Multicenter study of the natural history and therapeutic responses of patients with chikungunya, focusing on acute and chronic musculoskeletal manifestations - a study protocol from the clinical and applied research in Chikungunya (REPLICK network)

BACKGROUND: Chikungunya is associated with high morbidity and the natural history of symptomatic infection has been divided into three phases (acute, post-acute, and chronic) according to the duration of musculoskeletal symptoms. Although this classification has been designed to help guide therapeutic decisions, it does not encompass the complexity of the clinical expression of the disease and does not assist in the evaluation of the prognosis of severity nor chronic disease. Thus, the current challenge is to identify and diagnose musculoskeletal disorders and to provide the optimal treatment in order to prevent perpetuation or progression to a potentially destructive disease course. METHODS: The study is the first product of the Clinical and Applied Research Network in Chikungunya (REPLICK). This is a prospective, outpatient department-based, multicenter cohort study in Brazil. Four work packages were defined: i. Clinical research; ii) Translational Science - comprising immunology and virology streams; iii) Epidemiology and Economics; iv) Therapeutic Response and clinical trials design. Scheduled appointments on days 21 (D21) ± 7 after enrollment, D90 ± 15, D120 ± 30, D180 ± 30; D360 ± 30; D720 ± 60, and D1080 ± 60 days. On these visits a panel of blood tests are collected in addition to the clinical report forms to obtain data on socio-demographic, medical history, physical examination and questionnaires devoted to the evaluation of musculoskeletal manifestations and overall health are performed. Participants are asked to consent for their specimens to be maintained in a biobank. Aliquots of blood, serum, saliva, PAXgene, and when clinically indicated to be examined, synovial fluid, are stored at -80° C. The study protocol was submitted and approved to the National IRB and local IRB at each study site. DISCUSSION: Standardized and harmonized patient cohorts are needed to provide better estimates of chronic arthralgia development, the clinical spectra of acute and chronic disease and investigation of associated risk factors. This study is the largest evaluation of the long-term sequelae of individuals infected with CHIKV in the Brazilian population focusing on musculoskeletal manifestations, mental health, quality of life, and chronic pain. This information will both define disease burden and costs associated with CHIKV infection, and better inform therapeutic guidelines

Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST–RA database

OBJECTIVE: To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country. METHODS: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 "high GDP" countries with GDP per capita greater than US$24,000 and 11 "low GDP" countries with GDP per capita less than US$11,000. RESULTS: Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between "high GDP" and "low GDP" countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents. CONCLUSIONS: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in "low GDP" than in "high GDP" countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries

Gout successfully treated with diet and benzbromarone in a living kidney donor

Objective: To describe a patient with gout initiated after living kidney donation successfully treated with benzbromarone. Case Presentation: A 53 years old male with no previous history of prior illness who donated his left kidney to his father. Nine years after the surgical procedure, he had a podagra, and the arthritis progressed to other joints on evolution. He received allopurinol 300 mg/day plus colchicine 1 mg/day. He returned to our clinic 6 years later, referring to high alcoholic ingestion, especially beer on the weekend and using colchicine. His physical examination showed a podagra, but no tophi were noted. Laboratory tests revealed uric acid of 9.2 mg/dL (nr: < 7 mg/dL), 24 hours urinary uric acid (UUA) of 220 mg (nr: 25-750 mg/day), and C-reactive protein (CRP) was 8.3 mg/dL (nr: < 3 mg/dL). Benzbromarone colchicine, besides increased oral hydration to 3 liters/day, a hypocaloric diet, and stopping alcohol drinking were prescribed. After three months, he denied arthritis; his uric acid was reduced to 5.1 mg/dL, and UUA increased to 590 mg in 24 hours. After one year of treatment, he is asymptomatic, without alcoholic drinks, has normal inflammatory markers, hIs uric acid is 4.8 mg/dL, and uses only benzbromarone 100 mg/day. No side effect related to benzbromarone was observed in our patient. Conclusions: To the best of our knowledge, this is the first case illustrating a patient with gout after a living kidney transplant successfully treated with diet and benzbromarone

