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ABSTRACT: OBJECTIVE.: To clarify whether increase of body weight in patients with early rheumatoid arthritis upon administration of prednisone is a side-effect of prednisone or a result of better control of disease activity, we examined the association of prednisone and disease activity with a subsequent change in body mass index (BMI). METHODS.: In the Computer Assisted Management in Early Rheumatoid Arthritis trial-II (CAMERA-II), patients aged ≥ 18 years with early rheumatoid arthritis (RA, disease duration < 1 year, no prior use of DMARDs) had been randomized to a methotrexate (MTX)-based tight control strategy with either 10 mg Prednisone (MTX+pred) or placebo (MTX+plac). The MTX+pred group had lower disease activity, but gained more weight than the MTX+plac group: 2.9±4.2 kg versus 1.3±5.3 kg (P=0.03). Data from patients with monthly measurements of disease activity (DAS28) and BMI were analyzed with longitudinal regression (mixed model) analysis with BMI as dependent variable and treatment strategy and DAS28 as independent variables, correcting for baseline BMI and possible confounders (gender, age, rheumatoid factor status). RESULTS.: There was no independent association of glucocorticoid therapy with a change in BMI, but a lower DAS28 was associated with an increased BMI 6 months later. The association of the DAS28 with BMI was most strongly present in postmenopausal women. Clinical cut-off points showed a clear association between DAS28 level and the change in BMI 6 months later. CONCLUSION.: Weight gain during treatment with prednisone seems attributable to a reduction of disease activity and is probably, at least partly, regained weight.
Arthritis care & research. 07/2012;
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ABSTRACT: To study whether assessment of rheumatoid arthritis (RA) disease activity in individual patients using the disease activity score in 28 joints (DAS28) or other instruments excluding joints of feet may lead to misclassification of disease activity.
A cohort of RA patients was classified into three 'regional radiographic damage progression' groups: predominantly progression in feet, similar progression in hands and feet and predominantly progression in hands; both in early (0-2 years) and later (2-5 years) disease. Baseline and mean DAS28, individual DAS28 variables and tender joint counts (TJC) and swollen joint counts (SJC) of the feet were compared between groups. The longitudinal relation of DAS28 with radiographic damage was investigated using a mixed model analysis with rheumatoid factor status, baseline joint damage and TJC and SJC of the feet as covariates.
Early (n=265) and later (n=200) in the disease course, by definition, the classification procedure resulted in 25% as predominantly foot, 25% as predominantly hand and 50% as similar progressors. In early RA predominantly foot progressors had higher TJC and SJC of the feet compared with predominantly hand progressors (p<0.001), but DAS28 was similar. This was not seen in later disease. The longitudinal relation between DAS28 and radiographic progression was influenced by the region of progression (predominantly foot progressors vs others, p<0.001), suggesting that DAS28 underestimates disease activity in predominantly foot progressors. In this group, joint counts for the feet were independently related to radiographic progression.
DAS28 underestimates actual disease activity and expected joint damage of individual early RA patients predominantly with disease in the feet.
Annals of the rheumatic diseases 11/2011; 71(6):830-5. · 8.11 Impact Factor
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ABSTRACT: The aim of this study was to investigate whether serum biomarker levels of C2C, C1,2C, CS846, and CPII can predict the long-term course of disease activity and radiographic progression early in the disease course of rheumatoid arthritis (RA).
In patients in the CAMERA trial, levels of biomarkers were evaluated at baseline and after 1 year of treatment. Relations of (changes in) biomarker values with the mean yearly radiographic progression rate and mean disease activity over a 5-year period were evaluated by using regression analysis. The added predictive value of biomarkers over established predictors for long-term outcome was analyzed by multiple linear regression analysis.
Of 133 patients, serum samples were available at baseline and after 1 year of treatment. In the regression analysis C1,2C at baseline, the change in C2C, C1,2C, and the sum of the standardized changes in C2C + C1,2C scores were statistically significantly associated with the mean yearly radiographic progression rate; the change in CPII was associated with the mean disease activity over 5 years of treatment. In the multiple linear regression analysis, only the change in C1,2C was of added predictive value (P = 0.004) for radiographic progression. Explained variances of models for radiographic progression and disease activity were low (0.28 and 0.34, respectively), and the biomarkers only marginally improved the explained variance.
The change in C1,2C in the first year after onset of RA has a small added predictive value for disease severity over a 5-year period, but the predictive value of this biomarker combined with current predictive factors is too small to be of use for individual patients.
Arthritis research & therapy 05/2011; 13(3):R70. · 4.27 Impact Factor
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ABSTRACT: Rheumatoid arthritis is a chronic, inflammatory, systemic disease. In the past, treatment (strategy) for this disease has changed dramatically, becoming more aggressive and new drugs have become available. Furthermore, closely monitoring the disease and treatment has been advocated. Rheumatoid arthritis has an extensive impact on quality of life and the cost of the disease to society is high. Since rheumatoid arthritis is a chronic disease with life-long treatment, the long-term assessment of cost-effectiveness of new treatment (strategies) frequently implies modeling. This article reviews the assessment of the diagnosis, disease process and outcome (including quality of life and costs) and methodology of cost-effectiveness (modeling) studies in rheumatoid arthritis. Furthermore, it describes the recent trends in the treatment of rheumatoid arthritis and summarizes current evidence regarding the effects on quality of life, costs and cost-effectiveness of these new treatment strategies. Since traditional disease-modifying antirheumatic drug treatment is inexpensive, early aggressive treatment with these drugs is probably cost effective since these strategies do not appear to result in elevated toxicity and are usually found to be effective. Also, closely monitoring patients, if successful, is probably cost effective. The exact place (i.e., as a first-, second- or third-line drug) of new drugs for the treatment of rheumatoid arthritis remains somewhat controversial, since cost-effectiveness analyses have varying results and methodology. Expected future developments in the field are also discussed.
Expert Review of Pharmacoeconomics & Outcomes Research 08/2005; 5(4):395-410.
