482 research outputs found
Early remission is associated with improved survival in patients with inflammatory polyarthritis: Results from the Norfolk Arthritis Register
No full textObjectives: This study aimed to evaluate whether the early achievement of clinical remission influences overall survival in an inception cohort of patients with inflammatory polyarthritis (IP). Methods: Consecutive early IP patients, recruited to a primary care based inception cohort from 1990 to 1994 and from 2000 to 2004 were eligible for this study. Remission was defined as absence of clinically detectable joint inflammation on a 51-joint count. In sensitivity analyses, less stringent de finitions of remission were used, based on 28-joint counts. Remission was assessed at 1, 2 and 3 years after baseline. All patients were flagged with the national death register. Censoring was set at 1 May 2011. The effect of remission on mortality was analysed using the Cox proportional hazard regression model, and presented as HRs and 95% CIs. Results: A total of 1251 patients were included in the analyses. Having been in remission at least once within the first 3 years of follow-up was associated with a significantly lower risk of death: HR 0.72 (95% CI 0.55 to 0.94). Patients who were in remission 1 year after the baseline assessments and had persistent remission over time had the greatest reduction in mortality risk compared with patients who never achieved remission within the first 3 years of follow-up: HR 0.58 (95% CI 0.37 to 0.91). Remission according to less stringent definitions was associated with progressively lower protective effect. Conclusions: Early and sustained remission is associated with decreased all-cause mortality in patients with IP. This result supports clinical remission as the target in the management of IP
Predictors and consequences of achieving persistent remission, intermittent remission or never achieving remission in patients with recent onset inflammatory polyarthritis: Results from the norfolk arthritis register (NOAR)
No full textBackground: Relatively few studies have assessed sustained remission over a follow up of more than three years and at multiple time points to identify predictors and consequences of remission in patients with inflammatory polyarthritis (IP) and its subset rheumatoid arthritis (RA). Objectives: To assess: i) which baseline clinical and demographic factors are associated with achieving persistent remission (PR), intermittent remission (IR) or never achieving remission (NR) in patients with IP and ii) the association between achieving PR, IR or NR on functional disability progression. Methods: Patients aged >16 yrs with recent onset IP (≥2 swollen joints lasting for >4 weeks and symptom duration <2 years) were recruited to NOAR from 2000 to 2008. Baseline variables collected included age at symptom onset, BMI, C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody, DAS28-CRP, HAQ score and self-reported comorbidities. Remission was defined as no tender or swollen joints (out of 51) and was assessed 1, 2, 3 and 5 years after baseline. Patients were classified as NR if they were not in remission at any anniversary assessment, PR if they were in remission at ≥3 consecutive anniversaries and IR otherwise. Univariate and multivariate ordinal logistic regression analyses were used to assess the association between baseline characteristics and remission group (NR was the lowest order group). A stepwise variable selection process was used to derive the multivariate model. Missing values were imputed using multiple imputation by chained equations in the multivariate model. A random effects model was used to examine the effect of remission group status on HAQ scores over time. Results: 868 patients were included in this study; 65.8% female, mean age at symptom onset 55.9 (SD 14.6) yrs and median disease duration 6.5 [IQR 4.1 to 11.1] months at baseline. The number (%) of patients achieving NR, IR and PR was 471 (54.3), 296 (34.1) and 101 (11.6), respectively. In univariate analysis, female sex, higher number of swollen or tender joints, satisfying the 2010 RA criteria, higher HAQ and DAS28-CRP scores, having at least one comorbidity, being hypertensive, depressed or obese at baseline were all associated with lower odds of being in a higher remission group (table). Female sex, higher number of tender joints, CRP, DAS28, HAQ, time from symptom onset to starting DMARD treatment and being hypertensive at baseline were independently associated with lower odds of being in a higher remission group in a multivariate model. IR and PR were associated with a reduced HAQ score compared to NR (referent), adjusted β (95% CI) for IR and PR -0.51 (-0.60, -0.43), -0.85 (-0.98, -0.72) respectively, p<0.001. Conclusions: Only 11.6% of patients achieved PR during a five year follow up. As well as clinical and demographic factors, comorbidities at baseline were significantly associated with reduced probability of remission. Benefits of remission in terms of improved functional disability were seen, supporting the “treat to target” strategy. (Figure presented)
Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality
No full textObjectives. To test the hypothesis that individuals with regional and widespread pain disorders have an increased risk of mortality. Methods. We conducted a prospective cohort study of 4515 adults. Subjects were an age- and sex-stratified sample who had participated in a population study of pain occurrence during 1996. Based on those reports subjects were classified as having no pain, regional pain or widespread pain. All subjects were identified on the National Health Service Central Register and followed up until April 2005, a total of 8.2 yrs, at which time information was obtained on vital status, and if applicable, date and cause of death. The relationship between pain status and subsequent death is expressed as mortality rate ratios with 95% CIs, adjusted for age, gender, ethnicity and practice. Results. A total of 35.2% reported regional pain and 16.9% satisfied criteria for widespread pain. In comparison with those without pain, there was a 20% and 30% increased risk of dying over the follow-up period among subjects with regional and widespread pain, respectively. The specific causes of death in excess were cancer and cardiovascular disease. In addition, the mortality risk from both cancer and cardiovascular deaths was found to increase as the number of pain sites that subjects reported increased. Conclusions. This study supports a previous observation that persons with regional and widespread pain are at an increased risk of cancer death. Possible mechanisms should be explored. © The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved
How do we classify rheumatoid arthritis in established disease - can we apply the 2010 American College of Rheumatology / European League Against Rheumatism classification criteria?
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Review: silicone breast implants do not increase the risk for connective tissue diseases
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Reduction of long-term disability in inflammatory polyarthritis by early and persistent suppression of joint inflammation: Results from the Norfolk Arthritis Register
No full textTo test the predictive ability of remission in terms of long-term disability in patients with recent-onset inflammatory polyarthritis (IP). Methods Consecutive patients with early IP, recruited between 1990 and 1994 (first cohort) and 2000 and 2004 (second cohort), were included in this study. Remission was defined as the absence of clinically detectable joint inflammation on a 51–joint count. In additional analyses, less stringent definitions of remission were used based on the 40– and 28–joint counts. Remission was assessed at 1, 2, and 3 years after inclusion. A 5-year Health Assessment Questionnaire score =1 (moderate disability) was chosen as the primary outcome measure. Results A total of 841 and 498 patients from the first and second cohorts, respectively, completed 5 years of followup. In the first cohort, patients with at least 1 episode of remission had lower odds of 5-year disability (odds ratio [OR] 0.26, 95% confidence interval [95% CI] 0.17–0.41). The number of times in remission correlated with the odds of disability, with a mean decrease in the probability of disability of ~64% for each additional time point in remission (OR 0.38, 95% CI 0.28–0.52). The time until first remission was not associated with functional disability. Remission according to less stringent criteria showed a weaker protection against future disability. Similar results were found in the second cohort. Conclusion Patients with IP achieving a state of sustained remission early are less likely to show long-term deterioration of function compared with patients who do not achieve remission. The most persistent remission under the most stringent definition of remission has the lowest probability of long-term disability
The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus.
No full textThe safety and effectiveness of different methods of ear wax removal: a systematic review and economic evaluation
No full textEar wax (cerumen) is a natural secretion produced to protect the inner ear from dirt and other fragments by moving these particles towards the outer ear. If this process does not happen properly, wax may build up causing blockage in the ear canal and the possibility of impaction. People with a build up of ear wax may suffer from hearing loss, discomfort and, on occasions, infection. It may present problems in assessing hearing, blocking the view of the ear drum during medical examination and interfering with the fitting or function of hearing aids. Although it is thought to affect between 2% and 6% of the population in the England and Wales, some groups may be at a higher risk, such as those using hearing aids or with small ear canals and/or skin conditions. Recurrence is thought to be high among some of these groups. The consequences of the build up of ear wax in the ear canal are thought to be a common reason for consultation and cost in general practice with over 2 million consultations per year in the NHS.Methods of removal of ear wax include drops, flushing with water in general practice, and removal with suction or probes in specialist clinics. The relative safety and benefits of these different methods of removal remains uncertain. This research will systematically review published and unpublished evidence on the clinical and cost effectiveness of different methods for the removal of ear wax. Where appropriate, it will develop an economic model using data from this systematic review and other relevant sources to estimate the relative costs and benefits of different methods. In addition, the project will provide recommendations for future research to try to help answer any remaining areas of uncertainty
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