2011 Consensus Of The Brazilian Society Of Rheumatology For Diagnosis And Early Assessment Of Rheumatoid Arthritis

Objective: Develop guidelines for management of rheumatoid arthritis (RA) in Brazil, focusing on diagnosis and early assessment of the disease. Method: Literature review and expert opinions of RA Committee members of the Brazilian Society of Rheumatology. Results and conclusions: The following ten reccommendations were established: 1) RA diagnosis should be established onsidering clinical findings and complementary test results; 2) Special attention should be given to the differential diagnosis of arthritis; 3) Rheumatoid factor (RF) is an important diagnostic test, but has limited sensitivity and specificity, mainly in early RA; 4) Anti-CCP (anti-cyclic citrullinated peptide antibody) is a marker with sensitivity similar to that of the RF, but with higher specificity, mainly in the initial phase of disease; 5) Although unspecific, acute-phase reactants should be measured in patients with clinical suspicion of RA; 6) Conventional radiography should be performed for diagnostic and prognostic assessment of the disease. When necessary and available, ultrasound and magnetic resonance may be used; 7) Rheumatoid arthritis classification criteria (ACR/EULAR 2010), although not yet validated, may be used as a guide to aid in diagnosing patients with early RA; 8) One of the combined disease activity indices should be used to assess disease activity; 9) At least one of the functional capacity assessment instruments, such as mHAQ or HAQ-DI, should be regularly used; 10) At the early assessment of the disease, the presence of worse prognostic factors, such as polyarticular involvement, high titers of RF and/or anti-CCP, and early joint erosion, should be investigated. © Elsevier Editora Ltda.513199219Lee, D.M., Weinblatt, M.E., Rheumatoid arthritis (2001) Lancet, 358, pp. 903-911Alarcón, G.S., Epidemiology of rheumatoid arthritis (1995) Rheum Dis Clin North Am, 21, pp. 589-604Silman, A.J., Pearson, J.E., Epidemiology and genetics of rheumatoid arthritis (2002) Arthritis Res, 4, pp. S265-S272Marques-Neto, J.F., Gonçalves, E.T., Langen, L.F.O.B., Cunha, M.F.L., Radominski, S., Oliveira, S.M., Multicentric study of the prevalence of adult rheumatoid arthritis in Brazilian population samples (1993) Rev Bras Reumatol, 33, pp. 169-173Emery, P., The optimal management of early rheumatoid arthritis: The key to preventing disability (1994) British J Rheumatol, 33, pp. 765-768Sokka, T., Work disability in early rheumatoid arthritis (2003) Clin Exp Rheumatol, 21, pp. S71-S74Chehata, J.C., Hassell, A.B., Clarke, S.A., Mattey, D.L., Jones, M.A., Jones, W., Mortality in rheumatoid arthritis: Relationship to single and composite measures of disease activity (2001) Rheumatology, 40, pp. 447-452van der Horst-Bruinsma, L.E., Speyer, I., Visser, H., Breedvelt, F.C., Hazes, G.M., Diagnosis and course of early-onset arthritis: Results of a special early arthritis clinic compared to routine patient care (1998) Br J Rheumatol, 37, pp. 1084-1088Majithia, V., Geraci, S.A., Rheumatoid arthritis: Diagnosis and management (2007) Am J Med, 120, pp. 936-939Haque, U.J., Bathon, J.M., The role of biological in early rheumatoid arthritis (2005) Best Pract & Res Clin Rheum, 19, pp. 179-189Cabral, D., Katz, J.N., Weinblatt, M.E., Ting, G., Avorn, J., Solomon, D.H., Development and assessment of indicators of rheumatoid arthritis severity: Results of a Delphi panel (2005) Arthritis Rheum, 53, pp. 61-66Sokka, T., Kautiainen, H., Pincus, T., Verstappen, S.M., Aggarwal, A., Alten, R., Work disability remains a major problem in rheumatoid arthritis in the 2000s: Data from 32 countries in the QUEST-RA study (2010) Arthritis Res Ther, 12 (2), pp. R42Saag, K.G., Teng, G.G., Patkar, N.M., Anuntiyo, J., Finney, C., Curtis, J.R., American College of Rheumatology. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis (2008) Arthritis Rheum, 59 (6), pp. 762-784Smolen, J.S., Landewé, R., Breedveld, F.C., Dougados, M., Emery, P., Gaujoux-Viala, C., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs (2010) Ann Rheum Dis, 69 (6), pp. 964-975da Mota, L.M., Laurindo, I.M., dos Santos, N.L.L., Demographic and clinical characteristics of a cohort of patients with early rheumatoid arthritis (2010) Rev Bras Reumatol, 50 (3), pp. 235-248Louzada-Junior, P., Souza, B.D.B., Toledo, R.A., Ciconelli, R.M., Descriptive analysis of the demographical and clinical characteristics of the patients with rheumatoid arthritis in the State of São Paulo, Brazil (2007) Rev Bras Reumatol, 47 (2), pp. 84-90Schoels, M., Wong, J., Scott, D.L., Zink, A., Richards, P., Landewé, R., Economic aspects of treatment options in rheumatoid arthritis: A systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis (2010) Ann Rheum Dis, 69 (6), pp. 995-1003de Azevedo, A.B., Ferraz, M.B., Ciconelli, R.M., Indirect costs of rheumatoid arthritis in Brazil (2008) Value Health, 11 (5), pp. 869-877Chermont, G.C., Kowalski, S.C., Ciconelli, R.M., Ferraz, M.B., Resource utilization and the cost of rheumatoid arthritis in Brazil (2008) Clin Exp Rheumatol, 26 (1), pp. 24-31Mease, P.J., Inflammatory musculoskeletal disease: Identification and assessment (2011) J Rheumatol, 38 (3), pp. 557-561Scott, D.L., Wolfe, F., Huizinga, T.W., Rheumatoid arthritis (2010) Lancet, 376 (9746), pp. 1094-1108Dixon, W.G., Symmons, D.P., Does early rheumatoid arthritis exist? (2005) Best Pract Res Clin Rheumatol, 19, pp. 37-53Woolf, A.D., How to assess musculoskeletal conditions. History and physical examination (2003) Best Pract Res Clin Rheumatol, 17 (3), pp. 381-402Hazes, J.M., Hayton, R., Silman, A.J., A reevaluation of the symptom of morning stiffness (1993) J Rheumatol, 20 (7), pp. 1138-1142Yazici, Y., Pincus, T., Kautiainen, H., Sokka, T., Morning stiffness in patients with early rheumatoid arthritis is associated more strongly with functional disability than with joint swelling and erythrocyte sedimentation rate (2004) J Rheumatol, 31, pp. 1723-1726Turesson, C., Eberhardt, K., Jacobsson, L.T., Lindqvist, E., Incidence and predictors of severe extra-articular disease manifestations in an early rheumatoid arthritis inception cohort (2007) Ann Rheum Dis, 66 (11), pp. 1543-1544Goeldner, I., Skare, T.L., de Messias, R.I.T., Nisihara, R.M., Silva, M.B., da Rosa, U.S.R., Association of anticyclic citrullinated peptide antibodies with extra-articular manifestations, gender, and tabagism in rheumatoid arthritis patients from southern Brazil (2011) Clin Rheumatol, p. 22. , epub ahead of printDevlin, J., The acute phase and function in early rheumatoid arthritis. C-reactive protein levels correlate with functional outcome (1997) J Rheumatol, 24, pp. 9-13da Mota, L.M., dos Santos, N.L.L., de Carvalho, J.F., Autoantibodies and other serological markers in rheumatoid arthritis: Predictors of disease activity? (2009) Clin Rheumatol, 28 (10), pp. 1127-1134da Mota, L.M., dos Santos, N.L.L., Burlingame, R., Ménard, H.A., Laurindo, I.M., Laboratory