Comparison of composite disease activity indices for rheumatoid arthritis.

To evaluate the composite disease activity indices for rheumatoid arthritis (RA), we compared disease activities and the changes therein calculated using the Disease Activity Score based on 28 joint counts using erythrocyte sedimentation rate (DAS28-ESR), DAS28-CRP (C-reactive protein), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) in a cohort of 1,412 patients with RA. The median (1st; 3rd quartile) scores were 4.20 (3.31; 5.14) for DAS28-ESR, 3.44 (2.59; 4.36) for DAS28-CRP, 13.6 (7.49; 21.1) for SDAI, and 12.0 (6.9; 18.9) for CDAI. Absolute scores and their changes were significantly correlated (p < 0.0001) in all combinations among these four disease activity indices; however, their correlations were lower in males than in females. Correlations between disease activity indices and the clinical and acute phase reactant variables were different according to disease activity index, sex and age. A comparison of the number of patients in each disease activity category according to the disease activity indices using kappa-statistics revealed an almost perfect agreement between SDAI and CDAI (κ = 0.871), a moderate agreement between DAS28-ESR and SDAI (κ = 0.415) or CDAI (κ = 0.427), but only fair agreement between DAS28-ESR and DAS28-CRP (κ = 0.329). For the selection of a disease activity index for an evaluation of RA patients, both the convenience and the characteristics of the respective disease activity index should be considered.

Influences of anti-tumour necrosis factor agents on postoperative recovery in patients with rheumatoid arthritis.

The aim of this study is to investigate the influences of the anti-tumour necrosis factor (TNF) agents infliximab and etanercept on the postoperative recovery of patients with rheumatoid arthritis (RA). We also investigated the effects of biologics on wound healing. Patients with RA were split into a TNF group (n = 39) that underwent 39 operations and were treated with anti-TNF agents, and a non-TNF group (n = 74) that underwent 74 operations and were treated only with conventional disease-modifying antirheumatic drugs. Operations included ankle arthrodesis and total arthroplasty of the hip, knee, elbow, shoulder and ankle. Adverse events (AEs) of surgical wounds, time for complete wound healing, febrile period after operation and recovery parameters after operation (%recovery of haemoglobin (Hb), total protein and albumin at 4 weeks after operation compared with pre-operation levels) were investigated. AEs of surgical wounds occurred in two operations (5.1%) in the TNF group and in five operations (6.8%) in the non-TNF group, but this difference was not statistically significant. There were also no significant differences in the time for complete wound healing and in the length of the febrile period between the two groups. Percentage recovery of Hb was significantly better in the TNF group than in the non-TNF group (96.3% vs. 90.1%, respectively; p < 0.05). These results suggest that the use of anti-TNF agents does not cause specific AEs on surgical wounds after elective orthopaedic operations in RA patients and might improve the percentage recovery of Hb due to its prompt anti-TNF effects.

Prevalence of joint replacement surgery in rheumatoid arthritis patients: cross-sectional analysis in a large observational cohort in Japan.

The purpose of this study was to describe the prevalence of total joint arthroplasty (TJA) in Japanese rheumatoid arthritis (RA) patients undergoing conventional drug treatment in a large observational cohort in Japan. A total of 5,177 RA patients were studied for the prevalence of TJA, who were enrolled in the NinJa database during the fiscal year of 2006. The cases of 2,695 RA patients with more than ten years of disease duration were extracted and subjected to further analysis. The prevalence of TJA increased in accordance with the disease duration, and the prevalence was markedly increased after ten years. Among the 2,695 patients with more than ten years of disease duration, 1,431 TJAs were performed in 645 (24.6%) patients. The patients with TJA had higher disease activity than those without TJA. In this cross-sectional study, TJAs were performed in approximately a quarter of the Japanese RA patients with more than ten years of disease duration. The result showed that patients with higher disease activity required TJA.

Disease Activity Score 28 (DAS28) using C-reactive protein underestimates disease activity and overestimates EULAR response criteria compared with DAS28 using erythrocyte sedimentation rate in a large observational cohort of rheumatoid arthritis patients in Japan.

OBJECTIVES: To compare disease activity and the improvement of disease activity evaluated between by Disease Activity Score 28 using erythrocyte sedimentation rate (DAS28-ESR) and by DAS28 using C-reactive protein (DAS28-CRP) in Japanese patients with rheumatoid arthritis (RA). METHODS: Data from 3073 RA patients registered in the large cohort database (NinJa: National Database of Rheumatic Diseases by iR-net in Japan) of 2003 was used to calculate DAS28-ESR and DAS28-CRP and disease activities were evaluated. Improvements in disease activities were also evaluated according to the European League Against Rheumatism (EULAR) response criteria in 1482 RA patients whose DAS28-ESR and DAS28-CRP could be calculated from data for both 2002 and 2003. RESULTS: The mean value of DAS28-CRP (3.59, SD 1.25) was significantly smaller than that of mean DAS28-ESR (4.31, SD 1.32) (p < 0.0001). The number of patients who satisfied the criteria of remission was 297 (9.7%) in DAS28-ESR versus 705 (22.9%) in DAS28-CRP and the number of patients with high disease activity was 842 (27.4%) versus 357 (11.6%) for DAS28-ESR and DAS28-CRP, respectively; there was a significant difference between the two (p < 0.0001). Change of respective DAS28 was significantly correlated (DeltaDAS28-ESR -0.05, SD 1.14 versus DeltaDAS28-CRP -0.10, SD 1.10) (p < 0.0001); however, the number of "good response" patients was significantly different (p < 0.03) between DAS28-ESR (97 patients, 6.5%) and DAS28-CRP (136 patients, 9.2%). CONCLUSIONS: DAS28-CRP significantly underestimated disease activity and overestimated the improvement in disease activity compared with DAS28-ESR. DAS28-CRP should be evaluated using different criteria from that for DAS28-ESR.

Survival after total joint arthroplasty in patients with rheumatoid arthritis. Comparison of the postoperative life expectancies and survival by initial operative years: 1970s and 1980s group versus 1990s group.

Abstract A total of 867 patients with rheumatoid arthritis (RA) underwent 1764 total joint arthroplasties (total hip arthroplasty and/or total knee arthroplasty) over three decades from 1970 to 1999. A survey on their postoperative survival was conducted in December 2000 in which these patients were divided into two groups. The patients who had their initial arthroplasty in the period 1970 to 1989 were classified as the "70s and 80s group," and those who had their initial arthroplasty from 1990 to 1999 were classified as the "90s group." Using the Kaplan-Meier method, their cumulative survival rates were compared. The survival rates of the 70s and 80s group, consisting of 433 patients, were 84.8% at the 5th postoperative year, 60.1% at the 10th year, and 45.3% at the 15th year. Although the survey period of the 90s group is shorter than that of the 70s and 80s group, their survival rates were 90.2% at the 5th year and 84.3% at the 10th year. At present, the life expectancies of the 90s group are good, and their cumulative survival rate is significantly greater than that of the 70s and 80s group (P < 0.01). It seems that this improvement has been contributed to by the recent increase in the number of RA patients with good prognoses and the well-timed application of arthroplasty, which decreases the number of patients with poor risk.