human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE With the advent of new and expensive antirheumatic treatments with potentially serious side effects , it would be essential to identify as early as possible those rheumatoid arthritis ( RA ) patients who have a poor prognosis . Here study was made of the prognostic value of different markers recorded at the onset of RA . METHODS At the 20-year follow-up of our prospect i ve study , 66 patients had rheumatoid factor-positive ( RF+ ) RA . At commencement of follow-up ( disease duration < 6 months ) , the prognostic value of 19 demographic , laboratory , clinical and radiographic variables was tested to explain the 20-year Larsen score for peripheral joints and the Health Assessment  Question naire ( HAQ ) index using Somers'd for asymmetrical associations . RESULTS An association was observed between onset blood platelets ( 0.17 ) , serum IgG ( 0.18 ) , the onset Larsen score ( 0.33 ) and the 20-year Larsen score . Old age ( 0.30 ) , serum orosomucoid ( 0.17 ) , the function score ( 0.28 ) , morning stiffness ( 0.28 ) , and grip strength ( 0.24 ) were associated with the 20-year HAQ . CONCLUSION The correlation between the investigated entry variables and end-point outcome was poor . In our discussion we conclude that the most important prognostic factor in RF + RA is the treatment OBJECTIVES To describe the changes in functional ability ( FA ) taking place over 5 yr in patients with rheumatoid arthritis ( RA ) starting disease-modifying anti-rheumatic drug ( DMARD ) therapy  , to investigate the factors having most influence upon FA and to compare these factors at baseline and after 5 yr of treatment . METHODS Three hundred and sixty-six patients with active RA were studied as part of a 5-yr r and omized controlled study of DMARD therapy . FA was assessed by  Health Assessment Question naire  ( HAQ )  score every 6 months . Multiple linear regression was used to identify factors affecting FA at baseline and at 5 yr . The independent variables used were age , sex , visual analogue scale ( VAS ) pain , Ritchie articular index , C-reactive protein ( CRP ) , Larsen score and log-transformed morning stiffness ( EMS ) . RESULTS Mean HAQ score was 1.64 at baseline , improved by 21 % at 1 yr and gradually returned towards baseline levels by 5 yr . At baseline only 34 % of variance in HAQ score could be explained ; the most significant explanatory variables were the Ritchie articular index and CRP . At 5 yr the variance explained was 60 % . The Ritchie articular index remained the strongest factor followed by VAS pain , log(10 ) EMS and Larsen score . CONCLUSIONS Improvement in function did occur after commencement of the first DMARD therapy but was not maintained to 5 yr . The most consistent factor affecting function was joint tenderness . Global pain and duration of EMS were of lesser importance . Disease activity measures such as the CRP exerted an influence in the earlier , more active stages of disease : radiographic damage assumed greater importance as the arthritis progressed OBJECTIVES To predict the long-term outcome of rheumatoid arthritis ( RA ) with respect to radiographic damage , disability , and disease course using baseline variables , and to construct decision trees identifying patients on an individual level at the extremes of the outcome spectrum of these 3 dimensions . METHODS The 12-year outcome of 112 female RA patients from a prospect i ve inception cohort was assessed by measuring the tertiles of radiographic damage ( measured by the modified Sharp/van der Heijde method , SHS ) , disability ( measured by the Health Assessment Question naire , HAQ ) , and severe disease course as defined by patients with either the 33 % highest cumulative disease activity ( area under the curve of all observed disease activity scores ) or the highest tertile of radiographic damage . Patients in the lowest ( mild ) and highest tertile ( severe ) of each outcome measure were identified . All baseline parameters known to be associated with each outcome ( demographic and socioeconomic parameters ; disease duration ; disease activity measures ; laboratory measures including rheumatoid factor , HLA typing , percentage agalactosyl IgG , functional and radiographic measures ) were entered into cross-vali date d stepwise logistic regression models to find the best predictive combination of baseline parameters for each of the outcomes . Using the results of the logistic regression models , simple decision trees were constructed to categorize patients at an individual level in a particular prognostic group . RESULTS After 12 years , the lowest and highest tertiles were , respectively , 42.3 and 189 for the SHS and 0.37 and 1.25 for the HAQ . Fifty-five patients had a severe disease course . Mild and severe radiographic damage could be predicted with an accuracy of 90 % and 85 % , respectively . Mild and severe HAQ could be predicted with an accuracy of 90 % and 84 % , respectively , and severe disease course with an accuracy of 81 % . The baseline variables found to be