An introduction to the EULAR–OMERACT rheumatoid arthritis MRI reference image atlas

This article gives a short overview of the development and characteristics of the OMERACT rheumatoid arthritis MRI scoring system (RAMRIS), followed by an introduction to the use of the EULAR–OMERACT rheumatoid arthritis MRI reference image atlas. With this atlas, MRIs of wrist and metacarpophalangeal joints of patients with rheumatoid arthritis can be scored for synovitis, bone oedema, and bone erosion, guided by standard reference images

A protocol for a randomised controlled trial of prefabricated versus customised foot orthoses for people with rheumatoid arthritis: the FOCOS RA trial [Foot Orthoses – Customised v Off-the-Shelf in Rheumatoid Arthritis]

Abstract Background Foot pain is common in rheumatoid arthritis and appears to persist despite modern day medical management. Several clinical practice guidelines currently recommend the use of foot orthoses for the treatment of foot pain in people with rheumatoid arthritis. However, an evidence gap currently exists concerning the comparative clinical- and cost-effectiveness of prefabricated and customised foot orthoses in people with early rheumatoid arthritis. Early intervention with orthotics may offer the best opportunity for positive therapeutic outcomes. The primary aim of this study is to evaluate the comparative clinical- and cost-effectiveness of prefabricated versus customised orthoses for reducing foot pain over 12 months. Methods/design This is a multi-centre two-arm parallel randomised controlled trial comparing prefabricated versus customised orthoses in participants with early rheumatoid arthritis (< 2 years disease duration). A total of 160 (a minimum of 80 randomised to each arm) eligible participants will be recruited from United Kingdom National Health Service Rheumatology Outpatient Clinics. The primary outcome will be foot pain measured via the Foot Function Index pain subscale at 12 months. Secondary outcomes will include foot related impairments and disability via the Foot Impact Scale for rheumatoid arthritis, global functional status via the Stanford Health Assessment Questionnaire, foot disease activity via the Rheumatoid Arthritis Foot Disease Activity Index, and health-related quality of life at baseline, 6 and 12 months. Process outcomes will include recruitment/retention rates, data completion rates, intervention adherence rates, and participant intervention and trial participation satisfaction. Cost-utility and cost-effectiveness analyses will be undertaken. Discussion Outcome measures collected at baseline, 6 and 12 months will be used to evaluate the comparative clinical- and cost- effectiveness of customised versus prefabricated orthoses for this treatment of early rheumatoid arthritis foot conditions. This trial will help to guide orthotic prescription recommendations for the management of foot pain for people with early rheumatoid arthritis in future. Trial registration ISRCTN13654421. Registered 09 February 2016

Treating Rheumatoid Arthritis yesterday and today

Rheumatoid arthritis is a chronic, systemic inflammatory disorder that mainly affects joints. It is the most common form of inflammatory joint disease, and the second commonest joint disease, osteoarthritis being the commonest. The overall prevalence of rheumatoid arthritis has generally been given as 1% - with females outnumbering males in a ratio of 3-4:1, although there is some evidence that the incidence of the disease is decreasing. 1 Apart from this, the occurrence of rheumatoid arthritis is not the same throughout the world. It is quite rare in less developed rural parts of the world - thus one study in Nigeria failed to find one single case.2 Studies in Europe have shown that there is a gradient in the prevalence of rheumatoid arthritis, starting from a low prevalence in the South (e.g. Italy 0.31%)3 to a higher prevalence in the North (e.g. Finland 0.8%)4 While no formal epidemiological studies on rheumatoid arthritis have been carried out in Malta, a total of approximately 600 patients with the disease are followed up at the Rheumatology Clinic at St. Luke's Hospital, giving a prevalence of 0.16%.peer-reviewe

Systematic review of the psychometric properties of patient-reported outcome measures for foot and ankle in rheumatoid arthritis

Background Foot problems and pain are common in patients with rheumatoid arthritis. Patient-reported outcome measures provide a standardized method of capturing patients’ perspectives of their functional status and wellbeing. There are many instruments specific to people with feet affected by rheumatoid arthritis but knowledge of their psychometric validation or methodological quality is lacking Objectives To identify patient-reported outcome measures specific to the foot and ankle and rheumatoid arthritis and investigate their methodological quality and psychometric properties Design Systematic review. Data source : A search was conducted for psychometric or validation studies on patient-reported outcomes in Rheumatoid Arthritis published in different languages, by examining the Pubmed; Scopus, CINAHL; PEDro and Google Scholar databases. Review methods . The systematic review performed was based on the following inclusion criteria: psychometric or clinimetric validation studies on patient-reported outcomes specific to the foot and ankle that included patients with Rheumatoid arthritis. Two authors independently assessed the quality of the studies and extracted datas Results Of the initial 431 studies, fourteen instruments met the inclusion criteria. Significant methodological flaws were detected in most with only SEFAS met the COSMIN quality criteria. Conclusion SEFAS had the best quality and was ranked most appropriate for use with patients living with Rheumatoid Arthriti

Analysis of Humira, Electro-Acupuncture, and Pulsatile Dry Cupping on Reducing Joint Inflammation in Patients with Rheumatoid Arthritis

