Objective To evaluate the association of baseline serum level of vitamin D (vitD) with disease activity, disability and radiographic damage over the first year in early rheumatoid arthritis (RA). Methods Among early arthritis patients included in the ESPOIR cohort, patients with early RA were evaluated. 25OH vitamin D2D3 level was measured at baseline. Baseline associations between vitD level and DAS28-ESR, Health Assessment Questionnaire Disability Index (HAQ-DI) and van der Heijde-modified total Sharp score (mTSS) were assessed. Bivariate analysis was used to assess the association between vitD level and radiographic progression (mTSS increased by ≥1 point) or disability (HAQ-DI ≥0.5) over 12 months. Forward stepwise multiple logistic regression was used to evaluate the independent association of baseline variables and outcomes. Results Among 813 patients with early arthritis, data for 645 RA patients were analyzed. VitD level was <10 ng/ml (deficiency, group 1), 10-30 ng/ml (low level, group 2) and ≥30 ng/ml (normal, group 3) for 114 (17.7%), 415 (64.6%), and 114 (17.7%) patients, respectively. At baseline, DAS28-ESR and HAQ-DI were higher with vitD deficiency as compared with groups 2 and 3 combined (p=0.007 and p=0.001, respectively) as was mean mTSS but not significantly (p=0.076). On multivariate analysis, baseline vitD deficiency was associated with HAQ-DI at 6 months (OR=1.70) and mTSS at 12 months (OR=1.76). Conclusion VitD deficiency was associated with more active and severe disease at baseline and may predict disability and radiographic progression over 1 year in early RA patients.
ObjectiveA systematic review and meta-analysis of data from cohort studies to analyse the diagnostic performances (ie, sensitivity and specificity) of ultrasound (US) for diagnosis of calcium pyrophosphate deposition (CPPD) disease with microscopic crystal detection used as a gold standard.MethodsWe performed a systematic review of articles published up to December 2014 using EMBASE, MEDLINE and Cochrane databases and abstracts from the past two EULAR and ACR annual meetings. Only studies reporting the performance of US for diagnosis of CPPD disease were selected. A meta-analysis involved the inverse variance method to evaluate global sensitivity and specificity of US. Statistical heterogeneity was assessed by the Cochran Q-test and I2 values.ResultsThe search resulted in 85 articles and 11 abstracts; 17 and 4, respectively, were selected for the systematic review. A total of 262 patients with CPPD disease and 335 controls from 4 original articles and 4 abstracts were included in the meta-analysis. The US diagnostic patterns most frequently recorded were thin hyperechoic bands in the hyaline cartilage (8 articles); hyperechoic spots in fibrous cartilage or in tendons (7 articles); and homogeneous hyperechoic nodules localised in bursa or articular recesses (4 articles). The meta-analysis revealed a heterogeneity of the data, with a sensitivity of 87.9% (95% CI 80.9% to 94.9%) and specificity of 91.5% (95% CI 85.5% to 97.5%) using a random model.ConclusionsThis meta-analysis confirmed that US has high sensitivity and specificity for the diagnosis of CPPD and may be a promising tool for the diagnosis and management of CPPD.
BackgroundCalcium Pyrophosphate Deposition (CPPD) is a crystal related arthritis, which can be difficult to diagnose. Conventional radiography is considered as the routine modality to detect cartilage calcification. However, ultrasound (US) is a technique that has recently demonstrated higher sensibility in the detection of CPP crystal deposition.(1)ObjectivesTo analyze the sensitivity and the specificity of US in CPP crystals deposits detection in knee and cartilages of other joints using microscopic crystal detection as a gold standard by performing a systematic review and meta-analysis based on data from cohort studies.MethodsA systematic review of literature was performed until december 2014. Bibliographic references were selected from Embase, Medline and Cochrane databases, and abstracts from the two last European League Against Rheumatism and American College of rheumatology annual meetings. The reference lists of selected articles were manually searched to identify additional relevant reports. We chose studies reporting performance of US in diagnosis of CPPD. A meta-analysis was then performed, using the inverse variance method to evaluate a global sensibility and specificity of US. Statistical heterogeneity was assessed by Cochran Q-test and I2 values.ResultsThe search found out 85 articles and 11 abstracts of which respectively 17 and 4 were selected for analysis. Retrieved data allowed