Open Access Rheumatology-Research and Reviews最新文献

{"title":"The Clinical Presentation and Factors Associated with Disease Severity of Rheumatoid Arthritis in Uganda: A Cross-Sectional Study.","authors":"Ben Ochola,&nbsp;Joaniter Nankabirwa,&nbsp;William Buwembo,&nbsp;Mark Kaddumukasa,&nbsp;Harriet Mayanja-Kizza","doi":"10.2147/OARRR.S361454","DOIUrl":"https://doi.org/10.2147/OARRR.S361454","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is a chronic, debilitating disease that leads to joint destruction and disability if left untreated. Few studies on RA have been conducted in Uganda, and there is limited information on disease severity and associated factors. This study sought to characterize the clinical presentation and to determine disease severity and the factors associated with disease severity among participants with RA in Uganda.</p><p><strong>Methods: </strong>Between August 2018 and February 2019, patients presenting to the rheumatology outpatient clinic in Mulago National Referral Hospital were enrolled into the study using a cross-sectional design. Participants' demographics and clinical characteristics were collected using a study questionnaire, and laboratory results were extracted from their charts. The patients' functionality was assessed using the Modified Health Assessment Questionnaire and their disease severity was assessed using the RA Disease Activity Score based on 28-joint count (DAS28).</p><p><strong>Results: </strong>A total of 170 participants were enrolled, of whom 81.2% were female. Nearly two-thirds (111/170) were classified as having severe disease. Having a functional status score of >0.5 (adjusted odds ratio 1.7, 95% confidence interval 1.4-2.2, <i>p</i><0.001) was significantly associated with severe disease.</p><p><strong>Conclusion: </strong>In this population, the majority of the patients seen at the rheumatology outpatient clinic had severe disease, suggesting that patients may be presenting late, with limited early detection of the disease. Impaired functional status was associated with increased disease severity and may be used by clinicians to highlight disease severity when it is not possible to assess the RA DAS28.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"14 ","pages":"75-86"},"PeriodicalIF":2.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/a2/oarrr-14-75.PMC9078424.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9131614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Clinical Pattern of Mixed Connective Tissue Disease in Sudanese Patients at Omdurman Military Hospital: Hospital-Based Study.","authors":"Sulafah Abdelgalil Ali Ahmed,&nbsp;Mohammed Elmujtba Adam Essa,&nbsp;Amar F Ahmed,&nbsp;Elnour Mohammed Elagib,&nbsp;Noha Ibrahim Ahmed Eltahir,&nbsp;Huyam Awadallah,&nbsp;Abubakr Hassan,&nbsp;Amna Sirag Mohammed Khair,&nbsp;Mustafa Abdalla Bakhit Ebad","doi":"10.2147/OARRR.S335206","DOIUrl":"https://doi.org/10.2147/OARRR.S335206","url":null,"abstract":"<p><strong>Background: </strong>Mixed connective tissue disease (MCTD) is a rare autoimmune disease, characterized by the production of specific autoantibody anti-RNP, which presents with varied overlapping symptoms of different connective tissue disorders. The aim of this study is to identify the frequency and patterns of MCTD.</p><p><strong>Methods: </strong>This is a descriptive cross-sectional hospital-based study conducted at the rheumatology clinic at Omdurman Military Hospital between February 2019 and July 2019. The study included 30 patients and data were collected using a designated questionnaire.</p><p><strong>Results: </strong>The study showed that the majority of patients (96.7%) were females and only 3.3% was male. About 30% of the patients aged between 30 and 39 years were the most affected. As a first diagnosis, 10% of the patients had a MCTD fulfilling the Alarcon-Segovia criteria. The remaining 90% of the patients were diagnosed with other diseases before evolving into MCTD. The most common clinical presentation was arthralgia in 100% of the patients, 90% were symmetrically followed by myositis in 70% of the patients, arthritis in 63.3% of the patients, puffy fingers in 63.3% of the patients, and hand swelling in 60% as major musculoskeletal symptoms. Regarding the initial results in immunological profile, the most common positive autoantibodies among the patients were anti-RNP titer in 96.7% of the patients, ANA in 90%, anti-Sm in 50%, RF in 50%, anti-Ds DNA in 46.7%, and anti-Ro in 43.3%.</p><p><strong>Conclusion: </strong>This study showed that MCTD is more common in females, only 10% of patients presented with a fulfilling criteria of the disease at diagnosis, and the rest of the patients presented with other rheumatologic diseases before evolving into MCTD.