An intervention program with the aim to improve and maintain work productivity for workers with rheumatoid arthritis: design of a randomized controlled trial and cost-effectiveness study Effect of certolizumab pegol with methotrexate on home and work place productivity and social activities in patients with active rheumatoid arthritis. An expansion of rare lineage intestinal microbes characterizes rheumatoid arthritis Discriminant validity, responsiveness and reliability of the arthritis-specific Work Productivity Survey assessing workplace and household productivity in patients with psoriatic arthritis Rehabilitation in rheumatoid arthritis: a critical review. Rheumatoid factors, anti-filaggrin antibodies and low in vitro interleukin-2 and interferon-gamma production are useful immunological markers for early diagnosis of community cases of rheumatoid arthritis. A preliminary study. Costs of rheumatoid arthritis in Germany: a micro-costing approach based on healthcare payer’s data sources Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis. Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Physical activity and quality of life in subjects with chronic disease: Chronic obstructive pulmonary disease compared with rheumatoid arthritis and diabetes mellitus Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ignored. A prospective, single-centre, randomised study evaluating the clinical, imaging and immunological depth of remission achieved by very early versus delayed Etanercept in patients with Rheumatoid Arthritis (VEDERA) Tai Chi exercise and auricular acupressure for people with rheumatoid arthritis: an evaluation study. Effects of periodontal therapy on disease activity and systemic inflammation in rheumatoid arthritis patients. The Impact of Activity Based Working (ABW) on Workplace Activity, Eating Behaviours, Productivity, and Satisfaction Balneotherapy in medicine: A review Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Strengthening exercises to improve hand strength and functionality in rheumatoid arthritis with hand deformities: a randomized, controlled trial Prevention and reversal of cartilage degradation in rheumatoid arthritis by interleukin-10 and interleukin-4. Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. Synovial phenotypes in rheumatoid arthritis correlate with response to biologic therapeutics The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. The effect of 3435C>T MDR1 gene polymorphism on rheumatoid arthritis treatment with disease-modifying antirheumatic drugs
Background Workers with rheumatoid arthritis ( RA ) often experience restrictions in functioning at work and participation in employment . Strategies to maintain work productivity exist , but these interventions do not involve the actual workplace . Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA . Methods / design This study is a r and omized controlled trial ( RCT ) in specialized rheumatology treatment centers in or near Amsterdam , the Netherl and s. R and omisation to either the control or the intervention group is performed at patient level . Both groups will receive care as usual by the rheumatologist , and patients in the intervention group will also take part in the intervention program . The intervention program consists of two components ; integrated care , including a participatory workplace intervention . Integrated care involves a clinical occupational physician , who will act as care manager , to coordinate the care . The care manager has an intermediate role between clinical and occupational care . The participatory workplace intervention will be guided by an occupational therapist , and involves problem solving by the patient and the patients ’ supervisor . The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work . Data collection will take place at baseline and after 6 and 12 months by means of a question naire . The primary outcome measure is work productivity , measured by hours lost from work due to presenteeism . Secondary outcome measures include sick leave , quality of life , pain and fatigue . Cost-effectiveness of the intervention program will be evaluated from the societal perspective . Discussion Usual care of primary and outpatient health services is not aim ed at improving work productivity . Therefore it is desirable to develop interventions aim ed at improving functioning at work . If the intervention program will be (cost)effective , substantial improvements in work productivity might be obtained among workers with RA at lower costs . Results are expected in 2015.Trial registration OBJECTIVE To assess the impact of certolizumab pegol ( CZP ) , a novel PEGylated anti-tumor necrosis factor , in combination with methotrexate ( MTX ) on productivity outside and within the home , and on participation in family , social , and leisure activities in adult patients with rheumatoid arthritis ( RA ) . METHODS The efficacy and safety of CZP ( 200 mg and 400 mg ) plus MTX were assessed in 2 phase III , multicenter , double-blind , placebo-controlled trials ( Rheumatoid Arthritis Prevention of Structural Damage [ RAPID ] 1 and RAPID 2 ) . The novel , vali date d , RA-specific Work Productivity Survey ( WPS-RA ) was used to assess work place and home productivity . WPS-RA responses were collected at baseline and every 4 weeks until withdrawal/ study completion . RESULTS At baseline , 41.6 % and 39.8 % of subjects were employed outside the home in RAPID 1 and RAPID 2 , respectively . Compared with placebo plus MTX , CZP plus MTX significantly reduced work absenteeism and presenteeism among patients working outside the