<i>Background</i>. Ankylosing spondylitis (AS) is a chronic, progressive inflammatory rheumatic disease that leads to structural damage, functional impairment, and decrease in the quality of life. Red cell distribution width (RDW) is a part of the complete blood count (CBC) and estimates erythrocyte variability.<i> Objective</i>. To analyse RDW in patients with AS and to evaluate the relationships with acute phase reactants (APRs) and disease activity index.<i> Patients and Methods</i>. A total of 100 patients with AS (78 males and 22 females) were diagnosed according to the modified New York classification criteria for AS and 146 (99 males: 47 females) healthy individuals matched in age and sex as controls enrolled in the study. Demographic data, disease activity scores using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), medical history, C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), and complete blood count (CBC) were measured.<i> Results</i>. The mean age for patients and controls was 38.0 &#xb1; 9.0 and 35.8 &#xb1; 9.0 years, respectively (p=0.057). RDW was significantly higher in patients with AS compared with controls (14.133 &#xb1; 1.613 versus 12.299 &#xb1; 1.031, p &#x3c; 0.001). There was a direct correlation of RDW with both ESR and CRP (P &#x3c; 0.001); RDW had r=0.38 for C-reactive protein (CRP) and r=0.413 for ESR. Also BASDAI was directly correlated with RDW (r=0.326 p&#x3c;0.001). RDW was a valid measure to differentiate between patients with AS and controls (AUC=0,84, p&#x3c;0.001) and at optimum cut-off value&#x3e;13&#x25; has highest accuracy (78.9&#x25;) with very good sensitivity test (81&#x25;) and NPV (85.6&#x25;) as well as good specificity (77.4&#x25;) and PPV (71.1&#x25;).<i> Conclusion</i>. RDW was higher in AS patients compared with controls and was directly correlated with ESR, CRP, and BASDAI. RDW was a valid simple measure with good accuracy to differentiate between patients with AS and controls.

Faiq I. Gorial

Ali M. Hassan

Diagnostic Performance of Red Cell Distribution Width in Adult Iraqi Patients with Ankylosing Spondylitis

<i>Objective</i>. This study estimated the excess clinical, humanistic, and economic burden associated with depression among working-age adults with Rheumatoid Arthritis (RA).<i> Methods</i>. A retrospective cross-sectional study was conducted among working-age (18 to 64 years) RA patients with depression (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="22.173pt" style="vertical-align:-0.2064009pt" id="M1" height="8.8423pt" version="1.1" viewBox="-0.0498162 -8.6359 22.173 8.8423"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-79" d="M822 650H589L583 622C660 617 677 607 674 561C672 534 664 481 647 390L600 137H596L273 650H126L120 622C176 620 194 615 207 594C221 571 225 557 214 504L161 257C141 166 129 112 121 85C108 42 83 30 29 28L23 0H260L266 28C193 33 173 42 176 89C178 122 186 172 202 255L256 527H259L583 -8H612L690 390C708 481 720 535 728 558C744 603 756 619 816 622L822 650Z"/></g><g transform="matrix(.013,0,0,-0.013,14.542,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.956pt" style="vertical-align:-0.2064009pt" height="8.8423pt" version="1.1" viewBox="25.7551838 -8.6359 18.956 8.8423"><g transform="matrix(.013,0,0,-0.013,25.805,0)"><path id="g113-55" d="M137 343C167 482 260 545 321 574C357 591 397 603 429 609L423 641C382 634 335 622 295 608C189 570 37 457 37 238C37 84 125 -12 242 -12C362 -12 447 89 447 209C447 311 374 393 267 393C247 393 226 386 204 376L137 343ZM227 337C318 337 361 256 361 173C361 105 336 22 258 22C176 22 126 120 126 240C126 266 127 291 132 310C155 323 189 337 227 337Z"/></g><g transform="matrix(.013,0,0,-0.013,32.045,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,38.285,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g></svg></span>) and without depression (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="22.173pt" style="vertical-align:-1.583pt" id="M2" height="10.2189pt" version="1.1" viewBox="-0.0498162 -8.6359 22.173 10.2189"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-79"/></g><g transform="matrix(.013,0,0,-0.013,14.542,0)"><use xlink:href="#g117-34"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.194pt" style="vertical-align:-1.583pt" height="10.2189pt" version="1.1" viewBox="25.7551838 -8.6359 28.194 10.2189"><g transform="matrix(.013,0,0,-0.013,25.805,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,32.045,0)"><path id="g190-45" d="M95 130C70 130 46 113 46 88C46 72 54 64 59 64C93 55 121 33 121 -3C121 -41 93 -68 44 -88L55 -117C117 -98 186 -56 186 22C186 91 131 130 95 130Z"/></g><g transform="matrix(.013,0,0,-0.013,35.02,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,41.26,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,47.5,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg></span>) using data from the nationally representative Medical Expenditure Panel Survey for the years 2009, 2011, 2013, and 2015.<i> Results</i>. Overall, 25.8% had depression. In adjusted analyses, adults with RA and depression compared to those without depression were significantly more likely to have pain interference with normal work (severe pain: AOR = 2.22; 95% CI = 1.55, 3.18), functional limitations (AOR = 2.17; 95% CI = 1.61, 2.94), and lower mental health HRQoL scores. Adults with RA and depression had significantly higher annual healthcare expenditures ($14,752 versus 10,541, <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M3" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g></svg><span class="irelop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.921pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 21.921 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,25.569,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-50"/></g></svg></span>) and out-of-pocket spending burden. Adults with RA and depression were more likely to be unemployed and among employed adults, those with depression had a significantly higher number of missed work days annually and higher lost annual wages due to missed work days.<i> Conclusions</i>. This study highlights the importance of effectively managing depression in routine clinical practice of RA patients to reduce pain and functional limitations, improve quality of life, and lower direct and indirect healthcare costs.

