A comparison of rheumatoid arthritis in Australia and China

Rheumatoid arthritis

It is difficult to determine from ancient writings, old human specimens, and from Art over the centuries, as to when Rheumatoid Arthritis first appeared. It may be a relatively modern condition, as it was reasonably well described in the seventeenth century. Augustin Jacob Landre-Beauvais (1772-1840), University of Paris is credited, with the first clear description of the disease in his thesis. In 1859 Sir Alfred Baring Garrod (1819-1907), the "father of rheumatology", gave the disease its current name which was finally adapted in Britain by the Ministry of Health in 1922. Some forms of Juvenile Arthritis are related to adult Rheumatoid Arthritis (aka Still's disease). If untreated Rheumatoid arthritis can result in severe destructive joint damage and often there are associated severe systemic complications. Disease modifying agents have benefited the disease management, but it was the discovery of the anti TNF-alpha agents in the 1990s, and subsequently many additional Biologic agents, which have greatly changed the clinical outcome in Rheumatoid Arthritis.

Characteristics of rheumatoid arthritis in Algeria: a multicenter study

The aim of this study was to compare the epidemiology of rheumatoid arthritis (RA) in North Africa to that of Western countries. We have enrolled in a cross-sectional study all consecutive patients presenting with the diagnosis of RA according to the 1987 ACR criteria, and during a 5-month period, patients were included in 11 centers across northern Algeria. Demographics, clinical data, and health assessment questionnaires (HAQ) were collected for each patient. We have estimated means, standard deviations, and 95 % confidence intervals for all parameters. Of the 249 patients (213 females and 36 males) enrolled in the study, 10 (4 %) had juvenile onset of the disease. The mean age was 50.1 ± 14.5 years, and the mean duration of RA was 8.4 ± 7.8 years. In terms of comorbidities, 18.9 % of patients reported hypertension and 5.2 % had diabetes. The mean DAS28 at inclusion was 4.3 (95 % CI 4.1-4.5); 14.0 % were in remission (DAS28 ≤ 2.6). The mean HAQ score was 0.81 ± 0.82. Rheumatoid factor was positive in 78.5 % of cases, and anti-citrullinated protein/peptide antibodies, when measured, was positive in 69.0 % of cases. Seronegative patients were older and had a relatively less severe disease. For treatment, 89.7 % of patients were taking disease-modifying anti-rheumatic drugs and only 4 % were taking biologics (rituximab); 90.8 % of patients were taking glucocorticoids, and none of the patients satisfied the recommended calcium intake guidelines. RA in Algeria is more common in women. Compared to reports from Western countries, RA in Algeria appears to be less aggressive, with more dominant seronegative oligoarthritis forms. The remission rate is comparable to that of Western populations.

The efficacy of disease modifying anti-rheumatic drugs in rheumatoid arthritis in local patients of Karachi

