Impact of rheumatoid arthritis on quality of life

Mitochondrial calcium uniporter regulates human fibroblast-like synoviocytes invasion via altering mitochondrial dynamics and dictates rheumatoid arthritis pathogenesis

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that currently has no cure. Fibroblast-like synoviocytes (FLS), present in the RA synovium, play a pivotal role in RA pathogenesis. Notably, FLS in the RA patients (RA-FLS) exhibit characteristics similar to cancer cells, like enhanced migration, invasiveness, uncontrolled proliferation, resistance to apoptosis, and metabolic reprogramming. RA-FLS invasiveness is linked to radiographic joint damage in the patients, whereas inhibiting the FLS migration mitigates disease pathology. However, the molecular mechanisms underlying the migration and invasion capabilities of RA-FLS are not entirely understood. In this work, we have explored the function of mitochondrial calcium uniporter (MCU) and calcium signaling in FLS invasion. Our findings demonstrate a positive correlation between MCU expression and RA disease score. Interestingly, mitochondrial size was reduced, and peripheral localization was more pronounced in the RA-FLS when compared to the control FLS. Mitochondrial calcium import inhibition in the FLS by specific MCU inhibitor, Ruthenium-360 restored these altered mitochondrial dynamics and reduced the invasive phenotype. Through unbiased transcriptome analysis, we identified that MCU-mediated calcium signaling in RA-FLS leads to the enriched actin cytoskeleton and focal adhesion pathways responsible for the invasion phenotype, which can be effectively suppressed by inhibiting MCU. Additionally, we found that mitochondrial transport facilitator Miro1 binds to MCU in a calcium-dependent manner and regulates MCU-mediated mitochondrial dynamics and RA-FLS invasion. Experiments utilizing mice xenograft model demonstrated that MCU silencing diminishes the migration of RA-FLS toward the sites of inflammation in the immunocompromised SCID mice. Altogether, our findings highlight MCU as a promising therapeutic target to inhibit RA-FLS migration and RA progression.

Predictors of methotrexate adherence and patient's awareness of it in rheumatoid arthritis and its effect on quality of life

Introduction

Adherence studies among rheumatoid arthritis (RA) patients, in Egypt and throughout the Middle East region, are lacking. This study aimed to evaluate methotrexate (MTX) adherence in Rheumatoid arthritis (RA) patients and to identify specific non-adherence predictors.

Methods

A cross-sectional observational study included 300 RA patients who were administered MTX for at least one year. The survey was completed through direct interviews. The demographic patient data were collected (age, education, sex, work status, disease duration, duration of MTX administration and current dose). Patients' adherence to MTX predictors for non-adherence, MTX side effects and functional disability were assessed in the study.

Results

Majority of respondents showed good MTX adherence, and more than 50% of patient's experienced MTX side effects. A large percentage of participants showed low knowledge about MTX nature and side effects. Most participants reported no or some difficulty in quality of life-related activities and functional disability.

Conclusion

MTX adherence and awareness were positively correlated to many variables, including, age, educational level and disease duration, which in turn has its positive impact on the patient's quality of life. Still, more research is needed to determine the impact of non-adherence on the patient's health outcomes.

Health-related quality of life in patients with ANCA vasculitides compared to rheumatoid arthritis: a cross-sectional comparative study

OBJECTIVES

There are limited data regarding health-related quality of life (HRQoL) in patients with ANCA-associated vasculitides (AAVs). We aimed to evaluate the HRQoL in patients with AAVs and compare it to another chronic inflammatory disease like RA and to healthy controls (HC).

METHODS

This was a multicentre, cross-sectional study of patients with AAVs and RA recruited from three tertiary rheumatology clinics. HRQoL was assessed with the Short Form 36 Health Survey, which included the physical and mental component summary scores (PCS and MCS). Data from 1007 HC served as historical controls.

RESULTS

Sixty-six patients with AAVs and 71 with RA were included. Both AAV and RA patients had significantly lower PCS and MCS scores compared with HC (P < 0.05). HRQoL in AAV patients was worse in patients with microscopic polyangiitis compared with granulomatosis with polyangiitis (physical components) and those with high (VDI ≥ 3) vs low (VDI < 3) damage scores while it did not differ between those with active (BVASv3 ≥ 1) vs. inactive (BVASv3 < 1) disease. In contrast, in RA patients, HRQoL correlated both with disease activity (assessed by the DAS28-ESR) and functional impairment/damage (assessed by the HAQ). Although overall patients with RA had similar HRQoL compared with those with AAVs, those with active RA had worse HRQoL compared with those with active AAV.

CONCLUSIONS

In patients with AAVs, HRQoL correlated more with organ damage and less with disease activity whereas in RA patients, it correlated with both. These data emphasize the need for AAV therapies aiming at preventing organ damage and thus improving HRQoL.

Correlation between Quality of Life and Erythrocyte Sedimentation Rate with Disease Activity in Rheumatoid Arthritis

BACKGROUND

Inflammatory markers are crucial in diagnosing and monitoring rheumatoid arthritis. Patients with rheumatoid arthritis (RA) live with constant pain that limits their daily activities. Our study highlights the effects of disease activity on the quality of life in patients with rheumatoid arthritis.

METHODS

Swollen joint count (SJC), tender joint count (TJC), and visual activity scale (VAS) were utilized to acquire patients' subjective feelings of wellness and their performance of routine daily activities to determine the disease activity. The patient's erythrocyte sedimentation rate (ESR) was measured at the clinical hematology laboratory using the Westergren method. The Quality of Life was rated on a scale of 1 to 10.

RESULTS

Our study found that disease activity is inversely proportional to the quality of life. Out of 111 patients, 3 (2.7%) were in remission, 1 (0.9%) had mild disease, 51 (45.9%) had moderate disease, and 56 (50.5%) had high disease activity. The ESR was normal (<20) in 11 patients (9.9%), moderately elevated (20-50) in 56 (50.5%) patients, and very high (>50) in 44 (39.6%) patients. The study revealed that 66% of patients in remission had normal, while 33% had moderately elevated ESR. 12.5% of patients with moderate disease activity had normal ESR, and none with high disease activity had normal ESR. Of 44 patients with high ESR, 7 had moderate disease activity, and 37 had high disease activity. In our study, 60% of patients had a less than 50% quality of life compared to patients with pre-arthritis.

CONCLUSION

High disease activity affects the productivity and quality of life in patients with rheumatoid arthritis. Assessing the impact of different interventions on the QOL should be an essential task that can help define a holistic and integrative treatment and rehabilitation model for RA patients.

