Methods. In a large cohort of Caucasian RA patients treated with anti-TNF medications (total, n = 1050; etanercept, n = 455; infliximab, n = 450; and adalimumab, n = 142), the sIL-6R A358C polymorphism was genotyped using a Taqman 5'-allelic discrimination assay. Linear regression analysis adjusted for baseline 28 joint disease activity score (DAS28), baseline HAQ score, gender and use of concurrent DMARDs was used to assess the association of genotype at this polymorphism with response to anti-TNF therapy, defined by change in DAS28 after 6 months of treatment. Analyses were performed in the entire cohort, and also stratified by an anti-TNF agent. Additional analysis according to the EULAR response criteria was also performed, with the chi-squared test used to compare genotype groups.

Results. No association between genotype at sIL-6R A358C and response to anti-TNF treatment was detected either in the cohort as a whole or after stratification by anti-TNF agent, in either the linear regression analysis or with response segregated according to EULAR criteria.

Conclusions. This study shows that genotype at the functional sIL-6R A358C SNP is not associated with response to anti-TNF treatment in patients with RA.

Methods. The Childhood Arthritis Prospective Study recruits children <16 years with new inflammatory arthritis persisting for >=2 weeks from five UK tertiary referral centres. Demographics, disease features, joint count, CHAQ, physician's global assessment, parent's general evaluation of well-being (PGE), ESR and treatment, are collected at first presentation, 6 months and then yearly. Independent predictors of CHAQ >=0.75 at 1 year in children diagnosed with JIA were identified using multivariable logistic regression models.

Results. Seven hundred and forty children with JIA were included; median age at presentation 7.6 years, 64% girls. During the first year, 85% received NSAIDs, 70% IA corticosteroids, 47% MTX and 27% systemic steroids (oral or i.v.). Median presenting CHAQ score was 0.63 and decreased to 0.25 at 1 year; 32% had CHAQ >=0.75 at 1 year. The strongest predictor of CHAQ >=0.75 at 1 year was CHAQ >=0.75 at presentation (odds ratio 3.92; 95% CI 2.17, 7.09). Additional predictors included female gender and higher PGE

Conclusion. Although CHAQ score improved in most children, the strongest predictor of persistent disability at 1 year was moderate to severe disability at first presentation. Follow-up beyond 1 year will assess whether CHAQ at presentation will continue to be a predictor of future poor outcome.

Methods. The study was carried out in 50 Italian rheumatology centres (802 patients). All patients completed a 31-item questionnaire addressing their perceptions of current treatment and the preferences for treatment with anti-TNF agents. Statistical methods included analysis of variance (ANOVA), t-test and chi-square test.

Results. The response rate to the questionnaire was 97.6%. At the time of the survey, 310 (39.9%) patients were dissatisfied with current treatments, owing to inefficacy, side effects and inconvenience of administration. The i.v. and s.c. routes of administration were preferred by 50.2 and 49.8%, respectively. No significant difference was found in patients by gender, age, RA duration or number of drugs used. Reasons for the choice of i.v. administration were the safety of treatment at the hospital and the reassuring effect of physician presence. The s.c. administration was chosen for the convenience of treatment and in particular for home treatment. Patients dissatisfied with current therapy due to side effects preferred s.c. administration (P = 0.029), whereas patients choosing the i.v. route had slightly higher scores on ‘today pain’ (P = 0.047) and ‘articular pain’ (P = 0.023) of the Rheumatoid Arthritis Disease Activity Index (RADAI).

Conclusions. Both i.v. and s.c. treatments were well accepted by patients. However, treatment choice has to be discussed with patients, as individual preference seems to be determined by personal attitudes towards safety and convenience, by past experience and by the perception of current disease status.

Methods. Data were collected prospectively from consecutive Han Chinese clinic attendees with PsA and other chronic inflammatory arthritis. Subjects were classified according to Moll and Wright, European Spondyloarthropathy Study Group (ESSG) criteria for PsA, Vasey and Espinoza or CASPAR criteria. Sensitivity and specificity of each set of criteria were compared with the expert clinical diagnosis. Latent class analysis was used to calculate accuracy of criteria and confirm validity.

