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Routine Cancer Screenings Are Important for People With Rheumatoid Arthritis

Generally, we are all advised to get routine cancer screenings when appropriate, based on our gender and age. The screenings are even more important for people with rheumatoid arthritis. There is an increased risk of certain cancers with some of the rheumatic diseases and possibly with certain medications.

With an increased risk of cancer, it seems sensible to keep up with routine screenings. But, then, should those with an increased risk have more frequent cancer screenings? See what the experts say about cancer screenings for people with rheumatoid arthritis. Full article: Cancer Screenings Are Essential for Rheumatoid Arthritis Patients.

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Routine Cancer Screenings Are Important for People With Rheumatoid Arthritis originally appeared on About.com Arthritis on Thursday, May 29th, 2014 at 17:22:06.

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Early Rheumatoid Arthritis Less Likely to Be Well-Controlled in Overweight Patients

Rheumatoid arthritis is less likely to be well-controlled in its early stages among people who are overweight when diagnosed compared to those who are at their ideal or healthy weight. According to study results published online May 12, 2014 in the Annals of the Rheumatic Diseases, 90% of the 500 study participants were put on a disease-modifying anti-rheumatic drug (most often methotrexate) at the time of diagnosis. At 3 months, overweight patients were 33% less likely to exhibit low disease activity than those of healthy weight.

At 3 and 6 months, overweight patients reported more pain and were less likely to have achieved remission than healthy weight patients. Researchers concluded that body fat may affect the disease itself or the effectiveness of medications -- perhaps by increasing inflammation.

More: Maintaining Your Ideal Weight With Arthritis | Arthritis and Weight Loss Quiz

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Early Rheumatoid Arthritis Less Likely to Be Well-Controlled in Overweight Patients originally appeared on About.com Arthritis on Sunday, May 25th, 2014 at 22:58:16.

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Physical Therapy No More Effective Than Sham Treatment for Hip Osteoarthritis

In adults with hip osteoarthritis, physical therapy does not help pain or function, according to study results published in the May 21, 2014 issue of the Journal of the American Medical Association. The study involved 102 people with hip pain levels of 40 or higher on a visual analog scale of 100 mm (100 indicates worst pain possible) and hip osteoarthritis confirmed by x-ray.

Participants attended 10 treatment sessions over 12 weeks. Active treatment included education, manual therapy, home exercise, and gait aid. Sham treatment included inactive ultrasound and inert gel. For 24 weeks after treatment, the active group continued unsupervised home exercise and the sham group applied gel 3 times per week. There was no significant difference in results from physical therapy versus the sham treatment.

More: Hip Pain - What You Should Know | Hip Osteoarthritis

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Physical Therapy No More Effective Than Sham Treatment for Hip Osteoarthritis originally appeared on About.com Arthritis on Saturday, May 24th, 2014 at 22:10:05.

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Should Arthritis Patients With Joint Replacement Take Antibiotics Before Dental Procedures?

In 1980, after I had my first hip replacement, I was told by my orthopedic surgeon that I would need to take oral antibiotics before dental procedures or invasive diagnostics. He explained when and how the antibiotics would need to be taken. Over the years, there were questions raised about how necessary it was to take the antibiotics.

Actually, the issue of antibiotic prophylaxis just seemed to become confusing. In 2012, the American Academy of Orthopaedic Surgeons and the American Dental Association got together to issue updated guidelines. Read the latest on antibiotic prophylaxis for patients with joint replacement. Full article: Antibiotic Prophylaxis Recommendations for Patients With Joint Replacement.

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Should Arthritis Patients With Joint Replacement Take Antibiotics Before Dental Procedures? originally appeared on About.com Arthritis on Tuesday, May 20th, 2014 at 16:29:08.

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Vectra DA Predicts Disease Progression in Patients With Early Rheumatoid Arthritis

Vectra DA is a strong predictor of joint damage visible on x-rays (i.e., disease progression) in newly-diagnosed rheumatoid arthritis patients, according to study data published in the Annals of the Rheumatic Diseases. Vectra DA, which was developed by Crescendo Bioscience, is a multi-biomarker blood test used to assess rheumatoid arthritis disease activity. In Vectra DA, a panel of 12 proteins that have been associated with rheumatoid arthritis are combined into one test that produces an objective, quantitative score (0-100) related to disease activity. A lower score is indicative of less disease activity.

