Showing papers in "Arthritis Care and Research in 2013"

Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: results from a survey of the general population.

Abstract: Objective To evaluate fibromyalgia in the general population with emphasis on prevalence, dimensionality, and somatic symptom severity. Methods We studied 2,445 subjects randomly selected from the German general population in 2012 using the American College of Rheumatology 2010 preliminary diagnostic criteria for fibromyalgia, as modified for survey research, and the polysymptomatic distress scale (PSD). Anxiety, depression, and somatic symptom severity were assessed with the Patient Health Questionnaire (PHQ) series, and measures of symptoms and quality of life were assessed with the European Organization for Research and Treatment of Cancer questionnaire. Results The prevalence of fibromyalgia was 2.1% (95% confidence interval [95% CI] 1.6, 2.7), with 2.4% (95% CI 1.5, 3.2) in women and 1.8% (95% CI 1.1, 2.6) in men, but the difference was not statistically significant. Prevalence rose with age. Fibromyalgia subjects had markedly abnormal scores for all covariates. We found smooth, nondisordered relationships between PSD and all predictors, providing additional evidence against the hypothesis that fibromyalgia is a discrete disorder and in support of a dimensional or spectrum disorder. There was a strong correlation (r = 0.790) between the PSD and the PHQ somatic symptom severity scale; 38.5% of persons with fibromyalgia satisfied the proposed Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for a physical symptom disorder. Conclusion The modified 2010 diagnostic criteria do not result in high levels of fibromyalgia. PSD and fibromyalgia are strongly related to somatic symptom severity. There is evidence in support of fibromyalgia as a dimensional or continuum disorder. This has important ramifications for neurobiologic and epidemiology research, and for clinical diagnosis, treatment, and ascertainment of disability.

Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US.

Abstract: Objective To estimate the incidence and lifetime risk of diagnosed symptomatic knee osteoarthritis (OA) and the age at diagnosis of knee OA based on self-reports in the US population. Methods We estimated the incidence of diagnosed symptomatic knee OA in the US by combining data on age-, sex-, and obesity-specific prevalence from the 2007–2008 National Health Interview Survey, with disease duration estimates derived from the Osteoarthritis Policy (OAPol) Model, a validated computer simulation model of knee OA. We used the OAPol Model to estimate the mean and median ages at diagnosis and lifetime risk. Results The estimated incidence of diagnosed symptomatic knee OA was highest among adults ages 55–64 years, ranging from 0.37% per year for nonobese men to 1.02% per year for obese women. The estimated median age at knee OA diagnosis was 55 years. The estimated lifetime risk was 13.83%, ranging from 9.60% for nonobese men to 23.87% in obese women. Approximately 9.29% of the US population is diagnosed with symptomatic knee OA by age 60 years. Conclusion The diagnosis of symptomatic knee OA occurs relatively early in life, suggesting that prevention programs should be offered relatively early in the life course. Further research is needed to understand the future burden of health care utilization resulting from earlier diagnosis of knee OA.

Prevalence of oral glucocorticoid usage in the United States: a general population perspective.

Abstract: Objective There is little information on oral glucocorticoid use in the general US population. Previously, there have been published estimates of glucocorticoid use in countries outside of the US. This study aimed to estimate the prevalence of glucocorticoid use, duration of use, and concomitant use of antiosteoporosis pharmaceuticals in the US population age ≥20 years. Methods Data from 5 cycles (1999–2008) of the National Health and Nutrition Examination Survey (NHANES) were used to provide nationally representative weighted estimates. Oral glucocorticoids and concomitant use of antiosteoporosis pharmaceuticals (bisphosphonates, calcitonin, calcium, hormone replacement therapies, teriparatide, and vitamin D) were analyzed. Results There were 356 NHANES respondents ages ≥20 years who reported use of an oral glucocorticoid in the combined cycles between 1999 and 2008. The weighted prevalence of oral glucocorticoid use was 1.2% (95% confidence interval [95% CI] 1.1–1.4) from 1999–2008, corresponding to 2,513,259 persons in the US. The mean duration of oral glucocorticoid use was 1,605.7 days (95% CI 1,261.2–1,950.1), and 28.8% (95% CI 22.2–35.4) of oral glucocorticoid users reported use for ≥5 years. Concomitant use of a bisphosphonate was reported by 8.6% (95% CI 5.1–11.7) of oral glucocorticoid users, and 37.9% (95% CI 31.7–44.0) reported usage of any antiosteoporosis pharmaceutical. Conclusion Based on NHANES data from 1999–2008, it is estimated that the prevalence of glucocorticoid use in the US is 1.2%, with a long duration of use and infrequent use of antiosteoporotic medications compared to other estimates.

Prevalence of Fibromyalgia: A Population‐Based Study in Olmsted County, Minnesota, Utilizing the Rochester Epidemiology Project

Abstract: Fibromyalgia (FM) is a complex illness to diagnose and treat, with symptoms that may be part of, or overlap with other diseases or syndromes. It is also a costly public health problem. Medical costs related to health care utilization and pain-related medications for patients with FM are substantially higher than those for patients without FM (1–4). Therefore, evaluating the prevalence of FM has both clinical and economic relevance. Recognition of FM may not always be straightforward, because FM symptoms may be part of or overlap with other diseases or syndromes. Using the original 1990 American College of Rheumatology (ACR) criteria, Wolfe et al estimated that the prevalence of FM in the US general population is 2% (3.4% in women vs 0.5% in men) (5). Similarly, White et al (6), reporting on the London Fibromyalgia Epidemiology Study in Ontario, Canada, estimated the prevalence of FM at 3.3% (4.9% in women vs 1.6% in men), and Branco et al (7) reported on a multinational study of the prevalence of FM in 5 European countries, estimating it at 4.7%. A separate study, using a method similar to that of the ACR diagnostic criteria estimated the prevalence in Germany at 3.8%, with similar rates in men and women, (8). These differing estimates may reflect differences in study populations, study designs, and measurements. In 2010, the ACR published diagnostic criteria for FM that encompass the chronic widespread pain, fatigue, unrefreshing sleep, cognition, and somatic symptoms considered the hallmarks of this condition (9). These criteria were later modified to allow their use in epidemiologic and survey studies, without the requirement for an examiner to perform a tender point examination (10). The modification involved asking patients to report both pain and tenderness for the widespread pain index, in comparison to the ACR 2010 diagnostic criteria that only asked health care providers to determine areas of pain. Additionally, 3 representative items substituted for the comprehensive list of somatic symptoms that composed the ACR 2010 symptom severity score: 1) the presence or absence of headaches; 2) pain or cramps in the lower abdomen; and 3) depression in the past 6 months. Similar to the 2010 clinical criteria for FM, the modified criteria included a widespread pain index score of ≥7 and a symptom severity score of ≥5. Alternatively, participants are defined as having FM if the widespread pain index is 3 to 6 or the symptom severity score is ≥9. Additionally, symptoms must have been present at a similar level for at least 3 months. Routine use of these criteria in epidemiologic research may improve comparability of FM prevalence in different populations. Our primary objective in this study was to estimate the prevalence of FM in a defined population in 2 different ways. To accomplish this objective, we first estimated the prevalence of diagnosed FM in clinical practice in Olmsted County, Minnesota, using community medical records. We then surveyed a random sample of the population of Olmsted County using the modified 2010 ACR criteria to estimate the percentage of responders who fulfilled criteria.