A new acyl derivative of sulfadimethoxine inhibits phagocyte oxidative burst and ameliorates inflammation in a mice model of zymosan-induced generalised inflammation

Chronic inflammation and oxidative stress play a pivotal role in the pathophysiology of most challenging illnesses, including cancer, Alzheimer's, cardiovascular and autoimmune diseases. The present study aimed to investigate the anti-inflammatory potential of a new sulfadimethoxine derivative N-(4-(N-(2,6-dimethoxypyrimidin-4-yl) sulfamoyl) phenyl) dodecanamide (MHH-II-32). The compound was characterised by applying 1H-, 13C-NMR, EI-MS and HRFAB-MS spectroscopic techniques. The compound inhibited zymosan-induced oxidative bursts from whole blood phagocytes and isolated polymorphonuclear cells with an IC50 value of (2.5 ± 0.4 and 3.4 ± 0.3 µg/mL), respectively. Furthermore, the inhibition of nitric oxide with an IC50 (3.6 ± 2.2 µg/mL) from lipopolysaccharide-induced J774.2 macrophages indicates its in vitro anti-inflammatory efficacy. The compound did not show toxicity towards normal fibroblast cells. The observational findings, gross anatomical analysis of visceral organs and serological tests revealed the non-toxicity of the compound at the highest tested intraperitoneal (IP) dose of 100 mg/kg in acute toxicological studies in Balb/c mice. The compound treatment (100 mg/kg) (SC) significantly (P < 0.001) downregulated the mRNA expression of inflammatory markers TNF-α, IL-1β, IL-2, IL-13, and NF-κB, which were elevated in zymosan-induced generalised inflammation (IP) in Balb/c mice while upregulated the expression of anti-inflammatory cytokine IL-10, which was reduced in zymosan-treated mice. No suppressive effect was observed at the dose of 25 mg/kg. Ibuprofen was taken as a standard drug. The results revealed that the new acyl derivative of sulfadimethoxine has an immunomodulatory effect against generalised inflammatory response with non-toxicity both in vitro and in vivo, and has therapeutic potential for various chronic inflammatory illnesses.

Mutant p53R211* ameliorates inflammatory arthritis in AIA rats via inhibition of TBK1-IRF3 innate immune response

BACKGROUND

Rheumatoid arthritis (RA) is an autoimmune inflammation disease characterized by imbalance of immune homeostasis. p53 mutants are commonly described as the guardian of cancer cells by conferring them drug-resistance and immune evasion. Importantly, p53 mutations have also been identified in RA patients, and this prompts the investigation of its role in RA pathogenesis.

METHODS

The cytotoxicity of disease-modifying anti-rheumatic drugs (DMARDs) against p53 wild-type (WT)/mutant-transfected RA fibroblast-like synoviocytes (RAFLSs) was evaluated by MTT assay. Adeno-associated virus (AAV) was employed to establish p53 WT/R211* adjuvant-induced arthritis (AIA) rat model. The arthritic condition of rats was assessed by various parameters such as micro-CT analysis. Knee joint samples were isolated for total RNA sequencing analysis. The expressions of cytokines and immune-related genes were examined by qPCR, ELISA assay and immunofluorescence. The mechanistic pathway was determined by immunoprecipitation and Western blotting in vitro and in vivo.

RESULTS

Among p53 mutants, p53R213* exhibited remarkable DMARD-resistance in RAFLSs. However, AAV-induced p53R211* overexpression ameliorated inflammatory arthritis in AIA rats without Methotrexate (MTX)-resistance, and our results discovered the immunomodulatory effect of p53R211* via suppression of T-cell activation and T helper 17 cell (Th17) infiltration in rat joint, and finally downregulated expressions of pro-inflammatory cytokines. Total RNA sequencing analysis identified the correlation of p53R211* with immune-related pathways. Further mechanistic studies revealed that p53R213*/R211* instead of wild-type p53 interacted with TANK-binding kinase 1 (TBK1) and suppressed the innate immune TBK1-Interferon regulatory factor 3 (IRF3)-Stimulator of interferon genes (STING) cascade.

CONCLUSIONS

This study unravels the role of p53R213* mutant in RA pathogenesis, and identifies TBK1 as a potential anti-inflammatory target.

MITIG.RA: study protocol of a tailored psychological intervention for managing fatigue in rheumatoid arthritis randomized controlled trial

BACKGROUND

Despite remarkable medical advances in the treatment of rheumatoid arthritis (RA), a subset of patients fails to achieve complete clinical remission, as the Patient Global Assessment (PGA) of disease activity remains above 1, even after the inflammatory process is brought under control. This so-called state of 'PGA-near-remission' negatively impacts individuals' functioning and potentiates inadequate care. Fatigue is a distressing and disabling symptom frequently reported by patients in PGA-near-remission, and its management remains challenging. While classic cognitive-behavioural interventions show some benefits in managing fatigue, there is potential for improvement. Recently, contextual-cognitive behavioural therapies (CCBT), like mindfulness, acceptance, and compassion-based interventions, have shown promising results in fatigue-associated disorders and their determinants. This study primarily aims to examine the efficacy of the Compassion and Mindfulness Intervention for RA (MITIG.RA), a novel intervention combining different components of CCBT, compared to treatment-as-usual (TAU) in the management of RA-associated fatigue. Secondary aims involve exploring whether MITIG.RA produces changes in the perceived impact of disease, satisfaction with disease status, levels of depression, and emotion-regulation skills.

METHODS

This is a single center, two-arm parallel randomized controlled trial. Patients will be screened for eligibility and willingness to participate and will be assessed and randomized to the experimental (MITIG.RA + TAU) or control condition (TAU) using computer randomization. MITIG.RA will be delivered by a certified psychologist and comprises eight sessions of 2 h, followed by two booster sessions. Outcomes will be assessed through validated self-report measures, including fatigue (primary outcome), perceived impact of disease, depressive symptoms, mindfulness, self-compassion, safety, and satisfaction (secondary outcomes). Assessment will take place at baseline, post-intervention, before the first and second booster sessions (weeks 12 and 20, respectively), and at 32 and 44 weeks after the interventions' beginning.

DISCUSSION

We expect MITIG.RA to be effective in reducing levels of RA-associated fatigue. Secondarily, we hypothesize that the experimental group will show improvements in the overall perceived impact of disease, emotional distress, and emotion regulation skills. Our findings will contribute to determine the benefits of combining CCBT approaches for managing fatigue and associated distress in RA.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05389189. Registered on May 25, 2022.