predictive of all 3 outcome measures were very similar and consisted of combinations of the following baseline parameters : swollen joint count ( SJC ) , Ritchie score , rheumatoid factor ( RF ) , the presence of erosions , and the HAQ score . Additional knowledge of the HLA typing hardly improved the accuracy of the prediction . To predict outcome at the individual level , simple decision trees were constructed using the RF , HAQ , SJC , and presence of erosions at baseline . CONCLUSION The present study shows that prediction of outcome in long-term RA is possible and can be done using widely available baseline parameters OBJECTIVE To investigate the relationship between different outcome and process measures in early rheumatoid arthritis ( RA ) . METHODS A 3-year prospect i ve study of 149 patients with early RA ( symptoms < 1 year at entry ) . Results of serial measurements of process variables were transformed into time integrated values for comparison with the outcome measures . RESULTS A highly significant correlation was found between the acute phase response , swollen joints , and radiological progression whereas none of these measures correlated with joint tenderness . Physical disability as estimated by the Health Assessment Question naire ( HAQ ) however , appeared to be determined by joint tenderness rather than by joint swelling . CONCLUSION In early RA , joint swelling and acute phase reactants appear to be the most appropriate process variables for the prediction of radiological outcome , whereas joint tenderness is a strong determinant of physical disability ( HAQ ) OBJECTIVES To determine whether magnetic resonance ( MR ) scans of the dominant wrist of patients with early rheumatoid arthritis ( RA ) can be used to predict functional outcome at 6 years ' follow up . METHODS  Dominant wrist MR scans were obtained in 42 patients with criteria for RA at first presentation . Patients were followed up prospect ively for 6 years , and further scans obtained at 1 year ( 42 patients ) and 6 years ( 31 patients ) . Two radiologists scored scans for synovitis , tendonitis , bone oedema , and erosions . The Stanford Health Assessment Question naire ( HAQ ) score , indicating functional outcome , and st and ard measures of disease activity were assessed at 0 , 1 , 2 , and 6 years . The physical function component of the SF-36 score ( PF-SF36 ) was also used as a functional outcome measure at 6 years . RESULTS Baseline MR parameters , including bone oedema score and the total baseline MR score , were predictive of the PF-SF36 at 6 years ( R2 = 0.22 , p = 0.005 and R2 = 0.16 , p = 0.02 , respectively ) . The PF-SF36 score correlated strongly with the HAQ score at 6 years ( rs = -0.725 , p<0.0001 ) ; none of the baseline MR parameters predicted the 6 year HAQ score . The total MR score obtained at 1 year was predictive of the 6 year HAQ ( R2 = 0.04 , p = 0.01 ) . St and ard clinical and radiographic measures at baseline were not predictive of the 6 year PF-SF36 , but when combined in a model with baseline MR oedema score , prediction increased from 0.09 to 0.23 , or 23 % of the 6 year variance . CONCLUSION MR imaging of the wrist  in patients with early RA can help to predict function at 6 years and could be used to plan aggressive management at an earlier stage 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 prospect ively followed for five years . Clinical and laboratory data were collected to assess disease activity . Health Assessment Question naire ( HAQ ) and radiographic scores ( of h and s 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 objective of this study was to describe the development of radiographic damage in patients with RA and to search for predictors of radiographic progression over 5 yr . One hundred and thirteen patients , 75 female and 38 male , mean age 53 yr , with definite RA and mean disease duration of 11.4 months , were followed prospect ively for 5 yr at an out-patient clinic .  Radiographs of the h and s and feet were performed annually , and evaluated according to Larsen . The predictive value of demographic , clinical and laboratory variables at study start was evaluated . A stepwise logistic regression model was applied . We found that radiological joint damage occurred early and was significantly progressive during the 5 study years . The rate of progression was most prominent during the first 2 yr . At study start , 53 % of the patients had no detectable erosions , but only 11 % remained non-erosive . Twenty-six per cent of the patients with the initial presence of erosions did not progress substantially and needed no aggressive therapy . High joint damage progression during the first year , female gender and high baseline ESR could predict 57 % of the patients with high total radiographic progression . Age , disease duration , rheumatoid factor , genetic factors , active joint count and the presence of erosions at study start had no predictive value The effects of hydroxychloroquine and sulphasalazine on progression of joint damage shown by X-rays were compared in a double-blind , r and omised trial in 60 patients with rheumatoid arthritis not previously treated with slow-acting antirheumatic drugs .  