Publications by authors named "Sergio Toloza"

33 Publications

Drivers of Satisfaction With Care for Patients With Lupus.

ACR Open Rheumatol 2019 Dec 6;1(10):649-656. Epub 2019 Nov 6.

Cedars-Sinai Medical Center, Los Angeles, California.

Objective: Quality of life (QOL) and quality of care (QOC) in systemic lupus erythematosus (SLE) remains poor. Satisfaction with care (SC), a QOC surrogate, correlates with health behaviors and outcomes. This study aimed to determine correlates of SC in SLE.

Methods: A total of 1262 patients with SLE were recruited from various countries. Demographics, disease activity (modified Systemic Lupus Erythematosus Disease Activity Index for the Safety of Estrogens in Lupus Erythematosus: National Assessment trial [SELENA-SLEDAI]), and QOL (LupusPRO version 1.7) were collected. SC was collected using LupusPRO version 1.7. Regression analyses were conducted using demographic, disease (duration, disease activity, damage, and medications), geographic (eg, China vs United States), and QOL factors as independent predictors.

Results: The mean (SD) age was 41.7 (13.5) years; 93% of patients were women. On the univariate analysis, age, ethnicity, current steroid use, disease activity, and QOL (social support, coping) were associated with SC. On the multivariate analysis, Asian participants had worse SC, whereas African American and Hispanic patients had better SC. Greater disease activity, better coping, and social support remained independent correlates of better SC. Compared with US patients, patients from China and Canada had worse SC on the univariate analysis. In the multivariate models, Asian ethnicity remained independently associated with worse SC, even after we adjusted for geographic background (China). No associations between African American or Hispanic ethnicity and SC were retained when geographic location (Canada) was added to the multivariate model. Canadian patients had worse SC when compared with US patients. Higher disease activity, better social support, and coping remained associated with better SC.

Conclusion: Greater social support, coping, and, paradoxically, SLE disease activity are associated with better SC. Social support and coping are modifiable factors that should be addressed by the provider, especially in the Asian population. Therefore, evaluation of a patient's external and internal resources using a biopsychosocial model is recommended. Higher disease activity correlated with better SC, suggesting that the latter may not be a good surrogate for QOC or health outcomes.
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http://dx.doi.org/10.1002/acr2.11085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917325PMC
December 2019

Sex Differences in Quality of Life in Patients With Systemic Lupus Erythematosus.

Arthritis Care Res (Hoboken) 2019 12 20;71(12):1647-1652. Epub 2018 Dec 20.

University of Alabama at Birmingham.

Objective: Systemic lupus erythematosus (SLE) predominantly affects women. Clinical phenotype and outcomes in SLE may vary by sex and are further complicated by unique concerns that are dependent upon sex-defined roles. We aimed to describe sex differences in disease-specific quality of life (QoL) assessment scores using the Lupus Patient-Reported Outcome (LupusPRO) tool in a large international study.

Methods: Cross-sectional data from 1,803 patients with SLE on demographics, self-identified sex status, LupusPRO, and disease activity were analyzed. The LupusPRO tool has 2 constructs: health-related QoL (HRQoL) and non-HRQoL. Disease activity and damage were evaluated using the Safety of Estrogens in Lupus Erythematosus National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, respectively. Nonparametric tests were used to compare QoL and disease activity by sex.

Results: A total of 122 men and 1,681 women with SLE participated. The mean age was similar by sex, but the damage scores were greater among men. Men fared worse on the non-HRQoL social support domain than women (P = 0.02). When comparing disease and QoL among men and women ages ≤45 years, men were found to have greater damage and worse social support than women. However, women fared significantly worse on lupus symptoms, cognition, and procreation domains with trends for worse functioning on physical health and pain-vitality domains.

Conclusion: In the largest study of a diverse group of SLE patients, utilizing a disease-specific QoL tool, sex differences in QoL were observed on both HRQoL and non-HRQoL constructs. Although men performed worse in the social support domain, women (especially those in the reproductive age group) fared worse in other domains. These observations may assist physicians in appropriately addressing QoL issues in a sex-focused manner.
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http://dx.doi.org/10.1002/acr.23588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202275PMC
December 2019

Work disability in Argentinian patients with systemic lupus erythematosus is prevalent and it is due to ethnic, socioeconomic and disease-related factors.

Int J Rheum Dis 2018 Nov 2;21(11):2019-2027. Epub 2018 Apr 2.

Hospital de San Isidro, Ciudad de San Isidro, Argentina.

Objective: To study the prevalence and the associated factors of work disability (WD) in systemic lupus erythematosus (SLE) patients.

Methods: A sample of 419 SLE patients from an observational cross-sectional multicenter study was included. Sociodemographic features, disease characteristics, comorbidities, quality of life, unhealthy behaviors, and work-related factors were measured in a standardized interview. Work disability was defined by patient self-report of not being able to work because of SLE. To identify variables associated with work disability, two different multivariate regression models using a stepwise backward method were performed.

Results: Prevalence of WD due to SLE was 24.3%. Eighty-nine percent were female and 51% were Caucasians. Mean disease duration was 8.9 ± 7.2 years, and median System Lupus International Collaborating Clinics/American College of Rheumatology damage index SLICC-SDI was 1.5 (range 0-17). In stepwise multivariate logistic regression, living below the poverty line (odds ratio [OR] = 4.65), less than 12 years of education (OR = 2.84), Mestizo ethnicity (OR = 1.94) and SLICC-SDI (OR = 1.25) were predictors of WD. A second model was performed including patient-derived measures; in this model sedentary lifestyle (OR = 2.69) and lower emotional health domain score of the Lupus Quality of Life (LupusQoL) questionnaire (OR = 1.03) were found to be associated to WD and a higher score in LupusQoL physical health domain (OR = 0.93) was protective.

Conclusion: The prevalence of WD in Argentinian SLE patients was 24.3%. WD was associated with ethnic (Mestizo), socioeconomic (poverty) and disease-related factors. Patient-related outcomes such us sedentary lifestyle and poor emotional quality of life were also associated with WD.
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http://dx.doi.org/10.1111/1756-185X.13269DOI Listing
November 2018

Effects of Amerindian Genetic Ancestry on Clinical Variables and Therapy in Patients with Rheumatoid Arthritis.

