Rheumatoid Arthritis: Symmons DP

Symmons DP. · No affiliation provided · Arthritis Rheum. · Pubmed #18668582 No free full text.

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Hyrich KL, Watson KD, Isenberg DA, Symmons DP, Anonymous00067. · No affiliation provided · Rheumatology (Oxford). · Pubmed #18596052 No free full text.

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Goodson NJ, Farragher TM, Symmons DP. · No affiliation provided · J Rheumatol. · Pubmed #18528946 links to  free full text

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Scott DL, Symmons DP. · No affiliation provided · Rheumatology (Oxford). · Pubmed #18245801 No free full text.

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Symmons DP. · No affiliation provided · Rheumatology (Oxford). · Pubmed #17215261 links to  free full text

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Symmons DP. · No affiliation provided · Rheumatology (Oxford). · Pubmed #16936333 links to  free full text

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Hider SL, Buckley C, Silman AJ, Symmons DP, Bruce IN. · No affiliation provided · J Rheumatol. · Pubmed #15700388 links to  free full text

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Hider SL, Bruce IN, Silman AJ, Symmons DP. · No affiliation provided · J Rheumatol. · Pubmed #15630715 links to  free full text

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Symmons DP, Silman AJ. · No affiliation provided · Arthritis Rheum. · Pubmed #15188344 links to  free full text

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Symmons DP, Hazes JM, Silman AJ. · No affiliation provided · J Rheumatol. · Pubmed #12734878 No free full text.

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Harrison MJ, Dixon WG, Watson KD, King Y, Groves R, Hyrich KL, Symmons DP, Anonymous00028, Anonymous00029. · ARC Epidemiology Unit, The University of Manchester, Manchester, UK. · Ann Rheum Dis. · Pubmed #18385277 links to  free full text

Abstract: BACKGROUND: Anti-tumour necrosis factor (TNF)alpha treatments improve outcome in severe rheumatoid arthritis (RA) and are efficacious in psoriasis and psoriatic arthritis. However recent case reports describe psoriasis occurring as an adverse event in patients with RA receiving anti-TNFalpha therapy. OBJECTIVES: We aimed to determine whether the incidence rate of psoriasis was higher in patients with RA treated with anti-TNFalpha therapy compared to those treated with traditional disease-modifying antirheumatic drugs (DMARDs). We also compared the incidence rates of psoriasis between the three anti-TNFalpha drugs licensed for RA. METHODS: We studied 9826 anti-TNF-treated and 2880 DMARD-treated patients with severe RA from The British Society for Rheumatology Biologics Register (BSRBR). All patients reported with new onset psoriasis as an adverse event were included in the analysis. Incidence rates of psoriasis were calculated as events/1000 person years and compared using incidence rate ratios (IRR). RESULTS: In all, 25 incident cases of psoriasis in patients receiving anti-TNFalpha therapy and none in the comparison cohort were reported between January 2001 and July 2007. The absence of any cases in the comparison cohort precluded a direct comparison; however the crude incidence rate of psoriasis in those treated with anti-TNFalpha therapy was elevated at 1.04 (95% CI 0.67 to 1.54) per 1000 person years compared to the rate of 0 (upper 97.5% CI 0.71) per 1000 person years in the patients treated with DMARDs. Patients treated with adalimumab had a significantly higher rate of incident psoriasis compared to patients treated with etanercept (IRR 4.6, 95% CI 1.7 to 12.1) and infliximab (IRR 3.5, 95% CI 1.3 to 9.3). CONCLUSIONS: Results from this study suggest that the incidence of psoriasis is increased in patients treated with anti-TNFalpha therapy. Our findings also suggest that the incidence may be higher in patients treated with adalimumab.

Harrison MJ, Davies LM, Bansback NJ, Ingram M, Anis AH, Symmons DP. · Arthritis Research Campaign Epidemiology Unit, and Health Economics Research at Manchester, The University of Manchester, Manchester, UK. · J Rheumatol. · Pubmed #18278841 No free full text.

