<b><i>Background:</i></b> The sensitivity and specificity of anti-glomerular basement membrane (GBM) antibodies have not been systematically analyzed. In this systematic review, we aimed to evaluate the diagnostic accuracy of anti-GBM antibodies for anti-GBM disease. <b><i>Summary:</i></b> Potential studies were searched using MEDLINE, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform based on the index test and target condition. The inclusion criteria were prospective or retrospective cohort studies or case-control studies assessing the sensitivity and specificity of anti-GBM antibodies, and the reference standard was clinical diagnosis including biopsy results. The exclusion criteria were review articles, case reports, animal studies, and in vitro studies. Quality assessment was conducted based on the Quality Assessment of Diagnostic Accuracy Studies-2. The pooled estimates of sensitivity and specificity were calculated using a bivariate random-effects model. The overall quality was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation. Six studies (1,691 patients) and 11 index tests were included in our systematic review. A high risk of bias and concerns regarding the applicability of patient selection were noted because of the case-control design in 67% of the included studies. The pooled sensitivity and specificity were 93% (95% CI: 84–97%) and 97% (95% CI: 94–99%), respectively. The certainty of evidence was low because of the high risk of bias and indirectness. <b><i>Key Messages:</i></b> Anti-GBM antibodies may exhibit high sensitivity and specificity in the diagnosis of anti-GBM disease. Further cohort studies are needed to confirm their precise diagnostic accuracy and compare diagnostic accuracies among different immunoassays.
Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial.
BackgroundEarly menopause may be a risk of developing RA1. Although there are many reports about menopause and the onset of RA, it is not yet clear how the disease activity of RA differs for each generation including menopause.ObjectivesTo clarify how disease activity differs for each generation, especially in menopausal period.MethodsUsing the Japanese large RA cohort database (NinJa:National database of Rheumatic Diseases in Japan) of 2016, we divided 12257 RA females into three groups of age (under 44 years old=1, 45 to 55 years old=2, defined as a menopausal group, over 56 years old=3) and analysed them cross-sectionally. We conducted a one-way ANOVA on disease activity indexes such as Tender joint count (TJC), Swollen joint count (SJC), DAS28, HAQ-DI.ResultsTable 1 shows the number of people per group, the duration of disease, the titer of RF/ACPA, and the proportion of drugs used. The average usage of prednisone and the use of biologics was the most common in group 1. In table 2, TJC was the largest in group 2 (p<0.01). Furthermore, the difference between groups seen in TJC tends to be larger than TJC 28. There was no significant difference in SJC (SJC28) between three groups. Other disease activity indicators (ESR, CRP, DAS 28, HAQ-DI) were the largest in group 3 (p<0.01) and the percentage of Boolean remission was also lowest in group 3 (p=0.02).Abstract AB0255 – Table 1Characteristics of the three age groupsgroup123P-value Number of patients107116999487Symptom duration, years8.210.515.4p<0.01RF titer, (IU/mL)186233254p=0.06ACPA titer, (U/mL)90102132p<0.01On NSAIDs use, n(%)392 (36%)710 (41%)3668 (38%)p<0.01Daily mean prednisone dose, (mg/day)4.313.953.86p=0.01On DMARDs, n(%)984 (91%)1623 (95%)8835 (93%)p<0.01On a biologic, n(%)435 (40%)550 (32%)2570 (27%)Abstract AB0255 – Table 2Comparisons of values for disease outcomes of the three age groupsTender joint count(TJC), mean1.652.171.97p<0.01 Tender joint count(28 joints, TJC28), mean1.171.481.44p=0.01Swollen joint count(SJC), mean1.351.491.52p=0.23Swollen joint count(28 joints, SJC28), mean1.051.191.20p=0.12ESR, mean, (mm/h)17.318.829.7p<0.01CRP, mean, (mg/dl)0.320.370.58p<0.01DAS28, mean2.512.783.12p<0.01HAQDI score, mean0.250.420.77p<0.01Proportion in Boolean remission, n(%)351 (32%)485 (28%)2145 (22%)p=0.02ConclusionsThis study shows that TJC may increase during menopause, unlike other disease activity indicators. Especially in group 2, it is possible that the joints which can’t be evaluated at TJC 28 are affecting the results because in TJC, compared with TJC 28, there is a larger group difference. Although further studies are needed, an increase in TJC may reflect menopausal joint symptoms.Reference[1] Pikwer M, et al. Ann Rheum Dis. 2012Mar;71(3):378–81.Disclosure of InterestNone declared
