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ABSTRACT: OBJECTIVES: This paper aims to evaluate the relationship of patient-reported tender and swollen joints with active inflammation as detected by power Doppler (PDUS) and whether this relationship is affected by significant joint damage. METHODS: Fifty rheumatoid arthritis patients self-assessed 28 tender and swollen joints and were followed by PDUS assessment. Relationship of tender and swollen joints with active synovitis (PDUS 'gold standard') was assessed at the joint level by: a) percentage agreement at each PDUS semiquantitative grade (grade 1 to 3), b) positive likelihood ratio (LR) of agreement with PDUS, and c) LR of agreement with PDUS according to radiographic damage (significant erosive disease vs. non-erosive disease). Correlation of tender and swollen joint counts with disease activity markers was analysed by Spearman's. Sensitivity analyses examined the influence of disease activity or global pain on level of agreement at the joint level. RESULTS: Of joints with significant active inflammation (e.g. grade 3 PDUS), patients identified 75% as tender and 63% as swollen. Swollen joints showed strong association at the joint level with active synovitis when there was no significant radiographic damage (LR 2.54, 95%CI 1.93-3.34), but with no significant radiographic damage (LR 1.32, 95%CI 0.75-2.32). Swollen joint counts were statistically correlated with PDUS-DAS28 and CRP, but not PDUS score. Sensitivity analysis showed better agreement of tender and swollen joints with active synovitis when DAS28 was ≤ 3.2 and when patient global pain was <50mm on visual analogue scale. CONCLUSIONS: The relationship between patient-reported joints and active synovitis is stronger in the setting of low disease activity without erosive disease, affected also by degree of reported global pain. Further longitudinal studies of patient-reported joints are needed.
Clinical and experimental rheumatology 03/2013; · 2.15 Impact Factor
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ABSTRACT: Objective. Tight control in RA necessitates frequent disease monitoring; patients might participate by self-assessment of their functional status. Therefore, we assessed the feasibility and acceptability of autonomous online registry of physical functioning.Methods. In two tertiary-care centres (in the Netherlands and France), consecutive RA patients were approached to perform autonomous registry of the HAQ in an electronic medical record. Feasibility and acceptability of autonomous HAQ registry was assessed through: (i) the percentage of acceptances; (ii) the time needed to register the HAQ (the Netherlands); (iii) patient satisfaction with autonomous registry; and (iv) willingness for future home-based HAQ completion, either self-declared (the Netherlands) or actual file access from home within 6 months (France).Results. In all, 214 patients were approached; 163 agreed to participate; 137 (64% of 214) had complete data that were analysed. Median age was 56 years (range 20-78 years), 80% were female, median disease duration was 9 years. The median time needed to fill in the HAQ in the waiting room was 5.8 min; patient satisfaction was high (mean score 4.1 out of 5), self-declared willingness for autonomous registry at home was 73%. In the 6-month follow-up period, 46% of patients accessed their medical file from home at least once.Conclusion. Many RA patients reported willingness to self-monitor their disease online, but fewer than half of the patients actually did. To enhance patient autonomous monitoring, progress is needed in terms of Internet access, continuous patient support and, importantly, convincing patients that they will benefit from autonomous monitoring.
Rheumatology (Oxford, England) 01/2013; · 4.24 Impact Factor
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Clinical and experimental rheumatology 08/2012; 30(5):805. · 2.15 Impact Factor
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ABSTRACT: The Rheumatoid Arthritis Impact of Disease (RAID) is a patient-reported outcome measure evaluating the impact of rheumatoid arthritis (RA) on patient quality of life. It comprises 7 domains that are evaluated as continuous variables from 0 (best) to 10 (worst). The objective was to define and identify cut-off values for disease activity states as well as improvement scores in order to present results at the individual level (for example, patient in acceptable state, improved patient).
