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Achievement of Remission and Low Disease Activity Definitions in Patients with Rheumatoid Arthritis in Clinical Practice: Results from the NOR-DMARD Study.

https://arctichealth.org/en/permalink/ahliterature278963
Source
J Rheumatol. 2016 Apr;43(4):716-23
Publication Type
Article
Date
Apr-2016
Author
Till Uhlig
Elisabeth Lie
Vibeke Norvang
Åse Stavland Lexberg
Erik Rødevand
Frode Krøll
Synøve Kalstad
Inge C Olsen
Tore K Kvien
Source
J Rheumatol. 2016 Apr;43(4):716-23
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy
Female
Humans
Male
Middle Aged
Norway
Registries
Remission Induction
Severity of Illness Index
Treatment Outcome
Abstract
To examine the frequency of 6 definitions for remission and 4 definitions for low disease activity (LDA) after starting a disease-modifying antirheumatic drug (DMARD) in patients with rheumatoid arthritis (RA) in clinical practice, and to study whether predictors for achieving remission after 6 months are similar for these definitions.
Remission and LDA were calculated according to the 28-joint Disease Activity Score (DAS28), the Clinical Disease Activity Index (CDAI), the Simplified Disease Activity Index (SDAI), the Routine Assessment of Patient Index Data (RAPID3), and both the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission definitions 3 and 6 months after 4992 DMARD prescriptions for patients enrolled in the NOR-DMARD, a 5-center Norwegian register. Prediction of remission after 6 months was also studied.
After 3 months, remission rates varied between definitions from 8.7% to 22.5% and for LDA from 35.5% to 42.7%, and increased slightly until 6 months of followup. DAS28 and RAPID3 gave the highest and ACR/EULAR, SDAI, and CDAI the lowest proportions for remission. Positive predictors for remission after 6 months were similar across the definitions and included lower age, male sex, short disease duration, high level of education, current nonsmoking, nonerosive disease, treatment with a biological DMARD, being DMARD-naive, good physical function, little fatigue, and LDA.
In daily clinical practice, the DAS28 and RAPID3 definitions identified remission about twice as often as the ACR/EULAR Boolean, SDAI, and CDAI. Predictors of remission were similar across remission definitions. These findings provide additional evidence to follow treatment recommendations and treat RA early with a DMARD.
PubMed ID
26879358 View in PubMed
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Are there differences between young- and older-onset early inflammatory arthritis and do these impact outcomes? An analysis from the CATCH cohort.

https://arctichealth.org/en/permalink/ahliterature105048
Source
Rheumatology (Oxford). 2014 Jun;53(6):1075-86
Publication Type
Article
Date
Jun-2014
Author
Michael B Arnold
Vivian P Bykerk
Gilles Boire
Boulos P Haraoui
Carol Hitchon
Carter Thorne
Edward C Keystone
Janet E Pope
Source
Rheumatology (Oxford). 2014 Jun;53(6):1075-86
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Age of Onset
Aged
Aged, 80 and over
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy - epidemiology
Biological Products - therapeutic use
Canada - epidemiology
Cohort Studies
Comorbidity
Drug Utilization - statistics & numerical data
Female
Humans
Male
Middle Aged
Prognosis
Remission Induction
Severity of Illness Index
Sex Factors
Treatment Outcome
Young Adult
Abstract
The aim of this study was to determine the impact of age on disease and remission in suspected early RA (ERA).
Data from the Canadian Early Arthritis Cohort (CATCH) were examined at baseline, 6 and 12 months. Patients were divided into three groups based on age. Analysis of variance (ANOVA) and regression models were performed to determine the impact of age on the 28-joint DAS (DAS28) and remission at 12 months.
A total of 1809 patients were initially assessed: 442 (24.4%) young (
PubMed ID
24501240 View in PubMed
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[Arthrocentesis in rheumatology practice]

