Exploring the relationship between demographic and disease-related variables and perceived effect of health status on sexual activity in patients with axial spondyloarthritis: associations found only with non-disease variables.

OBJECTIVE: To explore the relationship between demographic and disease-related variables and the perceived effect of health status on sexual activity in patients with axial spondyloarthritis (ax-SpA). METHOD: The study assessed 379 ax-SpA patients consecutively recruited from two rheumatology outpatient clinics. Data collection included information on demographics, markers and measures of ax-SpA disease, treatment, comorbidity, and health-related quality of life (HRQoL) using the Short Form-36. The perceived effect of health status on sexual activity was assessed using question 15 in the HRQoL instrument 15D. RESULTS: The mean age of the patients was 45.6 years, 66.5% were men, 87.3% were human leucocyte antigen-B27 positive, and mean disease duration was 13.9 years. A total of 312 patients (82.3%) reported their health status to have no/little effect and 17.7% patients reported their health status to have a large negative effect on their sexual activity. In univariate analysis, increased body mass index (BMI), smoking, alcohol consumption, unemployed status, low physical activity, comorbidities, and higher disease activity (Bath Ankylosing Spondylitis Questionnaire), impaired body movement and lower HRQoL were associated with a large effect on sexual activity. In adjusted analyses, only female gender, high BMI, current smoking, and low HRQoL showed significant associations. CONCLUSION: Approximately 20% of ax-SpA patients reported a large negative effect on their sexual activity. Female gender, high BMI, current smoking, and reduced HRQoL were associated with health status having a large effect on sexual activity, whereas no measures reflecting ax-SpA disease showed an independent association.

Efficacy and safety of a novel synergistic drug candidate, CRx-102, in hand osteoarthritis.

OBJECTIVE: The novel synergistic drug candidate CRx-102 comprises dipyridamole and low dose prednisolone and is in clinical development for the treatment of immunoinflammatory diseases. The purpose of this clinical study was to examine the efficacy and safety of CRx-102 in patients with hand osteoarthritis (HOA). METHODS: The study was conducted as a blinded, randomised, placebo-controlled trial at four centres in Norway. Eligibility criteria included being of age 30-70 years, at least one swollen and tender joint, a Kellgren-Lawrence (K-L) score of 2 or higher on radiographs, and a score of at least 30 mm pain on the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) visual analogue pain scale (VAS). The primary endpoint was a reduction in pain from baseline to day 42 on the AUSCAN pain subscale. Two-sided p values for the differences in least squares (LS) means adjusted for baseline are presented. RESULTS: The mean age of the 83 patients with HOA was 60 years and 93% were females. CRx-102 was statistically superior to placebo at 42 days for changes in AUSCAN pain (LS mean -14.2 vs -4.0) and for clinically relevant secondary endpoints (joint pain VAS (-18.6 vs -6.3), patient global VAS (-15.9 vs -4.2)) in the intention to treat population. The most frequently reported adverse event during the study was headache (52% in CRx-102 vs 15% in the placebo group). CONCLUSIONS: The novel synergistic drug candidate CRx-102 demonstrated efficacy by statistically reducing pain compared to placebo in HOA and was generally well tolerated.

Polymyalgia rheumatica with low erythrocyte sedimentation rate at diagnosis.

OBJECTIVE: To determine the frequency and clinical characteristics of polymyalgia rheumatica (PMR) with low erythrocyte sedimentation rate (ESR) at diagnosis in a community based cohort of 232 patients. METHODS: A retrospective review of medical records of all the patients with a diagnosis of PMR in Olmsted County, Minnesota, seen and followed over a 22 year period, from 1970 through 1991. RESULTS: Seventeen (7.3%) patients had ESR < 40 mm/h at diagnosis. The findings and outcome in these patients were compared with the others in the group. There was no difference in sex or age between the 2 groups. Both groups had the same delay to diagnosis, typical gradual onset of the disease, the same frequency of both proximal and distal stiffness/pain, and the same frequency of synovitis. Systemic features were less frequent in the low ESR group than in the high ESR group (59 vs 81%, p = 0.05). Mean ESR in the low ESR group was 26+/-9 mm/h versus 74+/-24 mm/h in the high ESR group. The mean hemoglobin concentration was significantly lower (p = 0.0015) in the high compared to the low ESR group (12.2+/-1.4 g/dl versus 13.3+/-1.3 g/dl). The frequency of positive temporal artery biopsy and of diagnosed giant cell arteritis was the same in the 2 groups. Initial response to therapy, frequency of relapses, number of patients going into remission, time to remission, and daily dose of steroids were the same in both groups. CONCLUSION: Other than more frequent systemic symptoms, our population of patients with PMR and low ESR at diagnosis had similar clinical characteristics and course of disease as patients with high ESR at diagnosis.

Quantified neurological examination with emphasis on motor and sensory functions in patients with rheumatoid arthritis and controls.

A controlled study of quantified clinical neurological examination, including psychophysical assessment of sensory thresholds, in patients with rheumatoid arthritis (RA) was carried out. Fifty-five women with seropositive RA living in North Norway and 83 healthy controls underwent clinical neurological examination quantified by neurological symptom score (NSS) and neurological deficit score (NDS). Vibration threshold (VT), warm-cold detection threshold (limen) as well as heat pain detection threshold (HPDT) were performed to evaluate afferent myelinated and unmyelinated fibre functions. Higher scores on NSS and NDS were seen in RA patients compared with the controls. Higher index finger and big toe VT was demonstrated in the patients, while results from warm-cold limen and HPDT were not significantly different in the two groups. Among the disease-related variables, the most prominent finding was a positive association of index finger VT with disease duration in the patients (P = 0.01). Maximum walking time (15 m) was a significant predictor of big toe VT in the patient group (P = 0.0001). This study suggests impaired peripheral nerve function in afferent myelinated fibres. However, involvement of dorsal column fibres cannot be excluded, although patients with radiological atlantoaxial subluxation were not included in this study.

[Mixed connective tissue disease]. / Blandet bindevevssykdom.

Mixed connective tissue disease can be regarded as a distinct rheumatic disease syndrome. It can be differentiated from the other systemic rheumatic diseases and overlap syndromes, and has its own diagnostic criteria. The article presents symptoms, treatment, outcome, classification and diagnosis of mixed connective tissue disease. The most usual symptoms are Raynaud's phenomenon, swelling of the hands, polyarthritis, muscle weakness, oesophageal hypomotility and pulmonary disease. The recommended therapy should be based on patterns of involvement of organ systems and the severity of the disease. In severe cases the treatment is often a combination of corticosteroids and cytostatics. Due to severe impacts on lungs and kidneys it seems necessary to modify earlier predictions of a generally favourable outcome in patients with mixed connective tissue disease.