Since the previous studies showed that anti-citrullinated protein antibodies (ACPA) can induce osteoclasts differentiation and activation, even before arthritis onset, the aim of our study was to determine whether ACPA-positivity is associated with lower bone mineral density (BMD) at baseline visit of a register of early arthritis (EA) patients. The study population comprised 578 patients (80% females) from our EA clinic with a median disease duration, 5.1 months (p25–p75: 6–8); median age, 53.6 years (41.9–66.1), 38% ACPA-positive, and 55% fulfilling 2010 criteria for rheumatoid arthritis. BMD was measured using dual X-ray absorptiometry at lumbar spine, hip, and metacarpophalangeal (MCP) joints of the non-dominant hand to evaluate both systemic and juxta-articular bone mass. ACPA titers were determined through enzyme immunoassay. The effect of ACPA on BMD was analyzed using multivariable analysis based on generalized linear models adjusted for various confounders. ACPA-positive patients showed lower bone mass at lumbar spine and hip, but no differences were observed at MCP joints compared to ACPA-negative patients. However, ACPA-positive patients displayed higher disease activity and disability than ACPA-negative patients. After adjustment for gender, age, body mass index, and other bone-related variables, the presence of ACPA remained significantly associated with lower BMD at the lumbar spine, femoral neck, and hip but not at MCP joints. Disease activity was not associated with baseline bone mass. Our data reinforce the previous preclinical findings suggesting that the systemic bone loss detected at the initial phases of early ACPA-positive arthritis is independent of inflammatory status and, therefore, could be mediated by ACPA.Electronic supplementary materialThe online version of this article (doi:10.1007/s00296-017-3674-9) contains supplementary material, which is available to authorized users.

Our experience suggests that 1000 mg rituximab single infusion on demand is a reasonable schedule for long-term treatment of those patients with good response after the first cycles, especially in seropositive patients and when it is applied as a first- or second-line biological therapy.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Background The evaluation of cortical bone mineral density (BMD) on metacarpal bones by digital radiogrammetry (DXR) has been proven to be a simple, reliable and predictive method to evaluate the severity of the disease in patients with early arthritis (EA). However, DXR is a tool that is not usually available in our environment. By contrast, dual X-ray absorptiometry (DXA) is a more familiar and accessible technique in our clinical practice. Objectives The aim of this study was to compare the association between BMD measurements of the hand by DXR and DXA with parameters of activity and severity at two years of follow-up in a cohort of patients with EA. Methods A prospective longitudinal study of patients with EA was done. DXR was performed in a total of 111 patients (87.4% women) and DXA was implemented in a total of 378 (82% women). Mean age at disease onset was 57 years [46 - 65 (p25 - p50)] in the DXR group and 54 years [44 - 66 (p25 - p50)] in the DXA group. Anthropometric and clinical data were collected per protocol during 2 years of follow-up. Forty-two percent of patients in the DXR group presented citrullinated peptide antibodies and 41.3% in the DXA group. In both, the 57% fulfilled Rheumatoid arthritis (RA) 2010 criteria at the start of follow up (43% undifferentiated arthropathy). Each patient underwent a digital radiograph of both hands (GE © DX Definium 8000) at 0, 3, 12 and 24 months, determining BMD of each hand and the mean of both measures by DXR (Sectra, Linköping, Sweden). Also, DXA of global hand and metacarpophalangeal joints (MCPs) of the nondominant hand were performed and analyzed (Hologic QDR -4500 Elite©) at 0, 6, 12 and 24 months. In addition, a variable that measures the intensity of cumulative treatment received during the 2 year follow-up was specifically generated as a marker of severity. Statistical analysis was performed using the statistical package STATA 12. Results Our data show a good correlation between values of BMD obtained by DXR and DXA in the different locations studied (global hand and MCPs: r=0.830 and 0.718, respectively, p=0.0001), both at the baseline visit and along the two years of monitoring. In the bivariate analysis, a negative association is observed between baseline BMD values measured by DXA and disease activity by DAS28 at 2 yrs, which disappears when adjusting for other variables (age and sex). However, we found an inverse relationship between the intensity of cumulative treatment at two years and baseline BMD measured by DXA, both at global hand (r = -2.51, p=0.041, n=220) and MCPs (r = -3.45, p=0.007, n=221). The DXR association was not significant, probably due to the small sample size (n=32). Conclusions BMD of the global hand and MCPs of the nondominant hand assessed by DXA predicts disease severity and the intensity of cumulative treatment in the first two years of follow-up in a population of patients with EA. By contrast, predictive value of the hand DXR was not demostrated. Further studies with a larger population are needed to obtain ...

reporting also prompted the formation of a PROMIS study group within the department. This group's purpose is to share best practices in PRO related research methodology and statistical analysis. CONCLUSIONS: The introduction of PROMIS data collection in the outpatient clinics at our institution increased the usage and reporting of research related findings in musculoskeletal injuries and conditions. Aided by an enthusiastic department chairman and widespread institutional support, our clinical faculty's interest in collecting and reporting PROMIS data has increased precipitously. The large demand for PRO data within research studies has also spurred further development of WUPRO to include greater research functionality. This functionality includes multiple methods of REDCap integration including direct data transfer to REDCap studies and integrating research forms alongside clinical data which will further increase our ability to leverage clinical PRO data collection to support research applications.