Rheumatoid Arthritis: Carruthers D

Foster W, Shantsila E, Carruthers D, Lip GY, Blann AD. · University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK. · Rheumatology (Oxford). · Pubmed #19153145 No free full text.

Abstract: OBJECTIVES: RA is associated with endothelial cell dysfunction (ECD) and increased cardiovascular mortality and morbidity. Circulating endothelial cells (CECs) are a novel marker of severe endothelial damage. We hypothesized altered CECs in patients with RA compared with community controls (CCs) and hospital controls (HCs, with diabetes and hypertension) correlate with established plasma markers of inflammation and of ECD. METHODS: CECs (CD146-immunobeads), von Willebrand factor, soluble E-selectin, soluble intercellular adhesion molecule-1, soluble vascular endothelial adhesion molecule-1 (sVCAM, all ELISA) and C-reactive protein (CRP, immunonephelometry) were measured in 57 patients with RA, 45 CC and 23 HC patients. RESULTS: CECs in RA [median/interquartile range 8 (5-13.5) cells/ml] were elevated compared with either CC [4 (2-8.5) cells/ml] or HC [4 (1-8) cells/ml] (both P < 0.001). Levels of CECs did not correlate with other markers of ECD or of inflammation but did correlate inversely with sVCAM. CONCLUSION: Evidence of endothelial damage in the form of mildly increased numbers of CECs is present in RA and is independent of plasma markers of inflammation and of ECD.

Foster W, Carruthers D, Lip GY, Blann AD. · University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK. · Thromb Res. · Pubmed #18692223 No free full text.

This publication has no abstract.

Smith N, Gadsby K, Butt S, Carruthers D, Deeming A, Ledingham J, Fletcher M, Mulherin D, Roskell S, Kay L, Nicholl K, Cooper R, Worsley A, Deighton C. · Department of Rheumatology, Derbyshire Royal Infirmary, London Road, Derby, England, UK DE1 2QY. · Rheumatology (Oxford). · Pubmed #17666440 No free full text.

Abstract: OBJECTIVES: National Institute for Health and Clinical Excellence (NICE) guidelines for anti-tumour necrosis factor (TNF) in rheumatoid arthritis (RA) state that two pre-assessments of Disease Activity Score (DAS28) should be performed a month apart. We performed a retrospective audit of data from six centres to determine the stability of DAS28 between assessments, and the proportion of patients still satisfying eligibility criteria at baseline. METHODS: All RA patients assessed for anti-TNF from six centres had their pre-assessment DAS28 (DAS-1) compared with their baseline DAS28 (DAS0) using paired t-tests, and a similar analysis for the components of the DAS28. Patients who were no longer eligible for anti-TNF at DAS0 were noted. RESULTS: Six hundred and seventy-nine RA patients showed no significant change in the DAS28, with a mean DAS-1 of 6.74 and DAS0 of 6.73. (P = 0.86). Of the patients, 97.2% fulfilled the UK eligibility criteria at DAS0. Comparison of the individual components of the DAS28 between the two pre-assessment dates showed that there was no significant difference between either the numbers of swollen joints or the erythrocyte sedimentation rate (ESR), but there was a significant increase in the numbers of tender joints of 1.41 (P < 0.001) and in the visual analogue scale (VAS) of 4.22 (P < 0.001). DISCUSSION: The overwhelming majority of patients who fulfil eligibility criteria for anti-TNF drugs 1 month prior to baseline also fulfil the criteria at baseline. There is no significant change in the DAS28 over the month waiting to go onto anti-TNF therapy. A single assessment of the DAS28 would suffice to enable patients to go on to anti-TNF treatment.