Adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Serbia.

Rheumatoid arthritis (RA) is one of the most prevalent inflammatory rheumatic diseases. As it is a chronic and a lifelong destructive disease, the aim of the treatment is to reduce disability and improve quality of life. The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire is a patient-reported outcome measure, specific to RA. To adapt and validate the RAQoL for use in Serbia, two translation panels were involved to produce the Serbian RAQoL. After successful translation, face and content validity was determined via cognitive debriefing interviews. The psychometric properties of the questionnaire were examined, including reliability and construct validity, by using the Nottingham Health Profile (NHP) as a comparator scale. The RAQoL was translated successfully and rated as applicable, relevant and comprehensive by respondents. The questionnaire had high internal consistency (alpha = 0.94 at both time points) and test-retest reliability (r = 0.92). Moderately high correlations were found between the RAQoL and physical mobility, pain and energy level sections of the NHP, providing evidence of convergent validity. The RAQoL was able to distinguish between patients grouped by perceived general health, incidence of flare-up and disease severity. The Serbian language version of the RAQoL showed strong evidence of reliability and validity and is recommended for use in clinical trials and routine general practice in RA.

Dry Olive Leaf Extract in Combination with Methotrexate Reduces Cell Damage in Early Rheumatoid Arthritis Patients-A Pilot Study.

The effects of co-administration of dry olive leaf extract (DOLE) with standard methotrexate (MTX) therapy on the parameters of cell damage and inflammation in patients with early and long-term rheumatoid arthritis (RA) were evaluated at baseline, 3 and 6 weeks. Patients were assigned to groups: the early phase RA group on MTX monotherapy (E MTX), and the two RA groups that received co-treatment with DOLE and MTX: early (E MTX + DOLE) and long-term phase patients (L-t MTX+ DOLE). Baseline values indicated increased parameters of cell damage and disruption of redox balance in all groups. After three weeks the E MTX + DOLE group maintained high catalase activity, exhibited decrease of lipid peroxidation and protein damage indicators-thiols and nitrites, while levels of DNA damage and pro-inflammatory interleukin-6 were significantly reduced. In E MTX group catalase activity remained unaltered while significant lipid peroxidation and DNA damage reductions were seen only after six weeks. L-t MTX + DOLE group showed only modest alterations of cell damage parameters during six weeks. Combined administration of DOLE with MTX contributes to faster reduction of cell damage, restores oxidative balance and improves interleukin-6 suppression during high disease activity in early phase RA, but not in long term patients. Copyright © 2016 John Wiley & Sons, Ltd.

[The efficacy and tolerability of allopurinol dose escalation in patients with gout].

INTRODUCTION: Allopurinol is still the drug of choice for the long-term control of hyperuricemia in patients with gout. Objective The aim of the study was to investigate the efficacy and tolerability of different allopurinol doses used in order to attain a target serum uric acid concentration (SUc) of <6 mg/dl (360 micromol/L). METHODS: Prospective trial was carried out in patients with primary gout and normal renal function, no relevant liver disease, and SUc-lowering treatment indications involving 1-2 gout episodes per year, presence oftophus and/or chronic urate arthropathy or X-ray finding of erosions. The patients were administered allopurinol in a step-up dose scheme (beginning with 100 mg/ day then raised for 100 mg every four weeks) until therapeutic goal was achieved or development of adverse effects. RESULTS: Forty-one patients were enrolled in the study; 27 ended it so far.The treatment target was reached in 19/27 patients using allopurinol 300 mg/day (70.4%). After the increased dose up to 600 mg/day, the overall treatment success was reached in 25/27 patients (92.5%). Adverse drug reactions (ADRs) were evidenced in 12/27 patients; the most frequent ADRs were gouty flares. The mean SUc reduction from baseline 533.9+/-83.4 micromol/L to 346.9+/-87.9 micromol/L was obtained with allopurinol at a dose of 300 mg/day (p=0.000) as well as at a dose up to 600 mg/day (274.9+/-92.7 micromol/L) (p=0.000). CONCLUSIONS: Most of the investigated gouty patients attained target SUc <360 mmol/L at a 300 mg/day allopurinol dose. However, in 30% of patients further dose escalation up to 600 mg/day was needed but the increased dose was well tolerated, and the therapeutic goal was achieved even in 92.5% of patients. Such doses are in general well tolerated under the conditions of well preserved renal function.