home . Significant reductions in number of household days lost , household days with productivity reduced by > /=50 % , and days lost due to RA for participation in family , social , and leisure activities were reported by patients in active treatment relative to placebo plus MTX . Improvements in all measures were observed with CZP plus MTX as early as week 4 , and maintained until the study end ( 12 months in RAPID 1 , 6 months in RAPID 2 ) . Findings were consistent with clinical improvements with CZP plus MTX in both trials . CONCLUSION CZP plus MTX improved productivity outside and within the home and result ed in more participation in social activities compared with placebo plus MTX . These observations suggest that considerable indirect cost gains might be achieved with this therapeutic agent in RA Background The adaptive immune response in rheumatoid arthritis ( RA ) is influenced by an interaction between host genetics and environment , particularly the host microbiome . Association of the gut microbiota with various diseases has been reported , though the specific components of the microbiota that affect the host response leading to disease remain unknown . However , there is limited information on the role of gut microbiota in RA . In this study we aim ed to define a microbial and metabolite profile that could predict disease status . In addition , we aim ed to generate a humanized model of arthritis to confirm the RA-associated microbe . Methods To identify an RA biomarker profile , the 16S ribosomal DNA of fecal sample s from RA patients , first-degree relatives ( to rule out environment/ background as confounding factors ) , and r and om healthy non-RA controls were sequenced . Analysis of metabolites and their association with specific taxa was performed to investigate a potential mechanistic link . The role of an RA-associated microbe was confirmed using a human epithelial cell line and a humanized mouse model of arthritis . Results Patients with RA exhibited decreased gut microbial diversity compared with controls , which correlated with disease duration and autoantibody levels . A taxon-level analysis suggested an expansion of rare taxa , Actinobacteria , with a decrease in abundant taxa in patients with RA compared with controls . Prediction models based on the r and om forests algorithm suggested that three genera , Collinsella , Eggerthella , and Faecalibacterium , segregated with RA . The abundance of Collinsella correlated strongly with high levels of alpha-aminoadipic acid and asparagine as well as production of the proinflammatory cytokine IL-17A . A role for Collinsella in altering gut permeability and disease severity was confirmed in experimental arthritis . Conclusions These observations suggest dysbiosis in RA patients result ing from the abundance of certain rare bacterial lineages . A correlation between the intestinal microbiota and metabolic signatures could determine a predictive profile for disease causation and progression Introduction The novel arthritis-specific Work Productivity Survey ( WPS ) was developed to estimate patient productivity limitations associated with arthritis within and outside the home , which is an unmet need in psoriatic arthritis ( PsA ) . The WPS has been vali date d in rheumatoid arthritis . This report assesses the discriminant validity , responsiveness and reliability of the WPS in adult-onset PsA. Methods Psychometric properties were assessed using data from the RAPID-PsA trial ( NCT01087788 ) investigating certolizumab pegol ( CZP ) efficacy and safety in PsA. WPS was completed at baseline and every 4 weeks until Week 24 . Validity was evaluated at baseline via known-groups defined using first and third quartiles of patients ’ Disease Activity Score 28 based on C-reactive protein ( DAS28(CRP ) ) , Health Assessment Question naire-Disability Index ( HAQ-DI ) , Short Form-36 ( SF-36 ) items and  PsA Quality of Life ( PsAQoL ) scores . Responsiveness and reliability were assessed by comparing WPS mean changes at Week 12 in American College of Rheumatology 20 % improvement criteria ( ACR20 ) or HAQ-DI Minimal Clinical ly Important Difference ( MCID ) 0.3 responders versus non-responders , as well as using st and ardized response means ( SRM ) . All comparisons were conducted on the observed cases in the R and omized Set , regardless of the r and omization group , using a non-parametric bootstrap-t method . Results Compared with patients with a better health state , patients with a worse health state had on average 2 to 6 times more household work days lost , more days with reduced household productivity , more days missed of family/social/leisure activities , more days with outside help hired and a significantly higher interference of arthritis per month . Among employed patients , those with a worse health state had 2 to 4 times more workplace days lost , more days with patient workplace productivity reduced , and a significantly higher interference of arthritis on patient workplace productivity versus patients with a better health state . WPS was also responsive to clinical changes , with responders having significantly larger improvements at Week 12 in WPS scores versus non-responders . The effect sizes for changes in productivity in ACR20 or HAQ-DI MCID responders were moderate ( 0.5 < SRM < 0.8 ) or small . Conclusions These analyses demonstrate the validity , responsiveness and reliability of the WPS , as an instrument for the measurement of patient productivity within and outside the home in an adult-onset PsA population This article considers the evidence for effectiveness and