Patients with definite active RA requiring anti-tumour necrosis factor (anti-TNF) therapy were seen at screening, baseline and after 4 and 12 weeks of etanercept therapy. Answers to "Gold standard" questions on improvement (MCII: Minimum Clinically Important Improvement) and an acceptable status (PASS: Patient Acceptable Symptom State) were collected as well as the RAID score and Disease Activity Score 28- erythrocyte sedimentation rate (DAS28-ESR). Cut-offs were defined by different techniques including empirical, measurement error and gold standard anchors. The external validity of these cut-offs was evaluated using the positive likelihood ratio (LR) based on the patient's perspective (for example, patient's global) and on low disease activity status (such as DAS28-ESR).
Ninety-seven (97) of the 108 recruited patients (age: 54 ± 13 years old, female gender: 75%, rheumatoid factor positive: 81%, disease duration: 8 ± 7 years, CRP: 18 ± 30 mg/l, DAS28-ESR: 5.4 ± 0.8) completed the 12 weeks of the study. The different techniques suggested thresholds ranging from 0.2 to 3 (absolute change) and from 6 to 50% (relative change) for defining MCII and thresholds from less than 1 to less than 4.2 for defining PASS. The evaluation of external validity (LR+) showed the highest LR+ was obtained with thresholds of 3 for absolute change; 50% for relative change and less than 2 for an acceptable status.
This study showed that thresholds defined for continuous variables are closely related to the methodological technique, justifying a systematic evaluation of their validity. Our results suggested that a change of at least 3 points (absolute) or 50% (relative) in the RAID score should be used to define a MCII and that a maximal value of 2 defines an acceptable status.
Clinicaltrial.gov: NCT004768053.
Arthritis research & therapy 05/2012; 14(3):R129. · 4.27 Impact Factor
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Nasim Ahmed Khan,
Horace Jack Spencer,
Essam Ahmed Abda,
Rieke Alten,
Christof Pohl,
Codrina Ancuta,
Massimiliano Cazzato,
Pál Géher, Laure Gossec,
Dan Henrohn, [......],
Eduardo Kerzberg,
Maria Majdan,
Omondi Oyoo,
Ruben A Peredo-Wende,
Zahraa Ibrahim Selim,
Fotini Nikolaos Skopouli,
Alberto Sulli,
Kim Hørslev-Petersen,
Peter C Taylor,
Tuulikki Sokka
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ABSTRACT: OBJECTIVES: To assess (A) determinants of patient's global assessment of disease activity (PTGL) and patient's assessment of general health (GH) scores of rheumatoid arthritis (RA) patients; (B) whether they are equivalent as individual variables; and (C) whether they may be used interchangeably in calculating common RA activity assessment composite indices.METHODS: Data of 7023 patients from 30 countries in the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) was analysed. PTGL and GH determinants were assessed by mixed-effects analyses of covariance models. PTGL and GH equivalence was determined by Bland-Altman 95% limits of agreement (BALOA) and Lin's coefficient of concordance (LCC). Concordance between PTGL and GH based Disease Activity Score 28 (DAS28), Clinical Disease Activity Index (CDAI) and Routine Assessment of Patient Index Data 3 (RAPID3) indices were calculated using LCC, and the level of agreement in classifying RA activity in four states (remission, low, moderate, high) using κ statistics.RESULTS: Significant differences in relative and absolute contribution of RA and non-RA related variables in PTGL and GH ratings were noted. LCC of 0.64 and BALOA of -4.41 to 4.54 showed that PTGL and GH are not equivalent. There was excellent concordance (LCC 0.95-0.99) for PTGL and GH based DAS28, CDAI and RAPID3 indices, and >80% absolute agreement (κ statistics 0.75-0.84) in RA activity state classification for all three indices.CONCLUSIONS: PTGL and GH ratings differ in their determinants. Although they are individually not equivalent, they may be used interchangeably for calculating composite indices for RA activity assessment.