[Novelties in gout].

Chronic asymptomatic hyperuratemia (HUA), gout paroxysm in patients with chronic hyperuratemia (HU) and normouricemic attacks of gouty arthritis are well known, but poorly understood. A review of the current literature with attempt of its explanation is presented. The natural course of gout is associated with joint structure changes that may be evaluated by different imaging techniques; comparative advantages and shortcomings of each technique are presented. For almost over 50 years the market has not offered new drugs for the control of HU and gout, while management of such patients was a rather neglected field. Over the last five years an unpredictable number of prospective clinical studies have been conducted involving the investigation of the efficacy and safety of new drugs to control HU (febuxostat, pegloticase). The return of pharmaceutical industry into the world of gout has considerably changed the picture. New recommendations have been presented on appropriate colchicine dose regime for acute gouty flares. Emerging therapies, including pegloticase, uricosuric agent RDEA596 and the interleukin-1 inhibitors have shown promises in early and late phase clinical trials. Each of them deserves to be considered for implementation and feasibility in clinical practice as well as outcome measures for clinical trials. Another purpose of this review was to summarize new knowledge on approved drugs to treat hyperuricemia, or the clinical manifestations of gout. Results of several clinical trials provide new data on the efficacy and safety of the approved urate lowering drugs (allopurinol and febuxostat). Lifestyle and dietary recommendations for gout patients should take into consideration overall health benefits and risks, since gout is often associated with metabolic syndrome and an increased future risk of cardiovascular disease and mortality. This review also summarizes the recent data about lifestyle factors that influence serum uric acid levels and the gout risk, and attempts to provide holistic recommendations, considering both their impact on gout as well as on other health implications.

Late-onset systemic lupus erythematosus: clinical features, course, and prognosis.

There are contradictory opinions if late-onset systemic lupus erythematosus (SLE) is associated with a different, more benign disease course and better prognosis than early-onset SLE. The objective of this study was to evaluate the clinical manifestations, course, treatment, and prognosis of late-onset SLE. Patients who developed SLE after/or at the age of 50 years were considered late-onset SLE and compared to a group of randomly selected patients aged younger than 50 years at the diagnosis, matched for disease duration. Lower frequency of cutaneous manifestations (p = 0.01) and higher frequency of cytopenias (p = 0.02) were registrated at the SLE onset in the late-onset group. Atypical clinical presentation of SLE contributed to a longer delay of diagnosis in late-onset SLE patients (p = 0.005), who fullfiled less American College of Rheumatology criteria at the diagnosis (p = 0.022). Cumulative incidence of clinical manifestations showed lower frequency of cutaneous (p = 0.017), neuropsychiatric manifestations (p = 0.021), lupus nephritis (p = 0.006), and higher frequency of Sjogren's syndrome (p = 0.025) in the late-onset group. Late-onset SLE patients received lower doses of corticosteroid (p = 0.006) and cyclophosphamide (p = 0.001) and had more cyclophosphamide-induced complications (p = 0.005). Higher prevalence of comorbid conditions in the late-onset group (p = 0.025), and higher Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index was noticed (p = 0.018). Despite the less major organ involvement and more benign course of disease, late-onset SLE has poorer prognosis, because of the higher frequency of comorbid conditions and higher organ damage, due to the aging and longer exposition to a classical vascular risk factors.

Screen-film versus digital radiography of sacroiliac joints: evaluation of image quality and dose to patients.

The purpose of this paper is to evaluate the image quality and dose to patients in the radiography of sacroiliac joints and to perform a clinical comparative study of digital and conventional screen-film radiography. Routine radiography of sacroiliac joint was performed in 60 patients using digital and screen-film radiography. The visibility of five anatomical regions and the overall image quality were rated by experienced radiologists. Patient dose assessment in terms of entrance surface air kerma (ESAK) was performed. The digital system showed slightly improved visualisation of specific anatomical structures. Overall image quality was significantly better in the digital when compared with the screen-film imaging system. The average ESAK was 2.4 mGy in screen-film and 3.6 mGy in digital radiography. The digital radiography provided equal or better visibility of anatomical details and overall image quality, but on higher dose levels. Therefore, the practice on digital systems must be optimised.

