Katie Lennon

Last summer’s norovirus outbreak in Multnomah County, Oregon, appears to be linked to swimming in a natural lake in Blue Lake Regional Park, according to a study from the Centers for Disease Control and Prevention.

Swimming in the lake on July 12-13, 2014, was significantly associated with the 65 probable and five laboratory-confirmed cases of norovirus infection that were reported that same weekend, according to the retrospective cohort study. Among the study’s other findings was that people who swam in the lake were more than twice as likely to become ill, compared with others who visited the park that weekend but did not go swimming.

Diarrhea and vomiting were reported by 10 and 14 of the sickened individuals, respectively. A swimmer’s vomit or fecal incident on July 12 is the most likely cause of the lake’s contamination.

Engaging in strategies for preventing high-risk situations in recreational waters, such as Blue Lake’s biweekly water testing for fecal contamination, evidently do not ensure prevention of contamination, according to Amy Zlot of the Multnomah County Health Department and her colleagues.

Additionally, swimming area officials need to educate the public about healthy swimming practices, the researchers said. Toward that end, the agency has recently published a free downloadable brochure on healthy swimming.

Read the full study in the MMWR (2015 May 15;64:485-90).

[email protected]

Last summer’s norovirus outbreak in Multnomah County, Oregon, appears to be linked to swimming in a natural lake in Blue Lake Regional Park, according to a study from the Centers for Disease Control and Prevention.

Swimming in the lake on July 12-13, 2014, was significantly associated with the 65 probable and five laboratory-confirmed cases of norovirus infection that were reported that same weekend, according to the retrospective cohort study. Among the study’s other findings was that people who swam in the lake were more than twice as likely to become ill, compared with others who visited the park that weekend but did not go swimming.

Diarrhea and vomiting were reported by 10 and 14 of the sickened individuals, respectively. A swimmer’s vomit or fecal incident on July 12 is the most likely cause of the lake’s contamination.

Engaging in strategies for preventing high-risk situations in recreational waters, such as Blue Lake’s biweekly water testing for fecal contamination, evidently do not ensure prevention of contamination, according to Amy Zlot of the Multnomah County Health Department and her colleagues.

Additionally, swimming area officials need to educate the public about healthy swimming practices, the researchers said. Toward that end, the agency has recently published a free downloadable brochure on healthy swimming.

Read the full study in the MMWR (2015 May 15;64:485-90).

[email protected]

Last summer’s norovirus outbreak in Multnomah County, Oregon, appears to be linked to swimming in a natural lake in Blue Lake Regional Park, according to a study from the Centers for Disease Control and Prevention.

Swimming in the lake on July 12-13, 2014, was significantly associated with the 65 probable and five laboratory-confirmed cases of norovirus infection that were reported that same weekend, according to the retrospective cohort study. Among the study’s other findings was that people who swam in the lake were more than twice as likely to become ill, compared with others who visited the park that weekend but did not go swimming.

Diarrhea and vomiting were reported by 10 and 14 of the sickened individuals, respectively. A swimmer’s vomit or fecal incident on July 12 is the most likely cause of the lake’s contamination.

Engaging in strategies for preventing high-risk situations in recreational waters, such as Blue Lake’s biweekly water testing for fecal contamination, evidently do not ensure prevention of contamination, according to Amy Zlot of the Multnomah County Health Department and her colleagues.

Additionally, swimming area officials need to educate the public about healthy swimming practices, the researchers said. Toward that end, the agency has recently published a free downloadable brochure on healthy swimming.

Read the full study in the MMWR (2015 May 15;64:485-90).

[email protected]

Brexpiprazole dosages of 2-4 mg/day are effective at treating acute schizophrenia patients, a randomized, double-blind, placebo-controlled trial shows.

The investigators studied 623 people living in 10 countries who had been diagnosed with schizophrenia. Patients in the experimental group received varying amounts of brexpiprazole over the course of 6 weeks. The antipsychotic, a serotonin-dopamine activity modulator, acts as a partial agonist at specific serotonin and dopamine receptors.

Eighty-seven of the study’s participants received 0.25 mg/day of the drug. The other 358 participants in the experimental group began with a 1-mg/day dosage. By day 8, 180 of these patients’ dosages were increased to 2 mg/day. The dosages for the remaining 178 patients in the experimental group were upped to 4 mg/day. The 178 individuals in the control group took a placebo.