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 ","pages":"333-341"},"PeriodicalIF":2.1,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/17/oarrr-13-333.PMC8668256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39845178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Perspectives on Diagnosing Psoriatic Arthritis by Imaging Techniques","authors":"M. I. Sarbu, N. Sârbu, Doriana Cristea Ene, Daniela Corche, R. Baz, D. Negru, A. Nechita, S. Fotea, Lucreţia Anghel, A. Tatu","doi":"10.2147/OARRR.S331859","DOIUrl":"https://doi.org/10.2147/OARRR.S331859","url":null,"abstract":"Abstract Psoriatic arthritis is a chronic inflammatory condition that can lead to severe functional impairment and irreversible damage. The diagnosis can be difficult in early cases where the clinical exam is often scarce. The lack of a serological biomarker can lead to a considerable delay in diagnosis. In this review, we discuss the existent imaging methods that have improved the diagnosis of psoriatic arthritis (PsA). The degree and type of musculoskeletal involvement cannot be assessed by only one imaging method. We think that a combination of methods is the best approach to evaluate both structural damage and inflammatory lesions and that ultrasound (US) could be the best tool to screen a patient when considering the diagnosis of PsA. US is an accessible, non-ionizing technique that offers information regarding active inflammation in joints, entheses, and soft tissues.","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 1","pages":"343 - 352"},"PeriodicalIF":2.1,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48797270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Serum Immune Markers in Seropositive and Seronegative Rheumatoid Arthritis Among Sudanese Patients and the Relation Between the Serotype and Joint Involvement: A Cohort Study.","authors":"Ahmed Seri,&nbsp;Hala Kamal Ali Mohamed,&nbsp;Mohammed Elmujtba Adam Essa,&nbsp;Elnour Mohammed Elagib,&nbsp;Noha Ibrahim Ahmed Eltahirm,&nbsp;Salma Mohammed Alfatih Mansour,&nbsp;Abdelkareem A Ahmed","doi":"10.2147/OARRR.S339134","DOIUrl":"https://doi.org/10.2147/OARRR.S339134","url":null,"abstract":"<p><strong>Introduction: </strong>Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the synovial membrane. RA is classified as seropositive or seronegative, according to the absence or presence of primarily IgM RF, RF, and/or ACPA. The aim of this study is to identify the relationship between the serotype of rheumatoid arthritis and the level of ESR.</p><p><strong>Methods and materials: </strong>This is a descriptive, cross-sectional study done in Omdurman military hospital, Khartoum, Sudan. Conducted with 60 patients with RA, data were collected through a designated questionnaire which included demographic, age, gender, duration of the disease, laboratory finding. All the patients in the study were treated with conventional DMARDs and diagnosed according to the 2010 ACR/EULAR criteria; their disease activity status was assessed by DAS28/ESR. Data were analyzed using SPSS version 23.</p><p><strong>Results: </strong>The study found that 91.7% of the patients were females, patients of age group between 36 and 50 years had the highest percentage at 38.3% followed by those between 51 and 70 years and the least age group between 20 and 35 years, 36.7% and 15%, respectively. Of all the patients 61.7% were found to be SPRA, while the remaining 38.3% were seronegative (SNRA). Altogether 55% of the patients had moderate disease activity, followed by 16.7% who had a remission, 15% had high disease activity and the remaining 13.3% had low disease activity. The metacarpophalangeal (MCP) joint was found to be the only joint that was significantly associated with DAS28 and its involvement was greater among seropositive patients. The most affected joints were found to be shoulders, knees, wrist, MCP, PIP and elbow, in that order.</p><p><strong>Conclusion: </strong>Females, middle-age group and shoulder joint were the most affected. Most RA was found to be SPRA, and the seropositive group was found to be more associated with high disease activity, while the seronegative group was associated with remission and low disease activity.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 ","pages":"325-332"},"PeriodicalIF":2.1,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/84/13/oarrr-13-325.PMC8643210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39578635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Treatment Patterns and Outcomes from an Electronic Medical Records Database for Patients with Rheumatoid Arthritis Treated with Repository Corticotropin Injection.","authors":"Kyle Hayes, Mary P Panaccio, Parul Houston, John Niewoehner, Mohammed Fahim, George J Wan, Bhavna Dhillon","doi":"10.2147/OARRR.S329766","DOIUrl":"10.2147/OARRR.S329766","url":null,"abstract":"<p><strong>Purpose: </strong>Repository corticotropin injection (RCI; Acthar^® Gel) is a naturally sourced mixture of adrenocorticotropic hormone analogs and other pituitary peptides that exerts anti-inflammatory and immunomodulatory properties via melanocortin receptors. RCI is approved as a short-term adjunctive therapy for rheumatoid arthritis (RA) and is typically used in patients with refractory RA. The objective of this study was to describe real-world outcomes of RA patients treated with RCI by retrospective analysis of an electronic medical records (EMR) database.