Different pharmacological treatments for RA affect the clinical condition and subgingival microbiota.

We determined whether rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) can predict remission or severe disability in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor (TNF) alpha drugs. We performed a cohort study based on the clinical data from a referral center for the treatment of RA in Bogotá, Colombia, were included patients aged ≥18 years with diagnosis of RA with an active disease and for whom a treatment scheme was begun with anti-TNF alpha medication, with a minimum follow-up time of 12 months. Disease activity of Rheumatoid Arthritis was assessed through measurement of RF, ACPA, disease activity score (DAS28), and health assessment questionnaire (HAQ). We calculated the incidence rates (IRs) for remission and severe disability. We also calculated the incidence rate ratio (IRR) for each outcome by adjusting for possible confounders using the Poisson regression method. The hypothesis was tested with a P value of <.05. Statistical analysis was performed in Stata 15. We included 400 patients receiving an anti-TNF alpha agent. Median age was 60 years, and 322 patients were women (80.5%). RF was positive in 357 patients (89%), ACPA in 348 patients (87%), and co-positivity in 324 patients (81%). Median follow-up was 41 months (range, 12–79 months). The IR for remission was 23 per 100 person-years in RF-negative patients and 16 per 100 person-years in RF-positive patients. The adjusted IRR (age sex, treatment, and ACPA) was 1.51 (95%CI, 1.05–2.18). The IR for severe disability was 10.8 per 100 person-years in the RF-positive cohort and 2.3 per 100 person-years in the RF-negative cohort. The IRR adjusted for these factors was 4.37 (95%CI, 1.6–12). Co-positivity had a similar behavior to RF. No differences were recorded in the rates of remission or disability in ACPA-positive and ACPA-negative patients. Our findings suggest that remission is less frequent and severe disability more frequent in RF-positive patients treated with anti-TNF alpha agents than in RF-negative patients.

For the Pan American Health Organization (PAHO), the care of patients with chronic diseases currently experiences fragmentation in attention, generating poor performance of health services. Thus, comprehensive health care strategies arise to mitigate these problems; one of them are Centers of Excellence (CoEs), which aim to obtain high quality results in health from the adequate and minimum use of resources. The objective of this study was to describe the history and current context of the CoE in comprehensive care in patients with rheumatoid arthritis (RA). A systematic search of the literature terms (MeSH) was performed. The bases used were PubMed, Ebsco Host, Lilacs, Science Direct, Ovid, and Google (gray literature). The source of the information was evaluated to determine its quality. International standards focus the CoEs starting from comprehensive management of patients with RA and patient volume, continuous improvement, and quality of health care, constituting an interdisciplinary team. The REAL-PANLAR group suggested that the inclusion of the strategy “Treat to Target”, and patient education improves patient conditions and understanding of the disease. RA is a prevalent and costly disease. The creation of comprehensive care centers of the CoE type is an initiative that improves the prognosis of RA. This document aims to encourage rheumatologists and scientific societies to structure CoE in an interdisciplinary endeavor.

Management of rheumatoid arthritis (RA) in many Latin-American countries is impaired by fragmentation and scarce healthcare provision, resulting in obstacles to access, diagnosis, and treatment, and consequently in poor health outcomes. The aim of this study is to propose a comprehensive care program as a model to provide healthcare to RA patients receiving synthetic DMARDs in a Colombian setting by describing the model and its results. Health outcomes were prospectively collected in all patients entering the program. By protocol, patients are followed up during 24 months using a treat-to-target strategy with a patientcentered care (PCC) model, meaning that a patient should be seen by rheumatologist, physical and occupational therapist, physiatrist, nutritionist and psychologist, at least three times a year according to disease activity by DAS28. Otherwise, patients receive standard therapy. The incidence of remission and low disease activity (LDA) was calculated by periods of follow-up. A total of 968 patients entered the program from January 2015 to December 2016; 80.2% were women. At baseline, 41% of patients were in remission, 17% in LDA and 42% in MDS/SDA. At 24 months of follow-up, 66% were in remission, 18% in LDA and only 16% in MDS/SDA. Regarding DAS28, the mean at the beginning of the time analysis was 3.1 (SD 1.0) and after 24 months it was 2.4 (SD 0.7), showing a statistically significant improvement (p < 0.001). In all patients, the reduction of disease activity was 65% (95% CI, 58-71). Patients entering the PCC program benefited from a global improvement in disease activity in terms of DAS28.