Abstract: OBJECTIVE: Cost-utility analysis is increasingly important as healthcare providers aim to invest scarce resources in interventions offering the greatest health benefit. The ability to attach utility values to health states is essential, and is increasingly performed using generic scales. However, the evidence regarding the validity of generic utility scales in rheumatoid arthritis (RA) is unclear. We summarize and review evidence on the validity and comparative performance of generic utility scales in RA. METHODS: We searched the English-language medical literature for studies using utilities in RA between 1980 and mid-2006. Reports describing primary evidence of the validity or performance of a generic utility scale in RA were selected, summarized, and reviewed using the OMERACT filter. RESULTS: In total 923 articles were identified, of which 228 reported the use of utility scales in RA; 26 studies related to the validation or evidence of generic utility scales in RA, the EQ-5D, Health Utility Index-2 (HUI2) and HUI3, SF-6D, and Quality of Well-Being Scale. The EQ-5D, HUI2 and HUI3, and SF-6D all have consistent evidence of construct validity and responsiveness in RA, but each has limitations. CONCLUSION:The EQ-5D and HUI3 have been the most extensively studied instruments and show validity and responsiveness for use in RA, but both instruments have limitations. The SF-6D is relatively new and appears to have potential for use in milder RA, but needs further evaluation. More longitudinal head-to-head evaluation of measures is needed across the spectrum of RA disease severity to further investigate their comparative properties, and to seek consensus on the best utility measure for use in economic evaluation.

Naz SM, Symmons DP. · Rotherham General Hospital, South Yorkshire, UK. · Best Pract Res Clin Rheumatol. · Pubmed #17870033 No free full text.

Abstract: Rheumatoid arthritis (RA) is associated with reduced life expectancy. Whether the development of RA initiates this process of premature ageing or is part of it is not clear. The excess mortality is apparent within the first few years of disease and increases with RA disease duration. Most of the excess deaths are attributable to infection, cardiovascular disease (in particular coronary heart disease) and respiratory disease. Deaths due to lung cancer and non-Hodgkin's lymphoma, but not other cancers, are also increased. There is some evidence that effective disease-modifying therapy can improve survival but, overall, survival in RA patients has not improved to the same degree as in the general population over recent decades.

Dixon WG, Symmons DP. · ARC Epidemiology Unit, University of Manchester, Manchester, UK. · Ann Rheum Dis. · Pubmed #17251223 No free full text.

Abstract: Patients with rheumatoid arthritis (RA) have an increased burden of atherosclerotic cardiovascular disease which cannot be explained by an increased prevalence of traditional cardiovascular risk factors alone. Atherosclerosis is now being viewed as an inflammatory condition and the cumulative inflammation experienced in RA may contribute to accelerated atherosclerosis. It has been hypothesised that treatment with anti-tumour necrosis factor (TNF) alpha in RA may reduce both intra-articular inflammation and the inflammation associated with atherosclerosis. Thus, TNFalpha blockade may reduce the cardiovascular morbidity and mortality associated with RA. This review examines the pathophysiological role of TNFalpha in atherosclerosis and the evidence to date that anti-TNFalpha treatment modifies this process in RA.

Symmons DP, Silman AJ. · arc Epidemiology Unit, University of Manchester, UK. · Arthritis Res Ther. · Pubmed #16817941 links to  free full text

Abstract: Over 3500 patients with recent onset inflammatory polyarthritis (IP) have been recruited by the Norfolk Arthritis Register (NOAR) since 1990. Longitudinal data from this cohort have been used to examine the prevalence and predictors of remission, functional disability, radiological outcome, cardiovascular mortality and co-morbidity and the development of non-Hodgkin's lymphoma. Rheumatoid factor titre, high baseline C-reactive protein and high baseline HAQ score are all predictors of a poor outcome. There is a strong association between possession of the shared epitope and the development of erosions. Patients who satisfy the American College of Rheumatology criteria for rheumatoid arthritis (RA) have a worse prognosis than those who do not. However, it appears that these patients are a poorly defined subset of all those with IP rather than having an entirely separate disease entity. New statistical techniques offer exciting possibilities for using longitudinal datasets such as NOAR to explore the long-term effects of treatment in IP and RA.

Symmons DP, Silman AJ. · arc Epidemiology Unit, University of Manchester, UK. · Lupus. · Pubmed #16634363 No free full text.