J Rheumatol 2017 Dec 1;44(12):1804-1812. Epub 2017 Nov 1.

From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Departamento de Inmunología y Reumatología, Hospital General de Occidente y Universidad de Guadalajara, Zapopan; Unidad de Investigación "Dr. Mario Alvizouri Muñoz" Hospital General "Dr. Miguel Silva," Secretaría de Salud de Michoacán, Morelia; Servicio de Reumatología del Departamento de Medicina Interna, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González," Universidad Autonoma de Nuevo León, Monterrey; Departamento de Reumatología, Hospital General de Culiacán, Culiacán; Unidad de Reumatología, Hospital General de México "Dr. Eduardo Liceaga"; Unidad de Biología Molecular y Medicina Genómica from Instituto de Investigaciones Biomédicas de la Universidad Nacional Autónoma de México, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Hospital Provincial de Rosario; Instituto Lucha Antipoliomielítica de Rosario (ILAR); Hospital Escuela Eva Perón, Granadero Baigorria; Hospital José Maria Cullen; Hospital J.B. Iturraspe, Santa Fe; Hospital San Martín, Paraná; Hospital Privado de Córdoba; Hospital Italiano de Córdoba; Instituto Reumatológico Strusberg, Córdoba; Hospital Cosme Argerich; Hospital Italiano de Buenos Aires; Organización Médica Integral; Centro de Educación Médica e Investigaciones Clínicas (CEMIC); Instituto de Rehabilitación Psicofísica (IREP); Hospital Bernardino Rivadavia; Hospital de Clínicas de Buenos Aires, Buenos Aires; H.I.G.A. San Martín, La Plata; H.I.G.A. Oscar E. Alende, Mar del Plata; Centro Medico Privado de Reumatología; FUNIPSE, San Miguel de Tucumán, Tucumán; Hospital Interzonal San Juan Bautista, Catamarca; Hospital G. Rawson, San Juan; Sanatorio Parque, Rosario, Argentina; Facultad Medicina Occidente, and Facultad de Medicina Campus Centro, Universidad de Chile, Santiago de Chile, Chile; Servicio de Reumatología, Hospital Nacional Guillermo Almenara I, EsSalud y Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú; GENYO, Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica, Granada, Spain; Unit of Chronic Inflammatory Diseases, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

Objective: To define whether Amerindian genetic ancestry correlates with clinical and therapeutic variables in admixed individuals with rheumatoid arthritis (RA) from Latin America.

Methods: Patients with RA (n = 1347) and healthy controls (n = 1012) from Argentina, Mexico, Chile, and Peru were included. Samples were genotyped for the Immunochip v1 using the Illumina platform. Clinical data were obtained through interviews or the clinical history.

Results: Percentage of Amerindian ancestry was comparable between cases and controls. Morning stiffness (p < 0.0001, OR 0.05), rheumatoid factor (RF; p < 0.0001, OR 0.22), radiographic changes (p < 0.0001, OR 0.05), and higher number of criteria were associated with lower Amerindian ancestry after Bonferroni correction. Higher Amerindian ancestry correlated only with weight loss (p < 0.0001, OR 2.85). Increased Amerindian ancestry correlated with higher doses of azathioprine (p < 0.0001, OR 163.6) and sulfasalazine (p < 0.0001, OR 48.6), and inversely with methotrexate (p = 0.001, OR 0.35), leflunomide (p = 0.001, OR 0.16), and nonsteroidal antiinflammatory drugs (p = 0.001, OR 0.37). Only the presence of RF and weight loss were modified after confounders adjustment.

Conclusion: Amerindian ancestry protects against most major clinical criteria of RA, but regarding the association of RF with increased European ancestry, age, sex, and smoking are modifiers. Ancestry also correlates with the therapeutic profiles.
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http://dx.doi.org/10.3899/jrheum.160485DOI Listing
December 2017

Transancestral mapping and genetic load in systemic lupus erythematosus.

Nat Commun 2017 07 17;8:16021. Epub 2017 Jul 17.

Division of Rheumatology, Department of Medicine (DIMED), University of Padua, Padua 35122, Italy.

Systemic lupus erythematosus (SLE) is an autoimmune disease with marked gender and ethnic disparities. We report a large transancestral association study of SLE using Immunochip genotype data from 27,574 individuals of European (EA), African (AA) and Hispanic Amerindian (HA) ancestry. We identify 58 distinct non-HLA regions in EA, 9 in AA and 16 in HA (∼50% of these regions have multiple independent associations); these include 24 novel SLE regions (P<5 × 10), refined association signals in established regions, extended associations to additional ancestries, and a disentangled complex HLA multigenic effect. The risk allele count (genetic load) exhibits an accelerating pattern of SLE risk, leading us to posit a cumulative hit hypothesis for autoimmune disease. Comparing results across the three ancestries identifies both ancestry-dependent and ancestry-independent contributions to SLE risk. Our results are consistent with the unique and complex histories of the populations sampled, and collectively help clarify the genetic architecture and ethnic disparities in SLE.
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http://dx.doi.org/10.1038/ncomms16021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520018PMC
July 2017

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis.

Arthritis Rheumatol 2016 05 23;68(5):1060-71. Epub 2016 Mar 23.

University of Rochester Medical Center, Rochester, New York.

Objective: To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA).

Methods: GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire.

Results: Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema.

Conclusion: We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves.
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http://dx.doi.org/10.1002/art.39573DOI Listing
May 2016

Genome-Wide Association Study in an Amerindian Ancestry Population Reveals Novel Systemic Lupus Erythematosus Risk Loci and the Role of European Admixture.

Arthritis Rheumatol 2016 Apr;68(4):932-43

Hospital Universitario Dr. José Eleuterio González Universidad Autonoma de Nuevo León, Monterrey, Mexico.

Objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a strong genetic component. We undertook the present work to perform the first genome-wide association study on individuals from the Americas who are enriched for Native American heritage.

Methods: We analyzed 3,710 individuals from the US and 4 countries of Latin America who were diagnosed as having SLE, and healthy controls. Samples were genotyped with HumanOmni1 BeadChip. Data on out-of-study controls genotyped with HumanOmni2.5 were also included. Statistical analyses were performed using SNPtest and SNPGWA. Data were adjusted for genomic control and false discovery rate. Imputation was performed using Impute2 and, for classic HLA alleles, HiBag. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.

Results: The IRF5-TNPO3 region showed the strongest association and largest OR for SLE (rs10488631: genomic control-adjusted P [Pgcadj ] = 2.61 × 10(-29), OR 2.12 [95% CI 1.88-2.39]), followed by HLA class II on the DQA2-DQB1 loci (rs9275572: Pgcadj  = 1.11 × 10(-16), OR 1.62 [95% CI 1.46-1.80] and rs9271366: Pgcadj  = 6.46 × 10(-12), OR 2.06 [95% CI 1.71-2.50]). Other known SLE loci found to be associated in this population were ITGAM, STAT4, TNIP1, NCF2, and IRAK1. We identified a novel locus on 10q24.33 (rs4917385: Pgcadj  = 1.39 × 10(-8)) with an expression quantitative trait locus (eQTL) effect (Peqtl  = 8.0 × 10(-37) at USMG5/miR1307), and several new suggestive loci. SLE risk loci previously identified in Europeans and Asians were corroborated. Local ancestry estimation showed that the HLA allele risk contribution is of European ancestral origin. Imputation of HLA alleles suggested that autochthonous Native American haplotypes provide protection against development of SLE.

Conclusion: Our results demonstrate that studying admixed populations provides new insights in the delineation of the genetic architecture that underlies autoimmune and complex diseases.
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http://dx.doi.org/10.1002/art.39504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829354PMC
April 2016

Comprehensive treatment of dactylitis in psoriatic arthritis.

J Rheumatol 2014 Nov;41(11):2295-300

From the US National Institutes of Health, Bethesda, Maryland, USA; Rheumatology, Ministry of Health, San Fernando del Valle de Catamarca, Argentina; Department of Rheumatology, Hospital Militar Central, Faculty of Medicine UMNG, Bogotá, Colombia; University of Leeds, Leeds; and Bradford Hospitals NHS Foundation Trust, Bradford, UK.S. Rose, MD, PhD, Metzger Clinical Scholar, National Institutes of Health; S. Toloza, MD, Rheumatology, Ministry of Health; W. Bautista-Molano, MD, PhD(c), Department of Rheumatology, Hospital Militar Central, Faculty of Medicine UMNG; P.S. Helliwell, DM, PhD, FRCP, Senior Lecturer in Rheumatology, University of Leeds and Bradford Hospitals NHS Foundation Trust. Drs. Rose and Toloza contributed equally to this report.

Dactylitis, a hallmark clinical feature of psoriatic arthritis (PsA) and other spondyloarthropathies, may also be a severity marker for PsA and psoriasis. Traditionally, clinicians have used nonsteroidal antiinflammatory drugs and local corticosteroid injections to treat dactylitis, although conventional disease-modifying antirheumatic drugs are also used. We performed a systematic literature review to determine the most efficacious current treatment options for dactylitis in PsA. Effect sizes were greatest for the biologic agents ustekinumab, certolizumab, and infliximab, suggesting that therapy with one of these agents should be initiated in patients with dactylitis. However, the limited data highlight the need for randomized, placebo-controlled trials, with dactylitis as a primary outcome, to determine a valid, reliable, and responsive clinical outcome measure for PsA patients with dactylitis.
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http://dx.doi.org/10.3899/jrheum.140879DOI Listing
November 2014

Impact of race and ethnicity in the course and outcome of systemic lupus erythematosus.

Rheum Dis Clin North Am 2014 Aug 7;40(3):433-54, vii-viii. Epub 2014 Jun 7.

Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, 510 20 Street South, FOT 830, Birmingham, AL 35294, USA. Electronic address:

Genetic factors seem to play a more important role early in the course of systemic lupus erythematosus (SLE), whereas nongenetic factors seem to play a more important role over the course of the disease. SLE is more frequent with less favorable outcomes in nonwhite populations. To overcome these differences and reduce the immediate-term, mediate-term, and long-term impact of SLE among disadvantaged populations, it is essential to increase disease awareness, to improve access to health care and to provide care to these patients in a consistent manner regardless of the severity of their disease.
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http://dx.doi.org/10.1016/j.rdc.2014.04.001DOI Listing
August 2014

Work instability in rheumatoid arthritis patients from Argentina: prevalence and associated factors.

Rheumatol Int 2015 Jan 20;35(1):107-14. Epub 2014 Jun 20.

Reumatologia, Organizacion Medica de Investigacion. Servicio Nacional de Rehabilitacion, Buenos Aires, Argentina,

To determine the prevalence of and associated factors to work instability (WI) in rheumatoid arthritis (RA) Argentinean patients. Observational cross-sectional study that assessing employment status in currently working RA patients. They answered the validated version of RA work instability scale (RA-WIS). High-risk WI was considered when RA-WIS was ≥17. Factors associated with high-risk WI were examined by univariable and multivariable analysis. Four-hundred and fifty RA patients were enrolled; of these, 205 patients were currently employed, but only 172 have completed questionnaires required [RA-WIS and health assessment questionnaire (HAQ-A)]. Their mean age was 49.3 ± 10.8 years; 81.3 % were female; and their mean disease duration was 8.1 ± 7.2 years. Fifty-two percent of patients were doing manual work. The mean RA-WIS score was 11.4 ± 6.8, and 41 % of patients had a high-risk WI. High-risk WI was associated with radiographic erosions (p < 0.001) and HAQ-A >0.87 (p < 0.001) in the univariable analysis, whereas in the multivariable logistic regression analysis the variables associated with a high-risk WI were as follows: HAQ-A >0.87 [odds ratio (OR) 12.31; 95 % CI 5.38-28.18] and the presence of radiographic erosions (OR 4.848; 95 % CI 2.22-10.5). In this model, having a higher monthly income (OR 0.301; 95 % CI 0.096-0.943) and a better functional class (OR 0.151; 95 % CI 0.036-0.632) were protective. Forty-one percent of RA working patients had high-risk WI. The predictors of high RA-WIS were HAQ-A ≥0.87 and radiographic erosions, whereas having a better functional class and have higher incomes were protective.
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http://dx.doi.org/10.1007/s00296-014-3062-7DOI Listing
January 2015

Top 10 recent developments in health-related quality of life in patients with systemic lupus erythematosus.

