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The population of North Dakota is predominantly of Scandinavian (Norwegian) or German descent. We analyzed a cohort of all patients diagnosed with palindromic rheumatism (PR) and followed-up (by the investigator PK) at the St. Alexius Medical Center, Specialty Clinics, Bismarck, North Dakota, from August 16, 2006 to September 16, 2008. Standard statistical methodology was used to analyze the data. The proportion of patients with PR out of the total number of patients with rheumatoid arthritis (RA) seen during the timeframe of this study at our institution was 0.9%. The demographics, clinical features, and response to treatment of our patient-population with PR were quite similar to what has been described in the literature. However, we did not observe an evolution of PR into rheumatoid arthritis or any other “identifiable” inflammatory arthropathy although the follow-up was done very regularly (at least every 3 months), the average duration of follow-up being 12.1 months. Also, testing for the HLA B27 allele was positive in 3 (42.86%) patients, much higher than the “background” prevalence of this gene. This small, longitudinal study describes the epidemiology, clinical features, laboratory and radiographic findings, and course of PR in a small but closed community. This is the first descriptive report of PR to the best of our knowledge from the unique state of North Dakota. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Rheumatoid factor (RF) positivity has been associated with an unfavourable outcome in rheumatoid arthritis (RA). Our study aimed to find a baseline RF cut-off level that would determine the response to standard disease modifying anti-rheumatic drug (DMARD) combination treatment. Patients and methods: We studied 233 seropositive (RF levels ≥ 20 IU/mL at presentation) RA patients over a period of up to 5 years. Disease activity was assessed at each patient-encounter using disease activity score on 28 joints (DAS28). Treatment consisted of weekly methotrexate, daily hydroxychloroquine and low dose oral methlyprednisolone as an adjunct. Sulfasalazine or leflunomide were added to the ongoing regimen if satisfactory response was not achieved by 3 months of treatment. Individual response of patients to treatment was graded using the following DAS28 cut-off values: < 3 as low disease activity (satisfactory response), ≥ 3 as moderate and ≥ 5.1 as high (unsatisfactory response). Results: By analyzing all possible 2 × 2 contingency tables based on the different values of RF in the data set, using Fisher''s exact test of association between RF levels and DAS28 values, a cut-off level for RF of 70 IU/mL gave the optimal discrimination between ‘low’ versus ‘moderate or high’ disease activity in the follow-up. Conclusion: A baseline RF cut-off value of 70 IU/mL appears to predict a ‘satisfactory’ versus ‘unsatisfactory’ response to standard DMARD-combination therapy in RA over time. [Copyright &y& Elsevier]