timing of rehabilitation  for people with rheumatoid arthritis ( RA ) . The Cochrane Library , DARE , Medline , Embase , CINAHL and AMED were search ed to identify systematic review s and r and omized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis . Many trials identified had method ological limitations ( e.g. short follow-up periods , small sample sizes ) . Evidence to date is that symptomatic relief results from thermotherapy , laser therapy , acupuncture and assistive devices . In the short-term , comprehensive occupational therapy ( in established rheumatoid arthritis ) , orthoses , and mind-body approaches can help maintain function . Over at least a one-year period , the following are effective in reducing pain and maintaining function :  patient education and joint protection training using behavioural approaches ; dynamic exercise therapy , h and exercises and hydrotherapy ; and cognitive-behavioural therapy ( in people with poorer psychological status ) . Many trials have recruited people with moderate to severe , established RA and relatively little is known about the long-term effectiveness of early rehabilitation , although this is becoming much more common in practice . Despite the increased availability of guidelines and systematic review s , most conclude there is insufficient evidence for many areas of rheumatology rehabilitation . Further well- design ed clinical trials are needed recruiting people with early disease using patient-centred outcomes OBJECTIVE To determine whether measurements of different  autoantibodies ( Ab ) and cytokines  are useful to distinguish very early rheumatoid arthritis ( RA ) from other inflammatory rheumatisms . METHODS From a population -based recruitment , 32 patients with very early polyarthritis ( median duration : 4 months ) were studied . Evaluations at entry ( M0 ) , and at 6 ( M6 ) and 12 months ( M12 ) . Ab tested : rheumatoid factors ( RF ) by agglutination methods and ELISA , antiperinuclear factor ( APF ) , antikeratin Ab  ( AKA ) , anti-Sa and antinuclear Ab . Cytokine production ( TNFalpha , IL2 , IFNgamma , IL1beta , IL10 ) in whole blood cell culture ( WBCC ) was determined at M0 . At M12 , patients were classified as having RA ( N = 15 ) or other rheumatic diseases . RESULTS At M0 , AKA/APF and anti-Sa Ab frequencies were low , 13 % and 7 % , respectively . While most Ab detected at M0 persisted , others appeared during follow-up , particularly APF , which rose from 13 to 40 % at M12 . At M6 , IgM-RF was detected in two RA patients exclusively by ELISA . AKA/APF were found to be highly specific markers for RA ( 100 % specificity ) . At some time during follow-up , two RF-negative RA patients were AKA-positive . In two patients , AKA and APF were present at M0 before they satisfied ACR criteria . IL2 and IFNgamma production was significantly lower ( P < 0.05 ) for RA patients . CONCLUSION AKA/APF and anti-Sa Ab were detected in community cases of very early RA . AKA/APF and RF detected by ELISA might contribute to an earlier diagnosis of RA . Low production of IFNgamma and IL2 in WBCC constituted a distinct immunopathological feature in very early RA patients Objective : To develop a systematic set of German cost data in rheumatoid arthritis ( RA ) based solely on valid healthcare payer ’s cost data sources . Methods : Retrospectively one year cost data of 338 patients with RA were generated and analysed . The cost data were derived from a major statutory health insurance plan ( “ Allgemeine Ortskrankenkasse Niedersachsen ” ) and the regional physicians ’ association ( “ Kassenärztliche Vereinigung Niedersachsen ” ) . The recently published matrix of cost domains in RA was applied to structure the analysis . Descriptive statistics were used to analyse the data . Results : The total direct costs for the 338 patients during one year ( third quarter 2000 to second quarter 2001 ) were € 3815 per patient-year . RA related direct costs were € 2312 per patient-year . Outpatient costs accounted for 73.7 % , inpatient costs for 24.0 % , and other disease related costs for 2.3 % of RA related direct costs . Out patients cost drivers were RA related drugs ( € 1019 per patient-year ) , physician visits ( € 323 per patient-year ) , diagnostic and therapeutic procedures and tests ( € 185 per patient-year ) , and devices and aids ( € 168 per patient-year ) . 98 patients were retired prematurely owing to RA related work disability and incurred costs of € 8358 per retired patient-year . 96 patients were gainfully employed and incurred sick leave costs of € 2835 per employed patient-year . Conclusion : Micro-costing based on healthcare payer ’s data provides a relatively conservative albeit highly accurate estimate of costs in RA . Both RA related and non-RA related costs must be taken into account . In gainfully employed patients and in patients who receive RA related retirement payments productivity costs exceed direct costs OBJECTIVE To evaluate the prevalence and predictive value of  anti-cyclic citrullinated peptide ( anti-CCP ) antibodies  in individuals who subsequently developed rheumatoid arthritis ( RA ) and to determine the relationship to rheumatoid factor ( RF ) of any isotype . METHODS A case-control study was nested within the Northern Sweden Health and Disease Study and the Maternity cohorts of Northern Sweden . Patients with RA were identified among blood donors whose sample s had been taken years before the onset of symptoms . Control subjects matched for age , sex , date of sampling , and residential area were selected r and omly from the same cohorts . Anti-CCP antibody and RFs