Functional outcome and subset identification in RA patients from meridional Europe: analysis of a Spanish cohort.

The aim of this study was to study the short-term functional and anatomical prognosis of rheumatoid arthritis (RA) in a series of Spanish patients and to identify different subsets of patients as well as possible baseline factors associated with specific outcomes. All patients seen in our division who met the ACR criteria for RA and with disease duration between 2 and 7 years were eligible for the study. Available patients were further evaluated at the clinic for disease activity using biological tests and joint indices as joint counts and Thompson's index, functional capacity using the ACR functional classification (ACR-FC) and the modified Health Assessment Questionnaire (M-HAQ) and radiologic damage by the Sharp's radiologic scoring method. Cluster analysis was used to identify different clinical subsets of patients. One hundred and sixty-three patients were eligible for the study, 13 could not be located or refused to participate and 12 had died. Mean (+/-SD) age at disease onset and mean disease duration were, respectively, 56(+/-14) years and (55+/-20) months. Median (interquartile range) of M-HAQ was 0.4 (0.1-1.1) and 41% of patients were in III or IV ACR-FC. The majority of patients (93%) showed radiologic lesions and 65% had erosions. Cluster analysis identified three subsets: cluster I (70% of patients) was characterised by a good prognosis, cluster II (13%) by a high level of disease activity, and cluster III (17%) by a greater anatomic damage and longer disease duration. No baseline predictive markers were found for these different outcomes. We concluded that RA portends an overall poor short-term prognosis in a relative large percentage of our patients with significant anatomic and functional sequelae. Aggressive management is specially indicated in this subgroup of patients, although definitive prognostic markers for its early identification are still lacking.

A double-blind randomised controlled trial of droxicam versus indomethacin in rheumatoid arthritis.

This double-blind randomized controlled trial compares the efficacy of droxicam (20mg/day) and that of indomethacin (100mg/day) administered to 20 patients (7 men, 13 women; aged 54.7 +/- 13.2 years) with active classical or definite rheumatoid arthritis during 9 weeks, after a 7-day single-blind run-in paracetamol (1,500mg/day) period. Evaluations were carried out at weeks 0 (washout), 1,2,4,6 and 9. After 9 weeks of treatment, both drugs showed a statistically significant improvement of joint pain intensity, articular index (number of swollen or painful joints and degree of involvement), duration of morning stiffness, functional capacity, and level of fatigue. Inter-treatment differences at all study intervals were not observed. Grip strength improved only in indomethacin-treated patients. Withdrawals due to lack of therapeutic efficacy did not occur. Side effects occurred in four patients from each group. One patient in the indomethacin group withdrew at the week 1 due to epigastric pain and heartburn. In conclusion, droxicam (20mg/day) seems to be as effective as indomethacin (100mg/day) in the alleviation of symptoms in patients with rheumatoid arthritis.

[Anti-DNA determination using Crithidia luciliae. Specificity and clinical usefulness in systemic lupus erythematosus]. / Anti-DNA par Crithidia luciliae. Spécificité et utilité clinique dans le lupus érythémateux systémique.

The authors determined the existence of native anti-DNA antibodies by the crithidia lucilae (anti-DNA-CL) test in 44 patients suffering from systemic lupus erythematosus (SLE), 48 with rheumatoid arthritis (RA), 12 with scleroderma, 8 with polymyositis and/or dermatomyositis, 12 with mixed connective tissue disease, 53 with chronic liver disease and 100 blood donors in order to establish the specificity of the test in SLE, its possible correlation with the degree of clinical activity and the presence or absence of neuropathy, and its possible use in the therapeutic control of the disease. The presence of anti DNA-CL was specific to SLE. It was seen at significant titres only in patients with active disease. Anti DNA-CL antibodies capable of activating complement were seen more frequently and at higher titres in cases with active nephritis. In longitudinal studies it was seen that clinical activity or inactivity were associated with parallel oscillations in anti DNA-CL titres. These data confirmed the specificity of the method and its usefulness in the diagnosis and therapeutic control of the process.