Annals of the rheumatic diseases 04/2012; · 8.11 Impact Factor
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ABSTRACT: Rheumatoid arthritis (RA) may have consequences on sexual life. The objective was to develop and validate a questionnaire assessing the impact of RA on sexuality.
First, 6 patients (5 women, 1 man) with RA, 2 rheumatologists and 1 sexologist elaborated during a one-day focus-group type meeting an exhaustive list of issues relating to impact of RA on sexuality. The list was reduced by merging similar issues, then according to the relative importance for patients of each issue. A questionnaire was developed with input from these patients, with particular attention on phrasing. Psychometric properties (missing data, correlations with other disease aspects, reliability) were assessed in a multi-centre study.
The list of 33 issues related to impact of RA on sexuality included psychological issues (9), couple/relationship issues (9), physical issues (7), and general aspects (5). A 10-question numeric rating scale questionnaire was constructed. Preliminary validation was obtained on 53 patients (44 women, mean age 50.7 years; mean disease duration 14.4 years). The mean score was 3.3±2.5, missing data were acceptable (13%). Qualisex results were correlated with disease activity and symptoms (r=0.50-0.65, p< 0.001); but not with demographics, depression or coping. Qualisex was reliable in 40 patients: the intra-class correlation coefficient was 0.83 (95% CI: 0.70-0.91).
A simple (10 questions) and valid tool investigating impact of RA on sexuality has been developed with the involvement of patients. This tool can be useful to assess this important aspect of quality of life.
Clinical and experimental rheumatology 04/2012; 30(4):505-13. · 2.15 Impact Factor
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Eugénie Koumakis, Laure Gossec,
Muriel Elhai,
Vincent Burki,
Anne Durnez,
Isabelle Fabreguet,
Magali Meyer,
Judith Payet,
Fanny Roure,
Simon Paternotte,
Maxime Dougados
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ABSTRACT: Heel pain is a common but poorly studied feature of spondyloarthritis (SpA). The aims of this study were to assess the prevalence and clinical features of heel pain in a cohort of patients with SpA.
This was a retrolective single centre observational study in 2010. Patients with SpA as defined by Amor's criteria were recruited. The data collected were: demographic and disease characteristics, history of heel pain, age at first heel pain, localisation, nature and intensity of pain and treatments. The analyses were descriptive.
A total of 275 SpA patients (mean age 44.6±13.5 yrs, mean disease duration 16.7±11.8 yrs, 61.5% men) were assessed. A history of heel pain was reported in 130 patients (47.1%), and was the first symptom of SpA in 15.7% of all patients. Heel pain was frequent in both axial (89/201, 44.3%) and peripheral disease (27/56, 48.2%). Distribution was more frequently inferior (88, 69.3%) than posterior (61, 48.0%) (p<0.0001), and frequently bilateral: simultaneously (41.9%) rather than alternatively (29.1%) (p=0.03). Main clinical symptoms were: morning pain on weight bearing (83.6%), but also night pain (34.4%), and/or patient-described swelling (24.2%). Heel pain was frequently recurrent (74.2%), intense (70.3%), source of a limp (71.6%), and often resistant to non-steroidal anti-inflammatory drugs (NSAIDs) (54/108, 50%). Tumour necrosis factor blockers were efficacious on heel pain in 72/94 (76.6%) of cases.
This study confirmed heel pain as a frequent symptom in both axial and peripheral SpA. It occurred early in the disease course and it was frequently recurrent and resistant to NSAIDs.
Clinical and experimental rheumatology 04/2012; 30(4):487-91. · 2.15 Impact Factor
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Vincent Burki, Laure Gossec,
Judith Payet,
Anne Durnez,
Muriel Elhai,
Isabelle Fabreguet,
Eugénie Koumakis,
Magali Meyer,
Simon Paternotte,
Fanny Roure,
Maxime Dougados
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ABSTRACT: Hip involvement is a classic feature of spondyloarthritis (SpA). The aim of the present paper is to study the prevalence, clinical and radiological features of hip involvement, and the association with criteria for severity, in a cohort of patients with SpA in a tertiary care centre.