Serial multiple mediation of treatment adherence and disease activity in the relationship between continuity of care and health outcomes among rheumatoid arthritis patients

OBJECTIVE

To evaluate the effect of continuity of care on health outcomes (quality of life and functionality) in patients with rheumatoid arthritis and to reveal whether treatment adherence and disease activity have a serial multiple mediator role on this relationship.

METHODS

The study was cross-sectional on 440 rheumatoid arthritis patients who applied to a university hospital rheumatology outpatient clinic. Research data were obtained from both the questionnaire method, which is the primary data source, and the patient files, which are the secondary data source. Process analysis was used in the analysis of the data.

RESULTS

It was found that the continuity of care has a direct effect on the quality of life and the functionality. In addition, it is seen that treatment adherence has a single partial mediator role on the relationship between continuity of care and quality of life; It has been determined that treatment adherence and disease activity have both partial single mediation and serial multiple mediation roles on the relationship between continuity of care and functionality.

CONCLUSION

It is thought that these findings will provide clinicians with important data and information in the management of rheumatoid arthritis.

Effects of Locomotion Training on the Physical Functions and Quality of Life in Patients with Rheumatoid Arthritis: A Pilot Clinical Trial

Objectives:

Methods:

Results:

Conclusions:

Patient- and physician-reported outcomes from two phase 3 randomized studies (RAJ3 and RAJ4) of peficitinib (ASP015K) in Asian patients with rheumatoid arthritis

BACKGROUND

Peficitinib (ASP015K), a novel oral Janus kinase inhibitor, has demonstrated efficacy and safety in the treatment of patients with rheumatoid arthritis (RA). This study evaluated the effect of peficitinib on patient- and physician-reported outcomes in Asian patients with RA and an inadequate response to prior disease-modifying antirheumatic drugs (DMARDs).

METHODS

Patients from two randomized, placebo-controlled, double-blind, phase 3 trials (RAJ3 and RAJ4) received once-daily peficitinib 100 mg, peficitinib 150 mg, or placebo, alone or in combination with DMARDs (RAJ3), or in combination with methotrexate (RAJ4). Mean changes in Work Productivity and Activity Impairment (WPAI) questionnaire domain scores from baseline, and percentages of patients achieving minimal clinically important differences (MCIDs) for patient- and physician-reported outcomes (WPAI, Health Assessment Questionnaire - Disability Index [HAQ-DI], and Subject's Global Assessment of Pain [SGAP]), and Physician's Global Assessment of disease activity (PGA) were evaluated at weeks 4, 8, 12, and 12/early termination (ET).

RESULTS

Data from 1025 patients were analyzed. At week 12/ET in both studies, patients who received peficitinib 100 mg or 150 mg reported significantly improved WPAI domain scores from baseline (except for absenteeism in RAJ4) compared with placebo (both doses, p<0.05). A higher proportion of peficitinib- versus placebo-treated patients achieved MCID in WPAI, HAQ-DI, SGAP, and PGA in studies RAJ3 and RAJ4. Significant differences with peficitinib versus placebo were evident in both studies as early as week 4 in HAQ-DI (peficitinib 150 mg only), SGAP, and PGA, and week 8 in WPAI loss of work productivity and daily activity impairment. At week 12/ET, significantly higher proportions of patients receiving peficitinib versus placebo achieved MCID in HAQ-DI, SGAP, PGA, and WPAI domains of presenteeism (RAJ3 only), loss of work productivity (RAJ3 only), and daily activity impairment (p<0.05 for all comparisons).

CONCLUSIONS

Peficitinib 100 mg or 150 mg administered daily over 12 weeks resulted in clinically meaningful improvements in outcomes that are important to RA patients, including pain, physical function, and work productivity and activity. These observations were reinforced through similar improvements in physicians' rating of disease activity.

TRIAL REGISTRATION

RAJ3: ClinicalTrials.gov, NCT02308163 , registered 4 December 2014. RAJ4: ClinicalTrials.gov, NCT02305849 , registered 3 December 2014.

Malignancy risk in individuals with familial adenomatous polyposis receiving biologics and immunomodulators

Clinicians may be hesitant to prescribe biologics or immunomodulators to individuals with familial adenomatous polyposis (FAP) and comorbid inflammatory disease (CID) because of increased cancer risk. Our aim was to compare the risk of malignancy in FAP individuals with inflammatory bowel (IBD) and/or rheumatic disease that received biologics/immunomodulators to those who did not. Individuals with FAP and CID were included in the study. We compared the incidence of cancer between individuals exposed to biologics/immunomodulators compared to unexposed from the date of diagnosis of comorbid disease till last follow up or death. Hazard ratio (HR) for cancer was computed using Cox regression model and compared by exposure status to biologic/immunomodulators. 25 individuals with FAP and a comorbid inflammatory disease were identified including 9 (36%) with IBD and 16 (64%) with rheumatic disease. 14 (56%) were exposed to a biologic and or immunomodulator. Median duration of biologic/immunomodulator exposure was 48 (2-180) months. 3 (21.4%) in the exposed group compared to 1 (9.1%) in the unexposed group developed cancer with a HR for exposure of 1.92 (CI 0.2-18.5, p = 0.57). Median duration of follow up after the diagnosis of inflammatory disease was 10 (5.5-17.0) years in the exposed and 6 (3.0-15.0) years in the unexposed group. In the exposed group, 1 patient developed gastric and 2 developed colon cancer. One unexposed patient developed medullary thyroid cancer. There is a possible trend of more cancers in the group that received biologics/immunomodulators-but given the small number of patients and p-value, there may be no difference at all. This preliminary finding warrants study in a larger cohort.