were determined using enzyme immunoassays . RESULTS Eighty-three individuals with RA were identified as having donated blood before presenting with any symptoms of joint disease  ( median 2.5 years [ interquartile range 1.1 - 4.7 ] before RA ) . In sample s obtained before the onset of RA , the prevalence of autoantibodies was 33.7 % for anti-CCP , 16.9 % for IgG-RF , 19.3 % for IgM-RF , and 33.7 % for IgA-RF ( all highly significant compared with controls ) . The sensitivities for detecting these autoantibodies > 1.5 years and < /=1.5 years before the appearance of any RA symptoms were 25 % and 52 % for anti-CCP , 15 % and 30 % for IgM-RF , 12 % and 27 % for IgG-RF , and 29 % and 39 % for IgA-RF . In conditional logistic regression models , anti-CCP antibody and IgA-RF were found to be significant predictors of RA . CONCLUSION Anti-CCP antibody and RFs of all isotypes pre date d the onset of RA by several years . The presence of anti-CCP and IgA-RF predicted the development of RA , with anti-CCP antibody having the highest predictive value . This indicates that citrullination and the production of anti-CCP and RF autoantibodies are early processes in RA In rheumatoid arthritis ( RA ) benefit from non-steroidal anti-inflammatory drugs ( NSAIDs ) is mediated through inhibition of the cyclo-oxygenase enzyme , thereby decreasing production of the 2 series prostagl and ins ( PGs ) . The lipoxygenase enzyme is intact , however , allowing leucotriene ( LT ) production , e.g. , LTB4 ( an inflammatory mediator ) . Treatment with evening primrose oil ( EPO ) which contains gamma-linolenic acid ( GLA ) leads to production of the 1 series PGs , e.g. , PGE1 , which has less inflammatory effects . Also LT production is inhibited . Eicosapentaenoic acid ( EPA , fish oil ) treatment provides a substrate for PGs and LTs , which are also less inflammatory . In this study 16 patients with RA were given  540 mg GLA/day ( EPO ) , 15 patients 240 mg EPA and 450 mg GLA/day ( EPO/fish oil ) , and 18 patients an inert oil ( placebo ) . The aim of this study was to determine if EPO or EPO/fish oil could replace NSAID treatment in RA . The initial 12 month treatment period was followed by three months of placebo for all groups . Results at 12 months showed a significant subjective improvement for EPO and EPO/fish oil compared with placebo . In addition , by 12 months the patients receiving EPO and EPO/fish oil had significantly reduced their NSAIDs . After 3 months of placebo those receiving active treatment had relapsed . Despite the decrease in NSAIDs , measures of disease activity did not worsen . It is suggested that EPO and EPO/fish oil produce a subjective improvement and allow some patients to reduce or stop treatment with NSAIDs . There is , however , no evidence that they act as disease modifying agents Objective . Chronic diseases interfere with the life situation of the affected person in different ways . The aim was to compare the burden of disease in three chronic diseases – chronic obstructive pulmonary disease ( COPD ) , rheumatoid arthritis ( RA ) , diabetes mellitus ( DM ) – and in healthy subjects , with a particular interest in physical activity , quality of life , and psychological health . Design . Cross-sectional , observational study . Setting and subjects . Postal survey question naire to a stratified , r and om population of 68 460 subjects aged 18–84 years in Sweden . The subjects included were 40–84 years old ( n = 43 589 ) and data were analysed for COPD ( n = 526 ) , RA ( n = 1120 ) , DM ( n = 2149 ) and healthy subjects ( n = 6960 ) . Result : Some 84 % of subjects with COPD , 74 % ( RA ) , 72 % ( DM ) , and 60 % in healthy subjects ( p < 0.001 , COPD versus RA , DM , and healthy subjects ) had a physical activity level considered too low to maintain good health according to guidelines . Quality of life ( EuroQol five-dimension question naire , EQ-5D ) was lower in COPD and RA than in DM . Anxiety/depression was more common in subjects with COPD ( 53 % ) than in those with RA ( 48 % ) and DM ( 35 % ) ( p < 0.001 , COPD versus RA and DM ) , whereas mobility problems were more common in RA ( 55 % ) than COPD ( 48 % ) and DM ( 36 % ) ( p < 0.001 , RA versus COPD and DM ) . All differences between groups remained significant after adjusting for age , sex , and socioeconomic background factors . Conclusion . Subjects with chronic diseases had a low level of physical activity , most evident in subjects with COPD . COPD and RA had a higher negative impact on quality of life than DM . Our results indicate that increased attention regarding physical inactivity in subjects with chronic diseases is needed to minimize the burden of disease OBJECTIVE Fatigue is commonly reported by patients with rheumatoid arthritis ( RA ) but is rarely a treatment target . The aim of this study was to explore the concept of fatigue as experienced by patients with RA . METHODS Fifteen patients with RA and fatigue ( > or = 7 on a 10-cm visual analog scale ) were individually interviewed and asked about the description , cause , consequence , and management of fatigue . Transcripts were systematic ally analyzed by 2 research ers independently , relevant phrases were coded , and earlier transcripts were checked for the emerging codes . A r and om sample of analyses were independently review ed . A total of 191 codes arising from the data were grouped into 46 categories and overarching themes . RESULTS Vivid descriptions reflect 2 types of fatigue : severe weariness and dramatic overwhelming fatigue . RA fatigue is different from normal tiredness because it is extreme , often not