findings, imaging, mainly conventional radiography and magnetic resonance imaging (MRI), and laboratory results such as HLA B27 and CRP are important tools for classification and diagnosis of SpA. The Assessment of SpondyloArthritis international Society (ASAS), an international group of experts in the field of SpA since 1995, has published on assessments and outcome parameters in SpA. The publication of classification criteria for axSpA has now largely replaced the 1984 criteria for AS. However, the established cut-off between AS and nr-axSpA, 'definite' structural changes in the sacroiliac joints, has been recently debated because of limited reliability. Since imaging plays an important role in all criteria sets, the ASAS group has recently published definitions for inflammatory changes in the SIJ and the spine. The most important domains in AS are disease activity, function, spinal mobility, structural damage, and quality of life, some of which are discussed in this manuscript. For axSpA there are two major tools to assess disease activity, the BASDAI and the ASDAS, one for function, the BASFI, and several mobility measures including the BASMI. The AS Health Index (AS-HI) is introduced elsewhere in this supplement.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):96-104.
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    ABSTRACT: With this systematic review an overview is given of what is known about work participation in patients with systemic sclerosis (SSc).
    Clinical and experimental rheumatology 11/2014; 32 Suppl 86(6):206-213.
  • Clinical and experimental rheumatology 11/2014; 32 Suppl 86(6):3.
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    ABSTRACT: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease associated with rapid loss of function and radiographic damage. Treatment is targeted to achieve low disease activity/remission, as measured by various pooled indices comprised of laboratory measures, patient-derived, and physician-derived measures. Outside clinical trials, it can be difficult to obtain all these components at the time of the visit to provide immediate guidance. Subsequently, several pooled indices of patient reported outcomes (PROs) have been developed and shown to be equally and sometimes more effective as traditional assessor- and laboratory-derived measures in detecting treatment group and predicting long-term outcomes. With growing use of electronic medical record (EMR) and technology, many of these PROs can now be obtained remotely and directly incorporated into EMR to facilitate target to treat approach. Remotely collecting PROs through the internet allows better data capture, easier incorporation into EMR, and more frequent monitoring of patient's disease activity in between clinic visits for quicker assessment of adverse events and therapeutic efficacy. Adapting remotely collected PROs into clinical trials, clinical care, and long-term database has the potential for restructuring medical care while reducing costs and improving quality of care to achieve disease remission.
    Clinical and experimental rheumatology 11/2014; 32 Suppl 85(5):168-172.