Treating rheumatoid arthritis to target: recommendations assessment questionnaire in Korea.

Treat rheumatoid arthritis (RA) to target (T2T) is an international initiative to provide the rheumatology community with clear direction on treatment targets for RA. We performed a nationwide survey in Korea among rheumatologists to measure the levels of agreement with international T2T recommendations and to assess their practical application in Korea. A questionnaire was administered to 111 physicians. Responses were assessed using a 10-point Likert scale for the level of agreement with each of 10 recommendations and a 4-point Likert scale for the degree to which each recommendation was being applied in current daily practice. Respondents were also asked whether these recommendations would result in a change in their practice. This report outlines the consensus reached for T2T in Korea and compares those results with data obtained internationally. Agreement with T2T recommendations was high with average response scores above 8.3. The majority of respondents indicated they applied the recommendations "always" and "very often" in daily practice. More than half of the participants not currently applying these recommendations were willing to change their practice, but the percentage of Korean physicians willing to change was consistently more than the international average. The results of this survey of T2T recommendations in Korean rheumatologists revealed a good correlation with the views of the international rheumatology community. These results could be utilized to define key issues for better disease control in daily practice and used as a reference to improve the treatment environment.

Evaluation of imputation-based association in and around the integrin-alpha-M (ITGAM) gene and replication of robust association between a non-synonymous functional variant within ITGAM and systemic lupus erythematosus (SLE).

We recently identified a novel non-synonymous variant, rs1143679, at exon 3 of the ITGAM gene associated with systemic lupus erythematosus (SLE) susceptibility in European-Americans (EAs) and African-Americans. Using genome-wide association approach, three other studies also independently reported an association between SLE susceptibility and ITGAM or ITGAM-ITGAX region. The primary objectives of this study are to assess whether single or multiple causal variants from the same gene or any nearby gene(s) are involved in SLE susceptibility and to confirm a robust ITGAM association across nine independent data sets (n = 8211). First, we confirmed our previously reported association of rs1143679 (risk allele 'A') with SLE in EAs (P = 1.0 x 10(-8)) and Hispanic-Americans (P = 2.9 x 10(-5)). Secondly, using a comprehensive imputation-based association test, we found that ITGAM is one of the major non-human leukocyte antigen susceptibility genes for SLE, and the strongest association for EA is the same coding variant rs1143679 (log(10)Bayes factor=20, P = 6.17 x 10(-24)). Thirdly, we determined the robustness of rs1143679 association with SLE across three additional case-control samples, including UK (P = 6.2 x 10(-8)), Colombian (P = 3.6 x 10(-7)), Mexican (P = 0.002), as well as two independent sets of trios from UK (P(TDT) = 1.4 x 10(-5)) and Mexico (P(TDT) = 0.015). A meta-analysis combing all independent data sets greatly reinforces the association (P(meta) = 7.1 x 10(-50), odds ratio = 1.83, 95% confidence interval = 1.69-1.98, n = 10 046). However, this ITGAM association was not observed in the Korean or Japanese samples, in which rs1143679 is monomorphic for the non-risk allele (G). Taken together along with our earlier findings, these results demonstrate that the coding variant, rs1143679, best explains the ITGAM-SLE association, especially in European- and African-derived populations, but not in Asian populations.