X-rays of the h and s and feet at the start and after 24 and 48 weeks of treatment were available for 28 patients treated with hydroxychloroquine  and 22 treated with sulphasalazine .  Erosions and joint space narrowing were scored by a single observer unaware of treatment . At baseline there were no significant differences in demographic , clinical , or radiographic characteristics between the treatment groups . Patients withdrawn because of lack of effect were included in the analysis . The median number of erosions was lower in the sulphasalazine than the hydroxychloroquine group at 24 weeks of treatment ( 2.5 vs 10 ) and the difference was significant at 48 weeks ( 5 vs 16 ; p less than 0.02 ) . The difference in median total score of joint damage was significant at 24 weeks ( 6.5 vs 17 ; p less than 0.02 ) and at 48 weeks ( 8 vs 33 ; p less than 0.02 ) . The increase in number of erosions and total score was significantly greater in the hydroxychloroquine than the sulphasalazine group , both after 24 weeks and after 48 weeks of treatment An assessment of the onset of radiographic damage in the large joints ( hip , knees , shoulders , elbows , ankles and tarsus ) in patients with early rheumatoid arthritis , and the relationship of the progression of large joint damage with joint damage in h and s and feet , with physical disability , and with cumulative disease activity , was performed in a prospect i ve 6 yr follow-up study . Large joint damage appeared to be an early phenomenon with 20 % of the patients having some damage in at least one large joint within 1 yr , and 50 % of the patients within 6 yr after disease onset . Radiographic damage in large joints was significantly related to the damage in h and s and feet , the physical disability index , and the cumulative disease activity . The initial disease activity at study entry was the only prognostic factor that reached significance OBJECTIVE To describe the longitudinal radiographic course of rheumatoid arthritis ( RA ) , and to identify and quantitate predictors of radiographic progression . METHODS This prospect i ve , longitudinal study of radiographic progression and clinical predictors of RA involved 256 patients with RA who were seen within the first 2 years of disease ( mean 0.77 years ) and were followed up for up to 19 years . Participants underwent a total of 6,278 clinical assessment s  ( mean 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE With the advent of new and expensive antirheumatic treatments with potentially serious side effects , it would be essential to identify as early as possible those rheumatoid arthritis ( RA ) patients who have a poor prognosis . Here study was made of the prognostic value of different markers recorded at the onset of RA . METHODS At the 20-year follow-up of our prospect i ve study , 66 patients had rheumatoid factor-positive ( RF+ ) RA . At commencement of follow-up ( disease duration < 6 months ) , the prognostic value of 19 demographic , laboratory , clinical and radiographic variables was tested to explain the 20-year Larsen score for peripheral joints and the Health Assessment  Question naire ( HAQ ) index using Somers'd for asymmetrical associations . RESULTS An association was observed between onset blood platelets ( 0.17 ) , serum IgG ( 0.18 ) , the onset Larsen score ( 0.33 ) and the 20-year Larsen score . Old age ( 0.30 ) , serum orosomucoid ( 0.17 ) , the function score ( 0.28 ) , morning stiffness ( 0.28 ) , and grip strength ( 0.24 ) were associated with the 20-year HAQ . CONCLUSION The correlation between the investigated entry variables and end-point outcome was poor . In our discussion we conclude that the most important prognostic factor in RF + RA is the treatment OBJECTIVES To describe the changes in functional ability ( FA ) taking place over 5 yr in patients with rheumatoid arthritis ( RA ) starting disease-modifying anti-rheumatic drug ( DMARD ) therapy  , to investigate the factors having most influence upon FA and to compare these factors at baseline and after 5 yr of treatment . METHODS Three hundred and sixty-six patients with active RA were studied as part of a 5-yr r and omized controlled study of DMARD therapy . FA was assessed by  Health Assessment Question naire  ( HAQ )  score every 6 months . Multiple linear regression was used to identify factors affecting FA at baseline and at 5 yr . The independent variables used were age , sex , visual analogue scale ( VAS ) pain , Ritchie articular index , C-reactive protein ( CRP ) , Larsen score and log-transformed morning stiffness ( EMS ) . RESULTS Mean HAQ score was 1.64 at baseline , improved by 21 % at 1 yr and gradually returned towards baseline levels by 5 yr . At baseline only 34 % of variance in HAQ score could be explained ; the most significant explanatory variables were the Ritchie articular index and CRP . At 5 yr the variance explained was 60 % . The Ritchie articular index