Prolonged clinical remission and low disease activity statuses are associated with better quality of life in systemic lupus erythematosus.

OBJECTIVE: The objective of this study was to determine the association between disease activity status and health-related quality of life (HRQoL) in systemic lupus erythematosus (SLE) patients. METHODS: SLE patients in an out-patient clinic during the previous 12 months were included in the study. The Systemic Lupus Erythematosus-specific Quality-of-Life questionnaire (SLEQoL) was administered at the last visit. Disease activity status was determined retrospectively during the previous year. The categories of disease activity status were defined as: clinical remission (CR): clinical quiescent disease according to Systemic Lupus Erythematosus Disease Activity Index 2000, prednisolone ≤ 5 mg/day; low disease activity (LDA): SLEDAI-2K (without serological domain) ≤ 2, prednisolone ≤ 7.5 mg/day; and non-optimally controlled status: for those who were not in CR/LDA. Immunosuppressive drugs (maintenance dose) and antimalarials were allowed. Prolonged CR or LDA was defined as those with sustained CR or LDA for at least one year. The association between disease activity status and HRQoL was assessed by using regression analysis adjusting for other covariates. RESULTS: Of 237 SLE patients, 100 patients (42.2%) achieved prolonged CR, 46 patients (19.4%) achieved prolonged LDA and 91 patients (38.4%) were not in CR/LDA. Non-CR/LDA patients had significantly higher total SLEQoL score and in all domains compared to CR/LDA patients. No significant difference in SLEQoL domain scores was found between CR and LDA groups. Multivariable analysis revealed that non-CR/LDA was positively associated with SLEQoL score compared with CR/LDA (ß 20.02, 95% confidence interval (CI) 6.81-33.23, p < 0.003). Moreover, non-CR/LDA was at a higher risk of impaired QoL (SLEQoL score > 80) compared with CR (hazard ratio 3.8; 95% CI 1.82-7.95; p < 0.001). However, there was no significant difference between CR and LDA in terms of SLEQoL score or impaired QoL. Other factors associated with higher SLEQoL score were damage index (ß 9.51, 95% CI 3.52-15.49, p = 0.002) and anemia (ß 24.99, 95% CI 5.71-44.27, p = 0.01). CONCLUSION: Prolonged CR and LDA are associated with better HRQoL in SLE patients and have a comparable effect. Prolonged CR or optional LDA may be used as the treatment goal of a treat to target approach in SLE.

The efficacy, safety and carry-over effect of diacerein in the treatment of painful knee osteoarthritis: a randomised, double-blind, NSAID-controlled study.

OBJECTIVE: To evaluate the efficacy, safety and carry-over effect of diacerein, in comparison to piroxicam, in the treatment of Thai patients with symptomatic knee osteoarthritis (OA). DESIGN: This was a double-blind, randomised, piroxicam-controlled, parallel-group study. A 7-day non-steroidal anti-inflammatory drug washout period was followed by a 16-week treatment period with either diacerein 100mg/day or piroxicam 20mg/day, and an 8-week treatment-free observation period. The primary efficacy criterion was pain on Western Ontario and McMaster University Osteoarthritis (WOMAC) A. The secondary criteria included WOMAC B, C and total WOMAC, paracetamol intake, Short Form-36 questionnaire and global judgements on efficacy and tolerability by patients and investigators. RESULTS: Of 171 randomised patients, 150 completed the study and 161 were analysed in the intent-to-treat population (diacerein: 82, piroxicam: 79). Pain (WOMAC A) decreased to a similar extent in both groups at Week 16 (diacerein: -69.7%+/-31.5%; piroxicam: -74.1+/-26.2%; P=n.s.). On treatment discontinuation, pain increased in the piroxicam group at Weeks 20 (-47%+/-47.8%) and 24 (-26.8%+/-60.6%) while improvements persisted in the diacerein group at Weeks 20 (-66.9%+/-35.9%) and 24 (-69.5%+/-33.7%), with a significant difference in favour of diacerein at Weeks 20 and 24, demonstrating the carry-over effects of the drug. The incidence of adverse events was similar in both groups but more patients from the piroxicam group dropped out of the study due to these events. CONCLUSIONS: Diacerein was as effective as piroxicam in reducing pain and improving function but, unlike piroxicam, displayed a carry-over effect and a better safety profile.

Yttrium-90 radiochemical synovectomy in chronic knee synovitis: a one year retrospective review of 133 treatment interventions.

OBJECTIVE: To determine treatment success rates and factors predicting successful outcome using yttrium-90 intraarticular injections for chronic knee synovitis refractory to other treatments. METHODS: A retrospective one year review of 133 treatment interventions with yttrium-90 (Y-90) with response recorded at 3, 6, 9, and 12 mo after injection. RESULTS: An excellent, good, or fair response (a treatment benefit) as evaluated by objective (degree of joint effusion, joint tenderness, range of motion) and subjective (visual analog scale, degree of pain) assessments occurred in 81, 82, 80, and 75% of joints at 3, 6, 9, and 12 mo, respectively. When only excellent and good responses were considered successful treatment then 49, 48, 57, and 46% had successful treatment at 3, 6, 9, and 12 mo, respectively. 8 of 15 joints (53%) reinjected after primary treatment failure or relapse showed a beneficial response. Patients treated successfully were more likely to have a normal radiographic appearance rather than one showing destructive changes (78 vs 54% treatment success; p < 0.05); to have localized disease or systemic disease in remission, rather than active systemic disease (66 vs 30% treatment success; p < 0.001); and shorter duration of joint disease (6.9 vs 10.2 years; p < 0.05). CONCLUSION: Y-90 synovectomy successfully treats patients with chronic knee synovitis refractory to other therapies. Primary treatment failures or relapses may be successfully treated by reinjection. Patients with less destructive radiographic changes, shorter duration of joint disease, and localized disease tend to respond more favorably.