BackgroundDAS28 (Disease Activity Score based on 28 joints) is widely used to determine remission in rheumatoid arthritis (RA). The problems with DAS28 due to omission of the lower extremity joints have long been discussed. There are reports demonstrating that some patients meeting DAS28 remission criteria still have synovitis in their feet.1 It is suggested that patients with remaining foot synovitis can experience up to a 2-fold increase in relapse rates.2 Evidence supporting this hypothesis is still scarce.ObjectivesWe hypothesised that RA patients in remission according to the DAS28 remission criterion with remaining foot synovitis are less likely to stay in remission. We aimed to test this hypothesis among Japanese patients with RA.MethodsIn 2015, 15,071 RA patients were registered in a large nationwide database in Japan (NinJa). Among those patients, those who were in remission based on DAS28-CRP were included. We used DAS28-CRP<2.3 as the remission criteria. The study population was then divided into groups with or without tender/swollen joints in the feet. These patients were followed for one year and the remission rate was then calculated for each group. Comparison was performed with Chi-square test.ResultsWe included 706 RA patients in remission based on DAS28-CRP with foot synovitis in 2015 and 5182 without foot synovitis. Among patients with foot synovitis in 2015, 225 (31.9%) were not in remission in 2016 while among those without foot synovitis, 985 (19.0%) were not in remission. (X-squared=62.953, df=1, p=2.117 × 10–15)ConclusionsIn our study, RA patients in remission according to the DAS28 remission criterion with remaining foot synovitis had more relapses than those without it. Remission defined by DAS28-CRP does not take remaining foot synovitis into account. But a thorough foot examination may still be useful in RA patients with DAS28-CRP remission as they may be more at risk for relapse.References[1] van der Leeden, et al. Arthritis Res Ther. 2010;12,1:R3.[2] Wechalekar MD, et al. Arthritis Care Res. 2016;68,11:1616–1623.Disclosure of InterestNone declared
BackgroundTreat-to-target (T2T) is recommended and a widely accepted management strategy for rheumatoid arthritis (RA), which aims for remission or low disease activity. Disease activity is valuated by some composite measures which includes patient's and physician's global assessment, finding of joints and C reactive protein (CRP) etc. Patient's global assessment (PGA) is often the limiting factor for achieving remission. It remains unclear what is the factor contributing to elevation of PGA when finding of 28 joints and CRP implement the Boolean remission criteria.ObjectivesTo detect the factor contributing to elevation of PGA among Japanese RA patients whose scores on the tender joint count, swollen joint count and CRP (in mg/dl) are all 1 or less.MethodsWe performed an analysis of data from 15032 RA patients registered in the large database (NinJa: National Database of Rheumatic Diseases by iR-net in Japan) of 2014 (1). Patients whose scores of the tender joint count, swollen joint count and CRP (in mg/dl) were all 1 or less were included. Patients whose PGA was 1 or less and patients whose PGA was more than 1 were compared with a probabilistic approach employing logistic regression to investigate factor contributing to elevation of PGA among Japanese RA patients whose scores on the tender joint count, swollen joint count and CRP are all 1 or less.ResultsSeven thousand and two hundred and twenty-four patients were included; 5754 were women (79.7%) with a median age 65 years, a median disease duration 9 years, 826 (11.4%) had swelling or tenderness of forefoot joints which are not included in 28 joints (forefoot disease activity), 2313 (32.0%) were prescribed glucocorticoid, methotrexate 4993 (69.1%), biologic DMARDs 1986 (27.5%). In two groups; PGA ≤1 3584 (49.6%) and PGA >1 3640 (50.4%), the median modified health assessment questionnaire (mHAQ) was 0 (interquartile range: 0–0) and 0.13 (0–0.63), hospital anxiety and depression scale (HADS)-anxiety (A) was 2 (1–4) and 4 (2–7), HADS-depression (D) was 4 (2–6) and 5 (3–8), forefoot disease activity was 226 (6.3%) and 600 (16.5%), respectively. We performed the logistic regression analysis with age, Steinbrocker's stage, mHAQ, HADS-A, HADS-D and forefoot disease activity. Thereafter all variables were found factors of associating to elevation of PGA (Table).ConclusionsForefoot disease activity, mHAQ, HADS-A and HADS-D contribute to elevation of PGA in patients who implement the Boolean remission criteria except PGA in Japanese rheumatoid arthritis patients. We should care about the foot joints in addition to functional disability and psychological distress for implementation of T2T strategy.ReferencesMatsui T, Kuga Y, Kaneko A, et al. Disease Activity Score 28 (DAS28) using C-reactive protein underestimates disease activity and overestimates EULAR response criteria compared with DAS28 using erythrocyte sedimentation rate in a large observational cohort of rheumatoid arthritis patients in Japan. Ann Rheum Dis 2007;66(9):1221–6.AcknowledgementNinJa has been support...
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