earned , and unresolving . Participants described physical , cognitive , and emotional components and attributed fatigue to inflammation , working the joints harder , and unrefreshing sleep . Participants described far-reaching effects on physical activities , emotions , relationships , and social and family roles . Participants used self-management strategies but with limited success . Most did not discuss fatigue with clinicians but when they did , they felt it was dismissed . Participants held negative views on the management of fatigue . CONCLUSION The data show that RA fatigue is important , intrusive , and overwhelming , and patients struggle to manage it alone . These data on the complexity of fatigue experiences will help clinicians design measures , interventions , and self-managment guidance Background Rheumatoid arthritis ( RA ) is a chronic inflammatory arthritis , with significant impact on quality of life and functional status . Whilst biologic disease modifying anti-rheumatic drugs ( bDMARD ) such as tumour necrosis factor-inhibitor ( TNFi ) agents have revolutionised outcomes in RA , early diagnosis with immediate conventional therapy , titrated in a treat to target approach is also associated with high remission rates . The main aim of the VEDERA study ( Very Early versus Delayed Etanercept in Rheumatoid Arthritis ) is to assess the depth of remission , sustainability of remission and immunological normalisation induced by very early TNFi with etanercept ( ETN ) or st and ard of care + /- delayed ETN . Methods / Design VEDERA is a pragmatic , phase IV single-centre open-label r and omised superiority trial of 120 patients with early , treatment-naive RA . Patients will be r and omised 1:1 to first-line ETN and methotrexate ( MTX ) or MTX with additional synthetic disease modifying anti-rheumatic drugs ( sDMARDs ) according to a treat to target ( TT ) protocol with further step up to ETN and MTX after 24 weeks if remission is not achieved . Participants will have regular disease activity assessment s and imaging evaluation including musculoskeletal ultrasound and MRI . The main objective of this study is to assess the proportion of patients with early RA that achieve clinical remission at 48 weeks , following either treatment strategy . In addition , the participants are invited to take part in a cardio-vascular sub- study ( Coronary Artery Disease in RA , CADERA ) , which aims to identify the incidence of cardiovascular abnormalities in early RA . Discussion The hypothesis underlining this study is that very early treatment with first-line ETN increases the proportion of patients with rheumatoid arthritis achieving clinical remission , in comparison to conventional therapy . Trial registration NCT02433184 , AIMS AND OBJECTIVES ( i ) To assess the effectiveness of Tai Chi exercise in people with rheumatoid arthritis ( RA ) . ( ii ) To ascertain if Tai Chi and auricular acupressure have a potentiation effect in controlling pain . ( iii ) To evaluate the acceptability and enjoyment of the classes . BACKGROUND Tai Chi has been suggested as a suitable exercise for people with arthritis and specific programmes have been developed . Auricular acupressure is a therapeutic method by which points on the ear are stimulated to treat various disorders . DESIGN A pragmatic non-r and omised before/after study to compare the effects of the interventions . METHODS People with RA ( n=21 ) were recruited and allocated into two groups . Both groups followed a Tai Chi exercise programme , twice a week for 12 weeks , but one group ( n=14 ) had , in addition , the auricular acupressure .  Physical symptoms and function , pain , quality of life and self-efficacy were measured in both groups before and after the programme . Acceptability and enjoyment were assessed at the end . RESULTS At 12 weeks , both groups had achieved statistically significant improvements in balance , grip strength , pinch strength , 50 foot walk time self reported joint pain , swollen joint count , tender joint count and in self efficacy in relation to pain control . All participants stated that they enjoyed the classes . There was no evidence to suggest that the auricular acupressure enhanced the effects of the Tai Chi intervention . CONCLUSION The classes appeared to be mentally as well as physically helpful to participants . RELEVANCE TO CLINICAL PRACTICE People with a chronic debilitating disease such as RA should be encouraged to undertake gentle strengthening exercise such as Tai Chi because of its potential for physical and psychological improvements OBJECTIVE This observational prospect i ve cohort study aim ed to evaluate the effects of non-surgical periodontal treatment on clinical periodontal measurements and systemic inflammatory mediator levels in low or moderate to highly active rheumatoid arthritis ( RA ) patients with chronic periodontitis . SUBJECTS AND METHODS Rheumatoid arthritis activity was assessed with disease activity score test ( DAS28 ) . Thirty patients with RA with moderate to high disease activity ( DAS28 ≥ 3.2 ) and chronic periodontitis ( MHDA group ) and thirty patients with RA with low disease activity ( DAS28 < 3.2 ) and chronic periodontitis ( LDA group ) were enrolled in the study . The patients were monitored at the beginning and 3 months after undergoing periodontal therapy . Erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) , tumour necrosis factor-alpha ( TNF-α ) levels in serum , DAS28 and periodontal parameters were evaluated . RESULTS Erythrocyte sedimentation rate , CRP , TNF-α levels in serum , DAS28 and periodontal parameters