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Guermazi A.,Boston University | Roemer F.W.,Boston University | Haugen I.K.,Diakonhjemmet Hospital | Crema M.D.,Boston University | Hayashi D.,Boston University
Nature Reviews Rheumatology | Year: 2013

The use of MRI techniques to investigate tissue pathology has become increasingly widespread in osteoarthritis (OA) research. Semiquantitative assessment of the joints by expert interpreters of MRI data is a powerful tool that can increase our understanding of the natural history of this complex disease. Several reliable and validated semiquantitative scoring systems now exist and have been applied to large-scale, multicentre, cross-sectional and longitudinal observational epidemiological studies. Such approaches have advanced our understanding of the associations of different tissue pathologies with pain and improved the definition of joint alterations that lead to disease progression. Semiquantitative MRI outcome measures have also been applied in several clinical trials in OA. Indeed, interest in MRI-based semiquantitative scoring systems has led to the development of several novel scoring systems that can be applied to different joints: a knee synovitis scoring system based on contrast-enhanced MRI; the MRI Osteoarthritis Knee Score (MOAKS); the Hip Osteoarthritis MRI Score (HOAMS); and the Oslo Hand Osteoarthritis MRI score (OHOA-MRI). Although these new scoring systems offer theoretical advantages over pre-existing systems, whether they offer actual superiority with regard to reliability, responsiveness and validity remains to be seen. © 2013 Macmillan Publishers Limited. All rights reserved. Source

Mjaavatten M.D.,Diakonhjemmet Hospital | Bykerk V.P.,Hospital for Special Surgery
Best Practice and Research: Clinical Rheumatology | Year: 2013

New classification criteria for rheumatoid arthritis (RA) were presented by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) in 2010, aiming for early identification of patients at risk of developing persistent and erosive arthritis. Since their publication, the criteria have been extensively validated against several reference standards, but there is still debate regarding how the criteria should be implemented in studies and clinical care. We present an overview of the published validation studies and discuss the strengths and limitations of the classification criteria, as well as whether the criteria are ready for diagnostic purposes in clinical practice. © 2013 Elsevier Ltd. All rights reserved. Source

Uhlig T.,Diakonhjemmet Hospital
Best Practice and Research: Clinical Rheumatology | Year: 2012

Tai Chi and yoga are complementary therapies which have, during the last few decades, emerged as popular treatments for rheumatologic and musculoskeletal diseases. This review covers the evidence of Tai Chi and yoga in the management of rheumatologic diseases, especially osteoarthritis of the knee, hip and hand, and rheumatoid arthritis. There is evidence that Tai Chi and yoga are safe, and some evidence that they have benefit, leading to reduction of pain and improvement of physical function and quality of life in patients. Recommendations for Tai Chi in knee osteoarthritis have recently been issued by the American College of Rheumatology. To allow broader recommendations for the use of Tai Chi and yoga in rheumatic diseases, there is a need to collect more evidence researched with larger randomised controlled trials. © 2012 Elsevier Ltd. All rights reserved. Source

Lie E.,Diakonhjemmet Hospital | Lie E.,Copenhagen University | Lie E.,University of Cardiff
Annals of the rheumatic diseases | Year: 2014

OBJECTIVE: Domains identified as a result of qualitative research and Delphi exercises to assess rheumatoid arthritis (RA) flare include pain, function, swollen and tender joints, patient and physician global, laboratory measures, participation, stiffness, self-management and fatigue. Here we examine aspects of construct and content validity of these domains in a longitudinal observational study.METHODS: A total of 1195 patients with RA treated with non-biological disease-modifying antirheumatic drugs (DMARDs) or biologics were eligible for the analyses. Working definitions of 'flare' included patient-reported worsening between 3 and 6 months (primary) and treatment change at 6 months (DMARDs and/or systemic corticosteroids) (secondary). Available outcome measures were mapped to the flare domains. Changes between 3 and 6 months were compared between patients with and without 'flare'. Convergent and divergent construct validity and content validity were assessed by correlation analyses and logistic regression analysis, respectively.RESULTS: Applying the flare working definition based on patient-reported worsening, standardised mean differences (SMDs) were >0.5 for the majority of outcomes. The largest SMDs were observed for Pain visual analogue scale (1.30), SF-36 Bodily pain (1.24), Patient global (1.20) and morning stiffness intensity (1.17). The flare working definition based on treatment change yielded lower SMDs (<0.5 for most variables). Consistently stronger intradomain than corresponding interdomain correlations supported convergent and divergent validity of the domains.CONCLUSIONS: Probing a flare definition via outcome measures, the identified flare domains discriminated well between patients with and without worsening. Interdomain and intradomain correlation and logistic regression analyses provide further support for construct and content validity of the identified flare domains. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. Source

Uhlig T.,National Advisory Unit on Rehabilitation in Rheumatology | Moe R.H.,National Advisory Unit on Rehabilitation in Rheumatology | Kvien T.K.,Diakonhjemmet Hospital
PharmacoEconomics | Year: 2014

Rheumatoid arthritis (RA) is a chronic inflammatory disease which, if left untreated, leads to functional disability, pain, reduced health-related quality of life and premature mortality. Between 0.5 % and 1 % of the population are affected worldwide, and between 25 and 50 new cases evolve in a population of 100,000. Practically all patients with RA require initiation with disease-modifying antirheumatic treatment to retard or stop progression, control disease manifestations and reduce the disease burden. If disease course is monitored with adjustment of medication, lifestyle factors, and exercise, as well as physical activity levels, co-morbidities may be prevented in the course of RA. During the last decade, major progress has been made in treating RA through early identification and treatment of the disease. Many patients still experience premature work disability and co-morbidities. For societies, the economic burden of RA is high in terms of direct and indirect costs, including modern drug treatment. © 2014, Springer International Publishing Switzerland. Source

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