</p><p><strong>Patients and methods: </strong>EMR data were obtained from the United Rheumatology-Normal Integrated Community Evidence (UR-NICE^TM) data repository for patients who used RCI for the treatment of RA. Demographics, comorbidities, disease history, medications, and laboratory evaluations 365 days prior to and 365 days after initiation of RCI were examined.</p><p><strong>Results: </strong>The patient cohort was predominantly White females with a mean age of 60 years and high RA activity prior to RCI therapy. Clinical measures of disease severity indicated that patients had high RA activity before starting RCI therapy. Clinical Disease Activity Index (CDAI) scores were significantly reduced 365 days post-initiation of RCI. Swollen and tender joint counts and patient-reported outcomes, including Routine Assessment of Patient Index Data 3 (RAPID3), Physician Global Assessment, and patient assessment of pain severity were also significantly lower. The number of patients taking conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs), biologic (b) DMARDs, nonsteroidal anti-inflammatory drugs (NSAIDS), and opioids decreased, as did the number of drugs tried within each class for csDMARDs, bDMARDs, NSAIDs, and glucocorticoids.</p><p><strong>Conclusions: </strong>These findings suggest that RCI significantly improves clinical outcomes of RA and decreases the need for concomitant medications for up to 1 year following initiation of therapy. The study provides valuable insights into the use of RCI and management of these difficult-to-treat RA patients during routine clinical practice.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 ","pages":"315-323"},"PeriodicalIF":2.1,"publicationDate":"2021-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/72/oarrr-13-315.PMC8526946.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39564092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperuricemia Among Egyptian Rheumatoid Arthritis Patients. Is It an Association or an Inflammatory Marker? A Cross-Sectional Observational Study.","authors":"Doaa Nada,&nbsp;Rasha Gaber,&nbsp;Al Shymaa Mahmoud,&nbsp;Radwa Elkhouly,&nbsp;Doaa Alashkar","doi":"10.2147/OARRR.S331488","DOIUrl":"10.2147/OARRR.S331488","url":null,"abstract":"<p><strong>Objective: </strong>To detect the prevalence of hyperuricemia in Egyptian rheumatoid arthritis (RA) patients as well as to assess its association with the severity of joint inflammation and disease-modifying antirheumatic drugs (DMARDs) in those patients.</p><p><strong>Methods: </strong>A total of 150 RA patients were recruited; all patients were subjected to (1) clinical and functional assessment by disease activity score in 28 joints (DAS28) and modified health assessment questionnaire (MHAQ). (2) Laboratory investigations: serum uric acid (SUA) level, complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), tumor necrosis factor α (TNF-α), interleukin 1 (IL1), and interleukin 6 (IL6) levels. (3) Radiological evaluation: (A) plain X-ray of both hands and feet; (B) musculoskeletal ultrasound (MSUS) of both wrists, hands, shoulder, ankle, and knee joints.</p><p><strong>Results: </strong>SUA was significantly correlated with disease activity by DAS28. Acute-phase reactants and inflammatory markers (IL1β, IL6, and TNF-α) were also significantly elevated in RA patients with low and high hyperuricemia compared to those with normal SUA. A total of 90% of RA patients with low hyperuricemia had synovial proliferation with power Doppler (1+ and 2+), and 30 patients had mild effusion (1+), while nearly all patients with high hyperuricemia had hypoechoic synovial proliferation (2+ and 3+), and 20 patients had moderate effusion. However, 70% RA patients with normal serum uric acid showed mild synovitis and effusion (1+). No significant association was found between the administered DMARDs and levels of SUA as well as inflammatory markers; however, high-dose steroid treatment was associated with high SUA level.</p><p><strong>Conclusion: </strong>Elevation of serum uric acid levels in Egyptian RA patients was prevalent and might be an inflammatory marker for severity of joint inflammation. Moreover, higher doses of steroids could be considered a cause of hyperuricemia.