Arijita Deb

Nilanjana Dwibedi

Traci LeMasters

Jo Ann Hornsby

Wenhui Wei

Usha Sambamoorthi

Burden of Depression among Working-Age Adults with Rheumatoid Arthritis

<i>Background</i>. Juvenile idiopathic arthritis (JIA) is the most common form of rheumatic disease in childhood and adolescents, affecting between 16 and 150 per 100,000 young persons below the age of 16. The lower limb is commonly affected in JIA, with joint swelling and tenderness often observed as a result of active synovitis.<i> Objective</i>. The objective of this scoping review is to identify the existence of physical examination (PE) tools to identify and record swollen and tender lower limb joints in children with JIA.<i> Methods</i>. Two reviewers individually screened the eligibility of titles and abstracts retrieved from the following online databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL. Studies that proposed and validated a comprehensive lower limb PE tool were included in this scoping review.<i> Results</i>. After removal of duplicates, 1232 citations were retrieved, in which twelve were identified as potentially eligible. No studies met the set criteria for inclusion.<i> Conclusion</i>. Further research is needed in developing and validating specific PE tools for clinicians such as podiatrists and other allied health professionals involved in the management of pathological lower limb joints in children diagnosed with JIA. These lower limb PE tools may be useful in conjunction with existing disease activity scores to optimise screening of the lower extremity and monitoring the efficacy of targeted interventions.

Antoni Fellas

Davinder Singh-Grewal

Derek Santos

Andrea Coda

Physical Examination Tools Used to Identify Swollen and Tender Lower Limb Joints in Juvenile Idiopathic Arthritis: A Scoping Review

Systematic reviews of self-management programs for osteoarthritis suggest minimal evidence of benefit and indicate substantial heterogeneity in interventions. The purpose of this scoping review was to describe the nature of self-management interventions provided to patients with osteoarthritis focusing on the inclusion and type of education and social support components. We searched PsycINFO, EMBASE, MEDLINE, and Cochrane Library databases from 1990 to 2016 to identify studies addressing community-based management strategies for osteoarthritis that included aspects of disease-specific education and ongoing social support. Results are presented as a narrative synthesis to facilitate integration of diverse evidence. Data were extracted from 23 studies that met our inclusion and exclusion criteria, describing complex, multicomponent interventions for osteoarthritis. All studies included education components, and 18 of these were osteoarthritis-specific. Social support was most often offered through peers and health care professionals, but also through exercise trainers/instructors and researchers, and lasted between 5 and 52 weeks. We charted positive social interaction offered by peers in group settings and emotional/informational support offered by health care professionals. Overall, descriptions of self-management provided limited documentation of the rationale or content of the programs. This suggests that more precise definitions of the theoretical underpinnings, components, and mechanisms would be useful for greater insight into best practices for osteoarthritis self-management programs.

Shabana Amanda Ali

Kristina M. Kokorelias

Joy C. MacDermid

Marita Kloseck

Education and Social Support as Key Factors in Osteoarthritis Management Programs: A Scoping Review

A biosimilar is a biologic product that is highly similar to a licensed biologic (&#x201c;originator&#x201d;) such that there are no clinically meaningful differences in safety, purity, or potency between the biosimilar and the originator. As patent protection and data exclusivity for the biologic rituximab expire, several potential biosimilars to rituximab are in development, which could soon lead to the availability of numerous rituximab biosimilars. Biosimilars are evaluated using thorough and rigorous analyses of the potential biosimilar versus the originator biological to confirm similar structure, function, and clinical efficacy as well as safety. Approval of a biosimilar is based upon the totality of the evidence demonstrating similarity to the originator. An understanding of the process of the interchangeable designation of a biosimilar is important in the context of patient outcomes. We conducted an analysis of the properties and benefits of rituximab in the treatment of inflammatory diseases, the development and approval of biosimilars, and the potential benefits of rituximab biosimilars. PubMed and ClinicalTrials.gov databases were searched for &#x201c;biosimilar&#x201d; and &#x201c;rituximab&#x201d; and regulatory and pharmaceutical company web pages were screened regarding biosimilars in development and specific guidelines developed for the approval of biosimilars. The results indicate that, at present, six rituximab biosimilar candidates are undergoing comparative clinical development, and two were recently approved in the European Union. Our analysis indicates rituximab biosimilars are expected to have a continuing role in treating inflammatory conditions such as rheumatoid arthritis.