The study, which evaluated Vectra DA as a predictor of one-year radiographic progression, involved 235 patients with early rheumatoid arthritis. The findings are significant because the test may help doctors make treatment decisions based on a patient's risk of disease progression.

More: What Is Vectra DA?

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Vectra DA Predicts Disease Progression in Patients With Early Rheumatoid Arthritis originally appeared on About.com Arthritis on Sunday, May 18th, 2014 at 17:57:29.

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People With Arthritis Are Significantly More Likely to Fall

According to the CDC (Centers for Disease Control and Prevention), middle-aged and older adults with arthritis are significantly more likely to fall and become injured than people without arthritis. Here's the good news -- fall prevention programs can cut the risk of falls by up to a third.

The increased risk with arthritis is likely due to poor neuromuscular function (i.e., poor balance and walking speed). Additional findings, obtained from telephone surveys and published in the May 2, 2014 edition of the Morbidity and Mortality Weekly Report, included:

  • Adults with arthritis were about 30% more likely to have one fall in the past 12 months compared to those without arthritis.
  • Adults with arthritis were 2.5 times more likely to have fallen more than twice compared to those without arthritis.
  • Adults with arthritis were about 2.5 times more likely to have been injured from a fall compared to people without arthritis.

Exercise or physical therapy, by improving gait, balance, and lower body strengthen can cut the risk of falls by 14-37%. Consistent physical activity over time is what is necessary to decrease fall risk in people with arthritis.

Read more: How to Prevent Slips and Falls

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People With Arthritis Are Significantly More Likely to Fall originally appeared on About.com Arthritis on Tuesday, May 13th, 2014 at 19:40:03.

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Life Expectancy Has Significantly Increased for People With Rheumatoid Arthritis

When I started writing about arthritis 17 years ago, one of the facts I unearthed had to do with rheumatoid arthritis patients having decreased life expectancy. It was article-worthy so I wrote about it, but it was somewhat unsettling too, since I have rheumatoid arthritis. But, good news has come out of this year's annual meeting of the British Society for Rheumatology, as reported by MedpageToday.com. According to researchers, over the past 25 years, there has been a dramatic increase in the life expectancy of people with rheumatoid arthritis.

Study results revealed that between 1986 and 1998, the average age of death for a person with rheumatoid arthritis was 76.7 years. Between 2002 and 2012, the average age of death for someone with rheumatoid arthritis was 86.7 years. It was also determined that the average age of onset of rheumatoid arthritis went from 54.2 years of age to 58.5 years.

Read more: Mortality and Arthritis

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Life Expectancy Has Significantly Increased for People With Rheumatoid Arthritis originally appeared on About.com Arthritis on Tuesday, May 13th, 2014 at 18:06:30.

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Negative Rheumatoid Factor Test Can Delay Referral to Rheumatologist

A blood test, known as Rheumatoid Factor, is often ordered when you consult with a rheumatologist for the first time. Primary doctors sometimes order the test as well, but according to an oral abstract presented at the British Society for Rheumatology's annual conference, Rheumatology 2014, that can be a problem in some cases. Some primary doctors are misled by false negative results and delay the referral of a patient to a rheumatologist.

Researchers from the University of Oxford and the University of Bath analyzed a primary care database of 64,000 patients who were tested for rheumatoid factor between 2000-2008. There were 1,800 people diagnosed with rheumatoid arthritis within 2 years. Of those, 1,000 were positive for rheumatoid factor and 800 were negative for rheumatoid factor. Patients who had a negative result were not referred as quickly to a rheumatologist. The referral took about 67 days, which was 45 days longer than for rheumatoid factor positive patients.

Researchers concluded that the delay is significant because early diagnosis and treatment are essential for rheumatoid arthritis. Patients should be referred on the basis of symptoms and the rheumatoid factor test should not be used in primary care settings to rule out rheumatoid arthritis.

More: Rheumatoid Factor Blood Test | First Visit to the Rheumatologist

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Negative Rheumatoid Factor Test Can Delay Referral to Rheumatologist originally appeared on About.com Arthritis on Tuesday, May 6th, 2014 at 17:55:22.