The primary objective of the study is to assess the efficacy of the 'Disease Modifying AntiRheumatic Drugs (DMARDs) on the disease activity in Rheumatoid Arthritis (RA) in the local patients of Karachi. The secondary objective is to evaluate whether the combination of two concurrent DMARDs (Combination Therapy) is superior to a single DMARD (Mono-therapy). This is an open labeled retrospective case series. One hundred and five consecutive patients fulfilling 1987 ACR criteria for the diagnosis of RA were initially selected from the case notes of out patients department. Sixty nine patients fulfilled the inclusion criteria and were finally recruited for analysis. Details of the Tender Joint Count (TJC), Swolen Joint Count (SJC), Patient Global Assessment (PGA) and ESR were obtained at six weeks, three months, six months and one year. Out of the 69 patients studied 48 were in the mono-therapy group and 21 in the combination therapy group. Methotrexate (MTX) was the most commonly used single DMARD (75%) as well as the most frequent component of the combination groups (85%). The TJC, SJC and PGA analyses of all patients show that DMARDs are effective agents for clinically controlling RA activity. The speed of their beneficial effect is slow and unlike analgesics and NSAIDS, may take up to six weeks to start working. The 6 week responses showed 32.49% improvement in TJC, 33.19% improvement in SJC and 59% better responses in PGA. This response continued to show further improvement and at six months when TJC improved by 63.41%, SJC by 53.21% and PGA with 81% better responses. After 6 months the response reached a plateau but nevertheless maintained until 1 year with improvements in TJC by 66.23%, SJC by 56.48% and PGA with 88.23% better responses. The changes in ESR did not go parallel with the other three outcome measures. The mean baseline ESR of 56 reduced to 44 at 6 weeks but rose again gradually to 54 at 1 year. The sub-group analysis did not show the overall superiority of combination therapy over mono-therapy. DMARDs are effective in controlling disease activity in RA. Their effect starts slowly over 6 week and may take up to 6 months to show full benefits. The beneficial effect was maintained for at least 1 year. Sub-group analysis did not show any advantage of combination therapy over mono-therapy in this series of patients. Methotrexote being the most frequently used DMARDs in both groups and being most cost effective agent seems to be the most useful drug in RA in the developing world.

Incidence of rheumatoid nodule in Dalmatia: similarities and differences among populations

BACKGROUND

The specific aim of our study was neither prognosis nor long-term evaluation but focus on determining incidence of rheumatoid nodules (RN) in a large population of patients with rheumatoid arthritis (RA) on the coastline of Croatia (Dalmatia) within a certain range. We compared our data with those published previously in the literature.

METHODS

Our study was focused on determining incidence of RN occurrence in patients with rheumatoid arthritis in Dalmatia, Croatia by comparing these figures with data reported elsewhere and evaluating its importance in the process of diagnosing RA. The duration of the study was 10 years (1991-2001). There were 421 patients (344 women and 77 men) with confirmed RA diagnosis. Median follow-up time was 2 years (range: 1.4-3.5 years).

RESULTS

Existence of RN was established by clinical examination in 109 of 421 patients; incidence density was 17.3%. RN occurred somewhat more frequently in men (32%) as compared to women (24%) without statistically significant difference. In 38% of patients, RN occurred simultaneously in several sites, more frequently in men (64%) than in women (30%) (odds ratio [OR] 2.13, p <0.05). Correlation of seropositivity and RN appearance was very high: positive in 84% of patients with nodules as compared to 58% of patients without nodules (OR 1.45, p <0.05) with no statistically significant differences between sexes.

CONCLUSIONS

Results obtained warrant the conclusion that RN incidence in our patients from Dalmatia is comparable with results of earlier Croatian studies as well as with Western European figures and Caucasian population data reported on other continents. RN incidence differs significantly for Asian and Arabian populations, i.e., is less frequent, and for the U.S. population, where it is more frequent.

Neuromuscular complications of connective tissue diseases

The connective tissue diseases, such as rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus, systemic sclerosis, and vasculitis, may cause various disorders of the peripheral nervous system. In this review, the clinical effects of the connective tissues diseases on nerve and muscle are examined with particular attention to mononeuritis multiplex, distal symmetric neuropathy, fulminant motor neuropathy, compression neuropathy, sensory neuronopathy, and trigeminal sensory neuropathy.

Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis

OBJECTIVE

To review epidemiological studies dealing with the temporal and geographic variability in the occurrence of rheumatoid arthritis (RA) and clinical studies that address the variability of severity and manifestations among populations.

METHODS

An extensive search of the literature, including a Medline search, was completed. Studies addressing the origin, history, and trends in the occurrence of RA were reviewed first. Next, studies of the prevalence and incidence of RA in different populations were reviewed, and occurrence rates compared. Standardization was attempted by tabulating adult prevalence rates of studies using equivalent sets of criteria. Studies comparing RA patients from two populations were sought next. Finally, studies dealing with explanations of the presumed variability were reviewed.