exhibited similar and significant reduction 3 months after the non-surgical periodontal treatment . CONCLUSION Non-surgical periodontal treatment may prove beneficial in reducing RA severity as measured by ESR , CRP , TNF-α levels in serum and DAS28 in low or moderate to highly active RA patients with chronic periodontitis The re design of the physical workplace according to activity-based working ( ABW ) principles has potential to influence employee health and workplace outcomes . This natural experiment examined changes in accelerometer-derived workplace activity , self-reported eating behaviours , productivity , workplace satisfaction before ( March to November 2014 ) and six to nine months after moving to an ABW workplace compared to a comparison workplace ( n = 146 at baseline ( 56 % ABW , aged 40.1 ± 8.5 years , 72 % female ) . Interviews were also conducted with 21 ABW participants . Between- and within-group differences were examined and mixed model analysis examined intervention effects over time . Effect sizes were calculated on change scores ( Cohen ’s d ) . Although not statistically significant , ABW participants had meaningful improvements in workday sedentary time , light- , and moderate-to-vigorous intensity physical activity , job satisfaction and relationship with co-workers ( d = 0.379–0.577 ) , and small declines in productivity ( d = 0.278 ) . There were significant , meaningful , and beneficial intervention effects on perceived organisational support for being active in the workplace , frequency of eating lunch with colleagues , and satisfaction with the physical environment in ABW compared to comparison participants ( d = 0.501–0.839 ) . Qualitative data suggested that ABW employees associated ABW with greater opportunities for movement and collaboration , but had mixed views on the impact on productivity . Future research with larger sample s and over longer follow-up periods is warranted Bathing in water ( balneotherapy or spa therapy ) has been frequently and widely used in classical medicine as a cure for diseases . This paper review s the present literature on the use of balneotherapy in dermatologic , chronic musculoskeletal ( inflammatory and non-inflammatory ) , metabolic and psychological conditions . We performed a systematic review on related papers appearing in the Medline and Cochrane Library data base from 1966 to 2003 that included r and omized controlled and non-r and omized clinical trials using balneotherapy . We also determined to reflect where possible the chemical compositions of spas . The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis , psoriasis , rheumatoid arthritis ( RA ) , ankylosing spondylitis , osteoarthritis and low back pain . Moreover , the effects of spa therapy on several metabolic conditions are discussed . The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical , thermal and mechanical effects . The importance of balneotherapy either alone or as complement to other therapies should be considered after , or accompanying , orthodox medical treatments OBJECTIVE To investigate 1 ) the magnitude of indirect costs , 2 ) changes in cost components , and 3 ) correlations between changes in cost and social , clinical , and occupational variables within the first 3 years of rheumatoid arthritis ( RA ) . METHODS We evaluated the indirect costs  per person-year in 133 consecutive gainfully employed out- patients with early RA , in a prospect i ve multicenter followup study . Costs due to RA-related sick leave , work disability , and other work loss were assessed using the human capital approach . Variables associated with reduction in lost productivity were tested by multivariate logistic regression analysis . RESULTS Mean + /- SEM annual indirect costs were $ 11,750 + /- 1,120 per person . During the 3-year period of observation , a marked reduction in the costs associated with sick leave was seen , which exceeded the increase in costs due to work disability and other work loss . This phenomenon result ed in an overall reduction in indirect costs of 21 % . The final logistic regression model of reduced loss of productivity included 3 variables : no problems with st and ing ( odds ratio [ OR ] 7.1 ) , no problems with working speed ( OR 4.1 ) , and no problems with outdoor work ( OR 3.1 ) . CONCLUSION High indirect costs in early RA were demonstrated . An overall decrease of costs can be seen in the first 3 years , due to the reduction in sick leave . Since the absence of problems due to strenuous working conditions was found to be associated with a reduction in indirect costs , it is assumed that early intensified vocational rehabilitation , apart from controlling disease activity by adequate treatment , might help to reduce indirect costs Rheumatoid arthritis ( RA ) is a systemic inflammatory and chronic disease of joints , which may result in irreversible deformities . To evaluate the effects of an exercise programme aim ed at improving the h and strength in individuals with h and deformities result ing from RA and to analyse the impact these exercises have on functionality .  