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Rituxan May Be Better Than TNF Blockers for Rheumatoid Lung Disease

Rheumatoid arthritis patients with interstitial lung disease appear to improve their chance of survival if treated with Rituxan rather than TNF blockers, according to study results reported by the British Society for Rheumatology and MedpageToday.com. Results showed a four-fold reduction in respiratory mortality in patients treated with Rituxan compared to TNF blockers.

Pulmonary complications of rheumatoid arthritis are not uncommon. Histological evidence from post-mortem exams show 40-50% of rheumatoid arthritis patients with evidence of fibrosis. Radiological evidence of fibrosis has been found in about 25% of patients.

The aforementioned study involved 188 patients and while the findings involved small numbers, those numbers were considered statistically significant. It was an observational study and not a controlled trial though. A prospective, controlled trial to confirm the findings would be needed.

More: What Is Rheumatoid Lung Disease?

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Rituxan May Be Better Than TNF Blockers for Rheumatoid Lung Disease originally appeared on About.com Arthritis on Friday, May 2nd, 2014 at 22:29:45.

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Do You Need Financial Help With Your Biologic Treatment for Rheumatoid Arthritis?

Some arthritis patients are apprehensive when their doctor recommends one of the biologic drugs. The drugs are used to treat rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. While some patients shy away because of possible side effects, or they don't like the idea of self-injection or intravenous infusion, others are put off by the cost of the drugs.

I have compiled a list of where you can go for financial assistance. You may qualify even if you have insurance. Don't assume you don't qualify. Check it out. Full article: Financial Assistance for Arthritis Patients Prescribed Biologic Drugs.

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Do You Need Financial Help With Your Biologic Treatment for Rheumatoid Arthritis? originally appeared on About.com Arthritis on Thursday, April 24th, 2014 at 22:17:30.

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Site: Arthritis Research & Therapy - Latest Articles

Aberrantly expressed long noncoding RNAs in human intervertebral disc degeneration: a microarray related study
IntroductionIn addition to the well-known short noncoding RNAs such as microRNAs (miRNAs), increasing evidence suggests that long noncoding RNAs (lncRNAs) act as key regulators in a wide aspect of biologic processes. Dysregulated expression of lncRNAs has been demonstrated being implicated in a variety of human diseases. However, little is known regarding the role of lncRNAs with regards to intervertebral disc degeneration (IDD). In the present study we aimed to determine whether lncRNAs are differentially expressed in IDD. Methods: An lncRNA-mRNA microarray analysis of human nucleus pulposus (NP) was employed. Bioinformatics prediction was also applied to delineate the functional roles of the differentially expressed lncRNAs. Several lncRNAs and mRNAs were chosen for quantitative real-time PCR (qRT-PCR) validation. Results: Microarray data profiling indicated that 116 lncRNAs (67 up and 49 down) and 260 mRNAs were highly differentially expressed with an absolute fold change greater than ten. Moreover, 1,052 lncRNAs and 1,314 mRNAs were differentially expressed in the same direction in at least four of the five degenerative samples with fold change greater than two. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis for the differentially expressed mRNAs indicated a number of pathways, such as extracellular matrix (ECM)-receptor interaction. A coding-noncoding gene co-expression (CNC) network was constructed for the ten most significantly changed lncRNAs. Annotation terms of the coexpressed mRNAs were related to several known degenerative alterations, such as chondrocyte differentiation. Moreover, lncRNAs belonging to a particular subgroup were identified. Functional annotation for the corresponding nearby coding genes showed that these lncRNAs were mainly associated with cell migration and phosphorylation. Interestingly, we found that Fas-associated protein factor-1 (FAF1), which potentiates the Fas-mediated apoptosis and its nearby enhancer-like lncRNA RP11-296A18.3, were highly expressed in the degenerative discs. Subsequent qRT-PCR results confirmed the changes. Conclusions: This is the first study to demonstrate that aberrantly expressed lncRNAs play a role in the development of IDD. Our study noted that up-regulated RP11-296A18.3 highly likely induced the over-expression of FAF1, which eventually promoted the aberrant apoptosis of disc cells. Such findings further broaden the understanding of the etiology of IDD.

