scholarly journals Bioactivity and Physicochemical Properties of Three Calcium Silicate-Based Cements: An In Vitro Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Ranjdar Mahmood Talabani ◽  
Balkees Taha Garib ◽  
Reza Masaeli
Keyword(s):  
Physicochemical Properties ◽  
Calcium Ions ◽  
Calcium Silicate ◽  
Morphological Observation ◽  
Repair Material ◽  
Cement Interface ◽  
Root Repair ◽  
Significant Difference ◽  
Phosphate Buffered Saline ◽  
Over Time

Objective. This study evaluated the bioactivity and physicochemical properties of three commercial calcium silicate-based endodontic materials (MTA, EndoSequence Root Repair Material putty, and Biodentine™). Material and Methods. Horizontal sections of 3 mm thickness from 18 root canals of human teeth were subjected to biomechanical preparation with WaveOne Gold large rotary instruments. The twelve specimens were filled with three tested materials (MM-MTA, EndoSequence Root Repair Material putty, and Biodentine™) and immersed in phosphate-buffered saline for 7 and 30 days. After this period of time, each specimen of each material was processed for morphological observation, surface precipitates, and interfacial dentin using SEM. In addition, the surface morphology of the set materials, without soaking in phosphate-buffered solution after one day and after 28 days stored in phosphate-buffered saline, was evaluated using SEM; also, the pH of the soaking water and the amount of calcium ions released from the test materials were measured by using an inductively coupled plasma-optical emission spectroscopy test. Data obtained were analyzed using one-way analysis of variance and Tukey’s honest significant difference test with a significance level of 5%. Result. The formation of precipitates was observed on the surfaces of all materials at 1 week and increased substantially over time. Interfacial layers in some areas of the dentin-cement interface were found from one week of immersion. All the analyzed materials showed alkaline pH and capacity to release calcium ions; however, the concentrations of released calcium ions were significantly more in Biodentine and ESRRM putty than MM-MTA (P<0.05). ESRRM putty maintained a pH of around 11 after 28 days. Conclusion. Compared with MM-MTA, Biodentine and ESRRM putty showed significantly more calcium ion release. However, exposure of three tested cements to phosphate-buffered solution resulted in precipitation of apatite crystalline structures over both cement and dentin that increased over time. This suggests that the tested materials are bioactive.

scholarly journals Influence of Powder-to-Gel Ratio on Physicochemical Properties of a Calcium Silicate Sealer

2020 ◽  
pp. 337-345
Author(s):  
Fernanda F. E. Torres ◽  
Patricia Perinoto ◽  
Roberta Bosso-Martelo ◽  
Gisselle M. Chávez-Andrade ◽  
Juliane M. Guerreiro-Tanomaru ◽  
...  
Keyword(s):  
Physicochemical Properties ◽  
Calcium Silicate ◽  
Setting Time ◽  
Repair Material ◽  
Alkaline Ph ◽  
Root Canal Sealer ◽  
Work Time ◽  
Lower Solubility ◽  
Low Solubility ◽  
One Way Anova

Differences in liquid-to-powder ratio can affect the properties of calcium silicate-based materials. This study assessed the influence of powder-to-gel ratio on physicochemical properties of NeoMTA Plus. Setting time (minutes), flow (mm and mm²), pH (at different periods), radiopacity (mm Al) and solubility (% mass loss) were evaluated using the consistencies for root repair material (NMTAP-RP; 3 scoops of powder to 2 drops of gel) and root canal sealer (NMTAP-SE; 3 scoops of powder to 3 drops of gel), in comparison to Biodentine cement (BIO) and TotalFill BC sealer (TFBC). Statistical analysis was performed using one-way ANOVA and Tukey tests (α=0.05). BIO had the shortest setting time, followed by NMTAP-RP and NMTAP-SE. TFBC showed the highest setting time and radiopacity. BIO, NMTAP-RP, and NMTAP-SE had similar radiopacity. All materials promoted an alkaline pH. NMTAP-RP/SE presented lower solubility than BIO and TFBC. Regarding the flow, TFBC had the highest values, followed by NMTAP-SE, and NMTAP-RP. BIO had the lowest flow. In conclusion, NMTAP in both powder-to-gel ratios showed high pH and low solubility. The increase in the powder ratio decreased the setting time and flow. These findings are important regarding the proper consistency and work time to clinical application.

