Smokers and non smokers with rheumatoid arthritis have similar clinical status: data from the multinational QUEST-RA database.

OBJECTIVES: To analyse clinical severity/activity of rheumatoid arthritis (RA) according to smoking status. METHODS: The QUEST-RA multinational database reviews patients for Core Data Set measures including 28 swollen and tender joint count, physician global estimate, erythrocyte sedimentation rate (ESR), HAQ-function, pain, and patient global estimate, as well as DAS28, rheumatoid factor (RF), nodules, erosions and number of DMARDs were recorded. Smoking status was assessed by self-report as 'never smoked', 'currently smoking' and 'former smokers'. Patient groups with different smoking status were compared for demographic and RA measures. RESULTS: Among the 7,307 patients with smoking data available, status as 'never smoked,' 'current smoker' and 'former smoker' were reported by 65%, 15% and 20%. Ever smokers were more likely to be RF-positive (OR 1.32;1.17-1.48, p<0.001). Rheumatoid nodules were more frequent in ever smokers (OR 1.41;1.24-1.59, p<0.001). The percentage of patients with erosive arthritis and extra-articular disease was similar in all smoking categories. Mean DAS28 was 4.4 (SD 1.6) in non-smokers vs. 4.0 (SD 1.6) in those who had ever smoked. However, when adjusted by age, sex, disease duration, and country gross domestic product, only ESR remained significantly different among Core Data Set measures (mean 31.7mm in non-smokers vs. 26.8mm in ever smoked category). CONCLUSIONS: RA patients who had ever smoked were more likely to have RF and nodules, but values for other clinical status measures were similar in all smoking categories (never smoked, current smokers and former smokers).

Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database.

OBJECTIVE: To analyse associations between the clinical status of patients with rheumatoid arthritis (RA) and the gross domestic product (GDP) of their resident country. METHODS: The Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) cohort includes clinical and questionnaire data from 6004 patients who were seen in usual care at 70 rheumatology clinics in 25 countries as of April 2008, including 18 European countries. Demographic variables, clinical characteristics, RA disease activity measures, including the disease activity score in 28 joints (DAS28), and treatment-related variables were analysed according to GDP per capita, including 14 "high GDP" countries with GDP per capita greater than US$24,000 and 11 "low GDP" countries with GDP per capita less than US$11,000. RESULTS: Disease activity DAS28 ranged between 3.1 and 6.0 among the 25 countries and was significantly associated with GDP (r = -0.78, 95% CI -0.56 to -0.90, r(2) = 61%). Disease activity levels differed substantially between "high GDP" and "low GDP" countries at much greater levels than according to whether patients were currently taking or not taking methotrexate, prednisone and/or biological agents. CONCLUSIONS: The clinical status of patients with RA was correlated significantly with GDP among 25 mostly European countries according to all disease measures, associated only modestly with the current use of antirheumatic medications. The burden of arthritis appears substantially greater in "low GDP" than in "high GDP" countries. These findings may alert healthcare professionals and designers of health policy towards improving the clinical status of patients with RA in all countries.

Elevated serum nitrate concentrations in active spondyloarthropathies.

We determined the concentrations of nitrate, reflecting endogenous nitric oxide (NO) production, by gas chromatography in the sera of patients with spondyloarthropathy. In those patients with active disease, as indicated by elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) serum nitrate levels (n = 7; mean 73.2 +/- s.d. 21.7 mumol/l) were significantly (P < 0.001) increased in comparison to patients with inactive spondyloarthropathy (n = 7; 31.7 +/- 9.5 mumol/l) and healthy volunteers (n = 10; 33.4 +/- 15.9 mumol/l). The nitrate serum levels correlated closely with CRP and ESR (r = 0.8, P < 0.001, each). There were no major differences in dietary nitrate intake between the study groups. The increased concentrations of serum nitrate in patients with active spondyloarthropathy indicate that NO production is enhanced in these patients.

[Quantitative shifts in acid phosphatase isoenzymes in the blood in myocardial infarct]. / Kolichestvennye sdvigi izofermentov kisloi fosfatazy v krovi bol'nykh infarktom miokarda.

The spectrum of acid phosphatase isoenzymes was studied by means of disk electrophoresis in polyacrylamide gel. Seven isofractions were detected of this enzyme in blood plasma. In patients with the acute stage of myocardial infarction the amount of isofraction 3 was increased, its electrophoretic mobility was 0.479 +/- 0.059. It is suggested to use the test for acid phosphatase fraction 3 in blood plasma as an auxiliary method in the diagnosis of pathological conditions of the myocardium.