Estimated Frequency of Antiphospholipid Antibodies in Patients With Pregnancy Morbidity, Stroke, Myocardial Infarction, and Deep Vein Thrombosis: A Critical Review of the Literature

Abstract: Objective Antiphospholipid Syndrome Alliance For Clinical Trials and International Networking (APS ACTION) is an international research network devoted to conducting well-designed clinical trials in persistently antiphospholipid antibody (aPL)–positive patients. One of the first needs of APS ACTION was to know the true aPL frequency in patients with pregnancy morbidity (PM), stroke (ST), myocardial infarction (MI), and deep venous thrombosis (DVT). Methods The search for “aPL” and multiple keywords regarding the outcomes of interest was completed in PubMed. The median frequency for positive aPL tests (lupus anticoagulant, antibody against cardiolipin [aCL], and antibody against β2-glycoprotein I [anti-β2GPI]) was calculated for each outcome and was used to estimate the overall aPL frequency. Results Based on the analysis of 120 full-text papers, the overall aPL frequency was estimated as 6% for PM, 13.5% for ST, 11% for MI, and 9.5% for DVT. Limitations of the literature were that 60% of the papers were published before 2000, all 3 criteria aPL tests were performed in only 11% of the papers, 36% of papers used a low-titer aCL cutoff, anti-β2GPI cutoff was quite heterogeneous, aPL confirmation was performed in only one-fifth of papers, and the study design was retrospective in nearly half of the papers. Conclusion It is difficult to determine the frequency of a “clinically significant aPL profile” in patients with aPL-related clinical outcomes due to the lack of robust data. Our best estimates of the incidence of aPL-associated events should be confirmed with appropriately designed population studies.

Is symptomatic knee osteoarthritis a risk factor for a trajectory of fast decline in gait speed? Results from a longitudinal cohort study.

Abstract: Objective Gait speed is an important marker of health in adults and slows with aging. While knee osteoarthritis (OA) can result in difficulty walking, it is not known if radiographic knee OA (ROA) and/or knee pain are associated with a fast decline trajectory of gait speed over time. Methods Gait speed trajectories were constructed using a multinomial modeling strategy from repeated 20-meter walk tests measured annually over 4 years among participants from the Osteoarthritis Initiative, a prospective cohort study of adults ages 45–79 years at baseline with or at high risk of knee OA. We grouped participants into 4 knee OA categories (having neither ROA nor knee pain, ROA only, knee pain only, or symptomatic knee OA [ROA and pain]) and examined their association with trajectories of gait speed using a multivariable polytomous regression model adjusting for age and other potential confounders. Results Of the 4,179 participants (mean ± SD age 61.1 ± 9.1 years, 57.6% women, mean ± SD body mass index 28.5 ± 4.8 kg/m2), 5% (n = 205) were in a fast decline trajectory, slowing at a rate of 2.75%/year. People with symptomatic knee OA had an almost 9-fold risk (odds ratio 8.9; 95% confidence interval [95% CI] 3.1, 25.5) of being in a fast decline trajectory compared with those with neither pain nor ROA. Participants with knee pain had 4.5 times the odds of a fast decline (95% CI 1.4, 14.6), and those with ROA only had a slight but non–statistically significant increased risk. Conclusion People with symptomatic knee OA have the highest risk of a fast decline trajectory of gait speed compared with people with ROA or pain alone.

Anti-melanoma differentiation-associated protein 5-associated dermatomyositis: expanding the clinical spectrum.

Abstract: DM is a systemic autoimmune disease that affects muscle, lungs and skin to varying extents in different patients. Like many other systemic autoimmune diseases, DM patients frequently have specific autoantibodies which are strongly associated with distinct clinical phenotypes, making autoantibodies useful for disease diagnosis and prognosis (1). For example, autoantibodies which recognize Mi-2 are associated with a more severe cutaneous form of DM which responds favorably to therapy (2–4), while antibodies against the aminoacyl tRNA synthetases are associated with a clinical phenotype termed the “antisynthetase syndrome”, consisting of myopathy, fever, ILD, Raynaud’s phenomenon, non-erosive arthritis and mechanics hands (4–6). Autoantibodies against the interferon (IFN)-inducible antigen MDA5, have recently been described in 10–20% of Japanese DM patients. Anti-MDA5 antibody-positive patients had predominantly amyopathic DM and a high risk for ILD, including rapidly progressive ILD which was frequently fatal (7–11) (reviewed in (12)). To date, only one US cohort of DM patients has been systematically evaluated with regard to prevalence of MDA5 autoantibodies and the associated clinical attributes (13). These patients were drawn from an academic dermatology practice, and similar to the Japanese experience, 13% of DM patients had MDA5 autoantibodies. Consistent with previous reports, these patients were more likely to be amyopathic and have ILD. In addition, they demonstrated a characteristic cutaneous phenotype consisting of skin ulceration, tender palmar papules, or both. We sought to determine the prevalence of MDA5 autoantibodies in a cohort of 160 DM patients evaluated at a tertiary referral US myositis specialty center, and to define the clinical features of these patients. In this cohort, anti-MDA5 antibody positive patients often demonstrated hallmark features of the antisynthetase syndrome in the absence of tRNA synthetase autoantibodies. ILD was less severe than previously reported (7–11), and was absent completely in some patients over years of follow-up. Thus, anti-MDA5-associated myositis should be strongly considered when a patient with features of the antisynthetase syndrome is negative for anti-synthetase antibodies.