Design: retrospective single centre observational study in 2010 of patients with definite SpA who underwent direct interview by a physician. Hip involvement was defined as hip pain considered related to SpA inflammation and confirmed radiographically. Other data collection: demographic data, SpA characteristics, treatments performed for hip involvement. Analysis: prevalence of hip involvement was analysed according to disease duration (Kaplan-Meyer). Multivariate Cox analysis compared patients with vs. without hip involvement over time.
In all, 275 SpA patients were assessed. The median age was 45 (IQR 35-55) years, the median SpA symptom duration 14 (7-25) years, 61% (169) were men, and 79% were HLA-B27 positive. Hip involvement was found in 18% (49) SpA patients, with already 13% after 5 years of disease duration and with frequent bilateral involvement (61%). Hip involvement was associated with non-Caucasian origin (p=0.05). Thirty-three percent (16/49) needed surgery (23 total joint replacements in all) with good functional results.
Hip involvement is a frequent manifestation in SpA (18%), often bilateral, and associated with non-Caucasian origin. One third of the patients needed total joint replacement. Physicians should be wary of hip pain in SpA patients and implement rapid diagnostic procedures in such cases.
Clinical and experimental rheumatology 04/2012; 30(4):481-6. · 2.15 Impact Factor
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ABSTRACT: OBJECTIVE: Mortality rates in patients with rheumatoid arthritis (RA) have been reported to be higher than for the general population. Fortunately, efficient therapies have reduced disease activity and may be able to diminish the excess mortality risk. This study was designed to investigate RA mortality over the last 50years by systematic review of the literature and meta-analysis. METHODS: Data to January 2010 in the Medline, Cochrane and Embase databases were searched with the keywords "rheumatoid arthritis", "epidemiologic methods" and "mortality". Inclusion criteria were (i) longitudinal study, (ii) early RA patients, (iii) number of deaths and mean patient follow-up. Incidence mortality rates (IMR) were calculated and standardized mortality rates (SMR) were extracted when available. A meta-analysis by periods of inclusion and a Poisson regression were used to model IMR. Available SMR were computed as a meta-analysis. RESULTS: A total of 11 longitudinal studies starting from 1955 to 1995, representing 51,819patients, met the inclusion criteria. Mean IMR was 2.7/100person-years of follow-up (95% confidence interval [CI]: 2.2, 3.3) and ranged from 1.0 to 5.2/100 person-years. A decreasing IMR was found in the meta-analyses. Poisson regression analysis indicated a decrease in IMR of 2.3% per year (95%CI: 2.1; 2.6). SMR was available in 8 studies: the meta-SMR was 1.47 (95%CI: 1.19; 1.83) and no decrease was seen over time in the meta-regression. CONCLUSION: Mortality has decreased among RA patients over the past decades but remained higher than in the general population as assessed by the IMR and the SMR over time.
Joint, bone, spine: revue du rhumatisme 03/2012; · 2.25 Impact Factor
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Thao Pham,
Hervé Bachelez,
Jean-Marie Berthelot,
Jacques Blacher,
Pascal Claudepierre,
Arnaud Constantin,
Bruno Fautrel,
Cécile Gaujoux-Viala,
Vincent Goëb, Laure Gossec, [......],
Xavier Puéchal,
Pascal Richette,
Alain Saraux,
Thierry Schaeverbeke,
Martin Soubrier,
Manuelle Viguier,
Olivier Vittecoq,
Daniel Wendling,
Xavier Mariette,
Jean Sibilia
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ABSTRACT: To develop and/or update fact sheets about abatacept treatment, in order to assist physicians in the management of patients with inflammatory joint disease.