Curr Rheumatol Rep 2013 Dec;15(12):380

Allegheny Health Network, Pittsburgh, PA, USA.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that has major implications for health-related quality of life (HRQoL). Improvements in the monitoring and management of SLE improves survival; however, improvement of HRQoL remains of paramount importance among these patients. Measurement of HRQoL has been recommended in clinical practice and research including drug development and testing in clinical trials. Both generic and disease specific instruments have been developed to ascertain HRQoL. In an increasingly global collaborative environment, the importance of assessing HRQoL across nations, acknowledgment of their confounders, and limitations of used instruments are critical. Here, we review selected major developments in the past 5 years highlighting: the importance of measuring HRQoL in SLE patients, the benefits and limitations of instruments that exist, and their application in research settings.
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http://dx.doi.org/10.1007/s11926-013-0380-9DOI Listing
December 2013

Report from the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine organization 2012 workshop.

J Clin Rheumatol 2013 Sep;19(6):329-31

Department of Rheumatology, Hospital Militar, Universidad Militar Nueva Granada/Universidad de La Sabana, Bogotá, Colombia.

The first annual meeting of the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine (LASSERIM) was held in Bogotá, Colombia, in September 2012 and was attended by key opinion leaders, researchers, and rheumatologists. The meeting included presentations and discussions from renowned speakers during 2 days and a coaching leadership exercise led by an expert in the field followed by an open forum. Two groups defined a priori discussed the establishment of a professional network and organization to be involved in the identification, assessment, and effective resolution of health care issues in Latin America.A broad spectrum of topics were discussed but focused on the following: pharmacoeconomics in general rheumatology, spondyloarthritis and chronic back pain, therapeutic interventions in rheumatoid arthritis, ultrasonography in spondyloarthritis, impact of social media in medicine and global trends in leadership, quality of life, and innovation. A special workshop on coaching in health care and coaching as a tool to implement LASSERIM goals was part of the 2-day conference.LASSERIM will be working in the future on education, research, and innovation in the field of rheumatology and immunology. A special focus will be on spondyloarthritis, by promoting research, open discussions, and by conducting carefully planned research studies to impact on the quality of life of patients and doctors from Latin American countries.
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http://dx.doi.org/10.1097/RHU.0b013e3182a21dfbDOI Listing
September 2013

Diffuse idiopathic skeletal hyperostosis in psoriatic arthritis.

J Rheumatol 2013 Aug 15;40(8):1367-73. Epub 2013 Jun 15.

Centre for Prognosis Studies in the Rheumatic Diseases University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.

Objective: To determine the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in patients with psoriatic arthritis (PsA) and to identify the features associated with its occurrence.

Methods: Patients were recruited from the University of Toronto PsA observational cohort initiated in 1978. All patients fulfilled the CASPAR criteria. Radiographs of peripheral joints and spine were obtained every 2 years. DISH was defined as flowing bony bridges in at least 4 contiguous thoracic vertebrae. Each PsA patient with DISH was matched by sex to 3 PsA patients without DISH. Demographics, disease characteristics, and radiographic features were compared using McNemar test, Fisher's exact test, chi-square test, and paired t test as appropriate. Logistic regression analyses models with stepwise regression were conducted.

Results: DISH was observed in 78 (8.3%) of 938 patients with PsA. Patients with DISH were older and had longer disease duration, higher body mass index (BMI), and higher uric acid levels. Diabetes and hypertension were more prevalent in patients with DISH than in those without. The severity of radiographic damage to peripheral joints was also greater in patients with DISH. The presence of inflammatory back pain, HLA-B*27 allele, and sacroiliitis was similar in both groups. Patients with DISH had more syndesmophytes and calcaneal spurs. Older age, higher BMI, and the presence of radiographic damage to peripheral joints were associated with DISH in multivariate analysis.

Conclusion: The diagnosis of DISH is possible in the presence of axial PsA. DISH was associated with known DISH-related factors including older age and high BMI, as well as the presence of radiographic damage to peripheral joints.
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http://dx.doi.org/10.3899/jrheum.121433DOI Listing
August 2013

Rheumatoid arthritis in Latin Americans enriched for Amerindian ancestry is associated with loci in chromosomes 1, 12, and 13, and the HLA class II region.

Arthritis Rheum 2013 Jun;65(6):1457-67

Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigaciones Oncológicas, Granada, Spain.

Objective: To identify susceptibility loci for rheumatoid arthritis (RA) in Latin American individuals with admixed European and Amerindian genetic ancestry.

Methods: Genotyping was performed in 1,475 patients with RA and 1,213 control subjects, using a customized BeadArray containing 196,524 markers covering loci previously associated with various autoimmune diseases. Principal components analysis (EigenSoft package) and Structure software were used to identify outliers and define the population substructure. REAP software was used to define cryptic relatedness and duplicates, and genetic association analyses were conducted using Plink statistical software.