Results. A total of 108 (53 males and 55 females) subjects with PsA were recruited. Mean (s.d.) age and duration of illness were 48.4 (12.0) and 9.55 (7.66) years, respectively. Data were compared with 195 controls with RA (n = 154) and AS (n = 41). The ESSG criteria have the lowest sensitivity, followed by the Moll and Wright criteria. The sensitivity and specificity for the CASPAR criteria were 98.2 and 99.5%, respectively, which is similar to reported values in European populations. The latent class model agreed closely with the clinical criteria.

Conclusions. The CASPAR criteria performed well in a Chinese population, which is very different from the populations for which they were developed. The CASPAR criteria have higher sensitivity in classifying PsA.

Methods. Serum and genomic DNA samples of 91 RA patients and 78 healthy controls were obtained. Various ACPAs and IgM RF were determined by ELISA. HLA-DRB1 genotyping and subtyping was performed by PCR. HLA-DRB1 alleles were re-classified as described above. Correlations between SE and ACPAs were determined.

Results. Not only S2 and S3P, but, to a lesser extent, S1 and S3D alleles also predisposed to anti-cyclic citrullinated peptide (CCP) production (P < 0.0001, P = 0.004, P = 0.01 and P = 0.027, respectively), with the following hierarchy of association: S2+S3P > S1+S3D > X/X. Similar associations were observed for anti-citrullinated vimentin. Anti-citrullinated fibrinogen (CF) exerted a different association pattern with the strongest correlation with S1 alleles [odds ratio (OR) 16.00; P = 0.05]. In addition, HLA-DRB1*15 alleles may represent a special predisposing effect for anti-CF antibody production. Finally, in this study, RF production was associated only with the HLA-DRB1*0401 SE allele (P = 0.04).

Conclusions. Our approach of comparing individual S allele carriers with X/X genotype patients allowed us to perform unequivocal analyses and demonstrate new associations. Thus, novel subgroups of RA could be identified with potential relevance for prognosis and therapy.

Methods. Fifty-two AS patients and 59 RA patients completed Visual Analogue Scales (VASs) for pain, fatigue and global health, and Bath measures on Ankylosing Spondylitis Disease Activity Index (BASDAI) and Function Index (BASFI) (AS patients) or HAQs (RA patients) on touch screen and paper form in random order with a 1-h interval. Intra-class correlation coefficients (ICCs), 95% CIs and smallest detectable differences (SDDs) were calculated.

Results. ICC ranged from 0.922 to 0.988 (P < 0.001). The mean differences (95% CI) were: BASDAI [–0.5 (–14.5, 13.5) mm]; BASFI [–1.1 (–10.6, 8.4) mm]; Item 5 [–1.7 (–23.6, 20.2) mm] and Item 6 [–0.7 (–14.7, 13.3) mm] from BASDAI; HAQ score [0.023 (–0.183, 0.229)]. For VAS –0.4 to –2.8 mm (no significance for all except VAS global and VAS fatigue in RA). SDD for BASDAI was 14.0 mm; BASFI 9.5 mm; Item 5 21.8 mm; Item 6 14.0 mm; HAQ 0.206; VAS 11.1–18.8 mm.

Conclusions. Self-explanatory touch screens based on the DANBIO open-source system generates valid results in AS and RA patients on completion of BASDAI, BASFI, HAQ and VAS scores for pain, fatigue and global health when compared with the traditional paper form. Implementation of touch screens in clinical practice is feasible and patients need no instruction.

Methods. This study was undertaken in two inter-linked regional primary care databases: Consultations in Primary Care Archive (CiPCA) and Prescriptions in Primary Care Archive (PiPCA). During 2001–04, consultations in CiPCA were identified at 10 participating practices from gout-related Read morbidity codes. Lipid, blood pressure, glucose and renal function monitoring were identified from Read codes and consultation free text over the next month. Prescriptions for traditional NSAIDs, gastroprotective agents, colchicine, coxibs, corticosteroids, analgesic agents and urate-lowering therapies (ULTs) issued to these patients over the subsequent 12 months were identified from PiPCA.