1. selection by a committee of rheumatology experts of the main topics of interest for which fact sheets were desirable 2. identification and review of publications relevant to each topic 3. development and/or update of fact sheets based on three levels of evidence: evidence-based medicine, official recommendations, and expert opinion. The experts were rheumatologists and invited specialists in other fields (dermatologist, cardiologist, pediatric rheumatologist, endocrinologist, hematologist, immunologist, infectiologist), and they had extensive experience with the management of chronic inflammatory diseases, such as rheumatoid arthritis (RA). They were members of the CRI (Club Rhumatismes et Inflammation), a section of the French Rheumatology Society (Societe Francaise de Rhumatologie). Each fact sheet was revised by several experts and the overall process was coordinated by three experts.
Several topics of major interest were selected: contraindications of abatacept treatment; management of adverse effects and concomitant diseases that may develop during abatacept treatment; and management of common situations such as pregnancy, surgery, patient older than 75 years of age, and patients with co-morbidities (such as dialysis, hemoglobinopathy, or splenectomy). After a review of the literature and discussion among experts, a consensus was developed about the content of the fact sheets presented here. These fact sheets focus on several points: 1. in RA, initiation and monitoring of the abatacept treatment, management of patients with specific past histories, and specific clinical situations such as pregnancy 2. diseases other than RA, such as juvenile idiopathic arthritis, spondylarthropathies, or autoimmune diseases (systemic lupus erythematosus and other systemic autoimmune diseases) 3. models of letters for informing the rheumatologist and general practitioner 4. patient information about the use of abatacept in RA 5. and data on the new abatacept formulation for subcutaneous administration (approved by the FDA in August 2011 for patients with moderate-to-severe RA).
These fact sheets built on evidence-based medicine and expert opinion will serve as a practical tool for assisting physicians who manage patients on abatacept. They will be available continuously on www.cri-net.com and will be updated at appropriate intervals.
Joint, bone, spine: revue du rhumatisme 03/2012; 79 Suppl 1:3-84. · 2.25 Impact Factor
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Judith Payet, Laure Gossec,
Simon Paternotte,
Vincent Burki,
Anne Durnez,
Muriel Elhai,
Isabelle Fabréguet,
Eugénie Koumakis,
Magali Meyer,
Fanny Roure,
Maxime Dougados
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ABSTRACT: Dactylitis is a common but little studied feature of spondylarthritis (SpA). Our objective was to assess the prevalence of dactylitis among a cohort of patients with spondylarthritis in a tertiary care centre and to describe the clinical characteristics of dactylitis.
This was a prospective single centre observational study carried out in 2010. The patients included had been diagnosed as having definite SpA based on Amo's criteria. Each patient was interviewed by a physician. The data collected included prevalence of dactylitis and its clinical characteristics, effectiveness of the different treatments, and association with severe manifestations of SpA, and analysed by descriptive analysis.
275 consecutive SpA patients were assessed: mean age 43.2±13.5 years, mean disease duration 14.0±11.8 years, 169 (61.4%) were men. In all, 59 patients (21.5%) suffered from SpA-associated dactylitis. The localisation of dactylitis was toes in 46 patients (78.0%) and/or fingers in 25 patients (42.4%). The most frequent localisations were the second toe and the second finger. Dactylitis was the first symptom of SpA in 14 patients (5.1%), and 28.8% (n=17) of dactylitis appeared within the first 5 years of disease. Dactylitis was present in 35.1% (n=13) of patients with undifferenciated SpA and in 30.6% (n=15) of patients with psoriatic arthritis. It was significantly associated with history of peripheral arthritis or heel pain. In our population, there was no correlation between dactylitis and HLA B27 status or sex and it was not a marker of severity of disease.
Dactylitis is a frequent manifestation in SpA (21.5%) particularly in peripheral disease and it may be the first manifestation of the disease with localisation being more frequent in the toes.
