Association of depression with socioeconomic status, anticardiolipin antibodies, and organ damage in patients with systemic lupus erythematosus: results from the KORNET registry.

OBJECTIVES: Depression is more common in patients with systemic lupus erythematosus (SLE) compared to the general population. However, few studies have investigated risk factors of depression in SLE patients, and the results are inconsistent. This study evaluated the prevalence of, and risk factors for, depression in ethnically homogeneous Korean SLE patients. METHODS: In this study, 505 consecutive SLE patients were enrolled from the Korean Lupus Network registry. Demographic variables, clinical manifestations, laboratory findings, physician global assessment, and SLEDAI-2000 and SLICC damage index were recorded at enrolment. Patients were identified as having depressive symptoms using the Korean version of the Beck Depression Inventory (BDI) with a cut-off ≥16, and categorised into four groups. Multivariable logistic regression analyses were performed to identify independent risk factors for depression defined as a BDI score ≥16. RESULTS: Of the 505 patients, 97 (19.2%) were diagnosed with depression. Patients with a higher BDI score were older, more likely to be a current smoker, and had a SLICC score >1. Conversely, they had lower income and educational levels. Regarding the serologic findings, patients with a higher BDI score had lower anti-double-stranded DNA positivity and higher anticardiolipin (aCL) positivity. On multivariate analysis, the following factors were associated with depression: current smoking status (OR 2.533, p=0.049), aCL-positivity (OR 2.009, p=0.035), and a SLICC damage index score >1 (OR 2.781, p=0.039). On the other hand, high-level education (OR 0.253, p=0.024) and a high income (OR 0.228, p=0.008) were negatively associated with depression. CONCLUSIONS: Our results show that depression is prevalent in patients with SLE and multiple factors are associated with depression in SLE. These data could help guide target programmes for those at high risk of depression in SLE.

The prevalence of Behçet's disease in Korea: data from Health Insurance Review and Assessment Service from 2011 to 2015.

OBJECTIVES: The aim of this study is to identify the prevalence of Behçet's disease (BD) from data in the Healthcare Bigdata Hub of the Health Insurance Review & Assessment (HIRA) Service from 2011 to 2015 in Korea. METHODS: This study collected information on primary and auxiliary diagnoses of BD (M352) by physicians according to the Korean Standard Classification of Diseases (KCD) codes. The prevalence of BD was assessed on the basis of age, sex, and geographical distribution. We used time series analysis, using the ARIMA model for the expected prevalence of BD from 2016 to 2025. RESULTS: The overall prevalence of BD was gradually increased, ranging from 32.8 to 35.7 per 100,000 population over the study period. The male to female ratio of BD ranged from 0.54:1 to 0.56:1, revealing a female predominance from 2011 to 2015. Among five districts in Korea, the prevalence in the Seoul Metropolitan district was the highest, with a slowly increasing trend for the study period, accounting for about 60.3% of total BD patients. The expected prevalence of BD patients was estimated to range from 36.9 (95% CI 35.0 - 39.0) to 44.7 (95% CI 40.2 - 49.6) between 2016 and 2025. CONCLUSIONS: This study found that the overall prevalence of BD is estimated to be approximately 35.0 per 100,000 population, with female predominance, and predicts gradually increased prevalence of BD in Korea.

Mapping health assessment questionnaire disability index (HAQ-DI) score, pain visual analog scale (VAS), and disease activity score in 28 joints (DAS28) onto the EuroQol-5D (EQ-5D) utility score with the KORean Observational study Network for Arthritis (KORONA) registry data.