characteristics of a cohort of patients with early rheumatoid arthritis (2010) Rev Bras Reumatol, 50 (4), pp. 375-388Visser, H., Early diagnosis of rheumatoid arthritis (2005) Best Pract & Res Clin Rheum, 19, pp. 55-72Renaudineau, Y., Jamin, C., Saraux, A., Youinou, P., Rheumatoid factor on a daily basis (2005) Autoimmunity, 38, pp. 11-16Vittecoq, O., Pouplin, S., Krzanowska, K., Jouen-Beades, F., Menard, J.F., Gayet, A., Rheumatoid factor is the strongest predictor of radiological progression of rheumatoid arthritis in a three-year prospective study in community-recruited patients (2003) Rheumatology, 42 (8), pp. 939-946Visser, H., Gelinck, L.B., Kampfraath, A.H., Breedveld, F.C., Hazes, J.M., Diagnostic and prognostic characteristics of the enzyme linked immunosorbent rheumatoid factor assays in rheumatoid arthritis (1996) Ann Rheum Dis, 55, pp. 157-161Wolfe, F., Cathey, M.A., Roberts, F.K., The latex test revised rheumatoid factor testing in 8,287 rheumatic disease patients (1991) Arthritis Rheum, 34, pp. 951-960Vallbracht, I., Rieber, J., Oppermann, M., Förger, F., Siebert, U., Helmke, K., Diagnostic and clinical value of anti-cyclic citrullinated peptide antibodies compared with rheumatoid factor isotypes in rheumatoid arthritis (2004) Ann Rheum Dis, 63, pp. 1079-1084Greiner, A., Plischke, H., Kellner, H., Gruber, R., Association of anticyclic citrullinated peptide antibodies, anti-citrullin antibodies, and IgM and IgA rheumatoid factors with serological parameters of disease activity in rheumatoid arthritis (2005) Ann N Y Acad Sci, 1050, pp. 295-303Raza, K., Breese, M., Nightingale, P., Kumar, K., Potter, T., Carruthers, D.M., Predictive value of antibodies to cyclic citrullinated peptides in patients with very early inflammatory arthritis (2005) J Rheumatol, 32, pp. 231-238Klareskog, L., Widhe, M., Hermansson, M., Rönnelid, J., Antibodies to citrullinated proteins in arthritis: Pathology and promise (2008) Curr Opin Rheumatol, 20, pp. 300-305van der Linden, M.P., van der Woude, D., Ioan-Facsinay, A., Levarht, E., Stoeken-Rijsbergen, G., Huizinga, T.W., Value of anti-modified citrullinated vimentin and third-generation anti-cyclic citrullinated peptide compared with second-generation anti-cyclic citrullinated peptide and rheumatoid factor in predicting disease outcome in undifferentiated arthritis and rheumatoid arthritis (2009) Arthritis Rheum, 60, pp. 2232-22341Ioan-Facsinay, A., Willemze, A., Robinson, D.B., Peschken, C.A., Markland, J., van der Woude, D., Marked differences in fine specificity and isotype usage of the anti-citrullinated protein antibody in health and disease (2008) Arthritis Rheum, 58, pp. 3000-3008van der Helm, van Mil, A.H.M., Verpoort, K.N., Breedveld, F.C., Toes, R.E.M., Huizinga, T.W.J., Antibodies to citrullinated proteins and differences in clinical progression of rheumatoid arthritis (2005) Arthritis Res Ther, 7, pp. R949-R958Scott, D.L., Wolf, F., Huizinga, T.W.J., Rheumatoid arthritis (2010) Lancet, 376, pp. 1094-1108Mutlu, N., Bicakcigil, M., Tasan, D.A., Kaya, A., Yavuz, S., Ozden, A.I., Comparative performance analysis of 4 different anti-citrullinated protein assays in the diagnosis of rheumatoid arthritis (2009) J Rheumatol, 36 (3), pp. 491-500Santiago, M., Baron, M., Miyachi, K., Fritzler, M.J., Abu-Hakima, M., Leclercq, S., A comparison of the frequency of antibodies to cyclic citrullinated peptides using a third generation anti-CCP assay (CCP3) in systemic sclerosis, primary biliary