J Rheumatol
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Randomized Controlled Trial
Less radiographic progression with adalimumab plus methotrexate versus methotrexate monotherapy across the spectrum of clinical response in early rheumatoid arthritis.
To determine the relationship between radiographic progression and clinical response for adalimumab plus methotrexate (MTX) versus either monotherapy in patients with early rheumatoid arthritis (RA) in the PREMIER study. ⋯ In patients with early RA, adalimumab plus MTX resulted in less radiographic progression than MTX monotherapy across the spectrum of clinical response, including ACR20 non-responses and remission-like responses.
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To determine the effectiveness and cost-effectiveness of anti-tumor necrosis factor (anti-TNF) medications in a real-world environment for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) using the Health Assessment Questionnaire (HAQ). ⋯ We obtained data on the effectiveness and cost-effectiveness of anti-TNF drugs using the HAQ score, which is known to be an excellent predictor of work disability, morbidity, and mortality. HAQ scores decreased with treatment and were sustained throughout the 3-5 years of followup. The NNT of approximately 2 seems favorable and was similar between diseases.
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Comparative Study
Greater perceived helplessness in osteoarthritis predicts outcome of joint replacement surgery.
To determine if there is a difference between male and female patients in their perceived control of osteoarthritis (OA) symptoms at the time of joint replacement surgery, as measured by the Arthritis Helplessness Index (AHI), and how this helplessness affects surgical outcomes at 1 year. ⋯ Interventions to improve control over arthritis symptoms should be studied with the goal of improving surgical outcomes.
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Antiphospholipid syndrome (APS) is characterized by thrombosis (venous and arterial) and pregnancy loss in conjunction with the lupus anticoagulant, IgG or IgM anticardiolipin, or IgG or IgM anti-beta2-glycoprotein I. In most series, only a minority of patients with antiphospholipid antibodies develop a clinical manifestation. ⋯ The frequency of thrombosis and pregnancy loss is greater in APS associated with SLE than in primary APS. Risk factors differ for venous and arterial thrombosis in APS. Treatment of hypertension may be the most important intervention to reduce arterial thrombosis. Elevated triglycerides are a major associate of venous thrombosis, but the benefit of treatment is not known. Hereditary thrombophilia is an associate of venous but not arterial thrombosis, making it cost-effective to investigate only in venous thrombosis.
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To compare child self-report and parent/proxy report of health-related quality of life (HRQOL), disability, and fatigue in children with active polyarticular juvenile idiopathic arthritis (JIA) to that of children with inactive polyarticular JIA and to previous data from healthy controls. ⋯ Although children in this cohort with polyarticular JIA and inactive disease reported HRQOL scores similar to those of healthy controls, children with polyarticular JIA and their parents/proxies tended to report more fatigue than controls, regardless of disease activity. Application of these measures prospectively to larger cohorts of children with JIA is needed to assess these differences.