The aim of this study was to estimate the mapping model for EuroQol-5D (EQ-5D) utility values using the health assessment questionnaire disability index (HAQ-DI), pain visual analog scale (VAS), and disease activity score in 28 joints (DAS28) in a large, nationwide cohort of rheumatoid arthritis (RA) patients in Korea. The KORean Observational study Network for Arthritis (KORONA) registry data on 3557 patients with RA were used. Data were randomly divided into a modeling set (80 % of the data) and a validation set (20 % of the data). The ordinary least squares (OLS), Tobit, and two-part model methods were employed to construct a model to map to the EQ-5D index. Using a combination of HAQ-DI, pain VAS, and DAS28, four model versions were examined. To evaluate the predictive accuracy of the models, the root-mean-square error (RMSE) and mean absolute error (MAE) were calculated using the validation dataset. A model that included HAQ-DI, pain VAS, and DAS28 produced the highest adjusted R (2) as well as the lowest Akaike information criterion, RMSE, and MAE, regardless of the statistical methods used in modeling set. The mapping equation of the OLS method is given as EQ-5D = 0.95-0.21 × HAQ-DI-0.24 × pain VAS/100-0.01 × DAS28 (adjusted R (2) = 57.6 %, RMSE = 0.1654 and MAE = 0.1222). Also in the validation set, the RMSE and MAE were shown to be the smallest. The model with HAQ-DI, pain VAS, and DAS28 showed the best performance, and this mapping model enabled the estimation of an EQ-5D value for RA patients in whom utility values have not been measured.

Severity of fibromyalgia symptoms is associated with socioeconomic status and not obesity in Korean patients.

OBJECTIVES: Several studies conducted in Western countries have shown that obese or overweight patients with fibromyalgia (FM) exhibit more severe symptoms than patients of normal weight. However, there has been no study on the relationship between obesity and FM symptom severity in Asian patients. In this study, we evaluated the association between obesity, and other related factors such as socioeconomic status (SES), and FM symptom severity in Korean patients. METHODS: A total of 343 participants were enrolled in this prospective cohort study, which used a nationwide survey of FM patients who were followed on an annual basis. We investigated health-related quality of life (QoL) and associated factors, such as demographic characteristics, SES, and physical and psychological function. The FM patients were assessed using the following self-reported questionnaires: the Medical Outcomes Study Short-Form Health Survey, the Fibromyalgia Impact Questionnaire, the Brief Fatigue Inventory, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Self-Efficacy Scale, and the Social Support Scale. RESULTS: Of the 343 patients, 76 (22.1%) were obese; these patients did not differ from the non-obese patients in terms of tender points or self-reported questionnaire scores. FM patients with lower SES - as indexed by unemployment, lower income, and education levels - had more severe symptoms, and poorer QoL and function compared to those with higher SES. CONCLUSIONS: In contrast to Western patients, symptom severity in Korean FM patients is associated with SES, but not with obesity.

Routine Assessment of Patient Index Data (RAPID3) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Scores Yield Similar Information in 85 Korean Patients With Ankylosing Spondylitis Seen in Usual Clinical Care.

BACKGROUND: Disease-specific ankylosing spondylitis (AS) indices, including BASDAI (Bath AS Disease Activity Index), BASFI (Bath AS Functional Index), ASDAS (AS Disease Activity Score), and BASMI (Bath AS Metrology Index), are widely used in clinical trials and in some clinical settings, but not in most routine care. Laboratory tests usually are the only quantitative measures included in routine care of AS patients, but often are poorly informative. Routine Assessment of Patient Index Data 3 (RAPID3) on a Multidimensional Health Assessment Questionnaire (MDHAQ) is feasible and informative in many rheumatic diseases. OBJECTIVE: The aim of this study was to compare RAPID3 to BASDAI, BASFI, ASDAS, and BASMI in a cross-sectional analysis of 85 Korean AS patients collected in routine care. METHODS: MDHAQ/RAPID3, BASDAI, and BASFI were completed by patients, and ASDAS and BASMI assessed by health professionals. Indices and individual measures were compared using correlations, cross tabulations, scatter plots, and κ statistics. RESULTS: RAPID3 scores were correlated significantly with BASDAI (ρ = 0.82) and ASDAS-ESR (erythrocyte sedimentation rate) (ρ = 0.76), at levels similar to the correlation of BASDAI with ASDAS-ESR (ρ = 0.81). All 21 patients with BASDAI scores of 4 or greater, indicating active AS, were among 39 patients who had RAPID3 scores of greater than 12, indicating high severity, whereas 79% of 33 patients with ASDAS of greater than 1.3, indicating high activity, had RAPID3 high severity. CONCLUSIONS: RAPID3 gives similar information to BASDAI and ASDAS in AS patients, in this limited cross-sectional study from 1 setting. Ankylosing spondylitis-specific measures are needed for clinical trials, but poorly feasible in most busy clinical settings. The MDHAQ/RAPID3 offers pragmatic quantitative clinical assessment of AS patients in routine care.