cirrhosis and rheumatoid arthritis (2008) Clin Rheumatol, 27, pp. 77-83Anjos, L.M.E., Pereira, I.A., D'orsi, E., Seaman, A., Burlingame, R.W., Morato, E.F., A comparative study of IgG second and third generation anti-cyclic citrullinated peptide (CCP) ELISAs and their combination with IgA third generation ELISA for the diagnosis of RA (2009) Clin Reumatol, 28, pp. 153-158Caro-Oleas, J.L., Fernandez-Suarez, A., Reneses-Casteros, S., Porrino, C., Nunes-Roldan, A., Wichmann-Schlipf, I., Diagnostic usefulness of a third generation anti-cyclic citrulline antibody test in patients with recent-onset polyarthritis (2007) Clin Chem Lab Med, 45, pp. 1396-1401Lutteri, L., Malaise, M., Chapelle, J.P., Comparison of second- and third-generation anti-cyclic citrullinated peptide antibodies assays for detecting rheumatoid arthritis (2007) Clin Chim Acta, 386, pp. 76-81Besada, E., Nikolaisen, C., Nossent, H., Diagnostic value of antibodies against mutated citrullinated vimentin for rheumatoid arthritis (2011) Clin Exp Rheumatol, 29 (1), pp. 85-88Ursum, J., Nielen, M.M.J., van Schaardenburg, D., van der Horst, A.R., van de Stadt, R.J., Dijkmans, B.A., Antibodies to mutated citrullinated vimentin and disease activity score in early arthritis: A cohort study (2008) Arthritis Res Ther, 10, pp. R12Mathson, L., Mullazei, M., Wick, M.C., Sjöberg, O., van Vollenhoven, R., Klareskog, L., Antibodies against citrullinated vimentin in rheumatoid arthritis: Higher sensitivity and extended prognostic value concerning future radiographic progression as compared with antibodies against cyclic citrullinated peptides (2008) Arthritis Rheum, 58, pp. 36-45Cordonnier, C., Meyer, O., Palazzo, E., de Bandt, M., Elias, A., Nicaise, P., Diagnostic value of anti-RA33 antibody, antikeratin antibody, antiperinuclear factor and antinuclear antibody in early rheumatoid arthritis: Comparison with rheumatoid factor (1996) Br J Rheumatol, 35, pp. 620-624Vittecoq, O., Incaurgarat, B., Jouen-Beades, F., Legoedec, J., Letourneur, O., Rolland, D., Autoantibodies recognizing citrullinated rat filaggrin in na ELISA using citrullinatted and non-citrullinated recombinant proteins as antigens are highly diagnostic for rheumatoid arthritis (2004) Clin Exp Rheumatol, 135, pp. 173-180Nielen, M.M., van der Horst, A.R., van Schaardenburg, D., van der Horst-Bruinsma, I.E., van de Stadt, R.J., Aarden, L., Antibodies to citrullinated human fibrinogen (ACF) have diagnostic and prognostic value in early arthritis (2005) Ann Rheum Dis, 64, pp. 1199-1204Graudal, N., Svenson, M., Tarp, U., Garred, P., Jurik, A., Bendtzen, K., Autoantibodies against interleukin-1 alfa in rheumatoid arthritis: Association with long-term radiographic outcome (2002) Ann Rheum Dis, 61, pp. 598-602Saulot, V., Vittecoq, O., Charlionet, R., Fardellone, P., Lange, C., Marvin, L., Presence of autoantibodies to the glycolytic enzyme alphaenolase in sera from patients with early rheumatoid arthritis (2002) Arthritis Rheum, 46, pp. 1196-1201Newkirk, M.M., Goldbach-Mansky, R., Lee, J., Hoxworth, J., McCoy, A., Yarboro, C., Advanced glycation end-product (AGE)-damaged IgG and IgM autoantivodies to IgG-AGE in patients with early synovitis (2003) Arthritis Res Ther, 5, pp. R82-R90Aletaha, D., Neogi, T., Silman, A.J., Funovits, J., Felson, D.T., Bingham 3rd, C.O., 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative (2010) Ann Rheum Dis, 69 (9), pp. 1580-1588Klareskog, L., Catrina, A.I., Paget, S., Rheumatoid arthritis (2009) Lancet, 373, pp. 