Assessment of self-esteem and community integration in spondyloarthritis.

INTRODUCTION: The aim of this study was to identify the associated factors with lower self-esteem and restriction in community reintegration in SpA patients. METHODS: This study was a cross-sectional study including SpA patients (ASAS criteria) aged 18-50 years. The level of self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). The Reintegration to Normal Living Index (RNLI) evaluated the degree of reintegration to normal social activities. Anxiety, depression, and fibromyalgia were screened by the Hospital Anxiety and Depression Scale (HADS)-A, HADS-D, and FiRST, respectively. Statistical analysis was performed. RESULTS: A total of 72 patients were enrolled (sex-ratio=1.88), with median (IQR) age of 39 years (28.25-46). Median (IQR) disease duration was 10 (6-14) years. Median (IQR) BASDAI and ASDAS were 3 (2.1-4.7) and 2.7 (1.9-3.48), respectively. Anxiety symptoms were screened in 10% of SpA patients, depression in 11%; and fibromyalgia in 10%. Median (IQR) RSES and RNLI scores were 30 (23.25-34), and 83 (53.25-93.25), respectively. Multivariate regression analysis identified the domain (work) of pain interference, VAS pain, HAD anxiety, PGA, marital status, and morning stiffness as factors associated with lower self-esteem. Restriction in the reintegration community was predicted by the presence of IBD, VAS pain, FIRST, deformity, enjoyment of life, and HAD depression. CONCLUSION: Pain intensity and interference, deformities, extra-articular manifestations, and deterioration of mental health were associated with low self-esteem and severe restriction in community reintegration among patients with SpA rather than inflammatory parameters.

Central Sensitization in Spondyloarthritis: The Crossroads between Disease Activity, Health-related Quality of Life and Fibromyalgia.

OBJECTIVE: To assess central sensitization in young patients with spondyloarthritis (SpA) and to study the associated factors with higher central sensitization scores. METHODS: This was a cross-sectional study including patients with SpA (ASAS criteria) aged less than 50 years. For all patients, we collected the sociodemographic and disease characteristics data. Central sensitization was assessed using a validated tool: The Central Sensitization inventory (CSI). Pain status, fibromyalgia, quality of life, anxiety and depression were screened by the Brief pain inventory, the Fibromyalgia rapid screening tool (FiRST), the ASQoL, and the Hospital anxiety and depression scale (HAD) anxiety and depression. Univariable and multivariable linear regression analyses were performed to achieve our objective. RESULTS: Seventy-two patients were enrolled (65,2% males). The median age was 39 (28,25-46) years. Median BASDAI and ASDAS-CRP scores were 3 (2.1 - 4.7) and 2.7 (1.9 - 3.48), respectively. The median value of the CSI score was 15 (6,25-33,75); a CSI≥40 was noted in 15.3% of patients. Depression, anxiety scores, fibromyalgia and impaired QoL were screened in 11%, 9,7%, 9,7%, and 44,4%, respectively. CSI≥40 was positively correlated with ASQoL, FiRST, HAD anxiety, HAD depression and the 5 categories of pain interference (mood, regular work, relationships, sleep and enjoyment of life). Multivariate analysis identified a predictive model which included the combination of FiRST, BASDAI and ASQoL. First was the strongest predictive factor of a higher central sensitization. CONCLUSION: CS is frequent among SpA patients and should be looked for in order to improve QoL.

Spinal radiographic progression is correlated with preclinical atherosclerosis in spondyloarthritis.

