Objective-To assess fatigue in relation to depression, blood pressure, and plasma catecholamines in patients with primary Sjögren's syndrome (SS), in comparison with healthy controls and patients with rheumatoid arthritis. Methods-For the assessment of fatigue the Multidimensional Fatigue Inventory (MFI) was used, a 20 item questionnaire, covering the following dimensions: general fatigue, physical fatigue, mental fatigue, reduced motivation, and reduced activity. Furthermore, the Zung depression scale was used to quantify aspects of depression. Forty nine female primary SS patients, 44 female patients with rheumatoid arthritis (RA), and 32 healthy women filled in both questionnaires. In addition, supine values of blood pressure and plasma catecholamines were measured in the patients with primary SS. Results-Primary SS patients were more fatigued compared with the healthy controls on all the five dimensions of the MFI. When the analyses were repeated using depression as a covariate, group diVerences disappeared for the dimensions of reduced motivation and mental fatigue. In the primary SS patients, significant positive correlations between depression and the dimensions of reduced motivation and mental fatigue were found. Comparing patients with primary SS with those with RA, using depression as covariate, no statistically significant diVerences were found between these groups. No relation between fatigue and blood pressure was found, but a negative correlation was observed between the general fatigue subscale of the MFI and plasma noradrenaline. Conclusion-Patients with primary SS report more fatigue than healthy controls on all the dimensions of the MFI and when controlling for depression significant differences remain on the dimensions of general fatigue, physical fatigue, and reduced activity. The negative correlations between levels of noradrenaline and general fatigue in patients with primary SS may imply the involvement of the autonomic nervous system in chronic fatigue.

Triple DMARD induction therapy is better than MTX monotherapy in early RA. Furthermore, no differences were seen in medication adjustments due to adverse events after stratification for drug. Intramuscular and oral GCs are equally effective as bridging treatments and both can be used.

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IntroductionAn ACR/EULAR task force released new criteria to classify rheumatoid arthritis at an early stage. This study evaluates the diagnostic performance of these criteria and algorithms by van der Helm and Visser in REACH.MethodsPatients with symptoms ≤12 months from REACH were used. Algorithms were tested on discrimination, calibration and diagnostic accuracy of proposed cut-points. Two patient sets were defined to test robustness; undifferentiated arthritis (UA) (n=231) and all patients including those without synovitis (n=513). The outcomes evaluated were methotrexate use and persistent disease at 12 months.ResultsIn UA patients all algorithms had good areas under the curve 0.79, 95% CI 0.73 to 0.83 for the ACR/EULAR criteria, 0.80, 95% CI 0.74 to 0.87 for van der Helm and 0.83, 95% CI 0.77 to 0.88 for Visser. All calibrated well. Sensitivity and specificity were 0.74 and 0.66 for the ACR/EULAR criteria, 0.1 and 1.0 for van der Helm and 0.59 and 0.93 for Visser. Similar results were found in all patients indicating robustness.ConclusionThe ACR/EULAR 2010 criteria showed good diagnostic properties in an early arthritis cohort reflecting daily practice, as did the van der Helm and Visser algorithms. All were robust. To promote uniformity and comparability the ACR/EULAR 2010 criteria should be used in future diagnostic studies.

Objective. To study the occurrence of sick leave and to identify work characteristics related to sick leave in patients with early inflammatory joint conditions. Methods. Patients with inflammatory joint conditions present for <12 months were included in this cross-sectional study. Approximately 85% of patients satisfying the criteria participated. Data collection included demographics, clinical characteristics, pain, physical functioning and mental health (Short Form 36), fatigue, and behavioral coping (Coping of Rheumatic Stressors questionnaire). Work characteristics included physical load, psychosocial load, job control, and support at work. Outcome was defined as sick leave for >2 weeks during the past 6 months. Multiple logistic regression analysis was conducted. Results. Sick leave was reported by 54 (26%) of 210 employed patients, with 75% of the sick leave periods attributed to joint conditions. Of these 210 patients, 23% were classified as having rheumatoid arthritis (RA), 35% as having non-RA arthritis, and 42% as having inflammatory joint conditions without synovitis. Pain, poor physical functioning, and passive behavioral coping were related to increased sick leave, whereas diagnostic group was not. Low job control, i.e., low control over planning and pacing of activities within the job, was associated with increased sick leave (odds ratio [OR] 2.74), whereas being a supervisor (OR 0.21) and clerical work (OR 0.45) were related to reduced sick leave. Conclusion. Substantial sick leave in the past 6 months was reported by 26% of patients with early inflammatory joint conditions. Pain, functional limitations, and fewer opportunities to determine one's work activities were associated with the occurrence of sick leave.