Resting energy expenditure is not associated with disease activity in women with rheumatoid arthritis: cross-sectional study.

BACKGROUND/AIMS: Increased resting energy expenditure (REE) in rheumatoid arthritis (RA) patients is thought to be caused by hypermetabolism associated with production of proinflammatory cytokines. Our aim in the present study was to explore the possible association between REE and disease activity in females with RA. METHODS: A total of 499 female RA patients were recruited to this cross-sectional study assessing REE scores on disease activity indices (the routine assessment of patient index data 3 [RAPID3], the disease activity score 28, and the clinical/simplified disease activity index [CDAI/SDAI]) and the levels of RA-associated autoantibodies (rheumatoid factor and anticyclic citrullinated peptide [anti-CCP] antibodies). Age-matched healthy female controls (n = 131) were also enrolled. RESULTS: REE did not differ between RA patients (all patients, and those in remission or not) and controls, or between RA patients in remission or not (p > 0.05 for all comparisons). Increased REE in total RA patients was associated with younger age and a higher body mass index (BMI) (p < 0.001 and p < 0.001, respectively), but not with disease activity index scores on any of RAPID3, CDAI, or SDAI. BMI was the only clinical parameter exhibiting a significant relationship with REE quartiles (Q1 to Q4; p < 0.001); none of disease duration, functional status, or anti-CCP antibody titer in RA patients was significantly related to REE, based on analysis of covariance. CONCLUSIONS: We found no association between REE and disease activity in RA patients, implying that energy metabolism in RA patients might be independent of RA-associated systemic inflammation.

Performance of Routine Assessment of Patient Index Data 3 (RAPID3) for assessment of rheumatoid arthritis in clinical practice: differential agreement of RAPID3 according to disease activity categories.

To evaluate the performance of Routine Assessment of Patient Index Data 3 (RAPID3) with the disease activity score 28 (DAS28) and the clinical/simplified disease activity index (CDAI/SDAI) in a Korean population with rheumatoid arthritis (RA). Four hundred patients with RA were consecutively enrolled. All patients completed disease activity indices such as RAPID3, DAS28, SDAI, and CDAI. The kappa and/or weighted coefficients were used to assess agreement between RAPID3 and other disease activity indices. ANOVA, Mantel-Haenszel chi-square test, and Spearman's partial correlation analysis were used for analyses. RAPID3 scores were significantly correlated with DAS28 (r = 0.62), SDAI (r = 0.74), and CDAI (r = 0.75; p < 0.0001 for all indices) and other activity measures including swollen/tender joint counts, erythrocyte sediment rate, and C-reactive protein. The weighted kappa coefficients of RAPID3 with DAS28, SDAI, and CDAI among the four disease activity categories were 0.33, 0.34, and 0.33, respectively. Kappa coefficients for RAPID3 in two disease activity categories increased more than four categories (κ = 0.40-0.42) indicating fair agreement. More than 86 % of patients with high-to-moderate disease activity in DAS28, CDAI, and SDAI had high-to-moderate disease activity using RAPID3 criteria. However, approximately 50 % of patients with remission-to-low disease activity in DAS28, CDAI, and SDAI showed remission-to-low disease activity in RAPID3. This study confirms RAPID3 as an informative disease activity index with equivalent values in DAS28, CDAI, and SDAI. RAPID3 reveals differential agreement in patients with lower disease activity.

Effect of fibromyalgia syndrome on the health-related quality of life and economic burden in Korea.