Focal adhesion kinase is required for synovial fibroblast invasion, but not murine inflammatory arthritis
IntroductionSynovial fibroblasts invade cartilage and bone leading to joint destruction in rheumatoid arthritis. However the mechanisms that regulate synovial fibroblast invasion are not well understood. Focal adhesion kinase (FAK) has been implicated in cellular invasion in several cell types and FAK inhibitors are in clinical trials for cancer treatment. Little is known about the role of FAK in inflammatory arthritis, but given its expression in synovial tissue, its known role in invasion in other cells, and the potential clinical availability of FAK inhibitors, it is important to determine if FAK contributes to synovial fibroblast invasion and inflammatory arthritis. Methods: After treatment with FAK inhibitors, invasiveness of human rheumatoid synovial fibroblasts was determined with Matrigel invasion chambers. Migration and focal matrix degradation, two components of cellular invasion, were assessed in FAK inhibited rheumatoid synovial fibroblasts by transwell assay and microscopic examination of fluorescent gelatin degradation, respectively. Using mice with tumor necrosis factor alpha (TNF?) induced arthritis in which FAK could be inducibly deleted, invasion and migration by FAK deficient murine arthritic synovial fibroblasts was determined as above and arthritis was clinically and pathologically scored in FAK deficient mice. Results: Inhibition of FAK in human rheumatoid synovial fibroblasts impaired cellular invasion and migration. Focal matrix degradation occurred both centrally and at focal adhesions, the latter being a novel site for matrix degradation in synovial fibroblasts, but degradation was unaltered with FAK inhibitors. Loss of FAK reduced invasion in murine arthritic synovial fibroblasts, but not migration or TNF? induced arthritis severity and joint erosions. Conclusions: FAK inhibitors reduce synovial fibroblast invasion and migration, but synovial fibroblast migration and TNF? induced arthritis do not rely on FAK itself. Thus, inhibition of FAK alone is unlikely to be sufficient to treat inflammatory arthritis, but current drugs that inhibit FAK may inhibit multiple factors, which could increase their efficacy in rheumatoid arthritis.

Serum sclerostin in adult high-activity patients with juvenile idiopathic arthritis
IntroductionJuvenile idiopathic arthritis (JIA) is a disease associated with loss of bone mass, deterioration in its quality, and an increased risk of fractures. The objective of this study was to evaluate factors that predict bone mineral density (BMD) alterations in young adult patients with active JIA, before and during therapy with tumour necrosis factor alpha (TNF?) inhibitors. Methods: Thirty-one patients (12 males and 19 females aged 25.1???6.1?years) with active JIA (disease activity score 28 (DAS 28) 6.36???0.64; high-sensitivity C-reactive protein (hsCRP) 18.36???16.95?mg/l) were investigated. The control group consisted of 84 healthy individuals of matched gender and age. Bone mineral density, bone turnover markers, and serum concentrations of soluble receptor activator of nuclear factor kappa B ligand, osteoprotegerin, dickkopf-1 (Dkk1), and sclerostin were evaluated. Results: Baseline BMD values in the lumbar spine, proximal femur, femoral neck and distal radius were significantly lower in JIA patients compared to healthy controls. Baseline sclerostin serum concentrations were significantly higher in JIA patients compared to controls. After two years of treatment with TNF? inhibitors, BMD significantly increased in the lumbar spine. This increase correlated with a drop in DAS 28 score. A statistically significant correlation between hsCRP and Dkk1 was found at baseline, as well as during the 2-year follow-up period. A significant reduction in serum sclerostin after one year of therapy predicted a drop in DAS 28 score observed with a one-year delay after reduction of serum sclerostin. Conclusion: A significant correlation between the sclerostin serum concentration and the number of tender and swollen joints, but not BMD, supports the hypothesis that chondrocytes and cells of the subchondral bone may contribute to circulating sclerostin in JIA.