Utility of Anti–Melanoma Differentiation–Associated Gene 5 Antibody Measurement in Identifying Patients With Dermatomyositis and a High Risk for Developing Rapidly Progressive Interstitial Lung Disease: A Review of the Literature and a Meta-Analysis

Abstract: Objective To assess the utility of anti–melanoma differentiation–associated gene 5 (anti-MDA5) antibody measurement for predicting a risk for developing rapidly progressive interstitial lung disease (RP-ILD) in patients with polymyositis/dermatomyositis (PM/DM). Methods A single-center cohort of 64 consecutive Chinese patients with PM/DM was examined. Serum anti-MDA5 antibody was measured by enzyme-linked immunosorbent assay. For meta-analysis, we searched PubMed and the Institute for Scientific Information Web of Knowledge for original studies that measured anti-MDA5 antibodies in patients with PM/DM. We calculated pooled sensitivity, specificity, diagnostic odds ratio (DOR), and the summary receiver operating characteristic (sROC) curve. Results In Chinese patients, anti-MDA5 antibodies were detected in 26 patients with classic DM or clinically amyopathic DM (CADM). Compared with anti-MDA5–negative patients, anti-MDA5–positive patients showed a higher prevalence of RP-ILD (P = 0.001). In a total of 233 patients with anti-MDA5 antibody, derived from 16 studies, a higher frequency of CADM was found in Japanese than in non-Japanese patients (74.7% versus 39.2%; P = 1.2 × 10−7). Meta-analysis revealed that the pooled sensitivity and specificity of anti-MDA5 antibody for RP-ILD was 77% (95% confidence interval [95% CI] 64–87%) and 86% (95% CI 79–90%), respectively. The pooled DOR was 20.41 (95% CI 9.02–46.20) with a favorable area under the sROC curve of 0.89 (95% CI 0.63–0.98). Conclusion Detection of anti-MDA5 antibody is a valuable tool for identifying DM patients with a high risk for developing RP-ILD, but the distribution of classic DM and CADM in patients with this antibody varies among ethnic groups.

Fatigue and Factors Related to Fatigue in Rheumatoid Arthritis: A Systematic Review

Abstract: Objective Although patients with rheumatoid arthritis (RA) experience fatigue, little is known about its causes and consequences, and a fully developed theoretical model explaining the experience of fatigue in RA is lacking Our goal was to systematically review studies in RA that examined factors related to fatigue to gain more insight into its possible causes and consequences Methods Medline, Web of Science, Scopus, and PsycINFO were searched for relevant studies All studies with RA samples about the relationship between fatigue and other variables that defined dependent and independent variables and used multivariate statistical methods were preliminarily included After reviewing 129 full texts, we identified 25 studies on possible causes of fatigue and 17 studies on possible consequences of fatigue Results The studies found possible causes of fatigue in illness-related aspects, physical functioning, cognitive/emotional functioning, and social aspects Additionally, being a woman was related to higher levels of fatigue Inflammatory activity showed an unclear relationship with fatigue in RA Possible consequences of fatigue were also found among illness-related aspects, physical functioning, cognitive/emotional functioning, and social aspects The strongest evidence for a relationship between fatigue and other variables was found regarding pain, physical functioning, and depression Conclusion This review summarizes the current knowledge in the field in order to inform future research on causes and consequences of fatigue in RA However, the results are based on cross-sectional and longitudinal studies with different designs and different fatigue scales For a better identification of causal associations between fatigue in RA and related factors, longitudinal prospective designs with adequate fatigue measurements are suggested

Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long-term followup from disease onset

Abstract: Objective To determine the association of obesity, defined as a body mass index (BMI) ≥30 or ≥28 kg/m2 or by waist circumference (WC), with disease activity and severity, as well as its relationship to comorbidities in rheumatoid arthritis (RA). Methods The study population comprised 1,596 patients with early RA (mean ± SD age 55.6 ± 14.6 years, 67.8% women) who had been included in the Better Anti-Rheumatic Farmacotherapy observational study from 1992–2006. In 2010, data on lifestyle factors and comorbidities were collected through a postal questionnaire, answered by 1,391 patients. Clinical outcomes were the Disease Activity Score in 28 joints, sustained remission, physical function (Health Assessment Questionnaire [HAQ]), and pain and global health assessed on a visual analog scale, as well as predefined comorbidities. Results After a mean ± SD of 9.5 ± 3.7 years, the mean ± SD BMI had increased from 25.4 ± 4.2 to 26.0 ± 4.5 kg/m2 (P = 0.000). The prevalence of BMI ≥30 kg/m2 was 12.9% at baseline and 15.8% at followup. In multivariable regression, BMI and obesity, defined as a BMI ≥30 or ≥28 kg/m2, at both inclusion and the time of the survey were independently associated with higher disease activity, fewer patients in sustained remission, higher HAQ score, more pain, and worse general health. Also, BMI and obesity independently conferred to higher odds for being diagnosed with hypertension, diabetes mellitus, and chronic pulmonary disease. Further, BMI and WC were independently associated with angina pectoris/acute myocardial infarction/coronary revascularization. In contrast, none of the examined obesity variables was associated with the prevalence of stroke or transient ischemic attack. Lifestyle changes during the observational period, such as quitting smoking or diet change, had no impact on the outcomes. Conclusion Obesity was associated with worse RA disease outcomes and a higher prevalence of comorbidities. Body measurements are recommended to improve prediction of the disease course.

Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis.

Abstract: Objective To assess risk and risk factors for serious infections in seniors with rheumatoid arthritis (RA) using a case–control study nested within an RA cohort. Methods We assembled a retrospective RA cohort age ≥66 years from Ontario health administrative data across 1992–2010. Nested case–control analyses were done, comparing RA patients with a primary diagnosis of infection (based on hospital or emergency department records) to matched RA controls. We assessed independent effects of drugs, adjusting for demographics, comorbidity, and markers of RA severity. Results A total of 86,039 seniors with RA experienced 20,575 infections, for a rate of 46.4 events/1,000 person-years. The most frequently occurring events included respiratory infections, herpes zoster, and skin/soft tissue infections. Factors associated with infection included higher comorbidity, rural residence, markers of disease severity, and history of previous infection. In addition, anti–tumor necrosis factor agents and disease-modifying antirheumatic drugs were associated with a several-fold increase in infections, with an adjusted odds ratio (OR) ranging from 1.2–3.5. The drug category with the greatest effect estimate was glucocorticoids, which exhibited a clear dose response with an OR ranging from 4.0 at low doses to 7.6 at high doses. Conclusion Seniors with RA have significant morbidity related to serious infections, which exceeds previous reports among younger RA populations. Rural residence, higher comorbidity, markers of disease severity, and previous infection were associated with serious infections in seniors with RA. Our results emphasize that many RA drugs may increase the risk of infection, but glucocorticoids appear to confer a particular risk.