RESULTS

Temporal variability is indicated by paleopathological evidence that RA has existed in the New World since 4000 BC, whereas there is no evidence that it occurred in Europe before the 17th century, or in Africa before the 20th century. Epidemiological studies show a possible trend of decreasing incidence of RA in the United States and Western Europe, whereas reports from Africa note a rising incidence. In white populations of Europe and America, prevalence is approximately 1%, and incidence is 0.03%. Significantly higher rates are found in some North American Indians, and significantly lower rates in some Asian and African populations, even when the different population structures are taken into account. In the latter populations, different patterns of occurrence from those observed in whites emerge, such as greater female preponderance and a much younger peak age at onset. Direct standardized comparisons of two diverse populations of RA patients showed some differences in expression, severity, or manifestations of RA between populations.

CONCLUSION

The occurrence and manifestations of RA are temporally and geographically variable.

The epidemiology of hip osteoarthritis and rheumatoid arthritis in the Orient

The prevalence of hip osteoarthritis and rheumatoid arthritis has been found to be lower in Chinese, Japanese, and other Asian populations than in whites. The low prevalence of osteoarthritis hip in the Chinese and Japanese populations cannot be explained by the rarity of hip dysplasia, which is as prevalent in those two populations as in whites. As in other populations, rheumatoid arthritis in the Chinese is associated with the shared epitope of the third hypervariable region of the DR gene. However, the low prevalence of rheumatoid arthritis in the Chinese cannot be accounted for entirely by genetic factors.

The expression of rheumatoid arthritis in Saudi Arabia

This retrospective study describes the characteristics of rheumatoid arthritis patients seen at the King Khalid University Hospital, Riyadh over a period of 5 years. One hundred and ninety-five patients with rheumatoid arthritis seen during this period were reviewed. There were 155 females and 40 males (F:M ratio 4:1). Females had a younger age at onset than males (38.6 +/- 13.4 vs 42.9 +/- 13.3 year for male - p = 0.037). The majority of patients (76.4%) described an insidious onset. 45.1% used one or more forms of local medicine. Constitutional symptoms were reported in 78 (40%). Rheumatoid factor was positive in 79.5%. The most frequently involved joints were the proximal interphalangeal (PIP) joints, knees and metacarpophalangeal (MCP) joints. Rheumatoid nodules were observed in 15.9% and keratoconjunctivitis sicca in 14.4%. Most patients used second line drugs. The majority of patients (57.4%) were in functional class 1 and 2. The disease pattern and joint distribution resemble more the pattern reported in developed countries.

Rheumatoid arthritis in the northeastern area of the People's Republic of China and western Japan

The clinical features of 134 consecutive hospitalized patients with rheumatoid arthritis in the northeastern area of the People's Republic of China and 251 consecutive hospitalized patients from western Japan were compared. A total of 91.8% of the Chinese patients were of Han nationality, while all of the patients from Japan were Japanese. The patients in the People's Republic of China showed more inflammatory articular disease and more frequent subcutaneous nodules than did the Japanese patients in the presence of a less elevated ESR value and less radiographic joint destruction. The clinical features of the patients of Han nationality and the Japanese did not change even after adjusting the patients' age and disease duration. The reasons for the contradictory features in the Chinese patients still remain to be clarified. This study is hopefully a first step in promoting more precise studies on rheumatoid arthritis in the People's Republic of China.

A comparison of changes seen on radiographs of rheumatoid arthritis patients in Australia and in China

To test the hypothesis that rheumatoid arthritis in patients in China is milder in severity than that in patients in a western country, a comparison was made of 2 series of consecutive outpatients with definite or classic rheumatoid arthritis who were attending referral centers in Melbourne, Australia and Shanghai, China. This paper reports the findings on radiographs of the wrists and hands. Making allowances for age and duration of disease, changes were more frequent and severe in the Australian patient series, particularly at the metacarpophalangeal joints.