The Clinical Use of Curcumin for the Treatment of Rheumatoid Arthritis: A Systematic Review of Clinical Trials

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, which is prevalent in about 0.5-1.0% of the world population. Newer therapies for RA have only minimal efficacy in some cases and some adverse effects. Curcumin with anti-antioxidant, anti-inflammatory, and immunomodulatory properties might have beneficial effects on RA. We have carried out a systematic review with the main aim of estimating the effect of curcumin supplementation on RA. A systematic search of the medical databases, PubMed, Scopus, ISI, and Google Scholar was performed up to March 21, 2020 to identify clinical trials assessing the effect of turmeric or curcumin on RA. Six studies, comprising 259 patients with RA of 6-12 weeks duration, were included. Disease activity was assessed using 28 joints (DAS-28), visual analog scale (VAS), and American College of Rheumatology (ACR-20) scores. Treatment with curcumin significantly reduced DAS-28 scores in four out of five studies and VAS scores for pain in all three studies and significantly increased ACR-20 scores in all three studies in which it was measured. Erythrocyte sedimentation rate (ESR) and circulating C-reactive protein (CRP) were assessed in six and five studies, respectively, out of which four studies reported significant reductions in these parameters in response to curcumin treatment. Rheumatoid factor (RF) was significantly reduced after consumption of curcumin in all three relevant studies. None of the studies reported serious adverse effects with curcumin consumption. The present systematic review suggests that curcumin could be used as a safe agent to treat RA. Thus, further validation is justified.

Impact of periodontitis on quality of life among subjects with rheumatoid arthritis: a cross sectional study

BACKGROUND

This study aimed to assess the impact of periodontitis (PD) on the health related quality of life (HRQoL) and oral health related QoL (OHRQoL) of subjects with rheumatoid arthritis (RA) and PD.

METHODS

Subjects from dental and RA clinics were screened. Complete periodontal examinations were performed. Subjects were divided into 4 groups: RA-PD, RA, PD and healthy controls (HC). Questionnaires on characteristics and Malaysian versions of Oral Health Impact Profile (OHIP-14(M)) and Health Assessment Questionnaire (HAQ-DI)) were answered.

RESULTS

A total of 187 subjects were included (29 RA-PD, 58 RA, 43 PD and 57 HC). OHIP-14(M) severity score was highest in the PD group (17.23 ± 10.36) but only significantly higher than the HC group (p < 0.05). The HAQ-DI scores of the RA group was significantly higher than the PD and HC groups (p < 0.05). The interaction between the effects of PD and RA on the OHRQoL and HRQoL was statistically significant (p < 0.05).

CONCLUSION

PD and RA subjects both suffer impacts on their OHRQoL and HRQoL respectively. The interaction effect of both diseases significantly conferred impacts on their OHRQoL and HRQoL as measured by the OHIP-14(M) and HAQ-DI.

Association between low back pain and quality of life in patients with rheumatoid arthritis according to patient-reported outcomes using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ): A cross-sectional study

OBJECTIVES

To evaluate factors associated with low back pain (LBP) and effect on quality of life (QOL) using patient-reported outcome in patients with rheumatoid arthritis (RA).

METHODS

Overall, 414 patients with RA who answered the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were included in this study. LBP-positive was defined a visual analog scale (VAS) of LBP (LBP VAS) of ≥ 30 mm.

RESULTS

The rate of LBP-positive group was 24.9%. Body mass index (BMI) (odds ratio [OR]: 1.116), tender joint count (TJC) (OR: 1.598), global VAS (OR: 1.016), and Health Assessment Questionnaire Disability Index (HAQ-DI) (OR: 2.392) were found as significant LBP-associated factors. When adjusted for sex and van der Heijde-modified total Sharp score, BMI (OR: 1.120), TJC (OR: 1.619), global VAS (OR: 1.016), pain VAS (OR: 1.015), and HAQ-DI (OR: 2.312) were found to be the significant factors associated with LBP. Moreover, LBP VAS had relatively high correlations in all domains of the JOABPEQ scores (correlation coefficient: LBP, -0.601; lumbar function, -0.624; walking ability, -0.548; social life function, -0.479; and mental health, -0.463).

CONCLUSIONS

This study investigated the effect of LBP in patients with RA. The results of this study indicate that LBP is associated with the physical function and QOL in patients with RA. We believe that our results will be useful for physical function and QOL assessments in patients with RA with LBP.

Quantification of health-related quality of life among patients with rheumatoid arthritis: An institution-based study in Kolkata, West Bengal

Context:

Rheumatoid arthritis (RA) is a known chronic debilitating disease accounting for a large percentage of disability globally. Pain and stiffness, decreased work function, depression and emotional state alteration, fatigue, disability, and social handicaps are some patient reported outcomes, which if considered with priority the health-related quality of life (HRQOL) of patients with RA could improve.

Aims:

This study was conducted with the aim to assess the HRQOL of the patients with RA and the determinants related to it.

Settings and Design:

This was a cross-sectional study conducted at Rheumatology Department of a tertiary care hospital, Kolkata.

Subjects and Methods:

A total of 252 patients with RA were selected in this study through systematic random sampling.

Statistical Analysis Used:

Data were analyzed using appropriate statistical measures with Statistical Package for the Social Sciences(SPSS) version 16.0 (Armonk, NY: IBM Corporation) software program, version 16.0. Univariate and multivariable logistic regression were carried out.

Results:

In the study, the mean age of the patients was 43.1 years (mean age ±SD: 43.05±10.63 years). The proportion of female subjects was 84.5%. Unsatisfactory QOL was found in 59.9% study participants. In multivariable logistic regression unsatisfactory quality of life was significantly associated to moderate to high functional disability [AOR: 6.04, CI: 2.86, 12.78], disease activity moderate to high [AOR: 5.41, CI: 1.87, 15.69], presence of comorbidity [AOR: 2.90, CI: 1.39, 6.04], extra-articular manifestations [AOR: 3.14, CI: 1.41, 6.96] and delay in starting Disease-Modifying Anti-Rheumatoid Drugs (DMARDs) [AOR: 1.24, CI: 1.08, 1.42].

Conclusion:

Findings of this study clearly indicate the presence of high proportion of unsatisfactory QOL among the patients with RA. Early identification and prompt referral are the key strategies to prevent any permanent damage. Regular follow-up of the patients should be carried out to prevent or delay the disability progression and provide high-quality physical and mental health.