Association of cerebrospinal fluid anti-Sm antibodies with acute confusional state in systemic lupus erythematosus
IntroductionNeuropsychiatric systemic lupus erythematosus (NPSLE) is one of the most serious complications. Previous studies revealed the strong association between serum anti-Sm and organic brain syndrome, consisting mainly of acute confusional state (ACS) of diffuse psychiatric/neuropsychological syndromes (diffuse NPSLE). However, the precise mechanism by which anti-Sm causes diffuse NPSLE remains unclear. Interestingly, recent studies demonstrated that anti-U1 RNP antibodies (anti-RNP) in cerebrospinal fluid (CSF) are associated with NPSLE. The present study was designed to explore the association of anti-Sm antibodies in CSF with NPSLE. Methods: Paired serum and CSF specimens were obtained from 72 patients with NPSLE (49 with diffuse NPSLE, 23 with neurological syndromes or peripheral neuropathy (focal NPSLE)) and from 22 control patients with non-SLE neurological diseases. Sera were also obtained from 41 patients with active SLE without neuropsychiatric manifestations (non-NPSLE). Anti-Sm and anti-RNP were measured by enzyme-linked immunosorbent assay (ELISA). Blood?brain barrier (BBB) function and intrathecal anti-Sm production were evaluated by Q albumin and CSF anti-Sm index, respectively. Binding of anti-Sm to neuroblastoma cell lines SK-N-MC and Neuro2a was examined by flow cytometry and by cell ELISA.ResultAnti-Sm and anti-RNP in CSF and sera were elevated in NPSLE compared with non-SLE control. CSF anti-Sm, but not CSF anti-RNP, was significantly elevated in ACS compared with non-ACS diffuse NPSLE or with focal NPSLE. By contrast, there were no significant differences in serum anti-Sm or anti-RNP among subsets of NPSLE and non-NPSLE. Whereas there were no significant differences in CSF anti-Sm index, Q albumin was elevated in ACS compared with non-ACS or with focal NPSLE. Notably, CSF anti-Sm was correlated with Q albumin (r?=?0.2373, P?=?0.0447) or with serum anti-Sm (r?=?0.7185, P <0.0001) in 72 patients with NPSLE. Finally, monoclonal anti-Sm and purified human anti-Sm bound to the surface of SK-N-MC and Neuro2a. Conclusion: These results demonstrate that the elevation of CSF anti-Sm through transudation from systemic circulation due to damaged BBB, plays critical roles in the pathogenesis of ACS. More importantly, the data indicate that anti-Sm is yet another autoantibody with presumed neural toxicity, but might not be the last.

Activation of fibroblast-like synoviocytes derived from rheumatoid arthritis via lysophosphatidic acid - lysophosphatidic acid receptor 1 cascade
IntroductionLysophosphatidic acid (LPA) is a bioactive lipid that binds to G protein-coupled receptors (LPA1?6). Recently, we reported that abrogation of LPA receptor 1 (LPA1) ameliorated murine collagen-induced arthritis, probably via inhibition of inflammatory cell migration, Th17 differentiation and osteoclastogenesis. In this study, we examined the importance of the LPA-LPA1 axis in cell proliferation, cytokine / chemokine production, and lymphocyte transmigration in fibroblast-like synoviocytes (FLSs) obtained from the synovium of rheumatoid arthritis (RA). Methods: FLSs were prepared from synovial tissues of RA patients. Expression of LPA1?6 was examined by quantitative real-time reverse transcription-polymerase chain reaction. Cell surface LPA1 expression was analyzed by flow cytometry. Cell proliferation was analyzed by cell counting kit. Production of interleukin (IL)-6, vascular endothelial growth factor (VEGF), CC chemokine ligand 2 (CCL2), metalloproteinase-3 (MMP-3) and CXC chemokine ligand 12 (CXCL12) was measured by enzyme-linked immunosorbent assay. Pseudoemperipolesis was evaluated using a coculture of RA FLSs and T or B cells. Cell motility was examined by the scrape motility assay. Expression of adhesion molecules was determined by flow cytometry. Results: The expression of LPA1 messenger ribonucleic acid (mRNA) and cell surface LPA1 expression was higher in RA FLSs than that in FLSs from osteoarthritis. Stimulation with LPA enhanced the proliferation of RA FLSs and the production of IL-6, VEGF, CCL2, and MMP-3 by FLSs, which were suppressed by an LPA1 inhibitor (LA-01). Ki16425, another LPA1 antagonist, also suppressed IL-6 production by LPA-stimulated RA FLSs. However, the production of CXCL12 was not altered by stimulation with LPA. LPA induced the pseudoemperipolesis of T and B cells cocultured with RA FLSs, which was suppressed by LPA1 inhibition. In addition, LPA enhanced the migration of RA FLSs and expression of vascular cell adhesion molecule and intercellular adhesion molecule on RA FLSs, which were also inhibited by an LPA1 antagonist. Conclusions: Collectively, these results indicate that LPA-LPA1 signaling contributes to the activation of RA FLSs.