The entire population was “markedly ill at entry to the study,” as evidenced by Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions Scale (CGI) severity scores, according to Dr. Christoph U. Correll and his colleagues.

At the study’s start, the scores were 95.2 and 4.9, respectively. Within 2 weeks of beginning the experiment, the average PANSS score in the 2-mg/day and 4-mg/day groups improved significantly more than the average score in the control group, decreasing by 20.73 for the brexpiprazole 2-mg group and 19.65 for the 4-mg group, compared with a decrease of 12.01 for the control group. This trend continued throughout the remainder of the treatment period.

By week 6, the average effect of the two highest dosages of brexpiprazole on CGI severity scores also was significantly greater than the average effect of the placebo. The PANSS and CGI severity scores only changed minimally for the patients who received 0.25-mg dosages of brexpiprazole.

Although the overall incidence of treatment-emergent adverse events was lower in the entire experimental group than in the control group, akathisia was reported more frequently in the treatment groups, specifically, the 2-mg and 4-mg groups. Psychiatric disorders were the most frequently reported serious adverse events by all groups.

“Brexpiprazole at doses of 2 mg and 4 mg once daily demonstrated statistically significant efficacy compared with placebo and good tolerability for patients with an acute exacerbation of schizophrenia,” Dr. Correll and his associates wrote.

Longer-term research of a more diverse population will need to be conducted to further evaluate the benefits of treating schizophrenia with brexpiprazole and to compare the effectiveness of this drug to first-line antipsychotics, the researchers said.

Read the full study in the American Journal of Psychiatry (2015 April 16 [doi:10.1176/appi.ajp.2015.14101275]).

Brexpiprazole dosages of 2-4 mg/day are effective at treating acute schizophrenia patients, a randomized, double-blind, placebo-controlled trial shows.

The investigators studied 623 people living in 10 countries who had been diagnosed with schizophrenia. Patients in the experimental group received varying amounts of brexpiprazole over the course of 6 weeks. The antipsychotic, a serotonin-dopamine activity modulator, acts as a partial agonist at specific serotonin and dopamine receptors.

Eighty-seven of the study’s participants received 0.25 mg/day of the drug. The other 358 participants in the experimental group began with a 1-mg/day dosage. By day 8, 180 of these patients’ dosages were increased to 2 mg/day. The dosages for the remaining 178 patients in the experimental group were upped to 4 mg/day. The 178 individuals in the control group took a placebo.

The entire population was “markedly ill at entry to the study,” as evidenced by Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions Scale (CGI) severity scores, according to Dr. Christoph U. Correll and his colleagues.

At the study’s start, the scores were 95.2 and 4.9, respectively. Within 2 weeks of beginning the experiment, the average PANSS score in the 2-mg/day and 4-mg/day groups improved significantly more than the average score in the control group, decreasing by 20.73 for the brexpiprazole 2-mg group and 19.65 for the 4-mg group, compared with a decrease of 12.01 for the control group. This trend continued throughout the remainder of the treatment period.

By week 6, the average effect of the two highest dosages of brexpiprazole on CGI severity scores also was significantly greater than the average effect of the placebo. The PANSS and CGI severity scores only changed minimally for the patients who received 0.25-mg dosages of brexpiprazole.

Although the overall incidence of treatment-emergent adverse events was lower in the entire experimental group than in the control group, akathisia was reported more frequently in the treatment groups, specifically, the 2-mg and 4-mg groups. Psychiatric disorders were the most frequently reported serious adverse events by all groups.

“Brexpiprazole at doses of 2 mg and 4 mg once daily demonstrated statistically significant efficacy compared with placebo and good tolerability for patients with an acute exacerbation of schizophrenia,” Dr. Correll and his associates wrote.

Longer-term research of a more diverse population will need to be conducted to further evaluate the benefits of treating schizophrenia with brexpiprazole and to compare the effectiveness of this drug to first-line antipsychotics, the researchers said.

Read the full study in the American Journal of Psychiatry (2015 April 16 [doi:10.1176/appi.ajp.2015.14101275]).

Brexpiprazole dosages of 2-4 mg/day are effective at treating acute schizophrenia patients, a randomized, double-blind, placebo-controlled trial shows.

The investigators studied 623 people living in 10 countries who had been diagnosed with schizophrenia. Patients in the experimental group received varying amounts of brexpiprazole over the course of 6 weeks. The antipsychotic, a serotonin-dopamine activity modulator, acts as a partial agonist at specific serotonin and dopamine receptors.