Twenty women with RA h and deformities participated in the study . They were r and omly divided into two groups as follows : Group 1 ( n = 13 ) had women participating in the exercise programme  aim ed at improving h and grip ( HS ) and pinch strengths ( PS ) as well as the motor coordination of the h and ; Group 2 ( n = 7 ) had women with RA who received no treatment for their h and s ( control ) . The treatment programme for h and s consisted of 20 sessions , twice a week and at-home exercises . Both groups were su bmi tted to Health Assessment Question naire ( HAQ ) and evaluation of HS and PS by means of dynamometry . Re-evaluations were performed after 10 and 20 sessions in Group 1 and after 2 months in Group 2 . After 20 sessions of physiotherapy , Group 1 had a significant gain in HS and PS ( p < 0.05 ) in addition to the improvement of functionality as assessed by HAQ ( p = 0.016 ) . For Group 2 , no difference was found between the variables analysed ( p > 0.05 ) . The strengthening exercises for individuals with RA h and deformity are beneficial to improve h and grip and pinch strengths as well as functionality OBJECTIVE Inflammation-induced articular cartilage degradation is a major problem in rheumatoid arthritis ( RA ) . Type 1 T cell activity ( characterized by interferon-gamma/interleukin-2 [ IL-2 ] production ) , and consequently , the production of the proinflammatory cytokines IL-1 and tumor necrosis factor alpha ( TNF alpha ) , have been reported to play a major role in cartilage damage . IL-10 and IL-4 , both produced by type 2 T cells , are cytokines with the capacity to down-regulate proinflammatory responses . The present study was undertaken to investigate the way in which these cytokines affect activated mononuclear cells ( MNC ) of RA patients in relation to human articular cartilage degradation in vitro . METHODS MNC from synovial fluid and peripheral blood of RA patients were stimulated with bacterial antigen and treated with IL-10 and /or IL-4 . Bacterial antigen is known to activate type 1 T cells and to induce proinflammatory IL-1/TNF alpha-dependent cartilage damage . Cytokine production and effects of conditioned media , as well as effects of IL-10 and IL-4 on proteoglycan ( PG ) turnover ( as a measure for cartilage damage ) , were determined . RESULTS IL-10 and IL-4 inhibited proinflammatory cytokine production of stimulated RA MNC and completely reversed inhibition of cartilage PG synthesis induced by these stimulated RA MNC . IL-10 was more potent than IL-4 in this respect , and the combination of IL-10 and IL-4 had an additive effect . In addition , IL-10 directly stimulated cartilage PG synthesis . CONCLUSION IL-10 reverses the cartilage degradation induced by antigen-stimulated MNC , and IL-4 has an additive effect on this process . Furthermore , IL-10 has a direct stimulatory effect on PG synthesis , and IL-4 , as a growth factor for type 2 T cells , can reduce the ratio of type 1 to type 2 T cell activity . These results provide evidence in favor of the use of a combination of the two cytokines in the treatment of RA OBJECTIVE To determine whether the risk for cardiovascular and /or cerebrovascular disease ( CCVD ) is increased in rheumatoid arthritis ( RA ) compared to osteoarthritis ( OA ) , a disease not known to be associated with increased CCVD . METHODS In July 1999 , a survey was administered to a sample of 11,572 patients ( 9,093 with RA , 2479 with OA ) from the practice s of 709 US community-based rheumatologists . Patients reported past and current myocardial infa rct ion ( MI ) , stroke ( cerebrovascular accident , CVA ) , and lifetime congestive heart failure ( CHF ) , and also provided demographic and clinical information . To estimate the impact of recall bias , medical records were obtained and review ed for a 50 % r and om sample of the patients reporting CCVD events , with 95 % of CCVD reported events confirmed by record review . RESULTS Patients with RA and OA differed across all demographic variables . In addition , each variable was significantly associated with MI , CHF , and CVA outcomes . Logistic regression was performed to measure the associations of these outcomes with RA as compared to OA , adjusting for age , sex , education level , smoking , income , hypertension , and body mass index . Compared with OA , patients with RA had the following increased risks : for current MI [ odds ratio ( OR ) , 95 % confidence interval ( 95 % CI ) ] 2.14 , ( 1.48 , 3.09 ) , lifetime MI 1.28 ( 1.24 , 1.33 ) , CHF 1.43 ( 1.28 , 1.59 ) , current CVA 1.70 ( 1.29 , 2.24 ) , and lifetime CVA 1.005 ( 0.931 , 1.196 ) . The adjusted current and lifetime prevalences of MI were 0.76 and 4.14 % for RA versus 0.35 and 3.23 % respectively for OA ; 0.86 and 3.02 % ( RA ) versus 0.50 and 3.03 % ( OA ) for CVA ; and for lifetime CHF , 2.34 % ( RA ) versus 1.64 % ( OA ) , respectively . CONCLUSIONS RA is associated with an increased risk for CCVD morbidity due to MI , CHF , and probably for CVA , and may be an independent risk factor for these events Introduction Rheumatoid arthritis ( RA ) is a complex and clinical ly heterogeneous autoimmune disease . Currently , the relationship between pathogenic molecular drivers of disease in RA and therapeutic response is poorly understood . Methods We analyzed synovial tissue sample s from two RA cohorts of 49 and 20 patients using a combination of global gene expression , histologic and cellular analyses , and analysis of gene expression data from two further publicly available RA cohorts . To identify c and i date serum biomarkers that correspond to differential synovial biology and clinical response to targeted therapies , we performed pre-treatment biomarker analysis compared with therapeutic outcome at week 24 in serum sample s from 198 patients from the ADACTA ( ADalimumab ACTemrA ) phase 4 trial of tocilizumab ( anti-IL-6R ) monotherapy versus adalimumab ( anti-TNFα ) monotherapy .  