Contribution of obesity to the rise in incidence of rheumatoid arthritis.

Abstract: Objective Obesity is an underrecognized risk factor for rheumatoid arthritis (RA). In recent years, both the prevalence of obesity and the incidence of RA have been rising. Our objective was to determine whether the “obesity epidemic” could explain the recent rise in the incidence of RA. Methods An inception cohort of Olmsted County, Minnesota residents who fulfilled the 1987 American College of Rheumatology criteria for RA in 1980–2007 was compared to population-based controls (matched on age, sex, and calendar year). Heights, weights, and smoking statuses were collected from medical records. Obesity was defined as a body mass index ≥30 kg/m2. Conditional logistic regression was used to assess the influence of obesity on developing RA. Population attributable risk was used to estimate the incidence of RA in the absence of obesity. Results The study included 813 patients with RA and 813 controls. Both groups had extensive medical history available prior to the incidence/index date (mean 32.2 years), and ∼30% of each group was obese at the incidence/index date. The history of obesity was significantly associated with developing RA (odds ratio 1.24, 95% confidence interval 1.01–1.53; adjusted for smoking status). In 1985–2007, the incidence of RA rose by an increment of 9.2 per 100,000 among women. Obesity accounted for 4.8 per 100,000 (52%) of this increase. Conclusion Obesity is associated with a modest risk for developing RA. Given the rapidly increasing prevalence of obesity, this has had a significant impact on RA incidence and may account for much of the recent increase in the incidence of RA.

Obesity and reduction of the response rate to anti-tumor necrosis factor α in rheumatoid arthritis: an approach to a personalized medicine.

Abstract: Objective Obesity is a mild, long-lasting inflammatory disease and, as such, could increase the inflammatory burden of rheumatoid arthritis (RA). The study aim was to determine whether obesity represents a risk factor for a poor remission rate in RA patients requiring anti–tumor necrosis factor α (anti-TNFα) therapy for progressive and active disease despite treatment with methotrexate or other disease-modifying antirheumatic drugs. Methods Patients were identified from 15 outpatient clinics of university hospitals and hospitals in Italy taking part in the Gruppo Italiano di Studio sulle Early Arthritis network. Disease Activity Score in 28 joints (DAS28), body mass index (BMI; categorized as 30 kg/m2), acute-phase reactants, IgM rheumatoid factor, and anti–cyclic citrullinated peptide antibody values were collected. DAS28 remission was defined as a score of <2.6 lasting for at least 3 months. Results Six hundred forty-one outpatients with longstanding RA receiving anti-TNFα blockers (adalimumab, n = 260; etanercept, n = 227; infliximab, n = 154), recruited from 2006–2009 and monitored for at least 12 months, were analyzed. The mean ± SD DAS28 at baseline was 5.6 ± 1.4. A BMI of >30 kg/m2 was recorded in 66 (10.3%) of 641 RA patients. After 12 months of anti-TNFα treatment, a DAS28 of <2.6 was noted in 15.2% of the obese subjects, in 30.4% of the patients with a BMI of 25–30 kg/m2, and in 32.9% of the patients with a BMI of <25 kg/m2 (P = 0.01). The lowest percentage of remission, which was statistically significant versus adalimumab and etanercept (P = 0.003), was observed with infliximab. Conclusion Obesity represents a risk factor for a poor remission rate in patients with longstanding RA treated with anti-TNFα agents. A personalized treatment plan might be a possible solution.

Incidence of rheumatoid arthritis in Sweden: a nationwide population-based assessment of incidence, its determinants, and treatment penetration.

Abstract: Objective To estimate the nationwide incidence of rheumatoid arthritis (RA) in Sweden, including its variation across age, sex, geography, and demography, and to describe the sensitivity of register-based incidence estimates to different RA case definitions. Methods Incident RA patients were identified using the Swedish National Patient Register. In the base case, incident RA was defined as first-ever inpatient or nonprimary outpatient care visit listing an RA diagnosis in 2006–2008, with a second visit listing RA within 1 year. Patients prescribed disease-modifying antirheumatic drugs more than 6 months prior to the first visit listing RA were not regarded as incident. The robustness of this definition was evaluated by more liberal and strict criteria, and by penetration of antirheumatic treatment. Results Between 2006 and 2008, 8,826 individuals were identified as incident RA patients. The overall incidence was 41 per 100,000 (56 for women, 25 for men). The incidence increased with age and peaked in the 70–79 years age group for both women and men. The age- and sex-standardized incidences were lower in densely populated areas and in individuals with high educational level. No geographic trends were noted. More liberal and strict definitions of RA only altered the observed incidence by approximately 14%. Conclusion The overall nationwide register-based incidence of RA was robust across different case definitions. In a country with universal access to care, RA displayed demographic and socioeconomic, but no geographic, variations in incidence, and peaks at an older age than most commonly reported, with no difference in peak age at RA onset between sexes.

Obesity and the prediction of minimal disease activity: a prospective study in psoriatic arthritis.