https://arctichealth.org/en/permalink/ahliterature14106
Source
Tidsskr Nor Laegeforen. 2000 Mar 10;120(7):800-2
Publication Type
Article
Date
Mar-10-2000
Author
H. Hartmann
Author Affiliation
Revmatologisk avdeling, Innherred sykehus, Levanger.
Source
Tidsskr Nor Laegeforen. 2000 Mar 10;120(7):800-2
Date
Mar-10-2000
Language
Norwegian
Publication Type
Article
Keywords
Anti-Inflammatory Agents - administration & dosage
Arthritis, Rheumatoid - diagnosis - drug therapy - pathology
Attitude of Health Personnel
English Abstract
Humans
Injections, Intra-Articular - adverse effects
Norway
Paracentesis - adverse effects - methods
Physician's Practice Patterns
Questionnaires
Steroids
Synovial Fluid - cytology
Treatment Outcome
Abstract
This study of Norwegian rheumatologists' use of intraarticular steroid injections is based on a survey among members of the Norwegian Society for Rheumatology. 79% of the members responded, i.e. 108 rheumatologists. 69 reported having used intraarticular steroid injections in any joint during the last week, a total of 637 times. There have been no previous studies on this subject in Norway. The results show that Norwegian rheumatologists consider intraarticular steroid injections a very effective treatment. Only 9% reported that they had seen side effects over the last 12 months (a total of 51 side effects), of which post-injection pain and subcutaneous atrophy were the most common. There were no reports of septic arthritis. Almost all side effects were considered not serious.
PubMed ID
10806902 View in PubMed
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[Blockade of TNFalpha--new therapeutic principle in severe rheumatoid arthritis]

https://arctichealth.org/en/permalink/ahliterature14050
Source
Lakartidningen. 2001 Feb 21;98(8):828-31
Publication Type
Article
Date
Feb-21-2001
Author
P. Larsson
J. Bratt
A. Harju
R. van Vollenhoven
L. Klareskog
Author Affiliation
Reumatologiska kliniken, Karolinska sjukhuset, Stockholm. plarsson@rheum.ks.se
Source
Lakartidningen. 2001 Feb 21;98(8):828-31
Date
Feb-21-2001
Language
Swedish
Publication Type
Article
Keywords
Arthritis, Rheumatoid - diagnosis - drug therapy - immunology
Arthroscopy
Clinical Trials
Drug Approval
English Abstract
Humans
Receptors, Tumor Necrosis Factor - antagonists & inhibitors - immunology
Recombinant Fusion Proteins - therapeutic use
Tumor Necrosis Factor-alpha - antagonists & inhibitors - immunology
Abstract
TNF-alpha is a proinflammatory cytokine. It has a key function in the inflammatory cascade both systemically and locally in the inflamed joints of patients affected by rheumatoid arthritis (RA). Treatment with two different "biological" drugs that block the proinflammatory capacity of TNF-alpha has recently been approved by the European drug authorities. This paper discusses experience gained in clinical trials and during the first year of treatment in Sweden using infliximab (anti-TNF-alpha monoclonal antibodies) and etanercept (recombinant TNF-alpha receptor fusion protein).
PubMed ID
11265568 View in PubMed
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Care pathways in early rheumatoid arthritis.

https://arctichealth.org/en/permalink/ahliterature165304
Source
Can Fam Physician. 2006 Nov;52(11):1444-5
Publication Type
Article
Date
Nov-2006
Author
Sasha Bernatsky
Debbie Feldman
Ian Shrier
Karine Toupin
Jeannie Haggerty
Pierre Tousignant
Michel Zummer
Author Affiliation
Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
Source
Can Fam Physician. 2006 Nov;52(11):1444-5
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy
Attitude of Health Personnel
Clinical Competence
Diagnosis, Differential
Drug Utilization - statistics & numerical data
Female
Humans
Male
Middle Aged
Physician's Practice Patterns
Physicians, Family
Quebec
Questionnaires
Referral and Consultation
Abstract
To determine the proportion of family physicians who diagnose rheumatoid arthritis (RA) correctly and to note how they report they would manage RA patients.
Mailed survey (self-administered questionnaire) requesting comments on vignettes.
Province of Quebec.
Computer-generated random sample of family physicians registered with the Quebec College of Family Physicians.
The proportion of family physicians who recognized RA and their reported management strategies.
Most respondents recognized the vignette presentation as a case of RA; 133/138 (96.4%) indicated RA as their provisional diagnosis, and all but 1 of the remaining respondents listed RA as a differential diagnosis. Of those who considered RA as a provisional or possible diagnosis, 107 (77.5% of all respondents) suggested referring the patient to a rheumatologist. Among the physicians who suggested referral, none indicated they would initiate disease-modifying antirheumatic drugs (DMARDs).
Almost all respondents considered RA as a provisional or differential diagnosis. Although many suggested referring the patient to a rheumatologist, almost a quarter did not. Initiating DMARDs before referring patients to rheumatologists appears to be rare. Since DMARDs given during the early stages of RA are known to decrease damage and dysfunction, ways to increase their use and optimize care pathways for new-onset inflammatory arthritis are urgently needed.
Notes
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PubMed ID
17279204 View in PubMed
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Co-morbidity in patients with early rheumatoid arthritis - inflammation matters.