Results: A strong genetic association between RA and the major histocompatibility complex region was observed, localized within BTNL2/DRA-DQB1- DQA2 (P = 7.6 × 10(-10) ), with 3 independent effects. We identified an association in the PLCH2-HES5-TNFRSF14-MMEL1 region of chromosome 1 (P = 9.77 × 10(-6) ), which was previously reported in Europeans, Asians, and Native Canadians. We identified one novel putative association in ENOX1 on chromosome 13 (P = 3.24 × 10(-7) ). Previously reported associations were observed in the current study, including PTPN22, SPRED2, STAT4, IRF5, CCL21, and IL2RA, although the significance was relatively moderate. Adjustment for Amerindian ancestry improved the association of a novel locus in chromosome 12 at C12orf30 (NAA25) (P = 3.9 × 10(-6) ). Associations with the HLA region, SPRED2, and PTPN22 improved in individuals positive for anti-cyclic citrullinated peptide antibodies.

Conclusion: Our data define, for the first time, the contribution of Amerindian ancestry to the genetic architecture of RA in an admixed Latin American population by confirming the role of the HLA region and supporting the association with a locus in chromosome 1. In addition, we provide data for novel putative loci in chromosomes 12 and 13.
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http://dx.doi.org/10.1002/art.37923DOI Listing
June 2013

Psoriasis and psoriatic arthritis in Peruvian aborigines: a report from the GRAPPA 2011 annual meeting.

J Rheumatol 2012 Nov;39(11):2216-9

Department of Medicine, Hospital San Juan Bautista, Catamarca, Argentina; Hospital III, Juliaca, Peru.

Objective: To determine the presence of psoriasis and psoriatic arthritis (PsA) in aboriginal people living in the Andean Mountains of Peru.

Methods: Consecutive patients with psoriasis and PsA attending an arthritis clinic in Juliaca, Puno, Peru, located 3824 m above sea level were examined. The CASPAR (ClASsification of Psoriatic ARthritis) criteria were used for classification of PsA. Diagnosis of psoriasis was confirmed by a dermatologist.

Results: Seventeen patients [11 (65%) men and 6 (35%) women] fulfilled classification criteria for PsA; one patient was of European ancestry and is not included in this report. Of the 16 aboriginal patients in this report, 5 were natives of Quechua ancestry and one was native Aymara. At the time of their first clinic visit, no native patient with PsA had a family history of psoriasis or PsA, and all patients exhibited an established disease of long duration and severity. Methotrexate was the drug of choice for all patients; 2 patients are currently receiving biological therapy.

Conclusion: Contrary to what has been reported in the literature, both psoriasis and PsA are present in aboriginal people from the Andean Mountains of Peru. More studies are needed to further define the phenotype of these disorders, as well as the pathogenetic role of genetic and environmental factors.
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http://dx.doi.org/10.3899/jrheum.120828DOI Listing
November 2012

Development and assessment of users' satisfaction with the systemic lupus erythematosus disease activity index 2000 responder index-50 website.

J Rheumatol 2013 Jan 1;40(1):34-9. Epub 2012 Nov 1.

Institute of Medical Science, the Lupus Clinic, University of Toronto, Toronto, Ontario, Canada.

Objective: To describe the development of the Systemic Lupus Erythematosus Disease Activity Index 2000 Responder Index-50 (S2K RI-50) Website (www.s2k-ri-50.com) and to assess satisfaction with its training and examination modules among rheumatologists and rheumatology fellows.

Methods: The development of the Website occurred in 3 phases. The first was a deployment phase that consisted of preparing the site map along with its content. The content included the S2K RI-50 training manual, the tests and corresponding question bank, and the online adaptive training module, along with the extensive site testing. The second phase included the participation of rheumatologists and trainees who completed the Website modules. The third was a quality assurance phase in which an online survey was developed to determine the satisfaction level of its users. Further modifications were implemented per participants' recommendations.

Results: The site has been online since it was registered in September 2010. Fourteen rheumatologists and rheumatology trainees from different centers reviewed and completed the material contained in the Website. The survey revealed acceptance among rheumatologists for the Website's content, design, and presentation. The Website was rated as user-friendly and useful in familiarizing investigators with the S2K RI-50. After completion of the training and examination modules, participants reported a suitable level of preparation to implement the S2K RI-50 in clinical trials and research settings in a timely manner.

Conclusion: The Website includes training and examination modules that familiarize rheumatologists with the S2K RI-50 and assesses their competence to use the index. This prepares them for the use of the S2K RI-50 in clinical trials and research settings.
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http://dx.doi.org/10.3899/jrheum.120754DOI Listing
January 2013

Global partnering opportunities and challenges of psoriasis and psoriatic arthritis in Latin America: a report from the GRAPPA 2010 annual meeting.

J Rheumatol 2012 Feb;39(2):445-7

Section of Rheumatology, Louisiana State University HealthSciences Center, New Orleans, Lousiana 70112-2822, USA.

Documenting the disease burden of psoriasis and psoriatic arthritis (PsA) in Central and South America is difficult. The most conclusive data have come from the Iberoamerican Registry of Spondyloarthritis (RESPONDIA), which registered patients with a diagnosis of spondyloarthritis in a multinational, multicenter (Argentina, Brazil, Costa Rica, Chile, Mexico, Peru, Uruguay, Venezuela, Spain, and Portugal) cross-sectional study conducted between 2006 and 2007. Compared with elsewhere in the Western world, patients with PsA from RESPONDIA were older at study visit, at onset of symptoms, and at diagnosis of spondyloarthritis (SpA); had longer mean disease duration from onset of symptoms to diagnosis; and were more likely to have dactylitis, nail involvement, enthesitis, and peripheral arthritis in lower and upper extremities. It is critical to understand the biologic basis, estimate the disease burden, and determine the clinical treatment of PsA in Latin America. The Group for Research and Assessment of Psoriasis and PsA (GRAPPA) has an increasing number of members from this region. In a coordinated effort, GRAPPA, the Latin American Psoriasis and PsA Society (LAPPAS), and the Pan American League of Associations for Rheumatology (PANLAR) are supporting clinician researchers with educational initiatives in Latin America to understand these conditions.
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http://dx.doi.org/10.3899/jrheum.111246DOI Listing
February 2012

Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity.

Arthritis Care Res (Hoboken) 2012 Feb;64(2):206-14

University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Objective: To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them.

Methods: A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0-10-cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance.

Results: The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels.