659-672McInnes, I.B., Odell, J.R., State-of-the-art: Rheumatoid arthritis (2010) Ann Rheum Dis, 69, pp. 1898-1906Guidelines for the management of rheumatoid arthritis: 2002 Update (2002) Arthritis Rheum, 46, pp. 328-346. , American College of Rheumatology Subcommittee on Rheumatoid ArthritisVisser, H., Le, C.S., Vos, K., Breedveld, F.C., Hazes, J.M., How to diagnose rheumatoid arthritis early: A prediction model for persistent (erosive) arthritis (2002) Arthritis Rheum, 46, pp. 357-365Kaarela, K., Prognostic factors and diagnostic criteria in early rheumatoid arthritis (1985) Scand J Rheumatol Suppl, 57, pp. 1-54Jain, M., Samuels, J., Musculoskeletal ultrasound in the diagnosis of rheumatic disease (2010) Bulletin of the NYU Hospital For Joint Diseases, 68 (3), pp. 183-190Rahmani, M., Chegini, H., Najafizadeh, S.R., Azimi, M., Habiblollahi, P., Shakiba, M., Detection of bone erosion in early rheumatoid arthritis: Ultrasonography and conventional radiography versus non-contrast magnetic resonance imaging (2010) Clin Rheumatol, 29, pp. 883-891Wakefield, R.J., D'agostinho, M.A., Iagnocco, A., Filippucci, E., Backhaus, M., Scheel, A.K., The OMERACT ultrasound group: Status of current activities and research direction (2007) J Rheumatol, 34, pp. 848-851Fernandes, E.A., Castro Jr., M.R., Mistraud, S.A.V., Kubota, E.S., Fernandes, A.R.C., Ultrasonography in rheumatoid arthritis: Applicability and expectations (2008) Rev Bras Reumatol, 48, pp. 25-30Iagnocco, A., Epis, O., Delle, S.A., Meenagh, G., Filippucci, E., Riente, L., Ultrasoud imaging for the rheumatologist. XVII. Role of colour doppler and power doppler (2008) Clin Exp Rheumatol, 26, pp. 759-762Dohn, U.M., Ejbjerg, B.J., Hasselquist, M., Narvestad, E., Møller, J., Thomsen, H.S., Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography (2008) Arthritis Res Ther, 10 (1), pp. R25Brown, A.K., Wakefield, R.J., Conaghan, P.G., Karim, Z., Oconnor, P.J., Emery, P., New approaches to imaging early inflammatory arthritis (2004) Clin Exp Rheumatol, 22, pp. S18-S25Kubota, K., Ito, K., Morooka, M., Mitsumoto, T., Kurihara, K., Yamashita, H., Whole -body FDG-PET/CT on rheumatoid arthritis of large joints (2009) Ann Nucl Med, 23 (9), pp. 783-791Basu, S., Zhuang, H., Torigian, D.A., Rosenbaum, J., Chen, W., Alayi, A., Functional imaging of inflammatory diseases using nuclear medicine techniques (2009) Semin Nucl Med, 29, pp. 124-145Arnett, F.C., Edworthy, S.M., Bloch, D.A., McShane, D.J., Fries, J.F., Cooper, N.S., The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis (1988) Arthritis Rheum, 31, pp. 315-324Saraux, A., Berthelot, J.M., Chales, G., le Henaff, C., Thorel, J.B., Hoang, S., Ability of the American College of Rheumatology 1987 criteria to predict rheumatoid arthritis in patients with early arthritis and classification of these patients two years later (2001) Arthritis Rheum, 44, pp. 2485-2491Banal, F., Dougados, M., Combescure, C., Gossec, L., Sensitivity and specificity of the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis according to disease duration: A systematic literature review and meta-analysis (2009) Ann Rheum Dis, 68, pp. 1184-9191Scott, D.L., Panayi, G.S., van Riel, P.L., Smolen, J., van de Putte, L.B., Disease activity in rheumatoid arthritis: Preliminary report of the Consensus Study Group of the European Workshop for Rheumatology Research (1992) Clin Exp Rheumatol, 10, pp. 521-525Felson, D.T., Anderson, J.J., Boers, M., Bombardier, C., Chernoff, M., Fried, B., The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials (1993) Arthritis Rheum, 36, pp. 729-740. , The Committee on Outcome Measures in Rheumatoid Arthritis Clinical TrialsBoers, M., Tugwell, P., Felson, D.T., van Riel, P.L., Kirwan, J.R., Edmonds, J.P., World Health Organization and International League of Associations for Rheumatology core endpoints for symptom modifying antirheumatic drugs in rheumatoid arthritis clinical trials (1994) J Rheumatol Suppl, 41, pp. 86-89Tugwell, P., Bombardier, C., A methodologic framework for developing and selecting endpoints in clinical trials (1982) J Rheumatol, 9, pp. 758-762van der Heijde, D.M., vant Hof, M.A., van Riel, P.L., van Leeuwen, M.A., van Rijswijk, M.H., van de Putte, L.B., Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis (1992) Ann Rheum Dis, 51, pp. 177-181Goldsmith, C.H., Boers, M., Bombardier, C., Tugwell, P., Criteria for clinically important changes in outcomes: Development, scoring and evaluation of rheumatoid arthritis patient and trial profiles. OMERACT Committee (1993) J Rheumatol, 20, pp. 561-565Aletaha, D., Nell, V.P., Stamm, T., Uffmann, M., Pflugbeil, S., Machold, K., Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: Validation of a clinical activity score (2005) Arthritis Res Ther, 7, pp. R796-R806Aletaha, D., Smolen, J.S., The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): A review of their usefulness and validity in rheumatoid arthritis (2005) Clin Exp Rheumatol, 23 (SUPPL. 39), pp. S100-S108Schulz, K.F., Grimes, D.A., Multiplicity in randomized trials I: Endpoints and treatments (2005) Lancet, 365, pp. 1591-1595van der Heijde, D.M., Vant Hof, M., van Riel, P.L., van de Putte, L.B., Development of a disease activity score based on judgment in clinical practice by rheumatologists (1993) J Rheumatol, 20, pp. 579-581Ritchie, D.M., Boyle, J.A., McInnes, J.M., Jasani, M.K., Dalakos, T.G., Grieveson, P., Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis (1968) Q J Med, 37, pp. 393-406Smolen, J.S., Breedveld, F.C., Schiff, M.H., Kalden, J.R., Emery, P., Eberl, G., A simplified disease activity index for rheumatoid arthritis for use in clinical practice (2003) Rheumatology, 42, pp. 244-257Siegel, J.N., Zhen, B.G., Use of the American College of Rheumatology N (ACR-N) index of improvement in rheumatoid arthritis: Argument in favor (2005) Arthritis Rheum, 52, pp. 1637-1641van Gestel, A.M., Prevoo, M.L., vant Hof, M.A., van Rijswijk, M.H., van de Putte, L.B., van Riel, P.L., Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis (1996) Arthritis Rheum, 39, pp. 34-40. , , Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteriavan Gestel, A.M., Haagsma, C.J., van Riel, P.L., Validation of rheumatoid arthritis improvement criteria that include simplified joint counts (1998) Arthritis Rheum, 41, pp. 1845-1850Aletaha, D., Funovits, J., Wards, M.M., Smolen, J.S., Kvien, T.K., Perception of improvement in patients with rheumatoid arthritis varies with disease activity levels at baseline (2009) Arthritis Rheum, 61 (3), pp. 313-320Brandão, L., Ferraz, M.B., Zerbini, C.A.F., Evaluation of quality of life in rheumatoid arthritis (1997) Rev Bras Reumatol, 37, pp. 275-281Kosinski, M., Kujawski, S.C., Martin, R., Wanke, L.A., Buatti, M.C., Ware, J.R.J.E., Health-related quality of life in early rheumatoid arthritis: Impact of disease and treatment response (2002) Am J Manag Care, 8, pp. 231-240Ward, M.M., Outcome measurement: Health status and quality of life (2004) Curr Opin Rheumatol, 16, pp