Quality of Life and Cost Study of Rheumatoid Arthritis Therapy With Biological Medicines

Biological medicines are considered as a cornerstone in the therapy of rheumatoid arthritis (RA). They change the course of the disease and improve the quality of life of patients. To this date there has been no study comparing the quality of life of and cost of RA therapy in Bulgaria. This fact is what provoked our interest toward this research. The aim of this study is to analyse the cost and quality of life of patients with RA threated with biological medicines in Bulgaria. This is an observational, real life study of 124 patients treated with biological medicines during 2012-2016 at the University hospital "St. Ivan Riskli" in Sofia, specialized in rheumatology disease therapy. Patients were recruited after their consecutive transfer from non-biological to biological medicines. The yearly pharmacotherapy cost was calculated with tocilizumab (n = 30), cetrolizmab (n = 16), golimumab (n = 22), etanercept (n = 20), adalimumab (n = 20), rituximab (n = 16). Three measurements of the quality of life (QoL) were performed with EQ5D-at the beginning of the therapy, after 6 months and after 1 year of therapy. Both section of EQ5D were used-VAS and EQ5D questionnaire. Cost-effectiveness was calculated for unit of improvement in EQ5D score for a one year period and decision model was built with TreeAgePro software. The observed cost of therapy varied between 12 thousand Euros for tocilizumab to 6 thousand Euros for rituximab. All biological medicines let to substantial increase in the quality of life of the patients. Patients on tocilizumab increased their QoL from 0.43 to 0.63 after 1 year; on cetrolizumab from 0.32 to 0.56; on golimumab from 0.41 to 0.67; on etanercept from 0.45 to 0.62; on adalimumab from 0.43 to 0.57; on rhituximab from 0.46 to 0.66. The cost-effectiveness estimates of different biological therapies also varied between 66 to 30 thousand Euros for unit of improvement in the EQ5D during one the course of the year. Therapy with biological medicines improves statistically significant the quality of life of patients, measured through VAS and EQ5D scales. Despite the improvement in the quality of life all biological medicines appears not to be note cost-effective due to their high incremental cost-effectiveness ration (ICER). Rituximab's incremental ratio has (ICER) falls closer to the three times gross domestic product per capita threshold and should be considered as preferred alternatives for RA therapy. In general we can conclude that the treatment of rheumatoid arthritis with biologicals improves quality of life significantly. Only rituximab was cost-effective.

A prospective study on quality of life in patients with pulmonary tuberculosis at a tertiary care hospital in Kashmir, Northern India

BACKGROUND

Pulmonary Tuberculosis (PTB) is a contagious, airborne infection that destroys when M. tuberculosis primarily attacks the lungs. PTB is curable with an early diagnosis and antibiotic treatment. Stigmatization and negative emotions resulting from the illness could result in long term impairment of patients psychological well being which may result in work absenteeism resulting in loss of productivity and reduced monthly income.

METHODS

This was a prospective study which was conducted over a period of one and half year. A total of 198 patients were recruited for the study. Quality Of Life (QOL) was assessed at baseline and at the end of intensive phase. For QOL WHO based QOLBREF was used.

RESULTS

In the present study patients scored lowest in the baseline physical (8.36 ± 1.60) followed by the psychological domain (10.40 ± 1.72) however at the end of intensive phase both physical (11.98 ± 1.70) and psychological (12.75 ± 1.) domains improved very much and the difference was statistically significant.

CONCLUSION

We conclude that HRQOL is significantly reduced in patients with PTB, and that it improves rapidly and significantly with DOTS-based intensive phase of treatment. Special focus on reduction of stigmatization should be given in the management of TB to reduce the psychological distress.

Impairment of Health-related Quality of Life among Indian Patients with Hypothyroidism

CONTEXT

Health-related quality of life (HRQL) is an important outcome measure for various diseases, although there are sparse data regarding HRQL among Indian patients with hypothyroidism.

AIMS

This study aimed to assess HRQL among Indian patients with hypothyroidism using the SF-36 questionnaire.

METHODS

This cross-sectional study evaluated 244 consecutive patients with hypothyroidism who were treated at the Vydehi Institute of Medical Sciences and Research Centre in Bengaluru. All patients were >18 years old and visited the outpatient department for endocrine treatment. Perceived health status was evaluated using the SF-36 questionnaire. The patients' data were compared to data from 250 age-matched and sex-matched healthy controls.

RESULTS

Compared to the healthy controls, the patients with hypothyroidism had significantly lower scores for six of the eight SF-36 scales. No significant intergroup differences were observed in the "role emotional" and "social functioning" dimensions.

INTERPRETATION AND CONCLUSIONS

Hypothyroidism was associated with reduced HRQL among Indian patients. These patients generally experienced greater reductions in physical dimensions, compared to social and emotional dimensions.

The impact of ocular manifestations of rheumatoid arthritis on the health-related quality of life and the functional ability of black Africans

Objectives To determine the patterns, predictors and overall impact of ocular manifestations of rheumatoid arthritis (RA) on the health-related quality of life and disability index.

METHODS

A total of 50 Nigerian patients with RA were studied. Full ocular evaluation was done to determine the presence of each defined ocular manifestation of RA. All patients completed the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires.

RESULTS

The mean ± SD age of the patients was 47.2 ± 12.5 years. A total of 42 cases of ocular diseases were found in 23 (46%) patients. Keratoconjunctivitis sicca was found in 15 (30%) patients; cataract, 13 (26%); scleritis/episcleritis, 4 (8%); disk edema, 4 (8%); glaucoma, 3 (6%); ulcerative keratitis, 1 (2%); vitreitis, 1 (2%); and macula edema, 1 (2%) patient. There is an association of the presence of ocular manifestations with the physical component summary (PCS) [T = - 3.398, P = 0.001] and the mental component summary (MCS) [T = - 2.616, 0.012] of the SF-36 but not with the HAQ-DI (T = 1.685, 0.099). Following multiple regression analysis, the predictors of the presence of ocular manifestations were age greater than 45 years and positive anti-citrullinated protein antibody. Following linear regression analyses, Steinbrocker's functional class independently predicted the PCS while both Steinbrocker's functional class and female sex predicted the MCS.

CONCLUSIONS

The development of ocular disorders associated with RA is associated with a significant negative impact on the quality of life of the patients.

Quality of life and associated characteristics: application of WHOQOL-BREF in the context of Primary Health Care

This study aimed to identify the characteristics associated to quality of life (QOL) in users of four Basic Health Units (Unidades Básicas de Saúde, UBS) in Belo Horizonte, Minas Gerais. We conducted a cross-sectional study with 930 adult users enrolled in the selected UBS, using a questionnaire containing the WHOQOL-bref instrument and questions about sociodemographic characteristics, lifestyle and health conditions. Following descriptive analysis, we performed simple and multiple linear regression to evaluate the association between the exposure variables and the QOL domains. The highest mean values of QOL were observed in the social relationships domain. The lowest means were observed in the environment domain, with a statistically significant difference between some of the UBS. The worst perceptions of QOL were related to worse health, housing, education and income conditions, as well as problems in social relationships and psychological conditions. Actions are needed to improve QOL in Primary Health Care users through actions promoted by both health professionals and public managers.