https://arctichealth.org/en/permalink/ahliterature276975
Source
Arthritis Res Ther. 2016 Jan 28;18:33
Publication Type
Article
Date
Jan-28-2016
Author
Lena Innala
Clara Sjöberg
Bozena Möller
Lotta Ljung
Torgny Smedby
Anna Södergren
Staffan Magnusson
Solbritt Rantapää-Dahlqvist
Solveig Wållberg-Jonsson
Source
Arthritis Res Ther. 2016 Jan 28;18:33
Date
Jan-28-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy - epidemiology
Comorbidity
Early Diagnosis
Female
Humans
Inflammation - diagnosis - drug therapy - epidemiology
Male
Middle Aged
Prospective Studies
Risk factors
Sweden - epidemiology
Young Adult
Abstract
Patients with rheumatoid arthritis (RA) suffer from co-morbidities that contribute to a shortened lifespan. Inflammation is important for the development of cardiovascular disease, but little is known on its relationship with other co-morbidities. We investigated the role of inflammation for the development of new comorbidities in early RA.
Since 1995, all patients with early RA in Northern Sweden are included in a prospective study on co-morbidities, with a total of 950 patients being included. At the time for this study, 726 had been ill for =5 years. Data on co-morbidities, clinical and laboratory disease activity and pharmacological therapy were collected from patient records and further validated using a questionnaire at RA onset (T0) and after 5 years (T5).
Of the patients, 53.2 % of the patients had one or more co-morbidity at onset, the commonest being: hypertension (27.3 %), obstructive pulmonary disease (13.9 %), diabetes (8.0 %), hypothyroidism (6.3 %) and malignancy (5.0 %). After 5 years, 41.0 % had developed at least one new co-morbidity, the most common being: hypertension (15.1 %), malignancy (7.6 %), stroke/transient ischemic accident (5.1 %), myocardial infarction (4.3 %) and osteoporosis (3.7 %). Age at disease onset, a raised erythrocyte sedimentation rate (ESR) at inclusion, previous treatment with glucocorticoids (GC; p?
Notes
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PubMed ID
26818851 View in PubMed
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[Control of patients in an outpatient clinic of rheumatology]

https://arctichealth.org/en/permalink/ahliterature13959
Source
Tidsskr Nor Laegeforen. 2002 Apr 20;122(10):1003-4
Publication Type
Article
Date
Apr-20-2002
Author
Jan Tore Gran
Dag Soldal
Sigrid Jore
Geirmund Myklebust
Author Affiliation
Revmatologisk avdeling Institutt for klinisk medisin Universitetet i Tromsø 9037 Tromsø. jan.tore.gran@rikshospitalet.no
Source
Tidsskr Nor Laegeforen. 2002 Apr 20;122(10):1003-4
Date
Apr-20-2002
Language
Norwegian
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Arthritis - diagnosis - drug therapy
Arthritis, Rheumatoid - diagnosis - drug therapy
English Abstract
Female
Follow-Up Studies
Humans
Male
Middle Aged
Norway
Outpatient Clinics, Hospital - organization & administration - utilization
Rheumatic Diseases - diagnosis - drug therapy
Abstract
BACKGROUND: A high number of patients attending outpatient clinics of rheumatology are control cases. This study aimed at investigating the causes of such controls and how necessary they are. MATERIAL AND METHODS: 400 consecutive control patients selected from a local hospital were included. RESULTS: Inflammatory rheumatic diseases constituted 89% of the controls; rheumatoid arthritis was the diagnosis in 28% of cases. Routine control of patients with chronic disease was the main cause of control (41%). 15% of controls were regarded as partly or completely unnecessary; 95% of these were not repeated. INTERPRETATION: The reasons for controlling patients in rheumatology should be better defined. Regular evaluation could result in improved service to outpatients.
PubMed ID
12082690 View in PubMed
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Corticosteroids--from an idea to clinical use.