Abstract: Objective We prospectively evaluated whether obesity impacts achievement of minimal disease activity (MDA) in subjects with psoriatic arthritis (PsA). Methods Among PsA subjects with an active disease and who were starting a treatment with tumor necrosis factor α blockers, 135 obese (body mass index [BMI] >30 kg/m2) patients and 135 patients of normal weight (controls) were followed up for 24 months. At baseline and at the 12- and 24-month followup, all subjects underwent a clinical, rheumatologic, and laboratory assessment. Results With the exception of the prevalence of hypercholesterolemia and hypertriglyceridemia, case and control subjects were similar for all the clinical and demographic characteristics analyzed. At the 12-month followup, in both cases and controls, no significant changes in body weight were found (P > 0.05 for all). MDA was achieved by 98 (36.3%) of the 270 PsA individuals. The prevalence of obesity was higher in those that did not achieve MDA than in those that did (64.0% versus 25.5%; P < 0.001). After adjusting for all the other variables, obesity was associated with a higher risk of not achieving MDA (hazard ratio [HR] 4.90, 95% confidence interval [95% CI] 3.04–7.87; P < 0.001). The HR of not achieving MDA was 3.98 (95% CI 1.96–8.06, P < 0.001) and 5.40 (95% CI 3.09–9.43, P < 0.001) in subjects with first-degree (BMI <30 kg/m2) and second-degree (BMI 30–35 kg/m2) obesity, respectively. Among the 98 subjects who had achieved MDA at the 12-month followup, the presence of obesity was associated with a poor probability of sustained MDA at the 24-month followup (HR 2.04, 95% CI 1.015–3.61; P = 0.014). Conclusion Obesity is a negative predictor of achieving and maintaining MDA.

Biomechanical deviations during level walking associated with knee osteoarthritis: a systematic review and meta-analysis.

Abstract: Objective To identify which gait deviations are consistently associated with knee osteoarthritis (KOA) and how these are influenced by disease severity, the involved compartment, and sex. Methods Five electronic databases and reference lists of publications were searched. Cross-sectional, observational studies comparing temporospatial variables, joint kinematics, and joint moments between individuals with KOA and healthy controls or between KOA subgroups were considered for review. Only publications scoring ≥50% on a modified methodology quality index were included. Because of the number of gait deviations examined, only biomechanical variables reported by ≥4 publications were further analyzed. Where possible, a meta-analysis was performed using effect sizes (ES) calculated from discrete variables. Results In total, 41 publications examining 20 variables were included. The majority of consistent gait deviations associated with KOA were exhibited by those with severe disease in the temporospatial domain. Individuals with severe KOA exhibited greater stride duration than controls (ES 1.35 [95% confidence interval (95% CI) 1.03, 1.67]) and a decrease in cadence (ES −0.75 [95% CI −1.12, −0.39]) compared with controls. The evidence for kinematic and joint moment change was primarily limited or conflicting. There was a lack of evidence for alterations in the external knee adduction moment. Conclusion Individuals with KOA exhibit a range of gait deviations compared with controls. Despite its common usage in KOA gait studies, we did not find consistent evidence that knee adduction moment differs between those with and without KOA or between disease severity levels. Further research examining the reasons for a lack of difference in many gait variables in those with knee OA is needed.

Muscle weakness in hip osteoarthritis: a systematic review.

Abstract: Hip osteoarthritis (OA) is responsible for hip pain, stiffness, and dysfunction during activities of daily living and is the most common reason for a total hip replacement (1). It has been estimated that 3% of the adult population (2) and 8% of people ages 60 years (3,4) are affected by hip OA. There is no known cure for OA and therefore, clinical management of hip OA largely focuses on alleviating pain and maximizing function (5–10). A thorough understanding of the musculoskeletal factors underlying dysfunction in hip OA is required to effectively achieve these goals. There is consistent evidence for quadriceps muscle weakness in knee OA (11), with quadriceps strengthening exercise considered a core component of programs for the management of knee OA (12–16). A commonly held view among clinicians appears to be that lower extremity muscle weakness is also apparent in hip OA. However, compared to the knee, there is less literature on muscle strength in hip OA, and guidelines for therapeutic exercise prescription in hip OA tend to be based on expert opinion rather than supporting evidence (17,18). It therefore remains unclear whether muscle weakness as observed in knee OA is evident in hip OA, and if so, which muscles are most affected. The force generated by a muscle is largely a function of the muscle’s physiologic cross-sectional area and the level of motor unit pool activation (19,20), and weakness can result from one or both of these mechanisms. Another factor with the potential to influence muscle strength is muscle quality, which manifests as a reduction in muscle force per unit of muscle physiologic cross-sectional area, and can arise due to an increase in noncontractile material such as fat in the muscle, as reported for older compared to younger adults (21). If individuals with hip OA do exhibit muscle weakness, characterization of the mechanisms underlying this weakness is required to inform the development of best practice intervention programs to treat the weakness. The purpose of this systematic review and critical evaluation of the literature was to determine whether muscles of the affected legs of individuals with unilateral hip OA are weaker, smaller, and more inhibited than those of their contralateral leg and/or the legs of healthy controls.

Experiences and perspectives of adults living with systemic lupus erythematosus: thematic synthesis of qualitative studies.

Abstract: Objective Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that significantly impairs patients' quality of life and can be life threatening This study aimed to describe the experiences and perspectives of adults living with SLE Methods We conducted a systematic review and thematic synthesis of qualitative studies that explored the experiences of adults living with SLE We searched MEDLINE, Embase, PsycINFO, CINAHL (to November week 1, 2012), Google Scholar, a thesis database, and reference lists of relevant articles Results Forty-six studies involving 1,385 participants were included Five themes were identified: restricted lifestyle (including subthemes of pervasive pain, debilitating fatigue, mental deterioration, disruptive episodic symptoms, and postponing parenthood), disrupted identity (gaining diagnostic closure, prognostic uncertainty, being a burden, hopelessness, heightened self-consciousness, fearing rejection, and guilt and punishment), societal stigma and indifference (illness trivialization, socially ostracized, and averse to differential treatment), gaining resilience (optimism, control and empowerment, being informed and involved, and valuing mutual understanding), and treatment adherence (preserving health, rapport with clinicians, negotiating medication regimens, and financial burden) Conclusion SLE has a severe and pervasive impact on patients' self-esteem and independence Their physical and social functioning is limited and they feel anxious about their future Patients perceive that SLE is trivialized, misunderstood, and stigmatized by their family, friends, and physicians, which intensifies their sense of isolation Educational, psychosocial, and self-care interventions are needed to promote mental resilience, positive coping strategies, self-advocacy, and capacities for social participation, and thereby to achieve better treatment and health outcomes in patients with SLE

Validity and reliability of patient-reported outcomes measurement information system instruments in osteoarthritis.