Clinical and experimental rheumatology 02/2012; 30(2):191-6. · 2.15 Impact Factor
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Peter P Cheung,
Simon Paternotte,
Vincent Burki,
Anne Durnez,
Muriel Elhai,
Isabelle Fabreguet,
Eugenie Koumakis,
Magali Meyer,
Judith Payet,
Fanny Roure,
Maxime Dougados, Laure Gossec
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ABSTRACT: To evaluate the performance of the Assessment in Spondyloarthritis International Society (ASAS) criteria (axial or peripheral) against the Amor and European Spondylarthropathy Study Group criteria in established spondyloarthritis (SpA).
Rheumatologist-diagnosed patients with SpA were retrospectively classified according to the different criteria sets. Clinical characteristics of patients fulfilling all 3 criteria were compared with those who did not, by nonparametric statistics.
ASAS classified 90% of the 231 patients, with 169 (73%) fulfilling all 3 criteria sets. Multivariate analysis showed the 62 patients not fulfilling all criteria sets were older at symptom onset (p < 0.001) and less likely to have inflammatory back pain (p < 0.001), peripheral arthritis (p < 0.001), or elevated C-reactive protein levels (p = 0.034).
ASAS criteria can be used in established disease.
The Journal of Rheumatology 02/2012; 39(4):816-21. · 3.69 Impact Factor
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ABSTRACT: To investigate the relation of coping strategies to coping effectiveness, helplessness, and mental as well as physical well-being as indicators of quality of life.
Cross-sectional international study. Coping strategies were assessed by a validated 18-item questionnaire, while coping effectiveness and helplessness were measured by numerical rating scales. The predictability of both and quality of life (SF-36) was evaluated by multiple linear regression including demographic and disease-related factors.
Four hundred thirty-four rheumatoid arthritis (RA) patients (77% female; mean age 55.96 ± 13.34 years) were included. Distancing was the coping strategy used most frequently in RA patients (mean ± SD 1.89 ± 0.78 on a scale ranging from 0 to 3). Female RA patients used coping strategies significantly more often than males, whereas age and duration of disease did not seem to influence the use of coping strategies. Cognitive reframing and active problem-solving contributed to coping effectiveness while emotional expression was related to helplessness. Coping effectiveness was positively related to general health perception, suggesting certain coping strategies to be effective in influencing the quality of life of RA patients.
Coping strategies used in RA are dependent on gender, but not on age. The use of problem-focused coping strategies may allow for an improved coping effectiveness in patients with RA, while also influencing mental and physical well-being as indicators of quality of life. Coping should therefore be considered as an important factor in determining the overall health state of patients with RA.
Seminars in arthritis and rheumatism 02/2012; 41(4):545-55. · 4.72 Impact Factor
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Annals of the rheumatic diseases 01/2012; 71(6):1103-4. · 8.11 Impact Factor
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Muriel Elhai,
Simon Paternotte,
Vincent Burki,
Anne Durnez,
Isabelle Fabreguet,
Eugénie Koumakis,
Magali Meyer,
Judith Payet,
Fanny Roure,
Maxime Dougados, Laure Gossec
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ABSTRACT: OBJECTIVES: Anterior chest wall pain is a common but little studied feature of spondyloarthritis. The objectives of our study were to assess the prevalence of anterior chest wall pain and to describe its clinical characteristics in a cohort of spondyloarthritis patients in a tertiary care center. METHODS: Study design: retrolective single center observational study in 2010 (COSPA). Consecutive patients with definite spondyloarthritis according to Amor's criteria were included. Data collection: each patient underwent direct interview by a physician. Prevalence of anterior chest wall pain, according to spondyloarthritis subtype and its date of appearance, localization and nature were collected. RESULTS: In all, 275 consecutive spondyloarthritis patients were assessed. Among them, 102 patients (37.1%) suffered from spondyloarthritis-associated anterior chest wall pain. It was the first symptom of spondyloarthritis in 3.6% of cases. The prevalence after 5 and 10 years following the diagnosis of spondyloarthritis was 26.0% and 35.5%, respectively. Pain was usually in the upper chest and acute, increased by respiratory movements and movements of the arm; pain during the night was less frequent (41.0%). A flare lasted on average 5 weeks; recurrences were frequent (75%). Non-steroidal anti-inflammatory drugs and anti-tumor necrosis factor agents were reported as effective in 49.3% and 80.0% of cases, respectively. CONCLUSION: Anterior chest wall pain was a frequent manifestation in spondyloarthritis. It occurred early in the disease course, but the risk persisted after disease onset. Better knowledge of the clinical characteristics of this symptom may help physicians for diagnosis and follow-up.