Dynamic contrast-enhanced magnetic resonance imaging of metacarpophalangeal joints reflects histological signs of synovitis in rheumatoid arthritis
IntroductionSynovial inflammation and joint destruction in rheumatoid arthritis (RA) may progress despite clinical remission. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is increasingly used to detect synovial inflammation in RA. Although small joints such as metacarpophalangeal (MCP) joints are mainly affected by RA, MRI findings have never been directly compared to histological synovitis in MCP synovial tissue. The objective of the current study was therefore to analyse if DCE-MRI relates to histological signs of synovitis small RA joints. Methods: In 9 RA patients, DCE-MRI (3 Tesla, dynamic 2D T1 weighted turbo-flash sequence) of the hand was performed prior to arthroscopically-guided synovial biopsies from the second MCP of the imaged hand. Maximum enhancement (ME), rate of early enhancement, and maximum rate of enhancement were assessed in the MCP. Synovial biopsies were stained for determination of sublining CD68 and the Synovitis Score. Correlations between MRI and histological data were calculated according to Spearman. Results: ME of the MCP significantly correlated to sublining CD68 staining (r?=?0.750, P?=?0.02), the Synovitis Score (r?=?0.743, P?=?0.02), and the subscores for lining layer hypertrophy (r?=?0.789, P?=?0.01) and cellular density (r?=?0.842; P?=?0.004). Conclusions: Perfusion imaging of synovial tissue in RA finger joints employing DCE-MRI reflects histological synovial inflammation. According to our study, ME is the most closely associated parameter amongst the measures considered.

Cost-utility of cognitive behavioural therapy versus U.S. food and drug administration recommended drugs and usual care in the treatment of patients with fibromyalgia: an economic evaluation alongside a 6-month randomised controlled trial
IntroductionCognitive behavioural therapy (CBT) and U.S. Food and Drug Administration (FDA) recommended pharmacological treatments (RPT; pregabalin, duloxetine, and milnacipran) are effective treatment options for fibromyalgia (FM) syndrome and are currently recommended by clinical guidelines. We compared the cost-utility from the healthcare and societal perspectives of CBT versus RPT (combination of pregabalin?+?duloxetine) and usual care (TAU) groups in the treatment of FM. Methods: The economic evaluation was conducted alongside a 6-month, multicentre, randomised, blinded, parallel group, controlled trial. A total of 168 FM patients from 41 general practices in Zaragoza (Spain) were randomised to CBT (n?=?57), RPT (n?=?56) or TAU (n?=?55). The main outcome measures were Quality-Adjusted Life Years (QALYs, assessed using the EuroQoL-5D questionnaire) and improvements in health-related quality of life (HRQoL, assessed using EuroQoL-5D visual analogue scale, EQ-VAS). The costs of healthcare utilisation were estimated from patient self-reports (Client Service Receipt Inventory). Cost-utility was assessed using the net-benefit approach and cost-effectiveness acceptability curves (CEACs). Results: On average, the total costs per patient in the CBT group (1,847?) were significantly lower than patients receiving RPT (3,664?) or TAU (3,124?). Patients receiving CBT reported a higher quality of life (QALYs and EQ-VAS scores); the differences between groups were significant only for EQ-VAS. From a complete case analysis approach (base case), the point estimates of the cost-effectiveness ratios resulted in dominance for the CBT group in all of the comparisons performed, using both QALYs and EQ-VAS as outcomes. These findings were confirmed by bootstrap analyses, net-benefit curves and CEACs. Two additional sensitivity analyses (intention-to-treat analysis and per protocol analysis) indicated that the results were robust. The comparison of RPT versus TAU yielded no clear preference for either treatment when using QALYs, although RPT was determined to be more cost-effective than TAU when evaluating EQ-VAS. Conclusions: Due to lower costs, CBT is the most cost-effective treatment for adult FM patients. Implementation in routine medical care would require policymakers to develop more widespread public access to trained and experienced therapists in group-based forms of CBT.Trial registrationCurrent Controlled Trials ISRCTN10804772. Registered 29 September 2008.

Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis ¿ a probabilistic approach
IntroductionThis study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach. Methods: One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis were included. Patients were assessed clinically including joint examination, laboratory testing including acute-phase reactants, rheumatoid factor (RF) and anti citrulinated protein antibody (ACPA), and radiographs of hands and feet if clinically indicated. A diagnostic assessment was then performed by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints 2 to 5 in both hands, metatarsophalangeal (MTP) joints 2 to 5 in both feet and any symptomatic joints was performed and the results presented to the same rheumatologist. The latter then assessed the diagnostic probabilities again, using the same scale. Results: The rheumatologists? certainty for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P <0.001). With regard to a diagnosis of RA, the proportions were 31.1% pre-test and 61.2% post-test (P <0.001). MSUS findings agreed with the final diagnosis in 95% of patients. Conclusion: Musculoskeletal ultrasound, when added to routine rheumatologic investigation, greatly increases the diagnostic certainty in patients referred for the evaluation of inflammatory arthritis. The changes from pre-test to post-test probability quantify the diagnostic utility of musculoskeletal ultrasound in probabilistic terms.

Targeted exon sequencing fails to identify rare coding variants with large effect in rheumatoid arthritis
IntroductionAlthough it has been suggested that rare coding variants could explain the substantial missing heritability, very few sequencing studies have been performed in rheumatoid arthritis (RA). We aimed to identify novel functional variants with rare to low frequency using targeted exon sequencing of RA in Korea. Methods: We analyzed targeted exon sequencing data of 398 genes selected from a multifaceted approach in Korean RA patients (n?=?1,217) and controls (n?=?717). We conducted a single-marker association test and a gene-based analysis of rare variants. For meta-analysis or enrichment test, we also used ethnically matched independent samples of Korean genome-wide association studies (GWAS) (n?=?4,799) or immunochip data (n?=?4,722). Results: After stringent quality control, we analyzed 10,588 variants of 398 genes from 1,934 Korean RA case-controls. We identified 13 non-synonymous variants with nominal association in single variant association tests. In a meta-analysis, we did not find any novel variant with genome-wide significance for RA risk. Using a gene-based approach, we identified 17 genes with nominal burden signals. Among them, VSTM1 showed the greatest association with RA (P?=?7.80???10?4). In the enrichment test using Korean GWAS, although the significant signal appeared to be driven by total genic variants, we found no evidence for enriched association of coding variants only with RA. Conclusions: We were unable to identify rare coding variants with large effect to explain the missing heritability for RA in the current targeted resequencing study. Our study raises skepticism about exon sequencing of targeted genes for complex diseases like RA.

Fish consumption and risk of rheumatoid arthritis: a dose-response meta-analysis
IntroductionThe association between fish consumption and rheumatoid arthritis (RA) is unclear. The aim of this paper was to summarize the available evidence on the association between fish consumption and risk of RA using a dose-response meta-analysis. Methods: Relevant studies were identified by a search of MEDLINE and EMBASE through December 2013, with no restrictions. A random-effects dose-response meta-analysis was conducted to combine study specific relative risks. Potential non-linear relation was investigated using restricted cubic splines. A stratified analysis was conducted by study design. Results: Seven studies (four case-controls and three prospective cohorts) involving a total of 174 701 participants and 3346 cases were included in the meta-analysis. For each one serving per week increment in fish consumption, the relative risk (RR) of RA was 0.96 (95% confidence interval (CI) 0.91 to 1.01). Results did not change when stratifying by study design. No heterogeneity or publication bias was observed. When fish consumption was modeled using restricted cubic splines, the risk of RA was 20 to 24% lower for 1 up to 3 servings per week of fish (RR?=?0.76, 95% CI: 0.57 to 1.02) as compared to never consumption. Conclusions: Results from this dose-response meta-analysis showed a non-statistically significant inverse association between fish consumption and RA.


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