Treat-to-target (T2T) recommendations for gout.

The treat-to-target (T2T) concept has been applied successfully in several inflammatory rheumatic diseases. Gout is a chronic disease with a high burden of pain and inflammation. Because the pathogenesis of gout is strongly related to serum urate levels, gout may be an ideal disease in which to apply a T2T approach. Our aim was to develop international T2T recommendations for patients with gout. A committee of experts with experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. Eleven rheumatologists, one cardiologist, one nephrologist, one general practitioner and one patient met in October 2015 to develop T2T recommendations based on the available scientific evidence. Levels of evidence, strength of recommendations and levels of agreement were derived. Although no randomised trial was identified in which a comparison with standard treatment or an evaluation of a T2T approach had been performed in patients with gout, indirect evidence was provided to focus on targets such as normalisation of serum urate levels. The expert group developed four overarching principles and nine T2T recommendations. They considered dissolution of crystals and prevention of flares to be fundamental; patient education, ensuring adherence to medications and monitoring of serum urate levels were also considered to be of major importance. This is the first application of the T2T approach developed for gout. Since no publication reports a trial comparing treatment strategies for gout, highly credible overarching principles and level D expert recommendations were created and agreed upon

Performance of classification criteria for gout in early and established disease

OBJECTIVES: To compare the sensitivity and specificity of different classification criteria for gout in early and established disease. METHODS: This was a cross-sectional study of consecutive rheumatology clinic patients with joint swelling in which gout was defined by presence or absence of monosodium urate crystals as observed by a certified examiner at presentation. Early disease was defined as patient-reported onset of symptoms of 2 years or less. RESULTS: Data from 983 patients were collected and gout was present in 509 (52%). Early disease was present in 144 gout cases and 228 non-cases. Sensitivity across criteria was better in established disease (95.3% vs 84.1%, p<0.001) and specificity was better in early disease (79.9% vs 52.5%, p<0.001). The overall best performing clinical criteria were the Rome criteria with sensitivity/specificity in early and established disease of 60.3%/84.4% and 86.4%/63.6%. Criteria not requiring synovial fluid analysis had sensitivity and specificity of less than 80% in early and established disease. CONCLUSIONS: Existing classification criteria for gout have sensitivity of over 80% in early and established disease but currently available criteria that do not require synovial fluid analysis have inadequate specificity especially later in the disease. Classification criteria for gout with better specificity are required, although the findings should be cautiously applied to non-rheumatology clinic populations

Survey Definitions of Gout for Epidemiologic Studies: Comparison With Crystal Identification as the Gold Standard

OBJECTIVE: To identify the best-performing survey definition of gout from items commonly available in epidemiologic studies. METHODS: Survey definitions of gout were identified from 34 epidemiologic studies contributing to the Global Urate Genetics Consortium (GUGC) genome-wide association study. Data from the Study for Updated Gout Classification Criteria (SUGAR) were randomly divided into development and test data sets. A data-driven case definition was formed using logistic regression in the development data set. This definition, along with definitions used in GUGC studies and the 2015 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) gout classification criteria were applied to the test data set, using monosodium urate crystal identification as the gold standard. RESULTS: For all tested GUGC definitions, the simple definition of "self-report of gout or urate-lowering therapy use" had the best test performance characteristics (sensitivity 82%, specificity 72%). The simple definition had similar performance to a SUGAR data-driven case definition with 5 weighted items: self-report, self-report of doctor diagnosis, colchicine use, urate-lowering therapy use, and hyperuricemia (sensitivity 87%, specificity 70%). Both of these definitions performed better than the 1977 American Rheumatism Association survey criteria (sensitivity 82%, specificity 67%). Of all tested definitions, the 2015 ACR/EULAR criteria had the best performance (sensitivity 92%, specificity 89%). CONCLUSION: A simple definition of "self-report of gout or urate-lowering therapy use" has the best test performance characteristics of existing definitions that use routinely available data. A more complex combination of features is more sensitive, but still lacks good specificity. If a more accurate case definition is required for a particular study, the 2015 ACR/EULAR gout classification criteria should be considered

Diagnostic Arthrocentesis for Suspicion of Gout Is Safe and Well Tolerated

OBJECTIVE: To determine the frequency of adverse events of diagnostic arthrocentesis in patients with possible gout. METHODS: Consecutive patients underwent arthrocentesis and were evaluated at 6 weeks to determine adverse events. The 95% CI were obtained by bootstrapping. RESULTS: Arthrocentesis was performed in 910 patients, and 887 (97.5%) were evaluated for adverse events. Any adverse event was observed in 12 participants (1.4%, 95% CI 0.6-2.1). There was 1 case (0.1%, 95% CI 0-0.34) of septic arthritis. CONCLUSIONS: Diagnostic arthrocentesis is associated with a low frequency of adverse events. Septic arthritis rarely occurs