BACKGROUND: A higher prevalence of cardiovascular risk was observed in spondyloarthritis (SpA). The relationship between disease-related factors structural damage and subclinical atherosclerosis is still unknown. OBJECTIVE: The aim of our study was to evaluate the association of subclinical atherosclerosis with radiographic structural damage in patients with SpA. METHODS: Forty-seven SpA patients who fulfilled the ASAS criteria were enrolled in a case-control study conducted over 12 months and compared with 47 age and sex-matched healthy controls. None of the subjects had a previous history of cardiovascular diseases or cardiovascular risk factors. Demographic and disease characteristics were recorded. Structural lesions were evaluated using plain radiography, and two scoring tools were used to spine (BASRI and mSASSS). Subclinical atherosclerosis was assessed using ultrasound measurements of flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT). RESULTS: The median age of patients was 36 years. The sex ratio was 2.35. The median BASRI total score was 3 (IQR 2-4), median mSASSS score was 10 (IQR 415). cIMT was significantly increased in SpA patients compared to controls (p< 0.0001), and FMD was significantly lower in patients than in healthy subjects (p= 0.008). cIMT was significantly associated with ankylosis of the facet joints (p= 0.035) and Romanus spondylitis (p= 005). FMD was negatively associated with vertebral squaring (p= 0049), bridging syndesmophytes (p= 0031) and mSASSS score (p= 0.047). CONCLUSION: Our result supports the association of radiographic structural damage and subclinical atherosclerosis assessed using cIMT and FMD. This finding highlights the importance of earlier treatment in order to prevent radiographic damage progression and atherosclerotic events.

Adult-onset and Juvenile-onset Still's Disease: A Comparative Study of Both Sides.

BACKGROUND: Adult-onset Still's disease and systemic-onset juvenile idiopathic arthritis constitute two sides of the same continuum disease. We aimed to investigate the similarities and differences between those diseases. METHODS: We conducted a retrospective study including adult patients affected by still's disease, attending the rheumatology department and patients affected by systemic-onset juvenile idiopathic arthritis attending the pediatric department. We recorded clinical and radiological findings, different therapeutic regimens, and disease patterns. RESULTS: There were 8 adult patients (6 females and 2 males) and 8 juvenile patients (4 females and 4 males). The classical triad of spiking fever, arthritis, and evanescent skin rash was the first clinical presentation observed in 4 adult patients and in 2 juvenile patients. Arthritis was noted in 8 adult patients versus 6 juvenile patients. Joint deformities were seen in adult patients. Non-steroid antiinflammatory drugs and corticosteroids were the most prescribed molecules. csDMARDs and bDMARDs were used in second-line therapy only for adult patients. The monocyclic course was predominant in juvenile patients and the polycyclic course in adult patients. The chronic course was observed only in two adult patients. Remission was noted in 5 adult patients and 6 juvenile patients. There were no significant differences between the two groups regarding clinical findings, different therapeutic regimens, and disease patterns. CONCLUSION: From the findings of our study, it seems that AOSD and sJIA are the same syndrome continuum expressed in different hosts. This hypothesis is supported by clinical course, molecule evidence, cytokine profile, and treatment response.

Therapeutic drug monitoring of teriflunomide: do plasma concentrations predict response to leflunomide in patients with rheumatoid arthritis?

OBJECTIVES: Leflunomide is a commonly used treatment for rheumatoid arthritis. It acts by inhibiting dihydroorotate dehydrogenase through its active metabolite teriflunomide. The objective of the study was to investigate the relation between plasma-concentration of teriflunomide and disease-activity in rheumatoid arthritis. METHODS: Data were collected from patients with rheumatoid arthritis on a stable leflunomide dose for at least 2 months. Socio-demographic data, disease characteristics and DAS28 score were recorded. Blood samples were taken for determination of teriflunomide concentration. RESULTS: A total of 32 serum concentration-time measurements were collected. The concentration of teriflunomide was positively correlated with disease duration of RA (r2=0.2264) and the number of swollen joints (r2=0.2413). There was a trend towards a positive correlation between Health Assessment Questionnaire (HAQ) and plasma teriflunomide concentration (r2=0.1699). Weight was negatively correlated with the residual plasma concentration of teriflunomide (r2=0.2483). However, there was no significant correlation between residual-plasma-concentration of teriflunomide and the following parameters: age, sex, number of tender painful joints, patient-global-assessment, C-reactive protein (CRP) and duration of prescription of leflunomide. We did not find association between disease-activity and residual-plasma-concentration of teriflunomide (r2=0.0021) and haven't been able to define the threshold value of residual-plasma-concentration of leflunomide predictive of a good-response. CONCLUSIONS: We did not find a concentration-effect-relationship. However, therapeutic drug monitoring of teriflunomide may be useful to ensure adherence and evaluate toxic-levels in case of adverse-events.