Abstract: Objective Evaluation of known-group validity, ecological validity, and test–retest reliability of 4 domain instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) in osteoarthritis (OA) patients. Methods We recruited an OA sample and a comparison general population (GP) sample through an internet survey panel. Pain intensity, pain interference, physical functioning, and fatigue were assessed for 4 consecutive weeks with PROMIS short forms on a daily basis and compared with same-domain Computer Adaptive Testing (CAT) instruments that use a 7-day recall. Known-group validity (comparison of OA and GP), ecological validity (comparison of aggregated daily measures with CAT instruments), and test–retest reliability were evaluated. Results The recruited samples matched the demographic characteristics (age, sex, race, and ethnicity) of the US sample for arthritis and the 2009 Census for the GP. Compliance with repeated measurements was excellent at >95%. Known-group validity for CATs was demonstrated with large effect sizes (pain intensity 1.42, pain interference 1.25, and fatigue 0.85). Ecological validity was also established through high correlations between aggregated daily measures and weekly CATs (≥0.86). Test–retest validity (7-day) was very good (≥0.80). Conclusion PROMIS CAT instruments demonstrated known-group and ecological validity in a comparison of OA patients with a GP sample. Adequate test–retest reliability was also observed. These data provide encouraging initial data on the utility of these PROMIS instruments for clinical and research outcomes in OA patients.

Pulmonary hypertension and other potentially fatal pulmonary complications in systemic juvenile idiopathic arthritis

Abstract: Systemic Juvenile Idiopathic Arthritis (sJIA) is a distinct category of JIA which is characterized by arthritis accompanied by characteristic systemic features (mainly quotidian fevers and evanescent rash, often also organomegaly, lymphadenopathy and serositis). In addition to these features, sJIA patients often have highly abnormal acute phase reactants, anemia and hyperferritinemia. The ILAR criteria are most widely accepted [1] for children under the age of 16. SJIA patients are susceptible to a potentially fatal complication called macrophage activation syndrome (MAS), which is characterized by unremitting fever, pancytopenia, coagulopathy and organ dysfunction, commonly of the liver and central nervous system [2–4]. Tissue biopsies often show foamy macrophages and active phagocytosis of blood elements (hemophagocytosis). MAS is thought to be an acquired form of hemophagocytic lymphohistiocytosis (HLH) [2, 3, 5–7]. Many sJIA patients with active systemic features are thought to have “sub-clinical” MAS [2–4, 8]. One study of bone marrow biopsies of sJIA patients at disease diagnosis showed the presence of hemophagocytosis even when overt clinical features of MAS were absent [9]. In addition to increased morbidity and poor functional outcomes compared to other forms of JIA [10, 11], sJIA patients have an increased risk of death, with a mortality hazard ratio which can be almost double that of other JIA categories mostly because of complications such as MAS and serious infections [2, 4, 12]. Recently, advances in the understanding of sJIA and the discovery of its excellent response to IL1 and IL6 inhibitors have resulted in an improved prognosis for many patients with this difficult to treat disease [13–19]. About 4 years ago, spontaneous reports emerged on an international pediatric rheumatology electronic listserv of unusual pulmonary complications in sJIA patients which were often fatal, especially pulmonary artery hypertension (PAH) [20]. Although pleuritis, along with pericarditis, is a commonly recognized feature of sJIA [11, 21], other pulmonary complications, such as PAH, interstitial lung disease (ILD) and alveolar proteinosis (AP) or lipoid pneumonia, are extremely rare. Only scattered single case reports of PAH, AP, ILD and illnesses that may represent one of these conditions in sJIA and Still’s disease existed in the literature prior to 2008 [22–27], prompting speculation about a possible association between exposure to biologic medications such as IL1 inhibitors and the development of these complications in some patients, because the use of IL1 inhibitors became much more common in sJIA at around this time, when reports of its efficacy in this disease emerged [16, 17]. In this study, we sought to identify and describe sJIA patients with these complications and analyze disease features which might identify characteristics that are specific to these patients.

Psychological profiles and pain characteristics of older adults with knee osteoarthritis.

Abstract: Objective To identify psychological profiles in persons with knee osteoarthritis (OA) and to determine the relationship between these profiles and specific pain and sensory characteristics, including temporal summation and conditioned pain modulation. Methods Individuals with knee OA (n = 194) completed psychological, health, and sensory assessments. Hierarchical cluster analysis was used to derive psychological profiles that were compared across several clinical pain/disability and experimental pain responses. Results Cluster 1 had high optimism with low negative affect, pain vigilance, anger, and depression, along with the lowest self-reported pain/disability and the lowest sensitivity to mechanical, pressure, and thermal pain (P < 0.01 for all). Cluster 2 had low positive affect with high somatic reactivity, while cluster 3 showed high pain vigilance with low optimism. Clusters 2 and 3 had intermediate levels of self-reported pain/disability and cluster 3 experienced central sensitization to mechanical stimuli. Participants in cluster 3 also displayed significant pain facilitation (P < 0.05). Cluster 4 exhibited the highest pain vigilance, reactivity, negative affect, anger, and depression. These individuals experienced the highest self-reported pain/disability, including widespread pain (P < 0.001 for all). Cluster 4 was most sensitive to mechanical, pressure, and thermal stimuli, and showed significant central sensitization to mechanical and thermal stimuli (P < 0.001 for all). Conclusion Our findings demonstrate the existence of homogeneous psychological profiles displaying unique sets of clinical and somatosensory characteristics. Multidisciplinary treatment approaches consistent with the biopsychosocial model of pain should provide significant advantages if targeted to profiles such as those in our OA sample.

Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists.

Abstract: Objective Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada. Methods We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data. Results One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94–100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of “(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with ≥1 by a specialist in a 2-year period)” had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date. Conclusion We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance.

Evaluation of histologic, serologic, and clinical changes in response to abatacept treatment of primary Sjögren’s syndrome: a pilot study.