remained the strongest factor followed by VAS pain , log(10 ) EMS and Larsen score . CONCLUSIONS Improvement in function did occur after commencement of the first DMARD therapy but was not maintained to 5 yr . The most consistent factor affecting function was joint tenderness . Global pain and duration of EMS were of lesser importance . Disease activity measures such as the CRP exerted an influence in the earlier , more active stages of disease : radiographic damage assumed greater importance as the arthritis progressed OBJECTIVES To predict the long-term outcome of rheumatoid arthritis ( RA ) with respect to radiographic damage , disability , and disease course using baseline variables , and to construct decision trees identifying patients on an individual level at the extremes of the outcome spectrum of these 3 dimensions . METHODS The 12-year outcome of 112 female RA patients from a prospect i ve inception cohort was assessed by measuring the tertiles of radiographic damage ( measured by the modified Sharp/van der Heijde method , SHS ) , disability ( measured by the Health Assessment Question naire , HAQ ) , and severe disease course as defined by patients with either the 33 % highest cumulative disease activity ( area under the curve of all observed disease activity scores ) or the highest tertile of radiographic damage . Patients in the lowest ( mild ) and highest tertile ( severe ) of each outcome measure were identified . All baseline parameters known to be associated with each outcome ( demographic and socioeconomic parameters ; disease duration ; disease activity measures ; laboratory measures including rheumatoid factor , HLA typing , percentage agalactosyl IgG , functional and radiographic measures ) were entered into cross-vali date d stepwise logistic regression models to find the best predictive combination of baseline parameters for each of the outcomes . Using the results of the logistic regression models , simple decision trees were constructed to categorize patients at an individual level in a particular prognostic group . RESULTS After 12 years , the lowest and highest tertiles were , respectively , 42.3 and 189 for the SHS and 0.37 and 1.25 for the HAQ . Fifty-five patients had a severe disease course . Mild and severe radiographic damage could be predicted with an accuracy of 90 % and 85 % , respectively . Mild and severe HAQ could be predicted with an accuracy of 90 % and 84 % , respectively , and severe disease course with an accuracy of 81 % . The baseline variables found to be predictive of all 3 outcome measures were very similar and consisted of combinations of the following baseline parameters : swollen joint count ( SJC ) , Ritchie score , rheumatoid factor ( RF ) , the presence of erosions , and the HAQ score . Additional knowledge of the HLA typing hardly improved the accuracy of the prediction . To predict outcome at the individual level , simple decision trees were constructed using the RF , HAQ , SJC , and presence of erosions at baseline . CONCLUSION The present study shows that prediction of outcome in long-term RA is possible and can be done using widely available baseline parameters OBJECTIVE To investigate the relationship between different outcome and process measures in early rheumatoid arthritis ( RA ) . METHODS A 3-year prospect i ve study of 149 patients with early RA ( symptoms < 1 year at entry ) . Results of serial measurements of process variables were transformed into time integrated values for comparison with the outcome measures . RESULTS A highly significant correlation was found between the acute phase response , swollen joints , and radiological progression whereas none of these measures correlated with joint tenderness . Physical disability as estimated by the Health Assessment Question naire ( HAQ ) however , appeared to be determined by joint tenderness rather than by joint swelling . CONCLUSION In early RA , joint swelling and acute phase reactants appear to be the most appropriate process variables for the prediction of radiological outcome , whereas joint tenderness is a strong determinant of physical disability ( HAQ ) OBJECTIVES To determine whether magnetic resonance ( MR ) scans of the dominant wrist of patients with early rheumatoid arthritis ( RA ) can be used to predict functional outcome at 6 years ' follow up . METHODS  Dominant wrist MR scans were obtained in 42 patients with criteria for RA at first presentation . Patients were followed up prospect ively for 6 years , and further scans obtained at 1 year ( 42 patients ) and 6 years ( 31 patients ) . Two radiologists scored scans for synovitis , tendonitis , bone oedema , and erosions . The Stanford Health Assessment Question naire ( HAQ ) score , indicating functional outcome , and st and ard measures of disease activity were assessed at 0 , 1 , 2 , and 6 years . The physical function component of the SF-36 score ( PF-SF36 ) was also used as a functional outcome measure at 6 years . RESULTS Baseline MR parameters , including bone oedema score and the total baseline MR score , were predictive of