meta-analysis on 4 articles and 4 abstracts for the sensibility and specificity of US. A total of 262 patients with a CPPD disease and 335 controls were included. All CPPD diagnosis were confirmed by microscopic observation. The articular sites studied were mostly knees but also elbows, shoulders, wrists and feet. Included patients had the following features: mean age 49-74 years, male (29-71%). The US patterns researched were: 1) Thin hyperechoic bands in the hyaline cartilage (8 articles) 2) Hyperechoic spots in fibrous cartilage or in tendons (7 articles) 3) Homogeneous hyperechoic nodular localized in bursae or articular recesses (4 articles). The results showed a sensibility ranging from 60% to 100% and a specificity ranging from 39% to 100% according to the selected studies. The meta-analysis revealed a sensibility of 91% (95% CI 87.6 – 94.4) and a specificity of 96.6% (95% CI 94.7 – 98.4) with a heterogeneity of 72.4% and 87.24% respectively in a fixed model. The random model showed a sensibility of 87.9% (95% CI 80.9 – 94.9) and a specificity of 91.5% (95% CI 85.5 – 97.5).ConclusionsThe results of this meta-analysis confirm that US has very high sensibility and specificity values and is a promising tool in the diagnosis and management of CPPD.ReferencesBarskova VG, Kudaeva FM, Bozhieva LA, Smirnov AV, Volkov AV, Nasonov EL. Comparison of three imaging techniques in diagnosis of chondrocalcinosis of the knees in calcium pyrophosphate deposition disease. Rheumatol Oxf Engl. 2013 Jun;52(6):1090–4.Disclosure of InterestNone declared
BackgroundEnvironmental factors may play a crucial role in auto-immune diseases. Besides tobacco, other factors like vitamin D are suspected to impact the onset and the subsequent activity of inflammatory arthritis including rheumatoid arthritis (RA), but its association with severity of the disease has not been evaluated yet.ObjectivesTo examine the association of baseline vitamin D serum level with RA severity, disability, disease activity, response to treatment over the first year in early arthritis patients.MethodsPatients presenting with synovitis of at least 2 joints for 6 weeks to 6 months were included in the multicenter French ESPOIR cohort. 25OH vitamin D2 and D3 was measured at baseline and then separated into 3 groups: deficiency (<10 ng/ml), insufficiency (10-30 ngl/mL), normal level (≥30ng/mL). Correlation between vitamin D levels and DAS28, HAQ and van der Heijde modified total Sharp score (mTSS) were assessed at baseline by a Spearman correlation analysis. Bivariate analyses of the association between baseline vitamin D level and other outcomes were conducted: radiographic progression defined by an increase of at least 1 point of the mTSS at 12 months; disability (defined by an HAQ≥1); disease activity (DAS28) and RA diagnosis (2010 ACR/EULAR criteria) at baseline, 6 and 12 months; response to treatment (EULAR response) at 6 and 12 months. Forward stepwise multiple logistic regression was used to evaluate independent association between baseline variables and formerly described outcomes.ResultsAmong 813 patients included in the cohort, 810 were analyzed and 138 (16.97%), 522 (64.21%), 150 (18.45%) had vit D<10, 10-30 and ≥30ng/mL respectively. Vitamin D levels were found to be correlated with DAS28, mTSS and HAQ at baseline (Rho=-0.11, p=0.0016; Rho=-0.07, p=0.0335 and Rho=-0.11, p=0.0016 respectively). In bivariate analyses, patients with vitamin D deficiency had more radiographic progression at 12 months compared to vitamin D normal group (OR=1.82 95% CI 1.05-3.15, p=0.0323). Patients with a HAQ ≥1 were more frequent in deficiency group compared to normal group at baseline and 6 months (OR=1.89 95% CI 1.18-3.03, p=0.008 and OR=2 95% CI 1.15-3.49 p=0.0146 respectively). Patients with DAS28>5.1 were more frequent in deficiency group compared to normal group at baseline (OR=1.84 95%CI 1.15-2.87 p=0.011). There was no link between vitamin D level and RA diagnosis at baseline, 6 and 12 months nor with response to treatment at 6 and 12 months. In multivariate analysis, radiographic progression at 12 months was associated with vitamin D deficiency (OR=1.95 95% CI 1.05-3.62, p=0.038), age, ACPA, CRP, alcohol consumption and season of onset. Likewise, disability at baseline was associated with vitamin D deficiency (OR=1.73 95% CI 1.05-2.85, p=0.03), age, CRP, corticosteroid use and disease duration; disability at 6 months was associated with vitamin D deficiency (OR=2.01 95% CI 1.15-3.52, p=0.025), age and sex.ConclusionsVitamin D deficiency may be predictive of radiographic progression at 1 year and is a...
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