Results We documented evidence for four major phenotypes of RA synovium – lymphoid , myeloid , low inflammatory , and fibroid - each with distinct underlying gene expression signatures . We observed that baseline synovial myeloid , but not lymphoid , gene signature expression was higher in patients with good compared with poor  European league against rheumatism ( EULAR ) clinical response to anti-TNFα therapy at week 16 ( P = 0.011 ) . We observed that high baseline serum soluble intercellular adhesion molecule 1 ( sICAM1 ) , associated with the myeloid phenotype , and high serum C-X-C motif chemokine 13 ( CXCL13 ) , associated with the lymphoid phenotype , had differential relationships with clinical response to anti-TNFα compared with anti-IL6R treatment . sICAM1-high/CXCL13-low patients showed the highest week 24 American College of Rheumatology ( ACR ) 50 response rate  to anti-TNFα treatment as compared with sICAM1-low/CXCL13-high patients ( 42 % versus 13 % , respectively , P = 0.05 ) while anti-IL-6R patients showed the opposite relationship with these biomarker subgroups ( ACR50 20 % versus 69 % , P = 0.004 ) . Conclusions These data demonstrate that underlying molecular and cellular heterogeneity in RA impacts clinical outcome to therapies targeting different biological pathways , with patients with the myeloid phenotype exhibiting the most robust response to anti-TNFα . These data suggest a path to identify and vali date serum biomarkers that predict response to targeted therapies in rheumatoid arthritis and possibly other autoimmune diseases . Trial registration Clinical Trials.gov OBJECTIVES To compare the impact of the combination of etanercept ( ETN ) and MTX with MTX alone on work productivity among  MTX-naïve patients with active early RA over a 12-month period . METHODS The COMET ( COmbination of Methotrexate and ETanercept ) trial was a 2-year double-blind r and omized clinical trial . Absenteeism during the first year was measured and it included : ( i ) number of missed workdays ; ( ii ) reduced working time ; and ( iii ) number of stopped workdays . Each absenteeism measure was estimated using a mixed model , and their variations were estimated by bootstrapping . As a sensitivity analysis , the lost workdays due to presenteeism ( reduced performance at work ) was also estimated . RESULTS Two hundred and five patients [ MTX ( n = 100 ) vs ETN + MTX ( n = 105 ) ] , who were working full time or part time at baseline and had at least one follow-up observation , were included in the analysis . Compared with the MTX group , the ETN + MTX group had a maximum of 37 fewer missed workdays or at minimum 22 fewer missed workdays . The associated productivity gain equalled 2586 pounds and 1555 pounds , respectively . When additionally accounting for presenteeism , the total improvement could be as high as 42 ( 95 % CI 16 , 69 ) fewer lost workdays representing a productivity gain of 2968 pounds . CONCLUSIONS Our results demonstrated that early treatment with ETN + MTX led to a significant attenuation of absenteeism among patients with early active RA . These productivity gains represent benefit beyond the traditional measures of clinical and radiographic improvements . Further research to simultaneously measure both absenteeism and presenteeism is warranted Objective Rheumatoid arthritis ( RA ) is a multifactorial disease , with immunological , genetical as well as environmental factors being implicated in its pathogenesis . Treatment of RA is based mainly on drugs modulating the course of the disease , e.g. methotrexate ( MTX ) or sulfasalazine ( SL ) . The MDR1 gene product , P-glycoprotein ( P-gp ) , is probably one of the most important and best defined transporters for drug delivery in humans . P-gp transports a wide range of substrates with diverse chemical structures , among them anticancer agents , cardiac drugs , and immunosuppressants . The aim of this study was to examine the effect of the 3435C > T MDR1 gene polymorphism on the efficacy of RA treatment with disease-modifying antirheumatic drugs , i.e. MTX plus methylprednisolone ( MP ) , and SL . Methods The study was carried out on 255 patients with RA treated according to two regimes : ( 1 ) MTX ( 7.5–15.0 mg weekly ) plus low doses of MP ( n=174 ) , ( 2 ) SL ( 1.5–3 g daily , n=81 ) . Results The probability of remission of RA symptoms after MTX plus MP therapy was 4.65-fold higher in carriers of the TT genotype compared to patients with CC genotype ( P=0.003 , OR 4.65 , 95%CI 1.66–13.05 ) , whereas the probability of remission of RA symptoms in patients treated with SL was 2-fold higher in carriers of TT genotype compared to patients with CC genotype , but did not reach statistical significance ( P=0.358 , OR=2.00 95 % CI=0.58–6.87 ) . Conclusion The results from the present study suggest that the 3435C > T MDR1 gene polymorphism may influence the efficacy of RA therapy with disease-modifying antirheumatic drugs
RA-related work-disability rates were similar in the USA and European countries .
An apparent decrease in the prevalence of RA-related work disability since the 1970s may be related to a decrease in physically dem and ing work rather than to epidemiologic changes in RA .
The majority of the literature addresses permanent disability and temporary work loss ; none of the studies review ed reported the effect of RA on presenteeism , i.e. work limitation from the employer perspective , and there are few published studies of the effectiveness of disease-modifying anti-rheumatic drugs in reducing work-related productivity loss
BACKGROUND Rheumatoid arthritis ( RA ) is a chronic , debilitating disease with a significant impact on workplace productivity .
AIM To perform a systematic review of studies of the relationship between RA and reduced  workplace productivity .