Correlation between Abdominal Obesity and Pain in Knee Osteoarthritis.

OBJECTIVE: Obesity is an independent risk factor for the occurrence of knee osteoarthritis. The influence of abdominal obesity is not well studied. We proposed to determine the relationship between total abdominal obesity, pain, and functional impairment with the severity of radiographic changes in knee osteoarthritis. METHODS: A cross-sectional study including 92 patients with knee pain was performed. The evaluation of degree of pain in the knee was assessed by the visual analogue scale and the functional impairment by WOMAC and Lequesne indices. Radiographic severity was assessed by Kellgren and Lawrence score (KL score). RESULTS: Mean age of patients was 55.2 years (19-86), with a predominance of women (80.4% of patients). Mean body mass index (BMI) was 30.66 kg/m2 (18.5-49.97). Obesity was found in 53 patients (57.6%). The average waist circumference (WC) was 102.82 (± 15.51) centimeters. Abdominal obesity was found in 80 patients (87%). Patients had a mean visual analogue scale (VAS) of 18 ± 23.24 mm. The average algofunctionnal Lequesne score was 8.95 (0-23), and the WOMAC score was 26.82 (0-69). Fifty percent of patients had stage 3 of OA according to KL score. We found no association between BMI and intensity of knee pain (p = 0.278), but WC was significantly associated with the elevation of VAS (p = 0.008). Physical function was positively correlated with BMI and WC (p = 0.001). Finally, BMI and WC were significantly associated with radiographic severity (grade 1-2 of KL vs. grade 3-4 of KL) (respectively, p = 0.001; p = 0.017). CONCLUSION: Both obesity and abdominal obesity are independently associated with pain, disability, and radiographic severity of knee osteoarthritis.

Is improvement of fatigue in rheumatoid arthritis a proper effect of biologics?

Background. The objective of our present study is to assess the relation between persistent fatigue and rheumatoid arthritis (RA) disease activity and its functional impact and to determine if the positive effect of biologics on fatigue is due to good disease response or to a different pathway.Methods. A study cohort of patients with established RA was conducted. We included patients who had been prescried a biologic after at least failure of one conventional synthetic Disease Modifying Anti-Rheumatic Drug synthetic (csDMARDs). At baseline, patients had a moderately to highly active disease. Demographic characteristics, disease activity and functional impact were assessed by disease activity score (DAS28CRP) and health assessment questionnaire (HAQ) scores. Fatigue was evaluated by the Functional Assessment of Chronic Illness Therapy-Fatigue scale questionnaire (FACIT-F). Patients were examined before initiating biotherapy, then after three months and six months.Results. Thirty women with RA, with a mean age of 52.5 years, were included. At baseline, 57% received anti-TNFα: Etanercept (n = 9), Adalimumab (n = 6), Infliximab (n = 2) and 43% received Rituximab. Good Eular response was obtained in 80% of patients at the third month and 97% of patients at the sixth month. In the analytic study, a significant amelioration after 3 months of biotherapy was found in both disease response (DAS28CRP) and fatigue (FACIT-F), respectively (p = 0.01, p<0.001 and p<0.001). The disease activity decreased significantly also after sixth month (p = 0.01, p<0.001 and p = 0.012). In the linear multivariate analysis, the regression of visual analogic pain (VAS pain) was the only predictors of the improvement of fatigue.Conclusion. Biologics contribute to improve fatigue in patients with established RA and this effect seems to be independent from the clinical efficacy of this treatment.