Eighty-seven of the study’s participants received 0.25 mg/day of the drug. The other 358 participants in the experimental group began with a 1-mg/day dosage. By day 8, 180 of these patients’ dosages were increased to 2 mg/day. The dosages for the remaining 178 patients in the experimental group were upped to 4 mg/day. The 178 individuals in the control group took a placebo.

The entire population was “markedly ill at entry to the study,” as evidenced by Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions Scale (CGI) severity scores, according to Dr. Christoph U. Correll and his colleagues.

At the study’s start, the scores were 95.2 and 4.9, respectively. Within 2 weeks of beginning the experiment, the average PANSS score in the 2-mg/day and 4-mg/day groups improved significantly more than the average score in the control group, decreasing by 20.73 for the brexpiprazole 2-mg group and 19.65 for the 4-mg group, compared with a decrease of 12.01 for the control group. This trend continued throughout the remainder of the treatment period.

By week 6, the average effect of the two highest dosages of brexpiprazole on CGI severity scores also was significantly greater than the average effect of the placebo. The PANSS and CGI severity scores only changed minimally for the patients who received 0.25-mg dosages of brexpiprazole.

Although the overall incidence of treatment-emergent adverse events was lower in the entire experimental group than in the control group, akathisia was reported more frequently in the treatment groups, specifically, the 2-mg and 4-mg groups. Psychiatric disorders were the most frequently reported serious adverse events by all groups.

“Brexpiprazole at doses of 2 mg and 4 mg once daily demonstrated statistically significant efficacy compared with placebo and good tolerability for patients with an acute exacerbation of schizophrenia,” Dr. Correll and his associates wrote.

Longer-term research of a more diverse population will need to be conducted to further evaluate the benefits of treating schizophrenia with brexpiprazole and to compare the effectiveness of this drug to first-line antipsychotics, the researchers said.

Read the full study in the American Journal of Psychiatry (2015 April 16 [doi:10.1176/appi.ajp.2015.14101275]).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

Rapid cycling bipolar disorder and migraines are independently associated with each other, a cross-sectional study shows.

“Our findings provide further evidence that comorbid migraine in [bipolar disorder] represents a more homogenous subgroup of [bipolar disorder] that may be associated with an unstable rapid cycling illness course,” wrote K. Gordon-Smith, Ph.D., and her colleagues.

The United Kingdom–based study included 1,488 individuals with lifetime clinical characteristics of bipolar disorder (BD). Of the study’s sample, 375 had comorbid migraines. Both patients with bipolar disorder I and bipolar disorder II participated in the self-report research project.

Among the study’s findings is that numerous clinical characteristics occurred significantly more often in the migraine group. Such characteristics included having a history of panic attacks, rapid cycling (defined as experiencing four or more episodes in a 12-month period), family history of affective disorders, and younger age at illness onset. The study also found that significantly more subjects in the migraine group had a lower history of psychiatric admission, and less impairment in functioning during their worst episode of (hypo)mania. The study confirmed the finding of previous research showing that bipolar patients with comorbid migraines are more likely to be female.

Further in-depth analyses of this patient population with more detailed information about the migraine phenotype is needed, the researchers said.

Read the full study in Journal of Affective Disorders (doi: 10.1016/j.jad.2015.01.024).

The percentage of postpartum women who filled codeine prescriptions significantly declined after regulatory bodies announced that breastfeeding by mothers taking the opioids may cause infant death, according to a study.

Infants who are breastfed are at elevated risk of death, if their mothers carry polymorphisms for increased activity of an enzyme that metabolizes codeine to morphine, Kate Smolina, Ph.D., and her colleagues reported in a research letter in JAMA.

The study included 320,351 live births to 224,532 women in British Columbia, Canada, between January 1, 2002 and December 31, 2011. The researchers studied dispensation rates of codeine and other opioid drugs to women during the first 6 months after giving birth. New mothers’ use of cephalexin and hydrocortisone cream, which are commonly prescribed to postpartum women, served as the control measure. The announcements on the risks of breastfeeding while taking codeine were made by the U.S. Food and Drug Administration in August 2007 and Health Canada in October 2008. Prior to the FDA announcement, on average, nearly 17% of the postpartum mothers filled at least one codeine prescription. Between September and December 2011, the monthly average was down to 9% – representing a relative reduction of 45% over 4 years. Postpartum use of the opioids tramadol, hydromorphone, oxycodone, and morphine increased, but not at a large enough rate “to offset the reduction in codeine use,” according to the researchers.

