Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative.

OBJECTIVE: A patient-derived composite measure of the impact of rheumatoid arthritis (RA), the rheumatoid arthritis impact of disease (RAID) score, takes into account pain, functional capacity, fatigue, physical and emotional wellbeing, quality of sleep and coping. The objectives were to finalise the RAID and examine its psychometric properties. METHODS: An international multicentre cross-sectional and longitudinal study of consecutive RA patients from 12 European countries was conducted to examine the psychometric properties of the different combinations of instruments that might be included within the RAID combinations scale (numeric rating scales (NRS) or various questionnaires). Construct validity was assessed cross-sectionally by Spearman correlation, reliability by intraclass correlation coefficient (ICC) in 50 stable patients, and sensitivity to change by standardised response means (SRM) in 88 patients whose treatment was intensified. RESULTS: 570 patients (79% women, mean ± SD age 56 ± 13 years, disease duration 12.5 ± 10.3 years, disease activity score (DAS28) 4.1 ± 1.6) participated in the validation study. NRS questions performed as well as longer combinations of questionnaires: the final RAID score is composed of seven NRS questions. The final RAID correlated strongly with patient global (R=0.76) and significantly also with other outcomes (DAS28 R=0.69, short form 36 physical -0.59 and mental -0.55, p<0.0001 for all). Reliability was high (ICC 0.90; 95% CI 0.84 to 0.94) and sensitivity to change was good (SRM 0.98 (0.96 to 1.00) compared with DAS28 SRM 1.06 (1.01 to 1.11)). CONCLUSION: The RAID score is a patient-derived composite score assessing the seven most important domains of impact of RA. This score is now validated; sensitivity to change should be further examined in larger studies.

[Musculoskeletal ultrasonography in rheumatology]. / Ecografia musculo-esquelética em reumatologia.

AIMS: To evaluate the evolution of musculoskeletal ultrasonography and its role in rheumatological practice by comparing recent casuistics of the ultrasonography exams performed at the Rheumatology Department of University Hospital La Paz -Madrid with the exams performed before 2003. MATERIAL AND METHODS: Revision of the ultrasonographies made between January 2007 and June 2008 and comparison with the exams performed between 1998 and 2003. RESULTS: In the recent casuistics, that included 1,000 exams, anatomic ultrasonography represents 45.9% in contrast to 100% of the ultrasonographies preformed before 2003. The indication for the remaining 54.1% were: diagnosis of arthritis 16.3%, evaluation of inflammatory activity 6.8%, evaluation of enthesis 6.3%, study of temporal arteries 12.5% (9.7% for suspected temporal arteritis and 2.8% for disease monitoring); differential diagnosis of gout or chondrocalcinosis 2.2%, diagnosis of sacroiliitis 1.2%, diagnosis of carpal tunnel syndrome 1.5% and sonographic-guided procedures 7,3%. CONCLUSIONS: At the present time, the anatomic ultrasonography represents 45.9% of all ultrasonographies in contrast to what happened before 2003. Technological advances and the progress in science promote the evolution of ultrasonography from an anatomical imaging tool to a more clinical, diagnostic, monitoring and therapeutic profile.

[Hip arthritis in an young adult - a diagnosis to consider]. / Coxartrose em adulto jovem - um diagnóstico a pesquisar.

Osteoarthritis is the most common articular degenerative disease and can be classified as primary or secondary. The last one must be excluded in the context of a young adult. Optimal management requires early diagnosis and awareness of the risk factors (more importantly «modifiable¼ ones) that can affect the prognosis. The authors present a case of a young man who complaint about mechanical groin pain because degenerative changes on hip joint. After patient assessment it was encountered ultrasonographic typical images of gout in the context of asymptomatic hyperuricemia.

The safety and efficacy of adding etanercept to methotrexate or methotrexate to etanercept in moderately active rheumatoid arthritis patients previously treated with monotherapy.

OBJECTIVE: To determine if adding etanercept (ETN) to methotrexate (MTX) or MTX to ETN for 52 weeks in rheumatoid arthritis (RA) patients with moderate disease activity provides higher efficacy. METHODS: All patients (n = 227) received open-label ETN 25 mg subcutaneously twice-weekly and MTX orally up to 20 mg weekly for 52 weeks and had completed a 3-year study in which patients received MTX, ETN or combination therapy. Endpoints were based on Disease Activity Score (DAS) and European League Against Rheumatism (EULAR) responses. RESULTS: Patients previously receiving combination therapy (Combination group; n = 96) had a lower disease activity at baseline. The mean DAS for those previously receiving MTX (ETN-added group; n = 55) and previously receiving ETN (MTX-added group; n = 76) were in the moderate disease activity range at baseline; Combination patients had a low disease activity. The greatest increase in DAS remission rates from baseline to week 52 was in the ETN-added group (23.6% to 41.8%, p<0.01), although Combination (37.6% to 50.0%, p<0.01) and MTX-added (26.7% to 36.8%, p = NS) also demonstrated improvements. DAS low disease activity and EULAR responses showed similar results. No new safety issues were identified. CONCLUSION: RA patients who were partial responders to long-term MTX or etanercept monotherapy obtained a higher efficacy with combination therapy. Responses achieved by patients with combination therapy after 3 years in the previous study were sustained or improved during the fourth year of treatment. This trial supports the higher therapeutic effect of combination treatment with etanercept and MTX in RA patients with moderate disease activity despite monotherapy with one of the two agents.