Conclusion: Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the "disease experience" of patients, particularly pain and fatigue, is warranted for effective care of RA.
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http://dx.doi.org/10.1002/acr.20685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703925PMC
February 2012

Treatment of lupus: impact on quality of life.

Curr Rheumatol Rep 2011 Aug;13(4):324-37

Hospital San Juan Bautista, Catamarca, Argentina.

Systemic lupus erythematosus (SLE) is an autoimmune disease that disproportionately affects women of childbearing age during their most productive years. Current therapeutic measures have improved patient survival; however, the impact of interventions on general and specific domains of health-related quality of life requires further study. Medical Outcomes Survey Short Form 36 (SF-36), the most commonly used measure, has been included in some SLE randomized controlled trials, but the observed effect sizes were generally small and in some cases negligible. An SLE patient's quality of life is known to be significantly worse than that of someone in the general population and perhaps worse than those with most other common chronic diseases. SF-36, although useful as a general measure, may not be the most sensitive way to gauge changes perceived by patients with SLE. Ongoing trials and observational longitudinal studies using lupus-specific health-related quality-of-life measures may help better determine health-related quality-of-life responses and determine the domains most amenable to interventions.
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http://dx.doi.org/10.1007/s11926-011-0189-3DOI Listing
August 2011

Psoriatic arthritis in South and Central America.

Curr Rheumatol Rep 2011 Aug;13(4):360-8

Hospital San Juan Bautista, Catamarca, Argentina.

Psoriasis and its related manifestations, including psoriatic arthritis, are prevalent disorders in the Western world, particularly among Caucasians. The study of these disorders in Latin America lags way behind the study of other more common rheumatic disorders, such as rheumatoid arthritis and systemic lupus erythematosus. From the scarce evidence available, however, it appears that the prevalence and incidence of psoriasis and psoriatic arthritis are lower than in other parts of the Western world and almost negligible among natives from the Andean region, although confirmatory epidemiologic studies are lacking.
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http://dx.doi.org/10.1007/s11926-011-0185-7DOI Listing
August 2011

Systemic lupus erythematosus disease activity index 2000 responder index-50: a reliable index for measuring improvement in disease activity.

J Rheumatol 2011 May 15;38(5):868-73. Epub 2011 Feb 15.

Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada.

Objective: To test the interrater and intrarater reliability of the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) Responder Index (SRI-50), an index designed to measure ≥ 50% improvement in disease activity between visits in patients with systemic lupus erythematosus.

Methods: This was a multicenter, cross-sectional study with raters from Canada, the United Kingdom, and Argentina. Patient profile scenarios were derived from real adult patients. Ten rheumatologists from university and community hospitals and postdoctoral rheumatology fellows participated. An SRI-50 data retrieval form was used. Each rheumatologist scored SLEDAI-2K at the baseline visit and SRI-50 on followup visit, for the same patients, on 2 occasions 2 weeks apart. Physician global assessment (PGA) was determined on a numerical scale at baseline visit and a Likert scale on followup visit. Interrater and intrarater reliability was assessed using intraclass correlation coefficient (ICC) and kappa statistics whenever applicable.

Results: Forty patient profiles were created. The ICC performed on 80 patient profiles for interrater ranged from 1.00 for SLEDAI-2K and SRI-50 to 0.96 for PGA. The intrarater ICC for SLEDAI-2K, SRI-50, and PGA scores ranged from 1.00 to 0.86. Substantial agreement was determined for the interrater Likert scale, with a kappa statistic of 0.57.

Conclusion: The SRI-50 is reliable to assess ≥ 50% improvement in lupus disease activity. Use of the SRI-50 data retrieval form is essential to ensure optimal performance of the SRI-50. SRI-50 can be used by both rheumatologists and trainees and performs equally well in trained as well as untrained rheumatologists.
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http://dx.doi.org/10.3899/jrheum.101080DOI Listing
May 2011

Quality-of-life measurements in multiethnic patients with systemic lupus erythematosus: cross-cultural issues.

Curr Rheumatol Rep 2010 Aug;12(4):237-49

Hospital San Juan Bautista, Catamarca, Argentina.

Although the survival rate for systemic lupus erythematosus (SLE) has improved dramatically during the past 50 years, the quality of life of patients afflicted with this disease remains poor. Currently existent measures of disease activity and damage in SLE do not capture the patient's perspective and health-related quality of life (HRQoL). Most studies in SLE pertaining to HRQoL are from developed Western societies, with only a few from others. These studies have been conducted predominantly in women and using the Medical Outcomes Survey Short Form 36, a generic HRQoL instrument that has been shown not to be sensitive to change in lupus. Existent lupus-specific HRQoL measures have not yet been used in SLE clinical trials. New HRQoL research tools are currently undergoing validation in different countries, languages, and cultural settings, which may help dissect the underlying role of socioeconomic status and specific disease-related features that impact SLE-related quality of life.
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http://dx.doi.org/10.1007/s11926-010-0110-5DOI Listing
August 2010

Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study.

Arthritis Res Ther 2010 12;12(2):R42. Epub 2010 Mar 12.

Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.

Introduction: Work disability is a major consequence of rheumatoid arthritis (RA), associated not only with traditional disease activity variables, but also more significantly with demographic, functional, occupational, and societal variables. Recent reports suggest that the use of biologic agents offers potential for reduced work disability rates, but the conclusions are based on surrogate disease activity measures derived from studies primarily from Western countries.

Methods: The Quantitative Standard Monitoring of Patients with RA (QUEST-RA) multinational database of 8,039 patients in 86 sites in 32 countries, 16 with high gross domestic product (GDP) (>24K US dollars (USD) per capita) and 16 low-GDP countries (<11K USD), was analyzed for work and disability status at onset and over the course of RA and clinical status of patients who continued working or had stopped working in high-GDP versus low-GDP countries according to all RA Core Data Set measures. Associations of work disability status with RA Core Data Set variables and indices were analyzed using descriptive statistics and regression analyses.