Results. Six hundred and seventy-three new gout consultations were identified. Monitoring of lipids (5%), blood pressure (26%), glucose (6%) and renal function (21%) within 1 month of index consultation were infrequently recorded. There were 583 consultations for acute gout. Traditional NSAIDs (68%) were most commonly prescribed, followed by colchicine (15%), coxibs (5%) and analgesia only (5%). Seven per cent did not receive a prescription. The most frequently prescribed traditional NSAIDs were diclofenac (41%) and indomethacin (32%). Gastroprotection was co-prescribed with NSAIDs for 17% of patients. Sixty six per cent of patients treated with colchicine were prescribed high-dose regimens (500 µg at least four times daily). ULTs were prescribed within 12 months in 23% of patients. Nineteen per cent of ULTs were prescribed during acute attack.

Conclusions. Primary care acute gout management is suboptimal. Education of general practitioners about acute gout management and cardiovascular risk is a priority.

Methods. Six APS patient-derived PT-reactive monoclonal antibodies (mAbs) were analysed for prothrombinase activity on PT. One mAb with prothrombinase activity was examined for its proteolytic activity on PT. In addition, IgG was purified from plasma samples positive with IgG aPT antibodies, and their prothrombinase activity analysed.

Results. Initial analysis of six mAbs revealed that, upon incubation with PT, IS6 mAb displayed prothrombinase activity and catalysed the proteolysis of PT to fragments. Analysis of plasma samples revealed that 9/21 (42.8%) APS patients had IgG antibodies against PT, based on a cut-off value equal to mean + 3 s.d. of the level in 21 normal controls. Importantly, of those samples positive for IgG aPT antibodies, two polyclonal IgG (P1 and P2) also displayed prothrombinase activity.

Conclusions. In this study, we showed that some aPT antibodies displayed prothrombinase activity. Such catalytic aPT antibodies may contribute to thrombosis in APS.

Methods. We systematically searched EMBASE, PubMed and Ovid Medline for randomized controlled trials (RCTs) of combination therapy in early RA. We evaluated ACR responses, withdrawals for inefficacy and toxicity, HAQ and radiographic progression. Meta-analysis using Review Manager evaluated random effects odds ratios (ORs) and random effects weighted mean differences (WMDs) between treatments.

Results. A preliminary search identified 2029 citations; 15 were relevant RCTs (4200 randomized patients). Patients with active disease were enrolled. Compared with MTX monotherapy, both combination DMARDs and TNF/MTX increased ACR20–70 responses (OR 1.64–2.02 and 2.03–2.30, respectively), reduced withdrawals for inefficacy (OR 0.52 and 0.29), reduced HAQ (WMD –0.17 and –0.16) and reduced annual X-ray progression (WMD –1.20 and –0.84%). DMARD combinations increased withdrawals for toxicity (OR 2.69; there was no difference with TNF/MTX). The only head-to-head RCT showed comparable efficacy for combination DMARDs and TNF/MTX combinations.

Conclusions. In early active RA, both combination DMARDs and TNF/MTX are more effective than MTX monotherapy. DMARD and TNF/MTX combinations had equal efficacy on ACR response, withdrawals for inefficacy, disability and erosive progression. There is an apparent advantage for TNF/MTX combinations in the effect on toxicity with fewer consequent patients. We conclude that there is strong evidence in favour of combination treatment for RA but there is still uncertainty about which regimen is preferable.

Methods. We estimated hospitalization rates for infections following initiation of TNF- antagonists, other DMARDs and oral glucocorticoids in Tennessee Medicaid-enrolled RA patients (1995–2005). Exposure time was measured using pharmacy information and infections were identified using validated definitions. Initiation of RA regimens was compared using Cox regression models with MTX as the reference. Sensitivity analyses excluded glucocorticoid users, applied a first exposure carried forward approach, restricted observations to 2002–05 and first episodes of use and explored effects of unmeasured confounders.

Results. We identified 28 906 new episodes of medication use, including TNF- antagonists (8%), MTX alone (15%) and glucocorticoids alone (57%). Compared with MTX initiation, TNF- antagonist initiation did not significantly increase the risk of hospitalizations for pneumonia [adjusted hazard ratio (aHR) 1.61; 95% CI 0.85, 3.03] or any infection (aHR 1.31; 95% CI 0.78, 2.19). Initiation of LEF, SSZ or HCQ did not increase serious infections, compared with MTX. Both initiation and concurrent glucocorticoid use were associated with a dose-dependent increase in serious infections. Sensitivity analyses showed consistent results.