Abstract: In March 2002 the National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of anti-TNF therapy for patients with rheumatoid arthritis (RA). The guidelines recommended that all RA patients treated with these drugs should be enrolled on a national register which had been established by the British Society for Rheumatology (the BSRBR). A comparison cohort of RA patients treated with traditional disease modifying drugs (DMARDs) is also being recruited. The main role of the BSRBR is to study the long-term safety of biologic drugs. Up to the end of March 2005, 9508 patients with RA had been enrolled on the BSRBR. Four thousand, three-hundred and six had been treated with etanercept, 3561 with infliximab, 1500 with adalimumab and 141 with anakinra. With regards to anti-TNF drugs, 79% remained on their original drug at six months, 65% of whom could be classified as responders. Co-prescription with methotrexate was associated with a 70% response rate. Patients with a high baseline level of disability were less likely to respond. Overall the rates of serious infection were not increased in the anti-TNF versus the comparison cohort. However the rates of skin and soft tissue infection and of intracellular infections (eg, salmonella, listeria, legionella) were increased. There were 11 cases of tuberculosis (seven extra-pulmonary). There was concern about the high mortality rates among patients with baseline pulmonary fibrosis treated with anti-TNF therapy. It is unclear whether this is related to the drug or to the underlying disease. The rates of malignancy and mortality were not increased compared to the DMARD treated group in the short term. Further follow-up is needed to determine the long term safety of these drugs.

Franklin JP, Symmons DP, Silman AJ. · ARC Epidemiology Unit, Manchester University Medical School, UK. · Ann Rheum Dis. · Pubmed #15834052 links to  free full text

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Dixon WG, Symmons DP. · ARC Epidemiology Unit, University of Manchester Medical School, Oxford Road, Manchester M13 9PT, UK. · Best Pract Res Clin Rheumatol. · Pubmed #15588970 No free full text.

Abstract: The 'life cycle' of established rheumatoid arthritis can be divided into four phases. The first is the period leading up to the onset of arthritis. The second is the period during which persistence or remission is determined. The third is the evolution into a specific form of inflammatory arthritis, and the fourth is the outcome/severity of that arthritis. In some patients, these four phases follow in rapid succession; however, in other patients, the time course is prolonged over several months or years. This chapter explores the hypothesis that these four phases are distinct in the majority of patients, and that different genetic and environmental factors influence the various phases. It investigates the suggestion that a defect in the hypothalamic-pituitary-adrenal axis may underlie the persistence of inflammatory arthritis. It suggests that the term 'early rheumatoid arthritis' is not appropriate and that patients either have established rheumatoid arthritis or an undifferentiated inflammatory arthritis.

Bunn DK, Shepstone L, Galpin LM, Wiles NJ, Symmons DP. · Norfolk Arthritis Register, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK. · Rheumatology (Oxford). · Pubmed #15316124 links to  free full text

Abstract: OBJECTIVES: To evaluate the reliability and validity of the Norfolk Arthritis Register Damaged Joint Count (NOAR-DJC) in patients with early inflammatory polyarthritis (IP). METHODS: The NOAR-DJC examines deformity in 51 joints. Deformity is defined as inability to adopt the anatomical position, reduction in range of movement by at least one-third, and/or surgical alteration of the joint. Reliability was investigated by assessing intra- and inter-observer agreement in 40 and 32 patients, respectively. Validity was assessed by correlating the NOAR-DJC with the eroded joint count (criterion validity), the Health Assessment Questionnaire (HAQ) (convergent construct validity) and tender and swollen joint counts (divergent construct validity) and by discriminating between those who did and did not satisfy criteria for rheumatoid arthritis (discriminant validity). RESULTS: The intraclass correlation coefficient for the intra- and inter-rater studies were 0.88 [95% confidence interval (CI) 0.79, 0.94, P<0.00001] and 0.74 (95% CI 0.53, 0.86, P<0.00001), respectively. Correlations with eroded joint counts and HAQ scores after 5 yr follow-up were r(s) = 0.42 (95% CI 0.35, 0.49, P<0.01) and r(s) = 0.45 (95% CI 0.4, 0.5, P<0.01), respectively. Correlations with tender and swollen joint counts were weak (r(s) = 0.28 and r(s) = 0.33). CONCLUSION: The NOAR-DJC is a quick, reliable and valid tool for assessing articular damage in patients with early IP.

Hyrich KL, Silman AJ, Watson KD, Symmons DP. · ARC Epidemiology Unit, University of Manchester, Oxford Road, Manchester M13 9PT, UK. · Ann Rheum Dis. · Pubmed #15242866 links to  free full text

Abstract: Anti-TNFalpha therapy may have associated risks of serious infection, congestive heart failure, malignancy, and multiple sclerosis. The magnitude of these risks is difficult to assess. This article reviews publications on the current knowledge about the safety of these agents.

Pattison DJ, Harrison RA, Symmons DP. · ARC Epidemiology Unit, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom. · J Rheumatol. · Pubmed #15229949 No free full text.