Results: At the time of first symptoms, 86% of men (range 57%-100% among countries) and 64% (19%-87%) of women <65 years were working. More than one third (37%) of these patients reported subsequent work disability because of RA. Among 1,756 patients whose symptoms had begun during the 2000s, the probabilities of continuing to work were 80% (95% confidence interval (CI) 78%-82%) at 2 years and 68% (95% CI 65%-71%) at 5 years, with similar patterns in high-GDP and low-GDP countries. Patients who continued working versus stopped working had significantly better clinical status for all clinical status measures and patient self-report scores, with similar patterns in high-GDP and low-GDP countries. However, patients who had stopped working in high-GDP countries had better clinical status than patients who continued working in low-GDP countries. The most significant identifier of work disability in all subgroups was Health Assessment Questionnaire (HAQ) functional disability score.

Conclusions: Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.
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http://dx.doi.org/10.1186/ar2951DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888189PMC
September 2010

International multicenter psoriasis and psoriatic arthritis reliability trial for the assessment of skin, joints, nails, and dactylitis.

Arthritis Rheum 2009 Sep;61(9):1235-42

Toronto Western Hospital, Toronto, Ontario, Canada.

Objective: Clinical trials in psoriasis and psoriatic arthritis (PsA) involve assessment of the skin and joints. This study aimed to determine whether assessment of the skin and joints in patients with PsA by rheumatologists and dermatologists is reproducible.

Methods: Ten rheumatologists and 9 dermatologists from 7 countries met for a combined physical examination exercise to assess 20 PsA patients (11 men, mean age 51 years, mean PsA duration 11 years). Each physician assessed 10 patients according to a modified Latin square design that enabled the assessment of patient, assessor, and order effect. Tender joint count (TJC), swollen joint count (SJC), dactylitis, physician's global assessment (PGA) of PsA disease activity (PGA-PsA), psoriasis body surface area (BSA), Psoriasis Area and Severity Index (PASI), Lattice System Physician's Global Assessment of psoriasis (LS-PGA), National Psoriasis Foundation Psoriasis Score (NPF-PS), modified Nail Psoriasis Severity Index (mNAPSI), number of fingernails with nail changes (NN), and PGA of psoriasis activity (PGA-Ps) were assessed. Variance components analyses were carried out to estimate the intraclass correlation coefficient (ICC), adjusted for the order of measurements.

Results: There is excellent agreement (ICC >/=0.80) on the mNAPSI, substantial agreement (0.6 >/= ICC < 0.80) on the TJC, PASI, and NN, moderate agreement (0.4 >/= ICC < 0.60) on the PGA-Ps, LS-PGA, NPF-PS, and BSA, and fair agreement (0.2 >/= ICC < 0.40) on the SJC, dactylitis, and PGA-PsA. The only measure that showed a significant difference between dermatologists and rheumatologists was dactylitis (P = 0.0005).

Conclusion: There is substantial to excellent agreement on the TJC, PASI, NN, and mNAPSI among rheumatologists and dermatologists.
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http://dx.doi.org/10.1002/art.24562DOI Listing
September 2009

Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study.

Arthritis Res Ther 2009 14;11(1):R7. Epub 2009 Jan 14.

Jyväskylä Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, and Medcare Oy, Hämeentie 1, 44100 Aänekoski, Finland.

Introduction: Gender as a predictor of outcomes of rheumatoid arthritis (RA) has evoked considerable interest over the decades. Historically, there is no consensus whether RA is worse in females or males. Recent reports suggest that females are less likely than males to achieve remission. Therefore, we aimed to study possible associations of gender and disease activity, disease characteristics, and treatments of RA in a large multinational cross-sectional cohort of patients with RA called Quantitative Standard Monitoring of Patients with RA (QUEST-RA).

Methods: The cohort includes clinical and questionnaire data from patients who were seen in usual care, including 6,004 patients at 70 sites in 25 countries as of April 2008. Gender differences were analyzed for American College of Rheumatology Core Data Set measures of disease activity, DAS28 (disease activity score using 28 joint counts), fatigue, the presence of rheumatoid factor, nodules and erosions, and the current use of prednisone, methotrexate, and biologic agents.

Results: Women had poorer scores than men in all Core Data Set measures. The mean values for females and males were swollen joint count-28 (SJC28) of 4.5 versus 3.8, tender joint count-28 of 6.9 versus 5.4, erythrocyte sedimentation rate of 30 versus 26, Health Assessment Questionnaire of 1.1 versus 0.8, visual analog scales for physician global estimate of 3.0 versus 2.5, pain of 4.3 versus 3.6, patient global status of 4.2 versus 3.7, DAS28 of 4.3 versus 3.8, and fatigue of 4.6 versus 3.7 (P < 0.001). However, effect sizes were small-medium and smallest (0.13) for SJC28. Among patients who had no or minimal disease activity (0 to 1) on SJC28, women had statistically significantly higher mean values compared with men in all other disease activity measures (P < 0.001) and met DAS28 remission less often than men. Rheumatoid factor was equally prevalent among genders. Men had nodules more often than women. Women had erosions more often than men, but the statistical significance was marginal. Similar proportions of females and males were taking different therapies.

Conclusions: In this large multinational cohort, RA disease activity measures appear to be worse in women than in men. However, most of the gender differences in RA disease activity may originate from the measures of disease activity rather than from RA disease activity itself.
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http://dx.doi.org/10.1186/ar2591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688237PMC
September 2009

Remission and rheumatoid arthritis: data on patients receiving usual care in twenty-four countries.

Arthritis Rheum 2008 Sep;58(9):2642-51

Jyväskylä Central Hospital, Jyväskylä, Finland, and Medcare Oy, Aänekoski, Finland.

Objective: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA).

Methods: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR) definition, Disease Activity Score in 28 joints (DAS28), Clinical Disease Activity Index (CDAI), clinical remission assessed using 42 and 28 joints (Clin42 and Clin28), patient self-report Routine Assessment of Patient Index Data 3 (RAPID3), and physician report of no disease activity (MD remission).