Background: Care models can affect the clinical outcome of patients with rheumatic and musculoskeletal diseases. Objective: We aimed to compare how an innovative model of a rheumatoid arthritis disease-management program can improve the clinical outcomes of patients compared to a conventional assessment approach. Methods: We performed a retrospective analysis of real-world data from clinical records of a cohort of 5078 patients diagnosed with rheumatoid arthritis who were followed up at the Center of Excellence in Rheumatoid Arthritis vs the clinical outcomes reported in the Colombian National Registry of Rheumatoid Arthritis. Results: We found significant differences in the diagnosis and follow-up between the specialized Center program and the usual care reported by the Colombian National Registry (p<0.005), including the evaluation of rheumatoid factor, Anti-citrullinated antibodies Disease Activity Score, Health Assessment Questionnaire, number of visits to the rheumatologist, and clinical outcomes measured by the level of disease activity. In addition, when comparing the Center's clinical outcomes-from baseline to the last follow-up, we found an improvement in the level of disease activity, with patients classified in remission increasing from 20.8% to 58.5% (p<0.005), and a reduction in those with high disease activity from 18% to 4.7% (p<0.005). Conclusion: Real-world evidence showed that patients with rheumatoid arthritis who underwent follow-up under an innovative disease-management model improved their clinical outcomes compared with those patients in a conventional assessment program. These results could suggest a way of improving health policies for patients with rheumatoid arthritis.

The aim of this study was to evaluate the effect of treatment with methotrexate (MTX), by itself or combined with other non-biological disease-modifying antirheumatic drugs (DMARDs) (methotrexate, MTX with prednisolone, MTX with leflunomide, MTX with chloroquine, and MTX with sulfasalazine) on clinimetric outcomes in a retrospective cohort with a 6-month follow-up and under a Treat to Target (T2T) approach. Patients in treatment with conventional DMARDs and classified as moderate disease activity (MDA) and high disease activity (HDA) were included. Changes in disease activity score (DAS28), health assessment questionnaire (HAQ), tender joint count (TJC), and swollen joint count (SJC) are compared using the Wilcoxon nonparametric test for paired data. Hypothesis contrasts were raised in order to look for differences between the different exposure groups and the outcomes defined by means of the Kruskal-Wallis (KW) nonparametric test. Follow-up was documented in 307 patients, including 250 (81.4%) women. At the onset, 243 subjects (79.2%) were classified as MDA and 64 (20.9%) in HDA. A total of 247 subjects (80.4%) presented some degree of improvement, with 156 subjects (51%) entering remission, which is a significant number (p value = 0.047). There were no differences in the level of severity between the treatment groups (p = 0.98). This study, developed in a cohort of patients with RA with moderate or severe disease activity who were treated with MTX by itself or combined with other non-biological DMARDs under T2T strategy, showed a decrease in the severity of disease activity in 80% of patients. The difference between monotherapy (MTX) and the combinations with other non-biological DMARDs could not be established.

Background Globally, osteoarthritis (OA) is the third condition associated with disability. There is still poor treatment in OA but science holds the key to finding better treatments and a cure. It is essential to learn what’s important to patients from them to implement the most effective OA management. The OA Patients Task Force, conducted the Global OA Patient Perception Survey (GOAPPS)-the first global survey made by patients to analize the quality of life (QoL) & patient perceptions of care. The goal was to collect data on OA patients’ perception of OA to understand patients’ needs and expectations to improve OA management. Methods Observational, cross-sectional study by online survey data collection from six countries, translated into three languages. The questionnaire was comprised of 3 sections: patient demographics and clinical symptomology characteristics; relationship with physicians: perception of attention, treatment, and information provided; and OA impact on daily activity and QoL. The results of the survey were evaluated using the Limited Data Set. The survey results were analyzed using descriptive statistics to characterize the patients’ answers. Additionally, Cronbach’s alpha was calculated to determine internal consistency validity. Results A total of 1512 surveys were completed in 6 countries. 84.2% of respondents reported pain/tenderness and 91.1% experienced limitations to physical activities. 42.3% of patients were not satisfied with their current OA treatment. 86% had comorbidities, especially hypertension, and obesity. 51.3 and 78% would like access to additional drug or additional non-drug/non-surgical treatments respectively. 48.2% of patients perceived their QoL to be affected by OA. The Cronbach’s alpha was 0.61. Conclusions OA has a significant impact on patients’ daily activities and their desire to play an active role in managing this disease. Patients are seeking additional treatments, especially no pharmacological/no surgical treatments stressing the need for investing in clinical research, implementing OA preventive measures, and managing interventions to improve the healthcare value chain in OA.

Currently, traditional and non-traditional risk factors for cardiovascular disease have been established. The first group includes age, which constitutes one of the most important factors in the development of chronic diseases. The second group includes inflammation, the pathophysiology of which contributes to an accelerated process of vascular remodelling and atherogenesis in autoimmune diseases. Indeed, the term inflammaging has been used to refer to the inflammatory origin of ageing, explicitly due to the chronic inflammatory process associated with age (in healthy individuals). Taking this into account, it can be inferred that people with autoimmune diseases are likely to have an early acceleration of vascular ageing (vascular stiffness) as evidenced in the alteration of non-invasive cardiovascular tests such as pulse wave velocity. Thus, an association is created between autoimmunity and high morbidity and mortality rates caused by cardiovascular disease in this population group. The beneficial impact of the treatments for rheumatoid arthritis at the cardiovascular level has been reported, opening new opportunities for pharmacotherapy.