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This study aims to measure the serum level of 25-hydroxyvitamin D₃ (25-OH-D₃) in 302 patients with rheumatoid arthritis (RA), studying the association to disease activity. Three hundred two RA patients underwent clinical examination and serological analysis. 25-Hydroxyvitamin D₃ was determined by high-performance liquid chromatography-tandem mass spectrometry. Vitamin D₃ deficiency defined as serum levels of 25-hydroxyvitamin D₃ below 50 nmol/l was detected in 101 RA patients (33.4 %). There was no significant correlation between the serum level of 25-hydroxyvitamin D₃ and Disease Activity Score 28 (DAS28) (3w) score. In a subpopulation of RA patients with very low serum level of 25-OH-D₃ (≤15 nmol/l) (n = 15), there were significant differences compared to patients with normal 25-OH-D3 (n = 200): higher percentage of patients with positive rheumatoid factor (100.0 versus 77.5 %; p = 0.05), higher CRP (28.7 versus 14.8 mg/l; p = 0.001), higher number of patients treated with at least three disease-modifying antirheumatic drugs (DMARDs) (40.0 versus 14.5 %; p = 0.02), higher number of patients with high disease activity DAS28 score of ≥5.1 (20.0 versus 4.5 %; p = 0.01), lower age (54.5 versus 64.0 years; p = 0.003) and shorter disease duration (5.1 versus 10.3 years; p = 0.06). Deficiency of 25-hydroxyvitamin D₃ was detected in 33.4 % of the RA patients. A subpopulation of patients with severe deficiency of vitamin D₃ serum level of ≤15 nmol/l was characterised by all being positive for rheumatoid factor, high percentage of patients with very high disease activity and high percentage of patients treated with at least three DMARDs.

Aim: To examine the prevalence of sicca symptoms and secondary Sjögren's syndrome (sSS) in rheumatoid arthritis (RA) patients, and the impact of sSS on disease activity and treatment profile in RA patients., Methods: Three hundred and seven RA patients responding positive to at least one of the questions in a questionnaire about sicca symptoms, were examined by Schirmer I test for tear production, and unstimulated whole saliva collection (USWC). Secondary Sjögren's syndrome was defined by at least one subjective sicca symptom, in addition to a positive Schirmer I test and positive USWC., Results: Among the 307 RA patients, 86 (28%) responded positive to at least one question about sicca symptoms, and 11 patients were positive for both Schirmer I and USWC tests, giving a minimum prevalence of sSS at 3.6%. There were no differences in RA patients with and without sSS regarding age, sex, disease duration, disease activity score (DAS-28) and seropositivity for anti-cyclic citrullinated protein. RA patients with sSS had a tendency for higher numbers of tender and swollen joints and pain. None of the RA patients treated with tumor necrosis factor (TNF) inhibitors had sSS, compared to 22% of the rest of the RA population studied. The treatment of the RA patients with and without sSS was not different., Conclusion: Among the 307 RA patients, 28% had at least one sicca symptom. The estimated minimum of prevalence of sSS in 307 RA patients was 3.6%. Secondary Sjögren's syndrome was not found in RA patients treated with biologics such as TNF blockers., (© 2012 The Authors International Journal of Rheumatic Diseases © 2012 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.)

Objective: To study the frequency and pattern of arthritis in primary Sjögren's syndrome (pSS), and its association with clinical and immunological factors., Methods: 102 patients with pSS diagnosed according to the preliminary European Classification Criteria were examined yearly for 4.5 years in a prospective study design. Arthralgia and arthritis were registered during the 459 patient-years observation period., Results: Arthralgia was reported by 75 patients (73.5%) and arthritis was demonstrated in 18 patients (17.6%) during the observation period. The most commonly affected joints were ancles (n = 7), MCP joints (n = 6), shoulders (n = 6), MTP joints (n = 6) and wrists (n = 5). Symmetrical bilateral arthritis were most commonly observed in ancles (4 patients) and wrists, shoulders and MTP joints. Five patients had longstanding arthritis observed at more than one clinical examination, and one developed seronegative rheumatoid arthritis. Arthralgia/arthritis was not correlated to any clinical or immunological factors, and usually ESR and CRP were normal when arthritis was observed., Conclusion: Arthritis in pSS is usually mild, resolving, and unrelated to other clinical and immunological factors. A typical pattern is uni- and bilateral arthritis in the ankles, but joints in hands, feet and shoulders may also be affected.