the PF-SF36 at 6 years ( R2 = 0.22 , p = 0.005 and R2 = 0.16 , p = 0.02 , respectively ) . The PF-SF36 score correlated strongly with the HAQ score at 6 years ( rs = -0.725 , p<0.0001 ) ; none of the baseline MR parameters predicted the 6 year HAQ score . The total MR score obtained at 1 year was predictive of the 6 year HAQ ( R2 = 0.04 , p = 0.01 ) . St and ard clinical and radiographic measures at baseline were not predictive of the 6 year PF-SF36 , but when combined in a model with baseline MR oedema score , prediction increased from 0.09 to 0.23 , or 23 % of the 6 year variance . CONCLUSION MR imaging of the wrist  in patients with early RA can help to predict function at 6 years and could be used to plan aggressive management at an earlier stage 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 prospect ively followed for five years . Clinical and laboratory data were collected to assess disease activity . Health Assessment Question naire ( HAQ ) and radiographic scores ( of h and s 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 objective of this study was to describe the development of radiographic damage in patients with RA and to search for predictors of radiographic progression over 5 yr . One hundred and thirteen patients , 75 female and 38 male , mean age 53 yr , with definite RA and mean disease duration of 11.4 months , were followed prospect ively for 5 yr at an out-patient clinic .  Radiographs of the h and s and feet were performed annually , and evaluated according to Larsen . The predictive value of demographic , clinical and laboratory variables at study start was evaluated . A stepwise logistic regression model was applied . We found that radiological joint damage occurred early and was significantly progressive during the 5 study years . The rate of progression was most prominent during the first 2 yr . At study start , 53 % of the patients had no detectable erosions , but only 11 % remained non-erosive . Twenty-six per cent of the patients with the initial presence of erosions did not progress substantially and needed no aggressive therapy . High joint damage progression during the first year , female gender and high baseline ESR could predict 57 % of the patients with high total radiographic progression . Age , disease duration , rheumatoid factor , genetic factors , active joint count and the presence of erosions at study start had no predictive value The effects of hydroxychloroquine and sulphasalazine on progression of joint damage shown by X-rays were compared in a double-blind , r and omised trial in 60 patients with rheumatoid arthritis not previously treated with slow-acting antirheumatic drugs .  X-rays of the h and s and feet at the start and after 24 and 48 weeks of treatment were available for 28 patients treated with hydroxychloroquine  and 22 treated with sulphasalazine .  Erosions and joint space narrowing were scored by a single observer unaware of treatment . At baseline there were no significant differences in demographic , clinical , or radiographic characteristics between the treatment groups . Patients withdrawn because of lack of effect were included in the analysis . The median number of erosions was lower in the sulphasalazine than the hydroxychloroquine group at 24 weeks of treatment ( 2.5 vs 10 ) and the difference was significant at 48 weeks ( 5 vs 16 ; p less than 0.02 ) . The difference in median total score of joint damage was significant at 24 weeks ( 6.5 vs 17 ; p less than 0.02 ) and at 48 weeks ( 8 vs 33 ; p less than 0.02 ) . The increase in number of erosions and total score was significantly greater in the hydroxychloroquine than the sulphasalazine group , both after 24 weeks and after 48 weeks of treatment An assessment of the onset of radiographic damage in the large joints ( hip , knees , shoulders , elbows , ankles and tarsus ) in patients with early rheumatoid arthritis , and the relationship of the progression of large joint damage with joint damage in h and s and feet , with physical disability , and with cumulative disease activity , was performed in a prospect i ve 6 yr follow-up study . Large joint damage appeared to be an early phenomenon with 20 % of the patients having some damage in at least one large joint within 1 yr , and 50 % of the patients within 6 yr after disease onset . Radiographic damage in large joints was significantly related to the damage in h and s and feet , the physical disability index , and the cumulative disease activity . The initial disease activity at study entry was the only prognostic factor that reached significance OBJECTIVE To describe the longitudinal radiographic course of rheumatoid arthritis ( RA ) , and to identify and quantitate predictors of radiographic progression . METHODS This prospect i ve , longitudinal study of radiographic progression and clinical predictors of RA involved 256 patients with RA who were seen within the first 2 years of disease ( mean 0.77 years ) and were followed up for up to 19 years . Participants underwent a total of 6,278 clinical assessment s  ( mean 
    Output:
    