Humira, an anti-TNF drug aimed at decreasing inflammation in Rheumatoid Arthritis patients, can cause skin diseases from rashes to skin cancer. Humira works by blocking the chemical receptor RANKL which inhibits the production of osteoclasts. Osteoclasts are cells that attack and eat bone and cartilage therefore an inhibitory mechanism would cause inflammation.. By analyzing Humira’s effect on the human body, Humira can be compared to other treatments such as electro-acupuncture and pulsatile dry cupping to determine the viability of these alternative treatment methods in regards to their abilities to decrease inflammation in Rheumatoid Arthritis patients through blocking RANKL. An analysis of these treatment methods can also be used to determine the safest treatment method.. Under close examination of scientific journals written on studies where patients and animals were treated with Humira, acupuncture, and cupping for inflammation due to arthritis, the data collected suggests that Humira, electro-acupuncture, and pulsatile dry cupping all decrease inflammation in the joints of Rheumatoid Arthritis patients. However, acupuncture causes the least harmful side-effects, with nausea and localized tingling being the most common complaints. On the other hand, localized bruising is caused by cupping and Humira is associated to an increased risk of cancer, heart failure and liver failure. Therefore, electro-acupuncture and pulsatile dry cupping are safer alternatives to Humira for the treatment of inflammation associated with Rheumatoid Arthritis. As a result, the data collected from this review supports that acupuncture has the same therapeutic effects as Humira, but is less deleterious and an overall better treatment method to Rheumatoid Arthritis compared to Humira

Preclinical/subclinical rheumatoid arthritis-associated interstitial lung disease: misleading terms with potentially deleterious consequences

Interstitial lung disease (ILD) is a leading cause of mortality in patients with rheumatic diseases, including rheumatoid arthritis. The 5-year mortality rate is twice as high in patients with rheumatoid arthritis-associated ILD than in patients with rheumatoid arthritis without ILD. Moreover, a report showed that mortality rates in patients with disease codes for rheumatoid arthritis-associated ILD remained unchanged from 2005–18, even though the overall rheumatoid arthritis mortality rate declined during this time period. Despite the evidence that ILD contributes to premature death in rheumatoid arthritis, screening for ILD in patients with rheumatoid arthritis is not routinely performed in clinical practice and numerous questions remain regarding the management of rheumatoid arthritis-associated ILD

Change in bone mineral density in post menopausal women with rheumatoid arthritis

Introduction: Low bone mass is a serious complication of post menopausal women with rheumatoid arthritis. We determined the Change in Bone Mineral Density in postmenopausal women with rheumatoid arthritis. Methods: This retrospective cohort study was carried out on consecutive postmenopausal women with rheumatoid arthritis who were referred to the Azar 5th teaching hospital affiliated to Golestan University of Medical Sciences, North of Iran in 2009. The required data were gathered from the patients' medical records. The data were analyzed using SPSS software and statistical tests. Results: We studied 98 postmenopausal women with rheumatoid arthritis. Mean number of years since menopause and mean duration of disease were 9.39 and 5.13 respectively. T Score mean in femoral neck and lumbar spines was -1.45±1.26 and -2.45±1.44 respectively. The overall prevalence of osteoporosis at both the lumbar spine and femoral neck was 13.3. We have found a significant correlation between age, duration of disease, duration of menopause and bone mineral density (P-Value<0.01). Conlusion: Our results indicate a negative effect of age, number of years since menopause and duration of disease on bone mineral density. So, BMD should be measured in high risk women prior to the implementation of any treatment or prevention program

Periodontitis and rheumatoid arthritis:A search for causality and role of Porphyromonas gingivalis

There is currently much attention for early detection of rheumatoid arthritis, as early recognition enables timely treatment with a chance of remission of the disease before irreversible damage has occurred. In this respect, important questions are: who will develop rheumatoid arthritis, when and why? The main research question of this thesis was if chronic bacterial infection of oral soft- and hard tissues (periodontitis), in particular with the periodontal pathogen Porphyromonas gingivalis, predisposes to production of auto-antibodies specific for (the onset of) rheumatoid arthritis. Besides periodontitis, chronic inflammation of lung mucosal tissues has also been suggested to predispose to rheumatoid arthritis associated auto-antibody production. Indeed, presence of these auto-antibodies in patients without rheumatoid arthritis was associated with oral- or lung mucosal inflammation, although overall levels were low. Anti-Porphyromonas gingivalis antibody levels were not prognostic for development of rheumatoid arthritis. From this observation however, it cannot be concluded that there is no causal relationship between periodontitis and rheumatoid arthritis. Moreover, animal experiments confirm the suggested role of Porphyromonas gingivalis in development of human rheumatoid arthritis. Periodontitis is more prevalent among patients with rheumatoid arthritis. In addition, severity of periodontitis is correlated with rheumatoid arthritis disease activity. From this thesis is can be concluded that oral health assessment is extremely useful in patients with, or at risk for developing rheumatoid arthritis, given the potential role of chronic bacterial infection of oral tissues in development, progression and disease activity of rheumatoid arthritis

Rheumatoid meningitis sine arthritis.

Rheumatoid meningitis is a rare and very serious extra-articular manifestation of rheumatoid arthritis. We present a case of a 7()year-old female with no history of arthritis who developed stroke-like symptoms, seizures, psychosis and compulsive behavior. Serial brain magnetic resonance images (MRI) over four months demonstrated progressive interhemispheric meningeal thickening. She had mild lymphocytic pleocytosis on the cerebrospinal fluid analysis and serum anti-cyclic citrullinated peptide antibodies resulted positive in high titers. She underwent a brain biopsy showing necrotizing granulomas consistent with rheumatoid meningitis. Her symptoms resolved with treatment with glucocorticoids and cyclophosphamide. She has not been diagnosed with rheumatoid arthritis even after 1 year of follow up. Clinicians should be aware of the possibility of rheumatoid meningitis without rheumatoid arthritis and keep it on the differential for patients with aseptic meningitis and otherwise negative work up