Characterization of disease course and remission in early seropositive rheumatoid arthritis: results from the TACERA longitudinal cohort study

Background: To characterise disease course and remission in a longitudinal observational study of newly diagnosed, initially treatment-naïve patients with seropositive rheumatoid arthritis (RA). Methods: Patients with early untreated seropositive RA were recruited from 28 UK centres. Multiple clinical and laboratory measures were collected every 3 months for up to 18 months. Disease activity was measured using the 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and Simplified Disease Activity Index (SDAI). Logistic regression models examined clinical predictors of 6-month remission and latent class mixed models characterised disease course. Results: We enrolled 275 patients of whom 267 met full eligibility and provided baseline data. According to SDAI definition, 24.3% attained 6-month remission. Lower baseline Health Assessment Questionnaire (HAQ) and SDAI predicted 6-month remission (p = 0.013 and 0.011). Alcohol intake and baseline prescribing of methotrexate with a second disease-modifying antirheumatic drug (DMARD; vs monotherapy without glucocorticoids) were also predictive. Three distinct SDAI trajectory subpopulations emerged; corresponding to an inadequate responder group (6.5%), and higher and lower baseline activity responder groups (22.4% and 71.1%). Baseline HAQ and Short Form-36 Health Survey – Mental Component Score (SF-36 MCS) distinguished these groups. In addition, a number of baseline clinical predictors correlated with disease activity severity within subpopulations. Beneficial effects of alcohol intake were found across subpopulations. Conclusion: Three distinct disease trajectory subpopulations were identified. Differential effects of functional and mental well-being, alcohol consumption, and baseline RA medication prescribing on disease activity severity were found across subpopulations. Heterogeneity across trajectories cannot be fully explained by baseline clinical predictors. We hypothesise that biological markers collected early in disease course (within 6 months) may help patient management and better targeting of existing and novel therapies

Resilience isn't the same for all: comparing subjective and objective approaches to resilience measurement

Robust resilience measurement can improve our understanding of how people and societies respond to climate risk. It also allows for the effectiveness of resilience‐building interventions to be tracked over time. To date, the majority of measurement tools use objective methods of evaluation. Broadly speaking, these relate to approaches that solicit little, if any, judgment on behalf of the subject in question. More recently, subjective methods of evaluation have been proposed. These take a contrasting epistemological view, relying on people's self‐assessments of their own capacity to deal with climate risk. Subjective methods offer some promise in complementing objective methods, including: factoring in people's own knowledge of resilience and what contributes to it; more nuanced contextualization; and the potential to reduce survey length and fatigue. Yet, considerable confusion exists in understanding subjectivity and objectivity. Little is also known about the merits and limitations of different approaches to measurement. Here, I clarify the conceptual and practical relationships between objective and subjective forms of measuring resilience, aiming to provide practical guidance in distinguishing between them. In reviewing existing toolkits, I propose a subjectivity–objectivity continuum that groups measurement approaches according to two core tenets: (a) how resilience is defined and (b) how resilience is evaluated. I then use the continuum to explore the strengths and weaknesses of different types of toolkits, allowing comparison across each. I also emphasize that there is no one‐size fits all approach to resilience measurement. As such, evaluators should carefully consider: their epistemology of resilience; core objectives for measurement; as well as resource and data constraints, before choosing which methods to adopt

Climate Impacts, Political Institutions, and Leader Survival: Effects of Drought and Flooding Precipitation.

We explore how the political survival of leaders in different political regimes is affected by drought and flooding precipitation, which are the two major anticipated impacts of anthropogenic climate change. Using georeferenced climate data for the entire world and the Archigos dataset for the period of 1950-2010, we find that irregular political exits, such as coups or revolutions, are not significantly affected by climate impacts. Similarly, drought has a positive but insignificant effect on all types of political exits. On the other hand, we find that floods increase political turnover through the regular means such as elections or term limits. Democracies are better able to withstand the pressures arising from the economic and social disruptions associated with high precipitation than other institutional arrangements. Our results further suggest that, in the context of floods, political institutions play a more important role than economic development for the leaders’ political survival