Rheumatoid Arthritis: Möller I

Naredo E, Möller I, Cruz A, Carmona L, Garrido J. · Hospital Severo Ochoa, Madrid, Spain. <> · Arthritis Rheum. · Pubmed #18668537 links to  free full text

Abstract: OBJECTIVE: To evaluate the validity, responsiveness, and predictive value of power Doppler ultrasonography (PDUS) monitoring of response to tumor necrosis factor (TNF) blocking agents in rheumatoid arthritis (RA). METHODS: Three hundred sixty-seven RA patients were prospectively recruited at 25 Spanish centers; complete clinical, laboratory, and PDUS data were obtained on 278 patients. The patients underwent clinical, laboratory, and PDUS assessment at baseline and after 1, 3, 6, and 12 months of anti-TNF treatment, and radiographic assessment of the hands and feet at baseline and 12 months. The Disease Activity Score in 28 joints (DAS28) was recorded at each visit. PDUS examination included 86 intraarticular and periarticular sites in 28 joints. US synovial fluid (SF), synovial hypertrophy (SH), and PD signal were scored in all synovial sites. US count and index for SF, SH, and PD signal were obtained. Sensitivity to change of the PDUS variables was assessed by estimating the smallest detectable difference (SDD) from the intraobserver variability. RESULTS: A significant parallel improvement in DAS28 and PDUS parameters was found at followup assessment (P < 0.0005 for within-subject between-visit changes). The SDD for PDUS parameters was lower than the mean changes throughout followup. Time-integrated values of US joint count for PD signal and rheumatoid factor (RF) showed predictive value in relation to progression of radiographic erosion (R = 0.64), and time-integrated values of US joint count for PD signal, RF, and erythrocyte sedimentation rate were predictors of progression of the total radiographic score (R = 0.59). CONCLUSION: These findings indicate that PDUS is a valid method for monitoring response to anti-TNF therapy in RA; results obtained by PDUS are reproducible and sensitive to change. PDUS findings may have predictive value in relation to radiologic outcome.

Bruyn GA, Naredo E, Möller I, Moragues C, Garrido J, de Bock GH, d'Agostino MA, Filippucci E, Iagnocco A, Backhaus M, Swen WA, Balint P, Pineda C, Milutinovic S, Kane D, Kaeley G, Narvaez FJ, Wakefield RJ, Narvaez JA, de Augustin J, Schmidt WA. · Department of Rheumatology, Medisch Centrum Leeuwarden, 8934 AD Leeuwarden, Leeuwarden, The Netherlands. · Ann Rheum Dis. · Pubmed #18390570 No free full text.

Abstract: OBJECTIVE: To assess the intra and interobserver reproducibility of musculoskeletal ultrasonography (US) among rheumatologists in detecting destructive and inflammatory shoulder abnormalities in patients with rheumatoid arthritis (RA) and to determine the overall agreement between US and MRI. METHODS: A total of 14 observers examined 5 patients in 2 rounds independently and blindly of each other. US results were compared with MRI. Overall agreement of all findings, of positive findings on MRI, as well as intra and interobserver reliabilities, were calculated. RESULTS: Overall agreement between US and MRI was seen in 79% with regard to humeral head erosions (HHE), in 64% with regard to posterior recess synovitis (PRS), in 31% with regard to axillary recess synovitis (ARS), in 64% with regard to bursitis, in 50% with regard to biceps tenosynovitis (BT), and in 84% for complete cuff tear (CCT). Intraobserver and interobserver kappa was 0.69 and 0.43 for HHE, 0.29 and 0.49 for PRS, 0.57 and 1.00 for ARS, -0.17 and 0.51 for bursitis, 0.17 and 0.46 for BT and 0.52 and 0.6 for CCT, respectively. The intraobserver and interobserver kappa for power Doppler (PD) was 0.90 and 0.70 for glenohumeral signals and 0.60 and 0.51 for bursal signals, respectively. CONCLUSIONS: US is a reliable imaging technique for most shoulder pathology in RA especially with regard to PD. Standardisation of scanning technique and definitions of particular lesions may further enhance the reliability of US investigation of the shoulder.

Vergés J, Montell E, Tomàs E, Cumelles G, Castañeda G, Marti N, Möller I. · Scientific Medical Department, Bioibérica Farma, Plaza Francesc Macia 7, 08029 Barcelona, Spain. · Proc West Pharmacol Soc. · Pubmed #15633634 No free full text.

Abstract: In daily clinical practice, many patients attribute joint pain to weather conditions. There is little information published on this subject and most of it is contradictory. The objective of this study was to evaluate the effect of climatic conditions in rheumatic patients. The present work was carried out with patients attending the Instituto Poal de Reumatologia of Barcelona and the data were analyzed by Bioibérica Farma (Spain). It was a prospective, double-blind study including 92 patients with rheumatic disorders (80 with osteoarthritis, 12 with rheumatoid arthritis) compared to a control group of 42 subjects. The evaluation of pain (Huskisson VAS) and functional capacity (Health Assessment Questionnaire, HAQ) were determined daily during one month. The climatic variables studied were temperature, humidity and barometric pressure. The results obtained have been subject to binary regression analysis. Our data demonstrate that osteoarthritic patients experience increased joint pain in response to a decrease in pressure, indicating that low atmospheric pressure conditions exacerbate joint pain in these patients. Our work also suggests that some meteorological variables affect the occurrence of pain in rheumatoid arthritis, since we have found that low temperature increases the risk of joint pain. Therefore, these data suggest that in the future it may be possible to modulate pharmacological and non-pharmacological treatments for some osteoarthritic patients depending on the predictable weather conditions in order to avoid, as much as possible, the disease-associated joint pain and functional incapacity, thus improving patients' quality of life.