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 ","pages":"305-314"},"PeriodicalIF":2.1,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/e7/oarrr-13-305.PMC8502065.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39540233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Connective Tissue Disease-Related Intractable Disease with Biological Therapeutics.","authors":"Yoshio Ozaki,&nbsp;Shosaku Nomura","doi":"10.2147/OARRR.S328211","DOIUrl":"https://doi.org/10.2147/OARRR.S328211","url":null,"abstract":"<p><p>The treatment of connective tissue disease (CTD) and CTD-related intractable diseases (CTD-IDs) currently depends on the use of steroid therapy. Approximately 20 years have passed since the approval of infliximab for rheumatoid arthritis in 2003. Since then, several biological therapeutics have been marketed and adapted for many CTDs and CTD-IDs other than rheumatoid arthritis. Although conventional treatment for patients with these diseases is rarely used because of their poor prognosis, these cases may benefit from biological therapeutics. However, choosing biological therapeutics is difficult because they have different target molecules compared with conventional therapeutics. In this review, we address the current situation of biological therapeutics for CTD-IDs including Behcet's disease, psoriatic arthritis, ankylosing spondylitis, anti-neutrophil cytoplasmic antibody-related arthritis, and adult Still's disease, as well as the choice of biological therapeutics in clinical practice.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 ","pages":"293-303"},"PeriodicalIF":2.1,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/05/oarrr-13-293.PMC8487282.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39489856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcome Measures of Repeated Non-Animal Stabilized Hyaluronic Acid (Durolane) Injections in Osteoarthritis: A 6-Year Cohort Study with 623 Consecutive Patients.","authors":"Georgia Carney,&nbsp;Andrew Harrison,&nbsp;Jane Fitzpatrick","doi":"10.2147/OARRR.S331562","DOIUrl":"https://doi.org/10.2147/OARRR.S331562","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the duration of symptom relief following repeated administration of hyaluronic acid injections for osteoarthritis.</p><p><strong>Patients and methods: </strong>This was a 6-year observational study with 623 consecutive patients who had received hyaluronic acid injections. The primary outcome measure was the mean time between injections measured in days. Classical one-sample 2-sided <i>t</i>-tests, one-way analysis of variances and post-hoc analyses were performed to determine if there were statistically significant differences between age, gender, radiographic severity and the type of joints injected. All patients were invited to complete an online post-treatment experience and satisfaction survey.</p><p><strong>Results: </strong>The analysis included 727 joints (mean Kellgren-Lawrence grade, 2.9 ± 0.8 (range 2-4)) in 623 patients (297 (47.7%) male; mean age at first injection, 57.8 ± 12.7 years (range 21.2-92.1)). Patients ranged from having 1-8 injections per joint. The mean time between injections in days was 466.8 ± 321.7 (2nd injection, 157 joints), 400.5 ± 164.7 (3rd injection, 58 joints), 378.2 ± 223.1 (4th injection, 27 joints), 405.3 ± 216.3 (5th injection, 7 joints), 268.4 ± 104.4 (6th injection, 5 joints), 289.8 ± 99.4 (7th injection, 4 joints), and 272.5 ± 33.2 (8th injection, 2 joints). Patients with grades 2 and 3 compared to grade 4 osteoarthritis experienced a longer time between injections (F (2, 154) = 3.53, p = 0.0316). No statistically significant differences were observed between age, gender, or joint groups. The survey included 233 participants (109 (46.8% male)). A total of 144 respondents (64.9%) recommended hyaluronic acid injections for osteoarthritis.</p><p><strong>Conclusion: </strong>Pain relief from hyaluronic acid injections was sustained for on average 466.8 days post initial treatment. Patients who received subsequent 3rd, 4th, and 5th injections also experienced extended duration of benefit. Patients with grades 2 or 3 osteoarthritis are more likely to experience a longer duration of relief.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 ","pages":"285-292"},"PeriodicalIF":2.1,"publicationDate":"2021-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/a2/oarrr-13-285.PMC8457651.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39451336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Missed Doses on the Therapeutic Effect of Methotrexate for Rheumatoid Arthritis: A Pharmacokinetic Modeling Study.","authors":"Alan Morrison,&nbsp;Melissa E Stauffer,&nbsp;Anna S Kaufman","doi":"10.2147/OARRR.S329178","DOIUrl":"https://doi.org/10.2147/OARRR.S329178","url":null,"abstract":"<p><strong>Introduction: </strong>Patients rarely, if ever, take their medications exactly as prescribed. The extent to which missed doses interfere with a drug's therapeutic effect remains unclear.