Antibacterial Effect of New Bioceramic Pulp Capping Material on the Main Cariogenic Bacteria

2016 ◽  
Vol 17 (5) ◽  
pp. 349-353 ◽  
Author(s):  
Fahiem MM Elshamy ◽  
Husham Elraih ◽  
Iti Gupta ◽  
Faisal AI Idris
Keyword(s):  
Antibacterial Activity ◽  
Antibacterial Effect ◽  
Antibacterial Properties ◽  
Mineral Trioxide Aggregate ◽  
Mutans Streptococci ◽  
Repair Material ◽  
Cariogenic Bacteria ◽  
Pulp Capping ◽  
Root Repair ◽  
Significant Difference

ABSTRACT Background The purpose of this research was to assess the antibacterial activity of a new bioceramic pulp capping material (endosequence root repair material [ERRM]) against the main cariogenic bacteria: Salivary mutans streptococci (MS) and lactobacilli and compare the results with mineral trioxide aggregate (MTA) and calcium hydroxide (Dycal). Materials and methods The isolation of MS group bacteria and Lactobacillus (LB) spp. from stimulated saliva was performed with in-office caries risk test bacteria dip slide test. Endosequence root repair material, MTA (ProRoot MTA), and Dycal were used as pulp capping materials. Mutans Streptococci and LB were scattered on the agar dishes with a swab. The pulp capping materials under study were placed in the wells and prepared in the agar, immediately after mixing. The dishes were incubated for 24 hours at 37°C. The growth inhibition zones were recorded and compared for every material and bacterial strain. One-way analysis of variance test was done to compare the development of growth inhibition of selected bacteria against testing materials. Post hoc Tukey honest significant difference was conducted to compare each material group. Results All the three selected pulp capping materials were found to inhibit the bacteria LB and MS. The antibacterial activity of ERRM and ProRoot MTA was significantly better than the Dycal. Against MS, ERRM and MTA showed no statistically significant difference. Mineral trioxide aggregate showed significantly better inhibitory activity against LB. Conclusion Endosequence root repair material and MTA had superior antibacterial properties against the main cariogenic bacteria: MS and LB compared with Dycal. Clinical significance A pulp-capping agent having good antibacterial properties can have better success rate in maintaining the vitality of the tooth while treating deep carious lesions in patients. How to cite this article Elshamy FMM, Singh G, Elraih H, Gupta I, AI Idris F. Antibacterial Effect of New Bioceramic Pulp Capping Material on the Main Cariogenic Bacteria. J Contemp Dent Pract 2016;17(5):349-353.

scholarly journals Compressive strength of calcium silicate-based cement

2018 ◽  
Vol 65 (1) ◽  
pp. 7-13
Author(s):  
Vanja Opačić Galić ◽  
Zoran Stamenić ◽  
Violeta Petrović ◽  
Vukoman Jokanović ◽  
Slavoljub Živković
Keyword(s):  
Compressive Strength ◽  
Calcium Silicate ◽  
Calcium Silicate Cement ◽  
Crosshead Speed ◽  
Universal Testing ◽  
Significant Difference ◽  
Calcium Silicate Cements ◽  
Post Hoc ◽  
One Way Anova ◽  
Over Time

Summary Introduction The aim of this study was to compare compressive strength (Cs) of new nanostructural calcium silicate based cement (nCS) with commercial calcium silicate cement and conventional GIC. Methods Four nanostructural materials were tested: nanostructural calcium silicate based cement (nCS) (Jokanović et al.), MTA Plus (Cerkamed, Poland), Fuji IX (GC Corporation, Japan) and Ketac Universal Aplicap (3M ESPE, USA). Five samples of each material were mixed in accordance with manifecturer’s guidelines and positioned in metal moulds (ϕ4mm and 6mm). Compressive strength (Cs) expressed in MPa was determined after 24 hours, 7 days and 28 days respectively. Measurements were performed on universal testing equipment (Tinius Olsen, USA) at a crosshead speed of 1mm/min. For processing the results one-way ANOVA and post-hoc test were used. Results The highest values of compressive strength after 24h was found in conventional GIC Fuji IX (mean 38.56±13.31) and Ketac Universal (mean 40.77±7.96). Calcium silicate cements after 24h showed low values of compressive strength (MTA Plus 5.91±0.28 MPa, nCS 1.35±0.36 MPa). After 7 days, FUJI IX 47.42±9.33 MPa and Ketac Universal 35.25±10.60 MPa showed higher value of compressive strength than MTA Plus (15.09±2.77 MPa) and nCS (11.06±0.88 MPa). After 28 days the Cs value for conventional GIC Fuji IX was 48.03±7.82 MPa and Ketac Universal 36.65±11.13 MPa while for calcium silicate cements it was 16.47±1.89 MPa and nCS 14.39±1.63 MPa. There was statistically significant difference (p<0.05) in Cs between conventional GIC and CS cements after 24h, 7 and 28 days. Conclusions Calcium silicate cements initially showed lower values of compressive strength than conventional GIC that increased over time.