Joint, bone, spine: revue du rhumatisme 11/2011; · 2.25 Impact Factor
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Isabelle Fabreguet,
Eugénie Koumakis,
Vincent Burki,
Anne Durnez,
Muriel Elhai,
Magali Meyer,
Simon Paternotte,
Judith Payet,
Fanny Roure,
Bruno Fautrel,
Maxime Dougados, Laure Gossec
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ABSTRACT: Work status is an important outcome in SpA. The objective was to assess work instability and its determinants in a cohort of patients with SpA, using the AS-work instability scale (AS-WIS).
We performed a cross-sectional monocentre study. Patients were definite SpA patients with paid work. Work instability was measured by the AS-WIS. Its determinants were assessed by correlations with SpA scores (BASDAI, BASFI and patient's global assessment) and patients with low work instability (AS-WIS score < 11) were compared with those with moderate to high instability, through backward logistic regression.
In all, 156 patients were assessed: mean (s.d.) age 41 (11) years, mean disease duration 15 (11) years; 71 (45.5%) were on TNF blockers. The mean AS-WIS score was 9.5 (5.5); 55 (35%) patients had moderate and 8 (5%) patients had high work instability. Correlations of the AS-WIS score with SpA scores were significant but moderate (BASDAI R = 0.42, BASFI R = 0.41, patient's global assessment R = 0.53; P < 0.0001). In multivariate analysis, high patient's global assessment was the only element associated with moderate to high work instability; demographic characteristics and treatments were not significant elements.
Work instability was found to be high and its main determinant was patient's global assessment. The predictive validity of the AS-WIS in terms of job retention should be further assessed.
Rheumatology (Oxford, England) 11/2011; 51(2):333-7. · 4.24 Impact Factor
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ABSTRACT: Bronchiectasis is frequently associated (up to 30%) with chronic inflammatory rheumatic diseases and leads to lower respiratory tract infections. Data are lacking on the risk of lower respiratory tract infections in patients treated with biologic agents.
Monocenter, retrospective systematic study of all patients with a chronic inflammatory rheumatic disease and concomitant bronchiectasis, seen between 2000 and 2009. Univariate and multivariate analyses were performed to evidence predictive factors of the number of infectious respiratory events.
47 patients were included (mean age 64.1±9.1 years, 33 (70.2%) women), with a mean follow-up per patient of 4.3±3.1 years. Rheumatoid arthritis was the main rheumatic disease (90.1%). The mean number of infectious events was 0.8±1.0 event per patient-year. The factors predicting infections were the type of treatment (biologic vs. non biologic disease-modifying treatments), with an odds ratio of 8.7 (95% confidence interval: 1.7-43.4) and sputum colonization by any bacteria (odds ratio 7.4, 2.0-26.8). In multivariate analysis, both factors were independently predictive of infections.
Lower respiratory tract infectious events are frequent among patients receiving biologics for chronic inflammatory rheumatic disease associated with bronchiectasis. Biologic treatment and pre-existing sputum colonization are independent risk factors of infection occurrence.