CDK7 inhibition suppresses rheumatoid arthritis inflammation via blockage of NF-κB activation and IL-1β/IL-6 secretion

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling, joint tenderness and destruction of synovial joints, leading to severe disability. Anti‐inflammatory drugs and disease‐modifying anti‐rheumatic drugs (DMARDs) may improve RA process. However, in most patients the treatment effect is still not satisfactory. Cyclin‐dependent kinase 7 (CDK7) plays a well‐established role in the regulation of the eukaryotic cell division cycle, and recent studies indicated that it exerted anti‐inflammatory effect. In our previous research, we found that inhibition of CDK7 by highly selective inhibitor BS‐181 significantly impeded the development of collagen‐induced arthritis (CIA) mice. However, the underlying mechanism of CDK7 in RA remains to be explored. We elucidated the molecular mechanism of CDK7 inhibition in RA inflammation by administration of CDK7 highly selective inhibitor BS‐181 and siRNA‐CDK7. We found that both IL‐1β, IL‐6, IL‐8 and RANKL transcript levels and IL‐1β/IL‐6 secretion were effectively suppressed by BS‐181 treatment as well as CDK7 knockdown. Furthermore, CDK7 inhibition prevented NF‐κB signalling pathway activation and restrained p65 nuclear translocation. Moreover, CDK7 selective inhibitor BS‐181 also blocked phosphorylation of p65 in MH7A cells. These results strongly indicate that CDK7 inhibition by BS‐181 and siRNA‐CDK7 significantly suppresses rheumatoid arthritis inflammation, which may be via blockage of NF‐κB signalling pathway and IL‐1β/IL‐6 secretion.

Depression Risk in Patients with Rheumatoid Arthritis in the United Kingdom

Introduction

Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. The goal of this study was to analyze the risk of depression in patients diagnosed with RA and treated by general practitioners in the UK.

Methods

The present study included patients first diagnosed with RA between 2000 and 2014 (index date). Individuals were excluded if they had also been diagnosed with depression or if they had received therapy for depression at or prior to the index date. The primary outcome measure was the rate of patients with depression (ICD 10: F32, 33) within 5 years of the RA diagnosis. Demographic data included gender and age. Furthermore, a revised version of the Charlson comorbidity index was used as a generic marker of comorbidity.

Results

A total of 4187 patients were included in the study. After 5 years of follow-up, 23.7% of men and 36.5% of women had developed depression (log rank p value <0.001). Women were more likely to develop depression than men (HR 1.61, 95% CI 1.42–1.84). Age and Charlson comorbidity score had no significant impact on the risk of being diagnosed with this psychiatric disorder.

Conclusion

Around 30% of RA patients developed depression within 5 years of the RA diagnosis. The depression risk was higher in women than in men. The current findings also indicate that improved detection and treatment of patients with both RA and depression are important.

Diet quality of individuals with rheumatoid arthritis using the Healthy Eating Index (HEI)-2010

BACKGROUND

Rheumatoid arthritis (RA) afflicts approximately 1.5 million American adults and is a major cause of disability. As disease severity worsens, individuals with RA may experience functional decline that can impact dietary intake.

OBJECTIVE

The objective of this study is to assess the diet quality of individuals with RA using the Healthy Eating Index (HEI)-2010 and examine associations between diet quality and disease activity and functional status.

METHODS

This cross-sectional study assessed diet quality and disease activity and functional status in adults with RA. Participants completed seven-day weighed food records, which were scored using the HEI-2010. Participants had a fasting blood draw and completed the Multidimensional Health Assessment Questionnaire to determine disease activity and functional status.

RESULTS

The mean age of individuals with RA ( N = 84) was 53 ± 14 years, and 86.9% were female. The mean HEI-2010 total score was 58.7 ± 15.9, with 7.1% of participants scoring "good", 58.3% "fair", and 34.5% "poor". Most participants did not adhere to recommended intakes of total fruit, total vegetables, whole grains, fatty acids, refined grains, sodium, and empty calories. An unadjusted multiple linear regression model found duration of morning stiffness and C-reactive protein concentration to be significant variables to inversely predict HEI-2010 total score.

CONCLUSIONS

The diet quality of many individuals with RA needs improvement and may be related to functional disability associated with RA. Healthcare providers should encourage individuals with RA to meet dietary guidelines and maintain a healthy diet. Moreover, healthcare providers should be aware of the potential impacts of functional disability on diet quality in individuals with RA.

Psoriasis, psoriatic arthritis, and rheumatoid arthritis: Is all inflammation the same?

OBJECTIVES

To review the pathophysiology, co-morbidities, and therapeutic options for psoriasis, psoriatic arthritis and rheumatoid arthritis in order to further understand the similarities and differences in treatment paradigms in the management of each disease. New targets for individualized therapeutic decisions are also identified with the aim of improving therapeutic outcome and reducing toxicity.

SEARCH STRATEGY

Using the PubMed database, we searched literature published from 2000 to 2015 using combinations of the key words "psoriasis," "psoriatic arthritis," "rheumatoid arthritis," "pathogenesis," "immunomodulation," and "treatment."

INCLUSION AND EXCLUSION CRITERIA

This was a non-systematic review and there were no formal inclusion and exclusion criteria.

DATA EXTRACTION

Abstracts identified in the search were screened for relevance and articles considered appropriate evaluated further. References within these selected articles were also screened. Information was extracted from 198 articles for inclusion in this report.

DATA SYNTHESIS

There was no formal data synthesis. Articles were reviewed and summarized according to disease area (psoriasis, psoriatic arthritis, and rheumatoid arthritis).

HEADLINE RESULTS

The pathophysiology of psoriasis, psoriatic arthritis, and rheumatoid arthritis involves chronic inflammation mediated by pro-inflammatory cytokines. Dysfunction in integrated signaling pathways affecting different constituents of the immune system result in varying clinical features in the three diseases. Co-morbidities, including cardiovascular disease, malignancies, and non-alcoholic fatty liver disease are increased. Increased understanding of the immunopathogenesis allowed development of targeted treatments; however, despite a variety of potentially predictive genetic, protein and cellular biomarkers, there is still significant unmet need in these three inflammatory disorders.

Literature review of rheumatoid arthritis in India

AIM

Rheumatoid arthritis (RA) can lead to severe disability. This literature review assessed the descriptive epidemiology, comorbidities and extra-articular manifestations, functioning abilities and quality of life, and treatment patterns of RA patients in India.