OBJECTIVE: To investigate the health-related quality of life (HRQOL) and economic burden of patients with FM syndrome (FMS) and compare the changes in these parameters 3 months before and after FMS diagnosis. METHODS: A total of 2098 patients with FMS (1818 previously diagnosed with FMS and 280 newly diagnosed with FMS) were enrolled in this study. The newly diagnosed patients with FMS participated in a 3-month prospective observational study to assess HRQOL and economic burden in terms of direct health-care costs, direct non-health-care costs and indirect costs. HRQOL was estimated using the Short Form 36 Health Survey. RESULTS: Mean (S.D.) scores obtained on the physical component summary (PCS) and mental component summary (MCS) scales by patients with FMS were 34.01 (7.28) and 37.29 (11.17), respectively. The total expenditure for the 3 months before enrolment was $1481 (S.D. $2206). Indirect costs [$1126 (S.D. $2016)] were about three times higher than direct costs [$355 (S.D. $534)]. The PCS and MCS scores increased to 4.03 (S.D. 6.79) and 4.06 (S.D. 10.57), respectively, 3 months after the initial FMS diagnosis (P < 0.001, both). Total expenditure after FMS diagnosis was reduced by $1025 (S.D. $1347) as compared with costs before FMS diagnosis (P < 0.001). Conclusion. Patients with FMS experience a decline in their HRQOL and constitute a significant economic burden on health-service utilization. The improvement in health-related costs and HRQOL after a diagnosis of FMS demonstrates a need for early diagnosis and treatment of FMS to reduce costs and enhance HRQOL.

Assessment of liver fibrosis by transient elastography in rheumatoid arthritis patients treated with methotrexate.

OBJECTIVE: This study was designed to assess the degree of liver fibrosis with transient elastography and noninvasive biochemical methods in rheumatoid arthritis patients treated with methotrexate. METHODS: We reviewed the medical records of rheumatoid arthritis patients who were administered methotrexate for more than 3 years. Transient elastography was performed and serological markers of liver fibrosis were evaluated by prospectively and was compared with the result of healthy control group. A correlation of the cumulative dose of methotrexate with the elastography value (kPa) or the level of serological markers was assessed. Two subgroups of patients were compared; patients who received a cumulative dose of methotrexate of less than 4000 mg (group 1) and more than 4000 mg (group 2). A total of 177 consecutive rheumatoid arthritis patients were evaluated. RESULTS: The mean cumulative dose of methotrexate was 3988 ± 1566 mg with doses ranging from 652.5 to 10,415 mg. The mean elastography value of all patients was 4.01 ± 0.77 kPa. The kilopascal values and levels of biochemical markers did not correlate with the cumulative dose of methotrexate, but did correlate with the AST to ALT ratio, AST to platelet ratio index, haptoglobin level. Mean kilopascal values were not statistically different for group 1 and group 2 patients. For rheumatoid arthritis patients treated with a high cumulative dose of methotrexate, significant liver fibrosis is rare and is not accurately detected in patients with liver enzyme abnormalities. CONCLUSION: Taking into account the risk and benefit of a liver biopsy, transient elastography can be recommended as an additional diagnostic option.

Cost-effectiveness analysis of MTHFR polymorphism screening by polymerase chain reaction in Korean patients with rheumatoid arthritis receiving methotrexate.

OBJECTIVE: To determine whether a strategy based on methylenetetrahydrofolate reductase (MTHFR) genotype screening is more cost-effective than the conventional strategy in reducing the risk of methotrexate (MTX)-related toxicity in patients with rheumatoid arthritis (RA). METHODS: We consecutively enrolled 385 patients with RA (355 female, 30 male) who had received MTX and identified toxicity associated with MTHFR C677T genotypes. We designed a hypothetical decision model to compare the genotype-based strategy with the conventional strategy. The time horizon was set as 1 year, and direct medical costs were used. The measured outcomes were the total expected cost, the effectiveness, and the incremental cost-effectiveness ratio. RESULTS: MTHFR genotype distribution revealed 133 patients (34.6%) with 677CC, 193 (50.1%) with 677CT, and 59 (15.3%) with 677TT. A total of 154 patients (40.0%) exhibited MTX-related toxicity. Compared to RA patients with the CC genotype, the odds ratio (95% confidence interval) for risk of toxicity was 3.8 (2.29-6.33) for the CT genotype, and 4.7 (2.40-9.04) for the TT genotype. In the base-case model, the total expected cost and the probability of continuing MTX medication for the conventional and genotype-based strategies were 851,415 Korean won (710 US dollars) and 788,664 Korean won (658 US dollars), and 94.03% and 95.58%, respectively. CONCLUSION: The MTHFR C677T polymorphism may be an important predictor of MTX-related toxicity in patients with RA. The cost-effectiveness analysis suggests that the genotype-based strategy is both less costly and more effective than the conventional strategy for MTX therapy.