BMC Infectious Diseases 11/2011; 11:304. · 3.12 Impact Factor
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Nasim A Khan,
Horace J Spencer,
Esam Abda,
Amita Aggarwal,
Rieke Alten,
Codrina Ancuta,
Daina Andersone,
Martin Bergman,
Jurgen Craig-Muller,
Jacqueline Detert, [......],
Ieda Maria Magalhaes Laurindo,
Maria Majdan,
Antonio Naranjo,
Sapan Pandya,
Christof Pohl,
Georg Schett,
Zahraa I Selim,
Sergio Toloza,
Hisahi Yamanaka,
Tuulikki Sokka
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ABSTRACT: To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them.
A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0-10-cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance.
The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels.
Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the "disease experience" of patients, particularly pain and fatigue, is warranted for effective care of RA.
Arthritis care & research. 11/2011; 64(2):206-14.
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ABSTRACT: Imaging of heel enthesopathy in spondyloarthritis (SpA) could potentially be useful for diagnosis and monitoring. The aim of this study was to assess the diagnostic capacities of MRI and power Doppler ultrasonography (PDUS) of the heel to distinguish patients with SpA from controls and to distinguish between patients with SpA with and without enthesopathy.
A cross-sectional single-centre study was performed in 51 patients (102 heels) with definite SpA according to Amor's criteria. Patients with degenerative non-inflammatory low back pain (n=24, 48 heels) were included as controls. Bilateral heel MRI and PDUS were performed by two senior musculoskeletal radiologists blinded to the clinical and biological data on the same day as the clinical evaluation. The data were analysed by patient and by heel.
Neither MRI nor PDUS could discriminate between patients with SpA and controls; bone oedema on MRI was the only abnormality specific to SpA (94%), but with a poor sensitivity (22%). However, among patients with SpA, painful heels had more inflammatory abnormalities (81% by MRI, 58% by PDUS) than heels with no pain (56% at MRI, 17% at PDUS).
Heel MRI and PDUS frequently show inflammatory lesions in SpA, particularly in painful heels. However, they were also often abnormal in controls. These results suggest that heel MRI and PDUS cannot be used for the diagnosis of SpA. However, PDUS and MRI may be useful for the depiction and assessment of enthesis inflammatory lesions in patients with SpA with heel pain.
Annals of the rheumatic diseases 09/2011; 71(4):498-503. · 8.11 Impact Factor
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Laure Gossec,
Simon Paternotte,
Clifton O Bingham,
Daniel O Clegg,
Philippe Coste,
Philip G Conaghan,
Aileen M Davis,
Giampaolo Giacovelli,
Klaus-Peter Gunther,
Gillian Hawker, [......],
Steven A Mazzuca,
Karel Pavelka,
Leonardo Punzi,
Ewa M Roos,
Lucio C Rovati,
Helen Shi,
Jasvinder A Singh,
Maria E Suarez-Almazor,
Eleonora Tajana-Messi,
Maxime Dougados
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ABSTRACT: To define pain and physical function cutpoints that would, coupled with structural severity, define a surrogate measure of "need for joint replacement surgery," for use as an outcome measure for potential structure-modifying interventions for osteoarthritis (OA).
New scores were developed for pain and physical function in knee and hip OA. A cross-sectional international study in 1909 patients was conducted to define data-driven cutpoints corresponding to the orthopedic surgeons' indication for joint replacement. A post hoc analysis of 8 randomized clinical trials (1379 patients) evaluated the prevalence and validity of cutpoints, among patients with symptomatic hip/knee OA.
In the international cross-sectional study, there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement; indeed, it was not possible to determine cutpoints for pain and function defining this indication. The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression, high level of pain, and high degree of function impairment was low (2%-12%). The most discriminatory cutpoint to define an indication for joint replacement was found to be [pain (0-100) + physical function (0-100) > 80].
These results do not support a specific level of pain or function that defines an indication for joint replacement. However, a tentative cutpoint for pain and physical function levels is proposed for further evaluation. Potentially, this symptom level, coupled with radiographic progression, could be used to define "nonresponders" to disease-modifying drugs in OA clinical trials.
The Journal of Rheumatology 08/2011; 38(8):1765-9. · 3.69 Impact Factor