The rates of prescription filling did not significantly change for cephalexin and hydrocortisone cream.

Read the study in JAMA 2015 May 12 (doi:10.1001/jama.2015.3642).

The percentage of postpartum women who filled codeine prescriptions significantly declined after regulatory bodies announced that breastfeeding by mothers taking the opioids may cause infant death, according to a study.

Infants who are breastfed are at elevated risk of death, if their mothers carry polymorphisms for increased activity of an enzyme that metabolizes codeine to morphine, Kate Smolina, Ph.D., and her colleagues reported in a research letter in JAMA.

The study included 320,351 live births to 224,532 women in British Columbia, Canada, between January 1, 2002 and December 31, 2011. The researchers studied dispensation rates of codeine and other opioid drugs to women during the first 6 months after giving birth. New mothers’ use of cephalexin and hydrocortisone cream, which are commonly prescribed to postpartum women, served as the control measure. The announcements on the risks of breastfeeding while taking codeine were made by the U.S. Food and Drug Administration in August 2007 and Health Canada in October 2008. Prior to the FDA announcement, on average, nearly 17% of the postpartum mothers filled at least one codeine prescription. Between September and December 2011, the monthly average was down to 9% – representing a relative reduction of 45% over 4 years. Postpartum use of the opioids tramadol, hydromorphone, oxycodone, and morphine increased, but not at a large enough rate “to offset the reduction in codeine use,” according to the researchers.

The rates of prescription filling did not significantly change for cephalexin and hydrocortisone cream.

Read the study in JAMA 2015 May 12 (doi:10.1001/jama.2015.3642).

The percentage of postpartum women who filled codeine prescriptions significantly declined after regulatory bodies announced that breastfeeding by mothers taking the opioids may cause infant death, according to a study.

Infants who are breastfed are at elevated risk of death, if their mothers carry polymorphisms for increased activity of an enzyme that metabolizes codeine to morphine, Kate Smolina, Ph.D., and her colleagues reported in a research letter in JAMA.

The study included 320,351 live births to 224,532 women in British Columbia, Canada, between January 1, 2002 and December 31, 2011. The researchers studied dispensation rates of codeine and other opioid drugs to women during the first 6 months after giving birth. New mothers’ use of cephalexin and hydrocortisone cream, which are commonly prescribed to postpartum women, served as the control measure. The announcements on the risks of breastfeeding while taking codeine were made by the U.S. Food and Drug Administration in August 2007 and Health Canada in October 2008. Prior to the FDA announcement, on average, nearly 17% of the postpartum mothers filled at least one codeine prescription. Between September and December 2011, the monthly average was down to 9% – representing a relative reduction of 45% over 4 years. Postpartum use of the opioids tramadol, hydromorphone, oxycodone, and morphine increased, but not at a large enough rate “to offset the reduction in codeine use,” according to the researchers.

The rates of prescription filling did not significantly change for cephalexin and hydrocortisone cream.

Read the study in JAMA 2015 May 12 (doi:10.1001/jama.2015.3642).

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

A new teaching tool based on the acronym mnemonic PSA may help doctors to screen for psoriatic arthritis in patients with psoriasis or a strong family history of it.

The tool tells physicians to ask patients whether they are experiencing core features of psoriatic arthritis (PsA). Such features are tied to the acronym PSA. P stands for pain in the joints, S stands for stiffness more than 30 minutes after a period of inactivity and for sausage digits, and A represents axial spine involvement or back pain associated with stiffness that improves with activity. If patients with psoriasis and/or a strong family history of psoriasis say they are experiencing at least two of those features, then they “would have a higher than average chance of a PsA diagnosis,” according to Jeffrey M. Cohen and his colleagues.

Benefits of the tool include its ease of use and short administration time; it also covers “the core domains” of the disease, just like many of the current PsA screening tools.

The tool is limited, however, because it is unlikely to be as specific as the longer PsA screening instruments and it calls for questioning patients about features of PsA that are also features of other pathologies. Additionally, the tool is more specific to diagnosing seronegative peripheral and axial spondyloarthritides than inflammatory arthritis. It also is useful for distinguishing between noninflammatory arthritis and inflammatory arthritis.