</p><p><strong>Methods: </strong>After weekly oral dosing of methotrexate (MTX) for rheumatoid arthritis, its polyglutamate derivatives (MTXglu) accumulate in red blood cells, where they are markers for the drug's therapeutic effectiveness. We used Medication Event Monitoring System data and pharmacokinetic modeling to analyze whether missing MTX doses causes the MTXglu level in red blood cells to fall below the range associated with the drug's clinical effect.</p><p><strong>Results: </strong>For patients initiating oral MTX, the threshold for clinical effectiveness and the steady state level were reached in medians of 6 weeks and 22 weeks, respectively. For patients at steady state who discontinued MTX, the MTXglu level fell below the therapeutic threshold after a median of 3 weeks. After initiating MTX, single missed doses did not cause a loss of therapeutic effect in the median patient if they occurred after 10 weeks, while runs of ≥3 consecutive missed doses did cause the MTXglu level to fall below the therapeutic threshold.</p><p><strong>Conclusion: </strong>While there is considerable variation between patients, pharmacokinetic modeling indicates that instances of isolated single missed doses of MTX typically will not cause polyglutamated methotrexate levels in red blood cells to fall below the range associated with the therapeutic effect. Runs of ≥3 consecutive missed doses, however, are typically expected to result in a loss of the therapeutic effect.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 ","pages":"267-274"},"PeriodicalIF":2.1,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/07/oarrr-13-267.PMC8450605.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39442589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Demographics, Disease Activity, Disability, and Treatment Among Rheumatoid Arthritis Patients with and without Osteoporosis.","authors":"Altaf Abdulkhaliq,&nbsp;Mohamed Cheikh,&nbsp;Fahad Almuntashri,&nbsp;Haneen Alzahrani,&nbsp;Huda Nadwi,&nbsp;Eithar Kadi,&nbsp;Mutasem Abed,&nbsp;Murad Janaini,&nbsp;Alaa Monjed,&nbsp;Nahed Janoudi,&nbsp;Hani Almoallim","doi":"10.2147/OARRR.S318810","DOIUrl":"https://doi.org/10.2147/OARRR.S318810","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporosis (OP) is one of the most common comorbidities associated with rheumatoid arthritis (RA). Literatures reported that the risk for developing OP was strongly associated with duration and severity of RA. We aim to elaborate on the consequences of OP on disease activity and management plan in patients with RA.</p><p><strong>Patients and methods: </strong>A retrospective cohort study recruited 408 patients, including those with RA alone and with RA plus OP. The RA disease activity in the patients was assessed using disease activity score in 28 joints (DAS28-CRP). A statistical analysis was performed to compare data between the two groups of patients and determine any significant risk factor associated with the development of OP in RA patients.</p><p><strong>Results: </strong>Of 408 patients who were included in this study, 353 patients (86.5%) had only RA, while 55 patients (13.5%) had RA with OP and showed significant difference (<i>P</i> = 0.04) concerning age categories. Patients diagnosed with RA and OP had RA duration longer than RA-only patients (independent <i>t</i>-test, <i>P</i> = 0.01). The two groups had almost similar disease activity at the three clinical visits, as well, had nearly similar disability at their first visit, whereas RA with OP patients had significant greater disability at their 2^nd and 3^rd visits (independent <i>t</i>-test, <i>P</i> = 0.001). Both groups were treated with the same biologic and non-biologic medication of similar frequency, although RA patients with OP received steroid more frequently than patients had RA only (61.7% vs. 41.7%, chi square test, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>There was no significant difference in disease activity at both groups of patients. However, RA with OP group had longer duration of RA, were more frequently treated with steroids, and had greater disability. We recommend physicians focus on controlling RA disease activity, early screening for and treating of OP.</p>","PeriodicalId":45545,"journal":{"name":"Open Access Rheumatology-Research and Reviews","volume":"13 ","pages":"275-283"},"PeriodicalIF":2.1,"publicationDate":"2021-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/52/02/oarrr-13-275.PMC8449680.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39458874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}