Maria Greenwald

John Tesser

K. Lea Sewell

Biosimilars Have Arrived: Rituximab

Physical inactivity is important to address, and an objective way of measuring inactivity is by accelerometry. The objective of this study was to determine the reliability and construct validity of the SENS motion system to record physical activity and inactivity in patients with knee osteoarthritis. Participants with an age &#x3e; 40 years and an average weekly pain above 0 on a numeric rating scale (0 = no pain, 10 = worst pain) were included. Participants had a total of two study visits and at each visit participants completed a standardized activity. Data from 24 participants were analysed. A mean agreement of 99&#x25; (SD 3&#x25;) for sedentary behaviour and a mean agreement of 97&#x25; (SD 9&#x25;) for active behaviour were found. The agreement for &#x201c;walking&#x201d; was 28&#x25; (SD 18&#x25;). Mean agreement between recordings on the two visits was 96&#x25; (SD 8&#x25;) for sedentary behaviour and 99&#x25; (SD 1&#x25;) for active behaviour. The SENS motion activity measurement system can be regarded as a reliable and valid device for measuring sedentary behaviour in patients with knee OA, whereas detection of walking is not reliable and would require further work.

Cecilie Bartholdy

Henrik Gudbergsen

Henning Bliddal

Morten Kj&#xe6;rgaard

Kasper Lundberg Lykkegaard

Marius Henriksen

Reliability and Construct Validity of the SENS Motion&#xae; Activity Measurement System as a Tool to Detect Sedentary Behaviour in Patients with Knee Osteoarthritis

<i>Introduction</i>. We examined racial/ethnic disparities in healthcare providers&#x2019; recommendations for physical activity among individuals with arthritis and evaluated this association among groups of individuals who adhered to physical activity guidelines and those who did not.<i> Methods</i>. With a cross-sectional design based on Behavioral Risk Factor Surveillance System, we analyzed individuals with self-reported physician-diagnosed arthritis, &#x2265;18 years of age (<i>n</i> = 83,376). Outcome variable was healthcare providers&#x2019; recommendations for physical activity. Race/ethnicity was categorized as African American, Hispanic, and White. Associations were examined using multivariate logistic regression.<i> Results</i>. African Americans (Adjusted OR: 0.66; 95&#x25; CI: 0.55&#x2013;0.79) and Hispanics (Adjusted OR: 0.68; 95&#x25; CI: 0.56&#x2013;0.83) were less likely to receive providers&#x2019; recommendations.<i> Conclusions</i>. Although the importance of physical activity to improve health outcomes for adults with arthritis, as well as providers&#x2019; influence on individuals&#x2019; behavior change, is well established, providers are less likely to recommend physical activity to minorities. Further studies are required to identify the causes for this quality-of-care issue.

Shamly Austin

Kenneth G. Saag

Maria Pisu

Healthcare Providers&#x2019; Recommendations for Physical Activity among US Arthritis Population: A Cross-Sectional Analysis by Race/Ethnicity

<i>Objective.</i> Interprofessional collaboration is a crucial component of care for children with rheumatic disease. Interprofessional care, when delivered appropriately, prevents disability and improves long-term prognosis in this vulnerable group.<i> Methods.</i> The aim of this survey was to explore allied health professionals&#x2019; and nurses&#x2019; confidence in treating paediatric rheumatology patients.<i> Results.</i> Overall, 117 participants were recruited, 77.9&#x25; of participants reported being &#x201c;not confident at all,&#x201d; &#x201c;not confident,&#x201d; or &#x201c;neutral&#x201d; in treating children with rheumatic diseases (RD) despite 65.1&#x25; of participants reporting having treated &#x3e;1 paediatric rheumatology case in the past month. Furthermore, 67.2&#x25; of participants felt their undergraduate education in paediatric rheumatology was inadequate. &#x201c;Journals&#x201d; or &#x201c;texts books&#x201d; were used by 49.3&#x25; of participants as their primary source of continuing professional development (CPD) and 39.3&#x25; of participants indicated that they did not undertake any CPD related to paediatric rheumatology. Small group and online education were perceived to be potentially of &#x201c;great benefit&#x201d; for CPD.<i> Conclusion.</i> This paper highlights allied health professionals&#x2019; and nurses&#x2019; perceived inadequacy of their undergraduate education in paediatric RD and their low confidence in recognising and treating RD. Undergraduate and postgraduate education opportunities focusing on interprofessional collaboration should be developed to address this workforce deficiency.

Samuel Cassidy

Kerry West

Gordon Hendry

Debra Grech

Julie Jones

Fiona Hawke

Confidence amongst Multidisciplinary Professionals in Managing Paediatric Rheumatic Disease in Australia

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Arthritis