Abstract: OBJECTIVE: Many studies have examined the role of diet in the management of established rheumatoid arthritis (RA), warranting several recent reviews. However, none have considered the possible link between diet and the onset of RA in detail. Studies investigated a possible effect of individual components of diet and the development of RA, but the lack of a systematic review means there is no unbiased assessment of the evidence. METHODS: We systematically reviewed studies with comparison groups that examined dietary intake or biological markers prior to the onset of RA. Four electronic databases were searched to identify relevant reports. Six quality criteria were agreed, against which the studies were assessed. The main outcome measure was a diagnosis of RA according to the ARA 1958 or revised ACR 1987 classification criteria. RESULTS: Fourteen reports were included in the review. There was evidence of a protective effect of higher consumption of olive oil, oil-rich fish, fruit, vegetables and beta-cryptoxanthin. Lower serum concentrations of antioxidants were associated with an increased risk of RA in 3 studies. Due to the heterogeneity of study designs and analyses, the results could not be pooled. CONCLUSION: Evidence exists that diet may play a role in the etiology of RA, but it is inconclusive due to the small number of studies available and variation in study design.

Pattison DJ, Symmons DP, Young A. · Arthritis Research Campaign Epidemiology Unit, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK. · Proc Nutr Soc. · Pubmed #15099410 No free full text.

Abstract: Although dietary factors have been extensively studied in many chronic diseases, the role of diet in the epidemiology of rheumatoid arthritis (RA) has received little attention. Fruit and vegetables and dietary antioxidants are thought to play a protective role in the pathogenesis of CVD and some cancers, but few studies have investigated these dietary components in the aetiology of RA. Fish oil supplementation has consistently been shown to have a beneficial effect on the symptoms of established RA, but it is not known whether the PUFA present in fish oils can reduce the risk of developing the disease. There is evidence that RA is less severe in the southern Mediterranean countries, such as Italy and Greece, where oil-rich fish, fruit, vegetables and olive oil are consumed in greater amounts than in many other countries. Overall, the evidence for a role of diet in the aetiology of RA is limited to a small number of observational studies of very different designs. Recently, it was demonstrated that lower intakes of fruit and vegetables and dietary vitamin C are associated with an increased risk of developing inflammatory polyarthritis in a free-living population in Norfolk, UK. These findings provide further evidence for a role of diet in the development of inflammatory arthritis, although the mechanisms involved are uncertain.

Symmons DP. · ARC Epidemiology Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, United Kingdom. · J Rheumatol Suppl. · Pubmed #15053450 No free full text.

Abstract: This article discusses 5 methodological issues that arise in the course of conducting longitudinal observational studies: generalizability, missing data, repeated measures on the same individual, measures taken at varying time points from symptom onset, and assessing the effect of treatment. Methods discussed include general estimating equations and propensity scores. The points are illustrated by examples from the Norfolk Arthritis Register dataset.

Symmons DP, Silman AJ. · Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, United Kingdom. · Clin Exp Rheumatol. · Pubmed #14969058 No free full text.

Abstract: The Norfolk Arthritis Register (NOAR) has been recruiting and following patients with early inflammatory polyarthritis (IP) since 1989. Approximately three-quarters of the patients followed satisfy classification criteria for rheumatoid arthritis (RA) by 5 years from symptom onset. This paper summarises the publications which have been based on the NOAR cohort with respect to the incidence and prevalence of IP and RA, genetic and environmental risk factors for the development of IP, outcome following the development of IP and predictors of outcome. It also discusses methodological issues in examining the treatment effect in observational cohorts and the costs to the healthcare system of patients with early IP.

Symmons DP. · ARC Epidemiology Unit, University of Manchester Medical School, Oxford Road, M13 9PT, Manchester, UK. · Best Pract Res Clin Rheumatol. · Pubmed #12915154 No free full text.

Abstract: The outcome of rheumatoid arthritis (RA) is influenced by both genetic and non-genetic (environmental) factors. Treatment is the most important environmental factor which influences RA outcome. This chapter considers non-treatment environmental influences on the outcome of RA. There is evidence that socio-economic factors (such as level of formal education and area of residence), smoking, diet and psychological factors may affect the levels of pain and physical disability experienced by RA patients. More work is needed in order to understand the mechanisms underlying these associations. Smoking may also adversely affect radiological outcome in the longer term. It is possible that pregnancy may improve the outcome of RA. Contrary to popular lay opinion, there is no evidence that the weather has any influence on RA.