“We feel this teaching tool, while not specific for PsA, will help the nonrheumatologist begin to differentiate inflammatory from noninflammatory musculoskeletal pain and therefore prompt an appropriate referral for work-up,” the researchers wrote.

Read the full paper in the Journal of the American Academy of Dermatology (doi:10.1016/j.jaad.2014.12.008).

Rheumatoid arthritis (RA) patients’ severity of morning stiffness and morning pain have stronger correlations with their disease’s activity than does the duration of their morning stiffness, according to an analysis of 350 patients who participated in a randomized, controlled trial.

During the 12-week study of patients with symptomatic RA despite treatment with disease-modifying antirheumatic drugs, 231 of the patients added delayed-release prednisone to their treatment and the remaining 119 patients took a placebo. The patients’ disease activity was measured with the ACR20, 28-joint Disease Activity Score (DAS28), and the Health Assessment Questionnaire-Disability Index, while Pearson correlations were used to determine relationships between patients’ responses to treatment and their disease activity.

The correlations between severity of morning stiffness or intensity of pain on waking and DAS28 or ACR20 ranged from 0.44 to 0.48 for the full study cohort. The weaker correlation between duration of morning stiffness and disease activity ranged from 0.24 to 0.28. The researchers also found a statistically significant 0.91 correlation between the severity of morning stiffness and intensity of morning pain.

“These findings suggest that severity and duration of morning stiffness may provide subtly different measures of RA and its impact on patients. The superior measurement characteristics of the severity of morning stiffness favor this as the preferred outcome measure,” wrote first author Dr. Maarten Boers and his colleagues.

Find the full study in Arthritis Care & Research (doi:10.1002/acr.22592).

Rheumatoid arthritis (RA) patients’ severity of morning stiffness and morning pain have stronger correlations with their disease’s activity than does the duration of their morning stiffness, according to an analysis of 350 patients who participated in a randomized, controlled trial.

During the 12-week study of patients with symptomatic RA despite treatment with disease-modifying antirheumatic drugs, 231 of the patients added delayed-release prednisone to their treatment and the remaining 119 patients took a placebo. The patients’ disease activity was measured with the ACR20, 28-joint Disease Activity Score (DAS28), and the Health Assessment Questionnaire-Disability Index, while Pearson correlations were used to determine relationships between patients’ responses to treatment and their disease activity.

The correlations between severity of morning stiffness or intensity of pain on waking and DAS28 or ACR20 ranged from 0.44 to 0.48 for the full study cohort. The weaker correlation between duration of morning stiffness and disease activity ranged from 0.24 to 0.28. The researchers also found a statistically significant 0.91 correlation between the severity of morning stiffness and intensity of morning pain.

“These findings suggest that severity and duration of morning stiffness may provide subtly different measures of RA and its impact on patients. The superior measurement characteristics of the severity of morning stiffness favor this as the preferred outcome measure,” wrote first author Dr. Maarten Boers and his colleagues.

Find the full study in Arthritis Care & Research (doi:10.1002/acr.22592).

Rheumatoid arthritis (RA) patients’ severity of morning stiffness and morning pain have stronger correlations with their disease’s activity than does the duration of their morning stiffness, according to an analysis of 350 patients who participated in a randomized, controlled trial.

During the 12-week study of patients with symptomatic RA despite treatment with disease-modifying antirheumatic drugs, 231 of the patients added delayed-release prednisone to their treatment and the remaining 119 patients took a placebo. The patients’ disease activity was measured with the ACR20, 28-joint Disease Activity Score (DAS28), and the Health Assessment Questionnaire-Disability Index, while Pearson correlations were used to determine relationships between patients’ responses to treatment and their disease activity.

The correlations between severity of morning stiffness or intensity of pain on waking and DAS28 or ACR20 ranged from 0.44 to 0.48 for the full study cohort. The weaker correlation between duration of morning stiffness and disease activity ranged from 0.24 to 0.28. The researchers also found a statistically significant 0.91 correlation between the severity of morning stiffness and intensity of morning pain.

“These findings suggest that severity and duration of morning stiffness may provide subtly different measures of RA and its impact on patients. The superior measurement characteristics of the severity of morning stiffness favor this as the preferred outcome measure,” wrote first author Dr. Maarten Boers and his colleagues.

Find the full study in Arthritis Care & Research (doi:10.1002/acr.22592).