METHOD

A literature review of all observational studies published from 1985 to 2012 was conducted using MEDLINE and Embase. Quantitative and qualitative findings were summarized.

RESULTS

Twenty-eight studies were identified for data extraction. Seven described the descriptive epidemiology of RA, 14 described comorbidities and extra-articular manifestations, nine described the functioning abilities and quality of life among patients, and 10 provided information on treatments.

CONCLUSION

This review is confined to studies with small sample sizes, cross-sectional designs, and/or clinical settings that may not be representative of the entire Indian population. There is a need for more robust studies, as conclusions for the entire Indian RA population cannot be drawn from only the current observational studies.

[Quality of life in adults and elderly patients with rheumatoid arthritis]

OBJECTIVE

To analyze and compare quality of life (QoL) in adults and elderly patients with rheumatoid arthritis (RA).

METHODS

This was a cross-sectional quantitative study. The tools include the Medical Outcomes Study Short Form-36 (SF-36), the Disease Activity Score 28 (DAS-28), the Assessment Health Questionnaire (HAQ), the Beck Depression Inventory (BDI) and the 6-Minute Walk Test (6MWT). Data analysis was done by descriptive statistics, Student's t test and linear regression test, with significance level of p <0.05.

RESULTS

The sample consisted of 99 patients diagnosed with RA, divided into adults and elderly. Those considered adults were 18-59 years-old and those with 60 years or older where considered elderly. In SF-36, the groups showed the pain domain as the most compromised and the emotional aspects domain as the less compromised. Both showed moderate level of disease activity and mild disability. Applying the t test, it was found that there was no significant difference between groups with respect to QoL, functional ability, depression and disease activity. The difference was significant in the 6MWT, in which the elderly achieved an average of 330.8 m, and the adults, 412.2 m (p=0.000). In linear regression, a significant correlation (r=-0.31) between the 6MWT and increasing age was noted.

CONCLUSION

QoL and functional capacity in RA were affected in adults and the elderly. How-ever, the results showed no significant difference between groups, with the exception of the 6MWT.

Rheumatology in India--quo vadis?

Rheumatology has been a neglected subspecialty in India. A staggering patient load, a severely inadequate number of trained rheumatology specialists, therapeutic nihilism and limited advocacy are some of the critical challenges that confront rheumatology care, and possibly explain the high rates of reliance on complementary and alternative medicines in India. Disease spectrum and treatment patterns are not remarkably different from those in other countries, but biologic agents have limited use and are administered for short periods only. Consequently, outcomes in India do not yet match those reported in developed countries. Furthermore, the high prevalence of infectious diseases continues to be a major contributor to mortality in patients with rheumatic disorders such as systemic lupus erythematosus. Several tropical diseases with rheumatic manifestations are relevant in India, including chikungunya, brucellosis, leptospirosis, dengue and melioidosis. To address the many problems with rheumatology care in India, curricular reforms, capacity building, patient education and political support are sorely needed.

The role of quality of care and attitude towards disability in the relationship between severity of disability and quality of life: findings from a cross-sectional survey among people with physical disability in China

Background

People with physical disability (PWPD) is the largest subgroup of people with disability (PWD) in China, but few studies have been conducted among this vulnerable population. The objective of this study was to investigate the level of quality of life (QoL), self-perceived quality of care and support (QOCS), severity of disability and personal attitude towards disability among people with physical disability in China, as well as to identify how QoL can be affected by severity of disability through QOCS and personal attitude towards disability among PWPD.

Methods

A cross-sectional study was conducted among 1,853 PWPD in Guangzhou, China. Data were collected on participants’ QoL, QOCS, personal attitude towards disability and severity of disability. Structural equation modeling was used to examine the effects of the other variables on QoL.

Results

Even with a mild disability (mean score:1.72), relatively low levels of QoL (mean score: 2.65- 3.22) and QOCS (mean score: 2.95 to 3.28), as well as unfavorable personal attitude towards disability (mean score: 2.75 to 3.36) were identified among PWPD. According to SEM, we found that the influence of severity of physical disability on QoL is not only exerted directly, but is also indirectly through QOCS and their personal attitudes towards disability, with QOCS playing a more important mediating role than PWPD’s attitudes towards their own disability.

Conclusions

Unfavorable health status was identified among PWPD in China. Focusing on improvement of assistance and care services has the potential to substantially improve PWPD’s QoL. Further research should focus on understanding the needs and their current state of health care of PWPD in China thus being able to develop better interventions for them.

Relationship of EQ-5D quality of life with the presence of co-morbidity and extra-articular features in patients with rheumatoid arthritis

PURPOSE

Rheumatoid arthritis (RA) is associated with extra-articular features (ExRA) and other co-morbidities. The aim of this study is to quantify their relative contribution to quality of life (QOL) in patients with RA.

METHODS

A consecutive series of 114 ambulatory RA patients aged between 40 and 65 years were assessed by a research nurse on a single occasion. Assessment included a patient questionnaire (including EQ-5D), medication review and fasting venous blood sample. Medical records were reviewed by a rheumatologist for co-existing conditions. Multiple linear regression was used to adjust mean differences in EQ-5D in the presence/absence of co-existing conditions for age, sex, university education, arthritis duration, rheumatoid factor, erythrocyte sedimentation rate, current disease-modifying drug therapy, previous hand joint erosions and joint surgery.

RESULTS

Mean age was 54 years (82% female) and median arthritis duration 10 years. Unadjusted EQ-5D was -0.09 (95% CI -0.18 to -0.01) lower in patients with any co-existing condition. EQ-5D scores were inversely correlated with the overall number of co-existing conditions (Spearman's ρ -0.31, p = 0.001), number of co-morbidities (ρ -0.22, p = 0.02) and number of ExRA features (ρ -0.22, p = 0.02). There was a linear trend of lower EQ-5D with increasing number of co-existing conditions (p = 0.003). EQ-5D was -0.18 (95% CI -0.33 to -0.02) lower in the presence of more than two co-existing conditions compared to none. Co-morbidity and ExRA features were associated with comparable adjusted reductions (-0.05 vs. -0.06) in EQ-5D scores.

CONCLUSION

A wide range of co-existing conditions are associated with poorer QOL in patients with RA.