Background: During the last decade patients with active rheumatoid arthritis have been offered early and aggressive drug therapy in order to decrease the damaging effect of inflammation on cartilage and bone. Combination of two or more disease-modifying antirheumatic drugs has been used more frequently to achieve better efficacy than with monotherapy without increasing drug side effects., Materials and Methods: We have studied available rheumatological literature to find the best documented drug combinations., Results: The combination of methotrexate, sulfasalazine and hydroxychloroquine seems to be a well documented alternative, and so is the combination of methotrexate and cyclosporine. Modern biologic drugs like etanercept, infliximab and anakinra work best in combination with methotrexate., Interpretation: The combination of two or more disease-modifying antirheumatic drugs can be a good alternative to monotherapy in the treatment of patients with active rheumatoid arthritis, either when monotherapy has failed or unacceptable side effects have occurred, or as a first choice in patients who need very early and aggressive therapy. Combination therapy should only be initiated by a rheumatologist, after informed consent. A safe clinical and chemical monitoring must be organized in cooperation with the patient and the primary physician.

Objective: To determine if calprotectin is predictive for outcome in patients with rheumatoid arthritis (RA)., Methods: Fifty six RA in-patients with variable disease duration were prospectively followed for five years. Clinical and laboratory data were collected to assess disease activity. Health Assessment Questionnaire (HAQ) and radiographic scores (of hands and wrists) as described by Larsen were used as outcome measures. Plasma calprotectin levels were determined with ELISA technique., Results: Significant correlations (r) were found cross-sectionally at follow-up between calprotectin concentration and other known parameters of disease activity and severity: CRP (r = 0.67). investigator's global assessment of disease activity (r = 0.57). Waaler titre (r = 0.50). HAQ score (r = 0.48) and number of swollen joints (r = 0.48). Calprotectin at baseline was not identified as an independent predictor for HAQ or radiographic progression in the multivariate analysis., Conclusion: The results confirm calprotectin as a good measure of disease activity and joint inflammation in RA. However, the level of calprotectin at baseline was not predictive for radiographic damage or functional impairment five years later.

The purpose of this study was to determine the total and cause-specific mortality in rheumatoid arthritis (RA) patients compared to a control population in northern Norway. One hundred and eighty-seven patients with RA and 930 population controls matched for age, gender and municipality were followed until death or for a maximum of 17 years. The total mortality in RA patients was twice that of their controls (MRR = 2.0, 95% CI = 1.6-2.5). Patients possessing serum rheumatoid factors did not have a higher relative mortality than the seronegative patients. There was no statistically significant increased mortality from cancer or cardiovascular diseases. Indications for a higher death rate in RA patients than in controls were found for infection and sudden death.

Rheumatoid arthritis is a serious disease associated with increased morbidity and mortality, and requires adequate routines for therapy and follow-up examination. This article presents the work of the Norwegian Society for Rheumatology to improve the quality of the therapeutic assessment of patients with rheumatoid arthritis in Norway. The process of reaching an agreement involved a large number of rheumatologists. The final meeting included a variety of activities, plenary lectures, workshops, group discussions and opinion polls. A literature search through Medline was provided continuously. Agreement was achieved on a programme for monitoring therapy with disease-modifying antirheumatic drugs, which was to comprise visits to the physician and laboratory tests. This programme was later voted on and affirmed by the Annual Meeting of the Norwegian Society for Rheumatology. Proposals were issued regarding endpoint measures to assess progression of the disease. These proposals can be expected to improve the quality of treatment and management of patients with rheumatoid arthritis, both in primary health care and in the specialized rheumatological health service.

The prevalence of thyroid antibodies in 100 patients with rheumatoid arthritis in Northern Norway was studied. The serological data were compared with those from a major population survey in the same area. Compared to the prevalence in the normal population, the present study demonstrates that patients with rheumatoid arthritis have a higher prevalence of antibodies to both thyroid microsomal antigen and thyroglobulin.

Calprotectin (L1) is a major granulocyte and monocyte protein which is released during activation of these cells. The plasma level of L1 is thought to reflect disease activity in rheumatoid arthritis (RA). In our cross sectional study of 70 patients with RA, L1 had significant correlations with erythrocyte sedimentation rate (r = 0.50), C-reactive protein (r = 0.58), orosomucoid (r = 0.62), platelet count (r = 0.42), leukocyte count (r = 0.33) and IgM rheumatoid factor (r = 0.32); and with the following clinical variables: number of swollen joints (r = 0.24), grip strength (r = -0.22), PIP joint circumferences (r = 0.33) and a combined global assessment score (r = 0.24). L1 was higher in seropositive (median 14,861 micrograms/l) than seronegative patients (median 10,487 micrograms/l) (p less than 0.03).