Abstract: Objective To prospectively evaluate histopathologic, blood cellular, serologic, and clinical changes in response to abatacept treatment in patients with primary Sjogren's syndrome (SS). Methods Blood, saliva, and minor salivary gland biopsy samples were obtained before and after the last of 8 doses of abatacept in 11 primary SS patients. The histologic data evaluated the numbers of lymphocytic foci and B and T cell subtypes (CD20+, CD3+, CD4+, and CD8+). The numbers of FoxP3+ regulatory T cells were measured and the FoxP3:CD3 ratio was calculated. Histologic data were compared with results from peripheral blood and with changes in saliva secretion. Results The numbers of lymphocytic foci decreased significantly (P = 0.041). Numbers of local FoxP3+ T cells decreased significantly in percentage of total lymphocytic infiltrates (P = 0.037). In the peripheral blood, B cells increased (P = 0.038). This was due to an expansion of the naive B cell pool (P = 0.034). When adjusting for disease duration, an increase was also noted for total lymphocytes (P = 0.044) and for CD4 cells (P = 0.009). Gamma globulins decreased significantly (P = 0.005), but IgG reduction did not reach significance. Adjusted for disease duration, saliva production increased significantly (P = 0.029). Conclusion CTLA-4Ig treatment significantly reduces glandular inflammation in primary SS, induces several cellular changes, and increases saliva production. Remarkably, this increase in saliva production is significantly influenced by disease duration.

Meta-analysis of healing and prevention of digital ulcers in systemic sclerosis.

Abstract: Objective To assess the efficacy of therapies in healing and preventing digital ulcers (DUs) in systemic sclerosis (SSc; scleroderma). Methods Medline and EMBASE databases, and American College of Rheumatology and European League Against Rheumatism abstracts, were searched. Randomized controlled trials (RCTs) with outcomes investigating healing or prevention of DUs in SSc and comparing a pharmacologic therapy with placebo or an active agent were included. The pooled risk ratios (RRs) using the fixed-effects model were calculated and heterogeneity was tested using the I2 statistic. Results Sixty studies were found; 19 were not randomized, and 10 did not give DU quantitative data or no comparison of a different drug, leaving 31 RCTs with a total of 1,989 patients. Quality was 3 of 5 or less for 11 trials. DUs were not the primary outcome in many RCTs. Phosphodiesterase type 5 (PDE-5) inhibitors were significant for DU healing (RR 3.28 [95% confidence interval (95% CI) 1.32, 8.13], P = 0.01). Two large bosentan trials were significant for mean number of new DUs (standardized mean difference [SMD] −0.34 [95% CI −0.57, −0.11], P = 0.004). Oral prostacyclins were not statistically different from placebo, but intravenous (IV) iloprost prevented new DUs (SMD 0.77 [95% CI −1.46, −0.08], P = 0.03). Single trials for atorvastatin and vitamin E were positive in the prevention and healing of DU, respectively. There were many negative trials: antiplatelet therapy, oral N-acetylcysteine, heparin, dimethyl sulfoxide, ketanserin, prazosin, prostaglandin E1, cyclofenil, quinapril, and topical nitroglycerin formulation. Conclusion Small sample sizes, few comparative trials, and heterogeneity limits the conclusions. The results suggest a role for PDE-5 inhibitors in the healing of DUs; bosentan and IV iloprost may prevent new DUs.

Risk of venous thromboembolism in patients with rheumatoid arthritis.

Abstract: BACKGROUND Rheumatoid arthritis (RA) is associated with cardiovascular disease (CVD) but little is known about its association with another form of vascular disorder, venous thromboembolism (VTE).

Interstitial lung disease in anti-Jo-1 patients with antisynthetase syndrome.

Abstract: Objective To assess the outcome of interstitial lung disease (ILD) in anti–Jo-1 patients with antisynthetase syndrome, determine predictive variables of ILD deterioration in these patients, and compare features of anti–Jo-1 patients with and without ILD. Methods Ninety-one anti–Jo-1 patients were identified by medical records search in 4 medical centers. All of these patients had undergone pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) scans. Results Sixty-six patients (72.5%) had ILD. Patients could be divided into 3 groups according to their presenting lung manifestations: acute onset of lung disease (n = 12), progressive onset of lung signs (n = 35), and asymptomatic patients exhibiting abnormalities consistent with ILD on PFTs and HRCT scans (n = 19). Sixteen patients had resolution of ILD; 39 and 11 patients experienced improvement and deterioration of ILD, respectively. ILD led to decreased functional status, since 29.8% of patients exhibited a marked reduction of activities due to ILD and 13.6% had respiratory insufficiency requiring oxygen therapy; 5 of 6 patients died due to ILD complications. Predictive parameters of ILD deterioration were HRCT scan pattern of usual interstitial pneumonia, respiratory muscle involvement, and age ≥55 years. Furthermore, anti–Jo-1 patients with ILD, compared with those without, more frequently exhibited mechanic's hands and lower creatine kinase levels. Conclusion Our findings confirm that ILD is a frequent complication in anti–Jo-1 patients, resulting in high morbidity. We suggest that patients with predictive factors of ILD deterioration may require more aggressive therapy. Finally, anti–Jo-1 patients with ILD, compared with those without, may exhibit a particular clinical phenotype.

Differences Between Women and Men With Recent-Onset Axial Spondyloarthritis: Results From a Prospective Multicenter French Cohort

Abstract: Objective To clarify sex differences in early axial spondyloarthritis (SpA). Methods In total, 475 patients included in the Devenir des Spondylarthropathies Indifferenciees Recentes (Outcome of Recent Undifferentiated Spondylarthropathies) cohort, a prospective multicenter French cohort of patients with early inflammatory back pain suggestive of SpA, and fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial SpA were studied. The clinical and imaging features were compared between sexes and according to the clinical or imaging arm of the ASAS criteria using univariate and multivariate analysis. Results Comparisons between the 239 men and 236 women showed that women had higher disease activity when measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Patient Global Score and higher fatigue and functional scores despite having less radiographic sacroiliitis and magnetic resonance imaging (MRI) inflammation of sacroiliac joints and the spine than men. Disease activity measured by the C-reactive protein (CRP)–based Ankylosing Spondylitis Disease Activity Score was not different between men and women. In contrast to patients classified with the clinical arm, disease activity and functional scores did not differ between women and men with sacroiliitis on imaging scans, except for fatigue and the Ankylosing Spondylitis Quality of Life questionnaire. Women with sacroiliitis had more peripheral involvement and more family history, whereas HLA–B27 positivity, elevated CRP, and MRI inflammation of the spine were associated with male sex. Conclusion Women with early axial SpA according to the ASAS criteria had greater disease activity when measured by the BASDAI and worse functioning despite fewer radiologic abnormalities than men. The differences in disease expression may be confounding factors to establish the diagnosis of SpA and to assess disease activity in women, suggesting that the imaging arm is a pivotal measure in the ASAS criteria.