https://arctichealth.org/en/permalink/ahliterature13820
Source
Best Pract Res Clin Rheumatol. 2004 Feb;18(1):7-19
Publication Type
Article
Date
Feb-2004
Author
Ingrid E Lundberg
Cecilia Grundtman
Esbjörn Larsson
Lars Klareskog
Author Affiliation
Rheumatology Unit, Department of Medicine at Karolinska Hospital, Karolinska Institutet, SE-171 76 Stockholm, Sweden. ingrid.lundberg@medks.ki.se
Source
Best Pract Res Clin Rheumatol. 2004 Feb;18(1):7-19
Date
Feb-2004
Language
English
Publication Type
Article
Keywords
Adrenal Cortex Hormones - adverse effects - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy
Clinical Trials
Comparative Study
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Humans
Male
Prognosis
Rheumatic Diseases - diagnosis - drug therapy
Risk assessment
Sweden
Treatment Outcome
Abstract
Corticosteroids form the basis of treatment in many inflammatory rheumatic diseases, both as systemic treatment and as treatment with local injections to reduce inflammation. In 1948 the first systemic treatment of a patient with a rheumatic disease was given to a woman with severe rheumatoid arthritis (RA); the impressive effect in this patient, and in another 15 patients, was reported by Dr Hench and co-workers in 1949. Systemic corticosteroid treatment was rapidly adopted and used not only for patients with RA but also for those with other rheumatic diseases such as systemic lupus erythematosus-as well as other disorders such as asthma-with a similar positive effect. In the following year, 1950, the Nobel Prize was awarded for the discovery of the structure and biological effects of the adrenal cortex hormones. This open trial was followed by several controlled trials conducted in the UK in which the effects of cortisone were compared with the effects of aspirin in patients with RA-interestingly, without any significant clinical benefit for the cortisone-treated patients. It was not until 1959, in yet another multi-centre trial in Britain, that a significant effect on functional capacity and general well-being was reported after 2 years of treatment with prednisolone, compared to aspirin, in patients with early RA. Despite the dramatic effects that were observed in the severely ill RA patients reported by Hench and co-workers it took 10 years to demonstrate that this effect was superior to the effect of aspirin when the two compounds were compared in controlled trials. Why was this so? One explanation could be in the study designs and the different outcome measures used in the various studies. Perhaps the results in the first comparative studies would have been different if individual response criteria had been used. This is discussed in this chapter.
PubMed ID
15123034 View in PubMed
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Decline in work disability caused by early rheumatoid arthritis: results from a nationwide Finnish register, 2000-8.

https://arctichealth.org/en/permalink/ahliterature123654
Source
Ann Rheum Dis. 2013 May;72(5):672-7
Publication Type
Article
Date
May-2013
Author
Vappu Marianna Rantalaiho
Hannu Kautiainen
Salme Järvenpää
Lauri Virta
Timo Pohjolainen
Markku Korpela
Timo Möttönen
Kari Puolakka
Author Affiliation
Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland. vappu.rantalaiho@pshp.fi
Source
Ann Rheum Dis. 2013 May;72(5):672-7
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - diagnosis - drug therapy - epidemiology
Cohort Studies
Early Diagnosis
Employment - statistics & numerical data
Female
Finland - epidemiology
Follow-Up Studies
Humans
Incidence
Kaplan-Meier Estimate
Longitudinal Studies
Male
Middle Aged
Pensions - statistics & numerical data
Proportional Hazards Models
Registries - statistics & numerical data
Sex Distribution
Sick Leave - statistics & numerical data - trends
Young Adult
Abstract
To study whether the work disability (WD) rates in early rheumatoid arthritis (RA) have changed in Finland, where the treatment of RA has long been active but has intensified further since 2000.
All incident non-retired patients with RA of working age (18-64 years) in a nationwide register maintained by the Finnish Social Insurance Institution from 1 January 2000 to 31 December 2007 were identified. Patient cohorts were analysed in 2-year time periods (2000-1, 2002-3, 2004-5, 2006-7) and initial disease-modifying antirheumatic drugs (DMARDs) were elucidated from the drug purchase register. The incidence of continuous WD in the RA cohorts as well as in the entire Finnish population up to 31 December 2008 was analysed.
A total of 7831 patients were identified (71% women, 61% rheumatoid factor-positive). Throughout the follow-up period the use of methotrexate and combination DMARDs as the initial treatment of early RA increased. During the first 2 years the incidence of RA-related continuous WD was 8.9%, 9.4%, 7.2% and 4.8% in the year cohorts, respectively (p
PubMed ID
22679306 View in PubMed
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55 records – page 1 of 6.