[Quality of treatment in gouty patients considering EULAR recommendations].

INTRODUCTION: There are 12 recommendations for gout treatment, based on evidence and opinion of experts. OBJECTIVE: To assess the quality of therapy in patients with gout analyzing adherence to four selected recommendations. METHODS: Retrospective cross sectional study of 111 patients with gouty flare was conducted. Adherence to selected recommendation was defined as odds ratio between the number of patients whose therapy adhered to treatment recommendation and the number of patients eligible for the relevant recommendation. These recommendations refer to indications for allopurinol treatment (R1), prophylaxis of induced gouty flares in the first month of allopurinol treatment (R2), treatment goals (R3), and treatment monitoring regime (R4). RESULTS: Out of 111 patients with gout, 25 with tophi, 87 with frequent gouty flares and 46 with CUA or X-ray erosions were indicated for allopurinol treatment. The adherence to R1 was 76% for tophi patients, 54% for patients with frequent gouty flares, and 63% for patients with CUA. None of the patients starting allopurinol was either recruited for gouty prophylaxis or monitored properly; adherence to R2 as well as to R4 was 0%. Target serum uric acid (SUc) rating below 360 micromol/L was achieved in 13/50 patients treated with allopurinol, while the adherence to R3 was 26%. Therapeutic monitoring in accordance with P4 was not done in any of the patients on allopurinol. There were no differences in mean levels of the SUc between allopurinol users and non-users: 471.3 +/- 164.4 vs. 460.0 +/- 103.5 micromol/L (p = 0.067). Therefore, almost every second patient with gouty flares was on allopurinol therapy (50/111). CONCLUSION: The degree of deviation in relation to the key principles of correct treatment in patients with gout ranged from a relatively high (24%) to that of absolute digression (100%).

[Ultrasonography of the first metatarsophalangeal joint in gout].

INTRODUCTION: About one half of the first gout attacks occur in the first metatarsophalangeal joint (MTPJ1); in the disease course this joint is practically inevitably affected. Radiographic evidence of bone erosions is the indication for hypouricaemic therapy in order to prevent joint destruction and nephropathy. Advantages of ultrasonography (US) comparing to conventional x-ray findings in depicting early bone erosions in various inflammatory arthropathies have been demonstrated by several studies. OBJECTIVE: The aims of this study were to compare US and x-ray findings in the detection of MTPJ1 erosions in patients with gout, to correlate sonographic and clinical features, and to detect possible characteristic sonographic features of gout. METHODS: Thirty patients (60 MTPJ1) with primary gout (ACR) and 10 age-matched control subjects (20 MTPJ1) with different inflammatory arthropathies were clinically evaluated. Standard dorsiplantar weight bearing and lateral weight bearing x-ray views of both feet were taken. US was performed and interpreted by an independent sonographer on the presence of bone erosions, synovial fluid, synovial hypertrophy, Doppler signal and hyperechoic spots. Statistical analysis was performed (Spearman and Pearson correlation coefficient, Wilcoxon and chi2 test.) RESULTS: Twenty-four studied MTPJ1 had evidence of erosions, 17 only on US and seven both on x-ray and on US (Z = -4.123; p = 0.000). US findings showed that hyperechoic spots were the most prominent feature of gouty MTPJ1 (chi2 = 40.909; p = 0.000), followed by erosions and synovial fluid presentation. CONCLUSION: US of MTPJ1 in gout discovers significantly more erosions than x-ray, which may have therapeutic implications. The evidence of hyperechoic spots (surrogate crystals) of the different size, number and orientation is a major sonographic feature of the MTPJ1 in gout, which may be of importance in the diagnosis of certain cases (low serum urate, unavailable synovial fluid or the urate crystals absence).