In DMARD-naive early RA patients, initial therapy with MTX+high-dose intravenous steroid resulted in good disease control with little structural damage. MTX+IFX was not statistically superior to MTX+intravenous steroid when combined with a treat-to-target approach.

This, the first consensus-based US definition of elementary lesions in gout, demonstrated good reliability overall. It constitutes an essential step in developing a core outcome measurement that permits a higher degree of homogeneity and comparability between multicentre studies.

In most survival studies in NIDDM, microalbuminuria (urinary albumin excretion rate 20-200 microg/min) predicts early mortality; in cross-sectional studies, it is associated with coronary heart disease (CHD) morbidity. It is unclear, however, whether microalbuminuria is a risk factor for the development of CHD or the result of it, and little is known of the factors that predispose to the development of microalbuminuria in NIDDM. We examined these issues in a 7-year prospective study of a hospital-based cohort comprising 146 white NIDDM patients without clinical albuminuria. Microalbuminuria was a significant risk factor for both all-cause mortality (relative risk 3.94, 95% CI 2.04-7.62) and CHD mortality (relative risk 7.40, 95% CI 2.94-18.7) when adjusted for age only. Its independent predictive power did not persist, however, in age-adjusted multivariable survival analysis that allowed for the other significant risk factors: male sex, preexisting CHD, high levels of glycated hemoglobin, and high serum cholesterol. Among men free of CHD at baseline, the independent risk factors for CHD morbidity and mortality were microalbuminuria, current smoking, high diastolic blood pressure, and high serum cholesterol (all P < 0.05). For the 100 NIDDM patients with normoalbuminuria at baseline, the incidence of microalbuminuria was 29% over the 7-year period. In that group, fasting plasma glucose, current smoking, preexisting CHD, and high initial urinary albumin excretion rate were risk factors for the development of microalbuminuria (all P < 0.05). When men and women were analyzed separately, preexisting CHD was a significant risk factor in men only. These results demonstrate that microalbuminuria predicts incident clinical CHD in men with NIDDM. Preexisting CHD is also a risk factor for incident microalbuminuria in men, however, suggesting that microalbuminuria and CHD are not causally related but rather reflect common determinants.

Objective To estimate the prevalence of Rheumatoid Arthritis (RA) from international population-based studies and investigate the influence of prevalence definition, data sources, classification criteria and geographical area on RA prevalence. Methods A search of ProQuest, MEDLINE, Web of Science, and EMBASE was undertaken to include population-based studies investigating RA prevalence between 1980 and 2019. Studies were reviewed using the Joanna Briggs Institute approach for the systematic review and Preferred Reporting Items for Systematic Reviews guidelines. Results Sixty studies met the inclusion criteria. There was a wide range of point-prevalence reported (0.00% - 2.70%) with a mean 0.56% (S.D= 0.51) between 1986 and 2014 and period-prevalence 0.51% (S.D= 0.35) between 1955 and 2015.. RA point- and period-prevalence was higher in urban settings than rural settings, (0.69% vs 0.48%) and (0.54% vs 0.25%), respectively. The RA diagnosis validated by rheumatologists yielded the highest period-prevalence of RA and was observed in linked databases (0.80%, S.D=0.1). Conclusion The literature reports a wide range of point- and period- prevalence based on population forms and method of data collection, but average point- and period-prevalence of RA were 51/10,000 and 56/10,000, respectively. Higher urban vs rural prevalence may be biased by poor case finding with less health care or reflect risk environment. The population database studies were more consistent than sampling studies, and linked databases in different continents appeared to provide a consistent estimate of RA period-prevalence and confirming the high value of rheumatologist diagnosis as classification criteria.