scholarly journals Comparative evaluation of antimicrobial activity of biodentine and MTA against e. faecalis an in vitro study

2016 ◽  
Vol 4 (1) ◽  
pp. 16
Author(s):  
Jerin Jose ◽  
Shoba K ◽  
Nithya Tomy ◽  
Shibu Aman
Keyword(s):  
Antimicrobial Activity ◽  
In Vitro Study ◽  
Filling Material ◽  
Repair Material ◽  
Inhibition Of Growth ◽  
Root Repair ◽  
Agar Diffusion Test ◽  
Significant Difference ◽  
Surgical Options

<p><strong>Background:</strong> Surgical endodontic therapy is the prescribed treatment of choice whenever the non-surgical options fail which includes the use of a root end filling material. E. faecalis is the most prevalent organism associated with the treatment failed cases</p><p><strong>Aim:</strong> The purpose of the present study was to evaluate and compare the antimicrobial efficacy of Biodentine and MTA as root end filling material and root repair material against E. faecalis.</p><p><strong>Settings and Design:</strong> Comparative invitro study was conducted at Tropical Institute of Ecological Sciences, Kottayam under Mahatma Gandhi University, Kottayam, Kerala.</p><p><strong>Materials and Methods:</strong> The antimicrobial activity was determined using agar diffusion test. Freshly mixed MTA and Biodentine was added to respective wells and incubated. The zone of inhibition of growth was recorded.</p><p><strong>Statistical analysis:</strong> The data analysis was performed using Students ‘t’ test</p><p><strong>Results:</strong> Statistically significant difference was found between Biodentine and MTA in against E. faecalis growth.</p><p><strong>Conclusions:</strong> Biodentine was found to have superior antibacterial activity against E. faecalis than MTA. Hence it can be a better alternative to MTA as root end filling and root repair material.</p>

scholarly journals Physicochemical Properties of a Bioceramic Repair Material - BioMTA

2020 ◽  
Vol 31 (5) ◽  
pp. 511-515
Author(s):  
Hernán Coaguila-Llerena ◽  
Victor Manuel Ochoa-Rodriguez ◽  
Gabriela Mariana Castro-Núñez ◽  
Gisele Faria ◽  
Juliane Maria Guerreiro-Tanomaru ◽  
...  
Keyword(s):  
Physicochemical Properties ◽  
Setting Time ◽  
The Other ◽  
Repair Material ◽  
Alkaline Ph ◽  
Initial Setting Time ◽  
Significant Difference ◽  
Initial Setting ◽  
One Way Anova ◽  
Alkaline Material

Abstract This study aimed to assess the physicochemical properties of a repair material in the Brazilian market, BioMTA, in comparison to other two materials currently in use (Biodentine and MTA Angelus). The initial setting time was evaluated using Gillmore needle. The pH was measured with a pH-meter after 24 h, 3, 7, 14 and 21 days. The radiopacity was determined using the equivalence in millimeters of aluminum (mm Al) from digitized occlusal radiographs. Solubility was determined after immersion in water for 7 days. The data were analyzed by one-way ANOVA and Tukey tests (a=0.05). The BioMTA initial setting time (5.2 min) was lower than the other materials (p<0.05). All materials showed an alkaline pH at 21 days. At 24 h, BioMTA was the most alkaline material (p<0.05); and at 3, 7, 14 and 21 days there was no difference between BioMTA and Biodentine (p>0.05), both being more alkaline than MTA Angelus (p<0.05). The radiopacity of BioMTA (4.2 mm Al) was significantly higher compared to Biodentine (p<0.05) and lower than MTA Angelus (p<0.05). The solubility of the materials was -4.2%, -1.6% and 4.1% for BioMTA, MTA Angelus and Biodentine, respectively, with a significant difference between them (p<0.05). Therefore, it can be concluded that BioMTA displayed a shorter setting time, an alkaline pH, a higher radiopacity, and a gain in mass.