Conclusions. Compared with initiation of MTX alone, initiation of TNF- antagonists was not associated with a large increase in the risk of serious infections. Glucocorticoid use was associated with a dose-dependent increase in the risk of these infections.

Methods. We utilized multidimensional phospho-specific flow cytometry to characterize the activation status of peripheral blood (PB) fibrocytes derived from human RA patients at different stages of disease and from mice with CIA.

Results. Human PB fibrocytes from RA patients exhibited phosporylation activation of the p44/42 and p38 MAP kinases (MAPKs), and STAT3 (signal transducer and activator of transcription) and STAT-5 early in disease, within the first year of diagnosis. Similarly, in murine CIA, an increase in the total number of PB phosphoSTAT5-positive fibrocytes was observed at early time points in disease. Notably, in the affected paws of mice with CIA, we identified an increased number of fibrocytes, in contrast to the paws of control mice.

Conclusions. These data suggest that activated fibrocytes may influence the disease process in RA and may serve as surrogate markers for disease in the PB of affected patients.

Methods. Fourteen patients with SSc were evaluated. Eight patients were randomized to receive two cycles of RTX at baseline and 24 weeks [each cycle consisted of four weekly RTX infusions (375 mg/m²)] in addition to standard treatment, whereas six patients (control group) received standard treatment alone. Lung involvement was assessed by pulmonary function tests (PFTs) and chest high-resolution CT (HRCT). Skin involvement was assessed both clinically and histologically.

Results. There was a significant increase of forced vital capacity (FVC) in the RTX group compared with baseline (mean ± s.d.: 68.13 ± 19.69 vs 75.63 ± 19.73, at baseline vs 1-year, respectively, P = 0.0018). The median percentage of improvement of FVC in the RTX group was 10.25%, whereas that of deterioration in the controls was 5.04% (P = 0.002). Similarly, diffusing capacity of carbon monoxide (DL_CO) increased significantly in the RTX group compared with baseline (mean ± s.d.: 52.25 ± 20.71 vs 62 ± 23.21, at baseline vs 1-year respectively, P = 0.017). The median percentage of improvement of DL_CO in the RTX group was 19.46%, whereas that of deterioration in the control group was 7.5% (P = 0.023). Skin thickening, assessed with the Modified Rodnan Skin Score (MRSS), improved significantly in the RTX group compared with the baseline score (mean ± s.d.: 13.5 ± 6.84 vs 8.37 ± 6.45 at baseline vs 1-year, respectively, P < 0.001).

Conclusion. Our results indicate that RTX may improve lung function in patients with SSc. To confirm our encouraging results we propose that larger scale, multicentre studies with longer evaluation periods are needed.

Methods. Data from 3 datasets were merged, including 847 Belgian (ASPECT database), 1405 Spanish (REGISPONSER database) and 466 Ibero-American (RESPONDIA database) AS patients. The ASPECT and REGISPONSER database (Dataset A) are used for exploratory analysis; the RESPONDIA database (Dataset B) is used for confirmative analysis. Factors associated with hip involvement and the hip replacement surgery were analysed.

Results. Twenty four (REGISPONSER) to 36% (RESPONDIA) of AS patients under rheumatologist's care presented clinical hip involvement, including the 5% (Dataset A) of AS patients who needed hip replacement surgery. Patients with hip involvement had significantly worse overall Bath Ankylosing Spondylitis Functional Index (BASFI) scores compared with patients without hip involvement (mean difference = 1.6, P < 0.001) (Dataset A, confirmed in B). Corrected for disease duration, patients with early disease onset, enthesial and axial disease needed most frequently hip replacement surgery (Dataset A, confirmed in B).

Conclusion. Hip involvement is commonly recognized by rheumatologists in AS patients, and involves about one out of the three to four patients with AS and is associated with impaired functioning reflected by higher overall BASFI scores. Early onset of disease, axial and enthesial disease are associated with the hip replacement surgery in AS.