Body weight changes and corresponding changes in pain and function in persons with symptomatic knee osteoarthritis: A cohort study

Abstract: Osteoarthritis (OA) of the knee has multiple causes but one of the more powerful risk factors for OA onset and progression is excessive body weight1,2. The Framingham study, for example, reported that women who lost at least 5kg had a 50% reduction in the odds of developing symptomatic knee OA3. Given the high costs and high prevalence of knee OA, many researchers have focused on attempts to identify interventions that reduce body weight of persons with OA who are overweight or obese4-10. A meta analysis that examined the effects of various approaches to weight reduction with or without co-interventions for persons with symptomatic knee OA found that a weight reduction on the order of a 5% reduction of body weight was associated with insignificant reductions in knee pain but significant though small improvements in self reported functional status.6 Christensen and colleagues also reported a dose-response effect such that the extent of weight reduction was proportional to the extent of functional improvement. In recently published trials, weight reduction strategies leading to losses approximating 10% or more of body weight have resulted in more substantial reductions in pain and improved function4,7,10. In a recently published cohort study of 44 persons undergoing gastric surgery for severe obesity, the average reduction in body weight from baseline to 6-months following surgery was 20.2%11. Average WOMAC Pain and Physical Function scores were reduced by 50% or more. These data, in combination, suggest that weight reduction and improvements in pain and functional status may be proportional and respond in a dose-response manner. Several trials have examined the influences of weight loss on pain and function and we found one cohort study that examined effects of body weight gain on pain or functional status12. If a dose-response relationship exists between body weight changes and corresponding changes in pain and function for persons with symptomatic knee OA, one would expect that body weight gains may also be associated with proportional increases in pain and worsening functional status. We found no studies that determined if a dose-response relationship existed between body weight changes, both gains and losses, and changes in knee related pain and functional status in a large sample of persons with symptomatic knee osteoarthritis. Trial evidence suggests that weight reduction of at least 5% of body weight would lead to improved function and that weight reductions of 10% or more would lead to greater reductions in pain and substantially improved function. Recommendations based on trial findings on persons with knee OA are similar to federal government-based recommendations for weight reduction to optimize health.13,14 Participants in weight loss trials receive extensive attention and training during the trial and it is unclear whether persons in the community who are not part of a weight loss trial and who undergo similar amounts of weight reduction also experience similar changes in pain and function. It also is unknown whether persons who gain weight actually experience worse pain and function and whether this pain and functional loss is proportional to the amount of weight gained. Knowing whether persons in the community report proportionate reductions (or increases) in pain and function following changes in body weight would equip clinicians with additional evidence-based information to aid in managing patients with knee OA. The purpose of our longitudinal cohort study was to determine if a dose-response relationship exists between extent of weight changes (including both weight reduction and weight gain) and extent of changes in self-reported function-related pain and functional status.

Anakinra in adult-onset Still's disease: long-term treatment in patients resistant to conventional therapy.

Abstract: Objective Anakinra is effective in adult-onset Still's disease (AOSD) in the short term, but little is known regarding its efficacy over the long term. Our objective was to assess the long-term efficacy and safety of anakinra in AOSD. Methods A nationwide survey was conducted between 2009 and 2010 to identify AOSD patients treated with anakinra. Collected data consisted of disease characteristics at diagnosis and at medication onset; anakinra efficacy, safety, and dose adaptation; and reasons for discontinuation, if applicable. Results The study included 28 AOSD patients, with a mean age of 40.3 years and a mean disease duration at the start of anakinra of 9.3 years. All patients had previously failed to respond to steroids and disease-modifying antirheumatic drugs. All patients responded to anakinra, with a rapid and sustained decrease in steroid doses. At the last followup (mean 23 months), 16 patients were still being treated with anakinra: 4 had a partial response and 12 were in complete remission. Twelve patients had discontinued anakinra: 2 due to an insufficient response, 4 due to an AOSD flare after a period of complete remission, 2 due to side effects, and 1 due to a desire for pregnancy. In 3 patients, the drug discontinuation was possible because they achieved complete remission. Six additional patients experienced anakinra dose tapering, with sustained remission in 2 and relapse in the others. Anakinra was well tolerated and adverse events were rated as mild. Conclusion Anakinra was consistently efficacious in AOSD and displayed good therapeutic maintenance. Anakinra dose tapering or discontinuation was associated with relapse in half of the patients.

Prevalence and incidence in patients with autoimmune rheumatic diseases: A nationwide population‐based study in Taiwan

Abstract: Objective The purpose of this study was to determine the prevalence, incidence, and mortality rates of autoimmune rheumatic diseases (ARDs) by using a population-based database. Methods We used the longitudinal health insurance database (comprising 1,000,000 beneficiaries) of the Taiwan National Health Insurance from 2000 to 2008 and the National Death Registry of Taiwan from 2000 to 2008. Results The overall prevalence of major ARDs was 101.3 (95% confidence interval [95% CI] 27.5–107.9) per 100,000 populations; the prevalence was 165.1 (95% CI 44.8–177.1) in women and 40.1 (95% CI 10.9–46.1) in men. The prevalences of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren's syndrome, progressive systemic sclerosis, polymyositis/dermatomyositis, vasculitis, and Behcet's disease were 52.4 (95% CI 14.2–57.2), 37.0 (95% CI 10.0–41.0), 16.0 (95% CI 4.3–18.7), 3.8 (95% CI 1.0–5.3), 2.9 (95% CI 0.8–4.2), 5.7 (95% CI 1.6–7.4), and 1.4 (95% CI 0.4–2.3) per 100,000 persons, respectively. Between 2001 and 2008, the incidence rates (per 100,000 person-years) for these diseases were 17.3, 8.4, 10.6, 1.5, 1.5, 1.2, and 0.8, respectively. The incident cases with ARDs had a higher risk of mortality, with the standardized mortality ratio (SMR) ranging from 1.3 to 3.7. Conclusion In 2000, the prevalence of major ARDs was 1.4–52.4 per 100,000 persons in Taiwan. Between 2000 and 2008, the incidence rates of various ARDs were 0.8–17.3 per 100,000 person-years. The prevalence and incidence of RA were the highest, followed by SLE and Sjogren's syndrome, and those of Behcet's disease were the lowest. Patients with different types of ARDs had higher mortality and SMR than those of the general population.