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

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

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

Abstract 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

Development of Preliminary Remission Criteria for Gout Using Delphi and 1000Minds Consensus Exercises

Objective: To establish consensus for potential remission criteria to use in clinical trials of gout. Methods: Experts (n = 88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey, followed by a discrete-choice experiment using 1000Minds software. The exercises focused on identifying domains, definitions for each domain, and the timeframe over which remission should be defined. Results: There were 49 respondents (56% response) to the initial survey, with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%), and patient global assessment of disease activity (93%) as measurement domains in remission criteria. Consensus was also reached for domain definitions, including serum urate (<0.36 mm), pain (<2 on a 10-point scale), and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission, with equal responses for 6 months (51%) and 1 year (49%). In the discrete-choice experiment, there was a preference towards 12 months as a timeframe for remission. Conclusion: These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain, and patient global assessment. These preliminary criteria now require testing in clinical data sets

Changing rate of serious infections in biologic-exposed rheumatoid arthritis patients. Data from South American registries BIOBADABRASIL and BIOBADASAR

OBJECTIVE: Most reports on serious infections (SI) in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) are from the USA and Western Europe. Data from other regions are largely missing. We report data from South American countries with different backgrounds and health-care systems but similar registries. METHODS: We merged 2010-2016 data from two registries, BIOBADABRASIL (Brazil) and BIOBADASAR (Argentina), which share the same protocol, online platform and data monitoring process. Patients with active RA were included when they began the first bDMARD or a conventional synthetic DMARD (csDMARD, control group). The SI incidence rate (IR) per 1000 patient/years and adjusted IR ratio (aIRR) were estimated for bDMARDs and csDMARDs. RESULTS: Data were analysed for 3717 RA patients with an exposure of 13,380 patient/years. The 2591 patients treated with bDMARDs (64% tumour necrosis factor-alpha inhibitors (TNFi)) had a follow-up of 9300 years, and the 1126 treated with csDMARDs had an exposure of 4081 patient/years. The SI IR was 30.54 (CI 27.18-34.30) for all bDMARDs and 5.15 (CI 3.36-7.89) for csDMARDs. The aIRR between the two groups was 2.03 ([1.05, 3.9] p = 0.034) for the first 6 months of treatment but subsequently increased to 8.26 ([4.32, 15.76] p < 0.001). The SI IR for bDMARDs decreased over time in both registries, dropping from 36.59 (28.41-47.12) in 2012 to 7.27 (4.79-11.05) in 2016. CONCLUSION: While SI remains a major concern in South American patients with RA treated with bDMARDs, a favourable trend toward a reduction was observed in the last years.Key Points* New comprehensive data on biologic drugs safety from international collaboration in South America.* First proposal for national registries data merging in South America.* Serious infections remain a major concern in RA patients treated with biologics.* A significant reduction of serious infections in RA patients exposed to biologics was observed over a 7 years period

Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e initiative

Objective. To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). Methods. A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008–09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. Results. A total of 49?242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. Conclusions. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice

Changing rate of serious infections in biologic-exposed rheumatoid arthritis patients : data from South American registries BIOBADABRASIL and BIOBADASAR

Most reports on serious infections (SI) in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) are from the USA and Western Europe. Data from other regions are largely missing. We report data from South American countries with different backgrounds and health-care systems but similar registries. We merged 2010-2016 data from two registries, BIOBADABRASIL (Brazil) and BIOBADASAR (Argentina), which share the same protocol, online platform and data monitoring process. Patients with active RA were included when they began the first bDMARD or a conventional synthetic DMARD (csDMARD, control group). The SI incidence rate (IR) per 1000 patient/years and adjusted IR ratio (aIRR) were estimated for bDMARDs and csDMARDs. Data were analysed for 3717 RA patients with an exposure of 13,380 patient/years. The 2591 patients treated with bDMARDs (64% tumour necrosis factor-alpha inhibitors (TNFi)) had a follow-up of 9300years, and the 1126 treated with csDMARDs had an exposure of 4081 patient/years. The SI IR was 30.54 (CI 27.18-34.30) for all bDMARDs and 5.15 (CI 3.36-7.89) for csDMARDs. The aIRR between the two groups was 2.03 ([1.05, 3.9] p=0.034) for the first 6months of treatment but subsequently increased to 8.26 ([4.32, 15.76] p<0.001). The SI IR for bDMARDs decreased over time in both registries, dropping from 36.59 (28.41-47.12) in 2012 to 7.27 (4.79-11.05) in 2016. While SI remains a major concern in South American patients with RA treated with bDMARDs, a favourable trend toward a reduction was observed in the last years3882129213