Objective
To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.23177

Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II.

In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have been updated. The 2013 update has been developed by an international task force, which based its decisions mostly on evidence from three systematic literature reviews (one each on sDMARDs, including glucocorticoids, bDMARDs and safety aspects of DMARD therapy); treatment strategies were also covered by the searches. The evidence presented was discussed and summarised by the experts in the course of a consensus finding and voting process. Levels of evidence and grades of recommendations were derived and levels of agreement (strengths of recommendations) were determined. Fourteen recommendations were developed (instead of 15 in 2010). Some of the 2010 recommendations were deleted, and others were amended or split. The recommendations cover general aspects, such as attainment of remission or low disease activity using a treat-to-target approach, and the need for shared decision-making between rheumatologists and patients. The more specific items relate to starting DMARD therapy using a conventional sDMARD (csDMARD) strategy in combination with glucocorticoids, followed by the addition of a bDMARD or another csDMARD strategy (after stratification by presence or absence of adverse risk factors) if the treatment target is not reached within 6 months (or improvement not seen at

/pdf/eular-recommendations-for-the-management-of-rheumatoid-4fujp4paik.pdf

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update

OBJECTIVE
To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.


METHODS
The National Arthritis Data Workgroup reviewed published analyses from available national surveys, such as the National Health and Nutrition Examination Survey and the National Health Interview Survey. Because data based on national population samples are unavailable for most specific rheumatic conditions, we derived estimates from published studies of smaller, defined populations. For specific conditions, the best available prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau, to estimate the number affected with each condition.


RESULTS
We estimated that among US adults, nearly 27 million have clinical osteoarthritis (up from the estimate of 21 million for 1995), 711,000 have polymyalgia rheumatica, 228,000 have giant cell arteritis, up to 3.0 million have had self-reported gout in the past year (up from the estimate of 2.1 million for 1995), 5.0 million have fibromyalgia, 4-10 million have carpal tunnel syndrome, 59 million have had low back pain in the past 3 months, and 30.1 million have had neck pain in the past 3 months.


CONCLUSION
Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population. This report provides the best available prevalence estimates for the US, but for most specific conditions more studies generalizable to the US or addressing understudied populations are needed.

National Arthritis Data Work-group. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II

The increased understanding of the immune mechanisms of rheumatoid arthritis has led to the development of a considerable number of new therapeutic agents that alter the natural history of the disease and reduce mortality.

/pdf/the-pathogenesis-of-rheumatoid-arthritis-5ec7s76zig.pdf

The pathogenesis of rheumatoid arthritis.

Treatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-à-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs

The etiology of B lymphocyte hyperactivity in ankylosing spondylitis (AS) and in reactive synovitis is unknown and data available on the cellular immune system are controversial. We therefore evaluated peripheral blood T cell populations in AS patients and patients with reactive synovitis (RS) using monoclonal antibodies, previously shown to react with all T cells (OKT3), the inducer-helper T cell subset (OKT4) and the suppressor-cytotoxic T cell subset (OKT8). Results were compared with a normal control group and a group of rheumatoid arthritis (RA) patients. In AS an increase of OKT4+ cells was found, but the total number of T helper-inducer cells in peripheral blood was not different from the normal group and the group of patients with RS. Contrary to the results found in RA, where the helper-inducer/suppressor-cytotoxic ratio (OKT4+/OKT8+) was significantly increased, the immunoregulatory ratio in AS and in RS was normal suggesting another mechanism leading to B cell hyperactivity than in RA.

Peripheral blood T lymphocytes subpopulations in HLA-B7 related rheumatic diseases: ankylosing spondylitis and reactive synovitis.

Recombinant interferon gamma in rheumatoid arthritis. A double-blind study comparing immuneron (recombinant interferon gamma) with placebo

The aetiology of rheumatoid arthritis (RA) is unknown, but recent data highlight the autoimmune characteristics and the central role of T cells in the immunopathogenesis of this disease. It is not surprising that all constituents of the immune reaction have been considered as possible targets for new therapeutic developments: the macrophage and its superficial major histocompatibility complex molecules (class I or II), the unknown antigen, the helper T cell and its characteristic surface marker (CD4), the T cell receptor, and the cytokines interleukin (IL)-I, IL-2, tumour necrosis factor and interferon -y (Table 1). T cell vaccination is an attempt to decrease the immune response by the induction of anti-idiotypic T cells which ez~ert a suppressive action on the helper T cells involved in the pathogeny. The same objectives can be achieved by the injection of pooled immunoglobulins in the hope of inducing an anti-idiotypic effect (Zouali and Eyquem, 1983; Coutinho, 1989). In many reports a role for sex hormones in the development of autoimmune diseases was suggested both in humans and in experimental animal models (Ahmed et al, 1985). Some investigators found in these data a rationale for the use of sex hormones in the treatment of RA. The immunomodulatory effects of thymic hormones have been documented, especially in animal models, in which the suppressor T cell function

Intervention with immunomodulatory agents: new pharmacological developments

We report a case of polyarteritis nodosa with a clinical presentation mimicking polymyalgia rheumatica, as well as pathological findings of non-giant-cell arteritis on temporal artery biopsy with symptoms of jaw claudication. Although certain clinical syndromes have been attributed to specific types of systemic vasculitis, considerable overlap occurs. Obtaining tissue biopsy in cases of vasculitis is mandatory for diagnosis and classification.

Herman Mielants

Papers

Peripheral blood T lymphocytes subpopulations in HLA-B7 related rheumatic diseases: ankylosing spondylitis and reactive synovitis.

Recombinant interferon gamma in rheumatoid arthritis. A double-blind study comparing immuneron (recombinant interferon gamma) with placebo

Intervention with immunomodulatory agents: new pharmacological developments

Polyarteritis Nodosa Mimicking Polymyalgia Rheumatica

CARD15 mutations in patients with spondyloarthropathy are linked with disease progression and evolution to Crohn's disease