Objectives

Objectives To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke.Design Longitudinal nationwide register based cohort study. Setting Main outcome measures Rates of atrial fibrillation and stroke.Results Of 4 182 335 participants included in the cohort, 18 247 were identified as having rheumatoid arthritis during follow-up, with a mean age at disease onset of 59.2 years and a median follow-up of 4.8 years. A total of 156 484 people, including 774 with rheumatoid arthritis, were diagnosed as having atrial fibrillation (age and sex matched event rates of 8.2 per 1000 person years in rheumatoid arthritis patients and 6.0 per 1000 person years in the general population), with an adjusted incidence rate ratio of 1.41 (95% confidence interval 1.31 to 1.51). In addition, 165 343 people, including 718 with rheumatoid arthritis, had a stroke (7.6 per 1000 person years in rheumatoid arthritis and 5.7 per 1000 person years in the general population), with a resultant rate ratio of 1.32 (1.22 to 1.42). For both atrial fibrillation and stroke, relative risks were increased in all strata based on thirds of sex and age, with higher relative risks in younger patients but higher absolute risk differences in older patients.Conclusions Rheumatoid arthritis was associated with an increased incidence of atrial fibrillation and stroke. The novel finding of increased risk of atrial fibrillation in rheumatoid arthritis suggests that this arrhythmia is relevant in cardiovascular risk assessment of these patients.

AimTo monitor joint infl ammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/ methotrexate combination therapy using MRI and ultrasonography. To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring. Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/ radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy. Results No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p>0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off. Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p<0.05), as did DAS28, HAQ and tender and swollen joint counts (p<0.001). Patients with progression on CT had higher baseline MRI bone oedema scores. The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and timeintegrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann-Whitney; p<0.05). With CT as the reference method, sensitivities/specifi cities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively. Median intraobserver correlation coeffi cient was 0.95 (range 0.44-0.99). Conclusion During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased. Infl ammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.Radiographic data from randomised placebocontrolled studies of rheumatoid arthritis (RA) patients show that erosive progression is arrested, and occasionally even reversed, when starting methotrexate and tumour necrosis factor alpha (TNFα) antagonist combination therapy. 1 -3 MRI is more sensitive than radiography for bone erosions, including erosive progression, and MRI enables visualisation of synovitis and bone oedema. 4 -7 Diminished size of MRI bone erosions during TNFα antagonist therapy was reported from a study of fi ve RA patients, 8 but no systematic MRI studies addressing the repair of erosions are available.Ultrasonography is also more sensitive for bone erosions than radiography, 5 9 -12 but follow-up data are few. 13 -16 Ultrasonography allows the detection of synovial thickening by grey-scale ultrasonography (B-mode) 5 17 and increased synovial blood fl ow using Doppler techniques. 18 -21 CT is considered a reference method for bone destructions, and is more sensitive for bone erosions than radiography, MRI and ultrasonography. 12 22 No longitudinal RA studies comparing MRI,...

Levels and changes of 10 biomarkers in patients with axial spondyloarthritis during anti-TNFα therapy were documented. Construct validity and responsiveness of IL-6, VEGF, MMP-3, total aggrecan and osteocalcin were demonstrated. ASDAS was more associated with these biomarkers than BASDAI, and may better reflect the inflammatory disease processes. ClinicalTrials.gov identifier NCT00133315.

An individual dietary plan based on everyday food, combined with three follow-up visits (one, four, and eight weeks) after discharge, led to an improvement in nutritional status and self-rated health in geriatric patients.