Results: The overall remission rate was lowest using the ACR definition of remission (8.6%), followed by the Clin42 (10.6%), Clin28 (12.6%), CDAI (13.8%), MD remission (14.2%), and RAPID3 (14.3%); the rate of remission was highest when remission was defined using the DAS28 (19.6%). The difference between the highest and lowest remission rates was >or=15% in 10 countries, 5-14% in 7 countries, and <5% in 7 countries (the latter of which had generally low remission rates [<5.5%]). Regardless of the definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular exercise were statistically significantly associated with remission.

Conclusion: The use of different definitions of RA remission leads to different results with regard to remission rates, with considerable variation among countries and between sexes. Reported remission rates in clinical trials and clinical studies have to be interpreted in light of the definition of remission that has been used.
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http://dx.doi.org/10.1002/art.23794DOI Listing
September 2008

Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study.

Arthritis Res Ther 2008 6;10(2):R30. Epub 2008 Mar 6.

Hospital de Gran Canaria Dr, Negrin, University of Las Palmas de Gran Canaria, Barranco de la Ballena s/n 35011, Spain.

Introduction: We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care.

Methods: The study involved a clinical assessment by a rheumatologist and a self-report questionnaire by patients. The clinical assessment included a review of clinical features of RA and exposure to DMARDs over the course of RA. Comorbidities were recorded; CV morbidity included myocardial infarction, angina, coronary disease, coronary bypass surgery, and stroke. Traditional risk factors recorded were hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and body mass index. Unadjusted and adjusted hazard ratios (HRs) (95% confidence interval [CI]) for CV morbidity were calculated using Cox proportional hazard regression models.

Results: Between January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years. The prevalence for lifetime CV events in the entire sample was 3.2% for myocardial infarction, 1.9% for stroke, and 9.3% for any CV event. The prevalence for CV risk factors was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43% for ever-smoking, 73% for physical inactivity, and 18% for obesity. Traditional risk factors except obesity and physical inactivity were significantly associated with CV morbidity. There was an association between any CV event and age and male gender and between extra-articular disease and myocardial infarction. Prolonged exposure to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59; 95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98), glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents (HR 0.42; 95% CI 0.21 to 0.81; P < 0.05) was associated with a reduction of the risk of CV morbidity; analyses were adjusted for traditional risk factors and countries.

Conclusion: In conclusion, prolonged use of treatments such as methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor necrosis factor-alpha blockers appears to be associated with a reduced risk of CV disease. In addition to traditional risk factors, extra-articular disease was associated with the occurrence of myocardial infarction in patients with RA.
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http://dx.doi.org/10.1186/ar2383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453774PMC
September 2008

Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study.

Arthritis Rheum 2008 Jan;59(1):42-50

Jyväskylä Central Hospital, Jyväskylä, Finland.

Objective: Regular physical activity is associated with decreased morbidity and mortality. Traditionally, patients with rheumatoid arthritis (RA) have been advised to limit physical exercise. We studied the prevalence of physical activity and associations with demographic and disease-related variables in patients with RA from 21 countries.

Methods: The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) is a cross-sectional study that includes a self-report questionnaire and clinical assessment of nonselected consecutive outpatients with RA who are receiving usual clinical care. Frequency of physical exercise (>or=30 minutes with at least some shortness of breath, sweating) is queried with 4 response options: >or=3 times weekly, 1-2 times weekly, 1-2 times monthly, and no exercise.

Results: Between January 2005 and April 2007, a total of 5,235 patients from 58 sites in 21 countries were enrolled in QUEST-RA: 79% were women, >90% were white, mean age was 57 years, and mean disease duration was 11.6 years. Only 13.8% of all patients reported physical exercise>or=3 times weekly. The majority of the patients were physically inactive with no regular weekly exercise: >80% in 7 countries, 60-80% in 12 countries, and 45% and 29% in 2 countries, respectively. Physical inactivity was associated with female sex, older age, lower education, obesity, comorbidity, low functional capacity, and higher levels of disease activity, pain, and fatigue.

Conclusion: In many countries, a low proportion of patients with RA exercise. These data may alert rheumatologists to motivate their patients to increase physical activity levels.
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http://dx.doi.org/10.1002/art.23255DOI Listing
January 2008

Should all patients with systemic lupus erythematosus receive cardioprotection with statins?

Nat Clin Pract Rheumatol 2007 Oct;3(10):536-7

Centre for Prognosis Studies in the Rheumatic Diseases at Toronto Western Hospital, in Toronto, ON, Canada.

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http://dx.doi.org/10.1038/ncprheum0593DOI Listing
October 2007

QUEST-RA: quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries.

Ann Rheum Dis 2007 Nov 5;66(11):1491-6. Epub 2007 Apr 5.

Arkisto/Tutkijat, Jyvaskyla Central Hospital, 40620 Jyvaskyla, Finland.

Objective: To conduct a cross-sectional review of non-selected consecutive outpatients with rheumatoid arthritis (RA) as part of standard clinical care in 15 countries for an overview of the characteristics of patients with RA.

Methods: The review included current disease activity using data from clinical assessment and a patient self-report questionnaire, which was translated into each language. Data on demographic, disease and treatment-related variables were collected and analysed using descriptive statistics. Variation in disease activity on DAS28 (disease activity score on 28-joint count) within and between countries was graphically analysed. A median regression model was applied to analyse differences in disease activity between countries.

Results: Between January 2005 and October 2006, the QUEST-RA (Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis) project included 4363 patients from 48 sites in 15 countries; 78% were female, >90% Caucasian, mean age was 57 years and mean disease duration was 11.5 years. More than 80% of patients had been treated with methotrexate in all but three countries. Overall, patients had an active disease with a median DAS28 of 4.0, with a significant variation between countries (p<0.001). Among 42 sites with >50 patients included, low disease activity of DAS28 50% of patients had high disease activity of DAS28 >5.1.

Conclusions: This international multicentre cross-sectional database provides an overview of clinical status and treatments of patients with RA in standard clinical care in 2005-6 including countries that are infrequently involved in clinical research projects.
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http://dx.doi.org/10.1136/ard.2006.069252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2111618PMC
November 2007