Depressão e qualidade de vida em indivíduos com artrite reumatoide e indivíduos com saúde estável: um estudo comparativo

O objetivo deste estudo foi verificar a ocorrência de depressão e alterações da qualidade de vida (QV) em indivíduos com artrite reumatoide (AR).Participaram da pesquisa 60 indivíduos, divididos em 2 grupos com 30 cada, sendo o Grupo Teste composto por indivíduos com AR e o Grupo Controle composto por indivíduos com saúde estável. A QV foi avaliada pelo Medical Outcomes Study 36-Item Short-Form Healthy Survey (SF-36) e a depressão, pela Escala de Depressão de Beck (BDS). Para estabelecer comparações entre os grupos quanto aos escores de cada domínio do SF-36, utilizamos o teste de Mann-Whitney e, para os dados do "estado de saúde em geral" do SF-36, o teste do χ². Para comparar os grupos quanto ao escore total de depressão e quanto aos escores de cada categoria de depressão, empregamos respectivamente os testes Wilcoxon-Mann-Whitney (WMW) e χ². Para as variáveis "estado de saúde" em geral do SF-36 e classificação da depressão, calculou-se a Odds Ratio bruta e ajustada por meio de modelagem de regressão logística. O nível de significância foi estabelecido em 5%. Os resultados mostraram que houve diferenças entre os grupos nos oito domínios do SF-36, indicando queindivíduos com AR apresentam menores índices de QV e autoavaliação em saúde (ORajustada=14,38) e que 63,33% dos participantes com AR apresentam algum grau de depressão. Concluímos que a AR causa um impacto negativo na QV e que a depressão poder ser considerada um sintoma associado à diminuição da capacidade funcional decorrente da doença.

Disease patterns of rheumatology outpatients seen in a tertiary hospital serving a multi-ethnic, urban Asian population in Singapore

AIMS

To describe the spectrum of diseases seen in an outpatient setting in the Singapore General Hospital, the largest tertiary referral centre in Singapore.

METHODS

In this cross-sectional study, medical records of patients scheduled for an appointment at the rheumatology specialist outpatient clinics over a 4-month period (10 August 2010-31 December 2010) were reviewed. Primary diagnoses documented by the attending physician at the latest visit were recorded.

RESULTS

Among 4180 patients (29.5% male; mean [SD] age: 53.5 [15.1] years; 77.0% Chinese, 8.0% Malay, 8.8% Indian and 6.2% others), the spectrum of diseases seen was as follows [disease - definite n (%), probable n (%)]: Arthritis: rheumatoid arthritis - 958 (22.9%), 68 (1.6%); osteoarthritis - 452 (10.8%), 39 (0.9%); crystal arthritis - 417 (10.0%), 18 (0.4%); spondyloarthritis - 227 (5.4%), 61 (1.5%); psoriatic arthritis - 158 (3.8%), 9 (0.2%); other inflammatory arthritis - 153 (3.7%), 94 (2.2%); Connective tissues diseases: systemic lupus erythematosus - 412 (9.9%), 26 (0.6%); vasculitis - 105 (2.5%), 22 (0.5%); Sjögren's syndrome - 81 (1.9%), 32 (0.8%); overlap syndromes - 73 (1.8%); scleroderma - 50 (1.2%), 4 (0.1%); undifferentiated connective tissue diseases - 45 (1.1%), 106 (2.5%); myositis - 41 (1.0%), 12 (0.3%); antiphospholipid syndrome - 22 (0.5%), 7 (0.2%); polymyalgia rheumatica - 16 (0.4%); Others: soft tissue rheumatism - 155 (3.7%); osteoporosis - 61 (1.5%); other non-rheumatologic conditions - 189 (4.5%); other rheumatologic conditions - 67 (1.6%).

CONCLUSION

Rheumatoid arthritis, osteoarthritis and crystal arthritis were the three most common rheumatological diseases seen in a tertiary referral centre serving a multi-ethnic urban Asian population in Singapore.

[Health-related quality of life in Korean patients with rheumatoid arthritis: association with pain, disease activity, disability in activities of daily living and depression]

PURPOSE

The purpose of this predictive study was to identify factors affecting health related quality of life (HRQoL) in patients with rheumatoid arthritis (RA).

METHODS

The participants in this study were 131 patients with RA who were recruited from the outpatient clinic of a university hospital in Seoul. Disease activity in rheumatoid arthritis was evaluated by calculating the Disease Activity Score 28. Disability in activities of daily living (ADL) was assessed with the Korean Health Assessment Questionnaire, and depression with The Center for Epidemiologic Studies Depression Scale. HRQoL was evaluated using The Short Form 36 Health Survey. Data were analyzed using descriptive statistics, correlation, and hierarchical multiple regression.

RESULTS

Pain, disability in ADL, disease activity, and depression correlated negatively with physical and mental dimensions of HRQoL. But hierachical multiple regression analysis revealed that disability in ADL and depression were the only variables negatively influencing physical and mental QoL after adjustment for influences of sociodemographic variables.

CONCLUSION

Results of this study suggest that disability in ADL and depression, rather than disease activity and pain have profound effects on HRQoL in patients with RA. Further studies are needed to assess the predictive ability of disease activity and pain on HRQoL in this population.

The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis

BACKGROUND

Alterations in the feet of patients with rheumatoid arthritis (RA) are a cause of disability in this population. The purpose of this research was to evaluate the impact that foot impairment has on the patients' global quality of life (QOL) based on validated scales and its relationship to disease activity.

METHODS

This was a cross-sectional study in which 95 patients with RA were enrolled. A complete physical examination, including a full foot assessment, was done. The Spanish versions of the Health Assessment Questionnaire (HAQ) Disability Index and of the Disease Activity Score (DAS 28) were administered. A logistic regression model was used to analyze data and obtain adjusted odds ratios (AORs).

RESULTS

Foot deformities were observed in 78 (82%) of the patients; hallux valgus (65%), medial longitudinal arch flattening (42%), claw toe (lesser toes) (39%), dorsiflexion restriction (tibiotalar) (34%), cock-up toe (lesser toes) (25%), and transverse arch flattening (25%) were the most frequent. In the logistic regression analysis (adjusted for age, gender and duration of disease), forefoot movement pain, subtalar movement pain, tibiotalar movement pain and plantarflexion restriction (tibiotalar) were strongly associated with disease activity and disability. The positive squeeze test was significantly associated with disability risk (AOR = 6,3; 95% CI, 1.28-30.96; P = 0,02); hallux valgus, and dorsiflexion restriction (tibiotalar) were associated with disease activity.

CONCLUSION

Foot abnormalities are associated with active joint disease and disability in RA. Foot examinations provide complementary information related to the disability as an indirect measurement of quality of life and activity of disease in daily practice.