RESEARCH - Characteristics and medical management of patients with RA and AS

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Clin Rheumatol. 2008 Sep;27(9):1119-1125. Epub 2008 Mar 21.

Characteristics and medical management of patients with rheumatoid

arthritis and ankylosing spondylitis.

Bodur H, Ataman S, Akbulut L, Evcik D, Kavuncu V, Kaya T, Günaydýn R,

Kuran B, Kotevoðlu N, Bal A, Aydoð E, Altay Z, Uðurlu H, Kocabaþ H,

Olmez N, Yazgan P, Gürsoy S, Madenci E, Ozel S, Delialioðlu SU.

Physical Medicine and Rehabilitation (PMR) Department, Ankara Numune

Training and Research Hospital, Mürsel Uluç Mah. 129. sok. 35/17,

06450, Ankara, Turkey.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic,

progressive, systemic inflammatory rheumatic diseases that lead to

serious disability. The objective of this study was to investigate the

demographic and clinical characteristics of the patients with RA and

AS who were treated in tertiary hospitals in Turkey and to analyze

their current medical management. A total of 562 RA and 216 AS

patients were evaluated. The mean age of RA patients was 52.1 +/- 12.6

years. The female to male ratio was 3.7:1. Of the RA patients, 72.2%

had positive rheumatoid factor (RF), 62.9% had high C-reactive

protein, and 75.2% had radiological erosion. The ratio of patients

with Disease Activity Score (DAS) 28 >3.2 was 73.9% and of those with

Health Assessment Questionnaire (HAQ) >/=1.5 was 20.9%. There was a

statistically significant increase in RF positivity and HAQ scores in

the group with higher DAS 28 score. Frequency of extraarticular

manifestations was 22.4%. The ratio of the patients receiving disease

modifying antirheumatic drugs (DMARD) was 93.1%, and 6.9% of the

patients were using anti-tumor necrosis factor (TNF) blocking agents.

In AS, the mean age of the patients was 38.1 +/- 10.6, and the female

to male ratio was 1:2.5. The time elapsed between the first symptom

and diagnosis was 4.3 years. The ratio of peripheral joint involvement

was 29.4%. Major histocompatibility complex, class I, B 27 was

investigated in 31.1% of patients and the rate of positivity was 91%.

In 52.4% of the patients, Bath AS Disease Activity Index (BASDAI) was

>/=4. The erythrocyte sedimentation rate, Bath AS Functional Index,

and peripheral involvement were significantly higher in the group with

BASDAI >/=4. Frequency of extraarticular involvement was 21.2% in AS

patients. In the treatment schedule, 77.5% of AS patients were

receiving sulphasalazine, 15% methotrexate, and 9.9% anti-TNF agents.

Despite widespread use of DMARD, we observed high disease activity in

more than half of the RA and AS patients. These results may be due to

relatively insufficient usage of anti-TNF agents in our patients and

therefore these results mostly reflect the traditional treatments. In

conclusion, analysis of disease characteristics will inform us about

the disease severity and activity in RA and AS patients and could help

in selecting candidate patients for biological treatments.

PMID: 18357499

http://www.ncbi.nlm.nih.gov/pubmed/18357499

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