scholarly journals Ex Vivo Analysis of MTA FLOW® Biomineralization and Push-Out Strength: A Pilot Study

2020 ◽  
pp. 245-259
Author(s):  
Marianella Benavides García ◽  
Erick Hernández Meza ◽  
Jessie Reyes-Carmona
Keyword(s):  
Pilot Study ◽  
Calcium Ions ◽  
Bonding Strength ◽  
Ex Vivo ◽  
Carbonate Apatite ◽  
Ex Vivo Model ◽  
Biomineralization Process ◽  
Significant Difference ◽  
Phosphate Buffered Saline ◽  
Push Out

This study evaluated the biomineralization processes and push-out strength of MTA Flow® with radicular dentine in three different consistencies. The push-out test was performed on an ex vivo model, using 2mm thick dentin discs from the middle third of the root with standardized cavities of 1.5 mm. Samples were filled with MTA-Angelus (Angelus Dental, Brazil), Biodentine (Septodont, France), MTA Flow® Putty (Ultradent, USA), MTA Flow® Thick or MTA Flow® Thin. The samples were divided into 3 groups: subgroup 1 (n=5), analysis of the biomineralization process; 2 (n=20), evaluation of the bonding strength and push-out resistance; and 3 (n=5), evaluation of the cement/dentin interface. The samples filled with Biodentine had a higher precipitation of carbonate apatite. However, there was no significant difference between MTA-Angelus, MTA Flow® Putty, or Thick (p=0.0536), but there was a significant difference in the Thin group (P<0.05). The samples with Biodentine displayed the greatest release of calcium ions. The formation of a partially carbonated intermediate apatite layer was observed in all groups. Zones of biomineralization were observed at the interface but were not continuous. After 72 hours, a significant difference was found between the Biodentine and MTA Flow® Thin groups (p=0.0090) in the push-out test. The samples submerged in phosphate-buffered saline (PBS) for 15 days showed a significant difference between all groups and MTA Flow® Thin (p=0.0147). Putty or Thick consistencies presented a similar bonding strength to MTA-Angelus and Biodentine. MTA Flow® Putty and Thick consistencies show a good adaptation to dentin, similar to MTA-Angelus. However, the thickness of the interface was lower compared to that of Biodentine. MTA Flow® Thin, despite their tubular infiltration, results in gaps and a defective peripheral seal. Therefore, MTA Flow®, in Putty or Thick consistencies, presents a biomineralization process and push-out strength similar to MTA Angelus and Biodentine, however, both characteristics decreases considerably in Thin consistency.

scholarly journals Engineering students’ attitudinal beliefs by gender and student division: a methodological comparison of changes over time

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Madison E. Andrews ◽  
Anita D. Patrick ◽  
Maura Borrego
Keyword(s):  
Self Efficacy ◽  
Engineering Students ◽  
Focal Point ◽  
Value Engineering ◽  
Longitudinal Analyses ◽  
Utility Value ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Significant Difference ◽  
Over Time

Abstract Background Students’ attitudinal beliefs related to how they see themselves in STEM have been a focal point of recent research, given their well-documented links to retention and persistence. These beliefs are most often assessed cross-sectionally, and as such, we lack a thorough understanding of how they may fluctuate over time. Using matched survey responses from undergraduate engineering students (n = 278), we evaluate if, and to what extent, students’ engineering attitudinal beliefs (attainment value, utility value, self-efficacy, interest, and identity) change over a 1-year period. Further, we examine whether there are differences based on gender and student division, and then compare results between cross-sectional and longitudinal analyses to illustrate weaknesses in our current understanding of these constructs. Results Our study revealed inconsistencies between cross-sectional and longitudinal analyses of the same dataset. Cross-sectional analyses indicated a significant difference by student division for engineering utility value and engineering interest, but no significant differences by gender for any variable. However, longitudinal analyses revealed statistically significant decreases in engineering utility value, engineering self-efficacy, and engineering interest for lower division students and significant decreases in engineering attainment value for upper division students over a one-year period. Further, longitudinal analyses revealed a gender gap in engineering self-efficacy for upper division students, where men reported higher means than women. Conclusions Our analyses make several contributions. First, we explore attitudinal differences by student division not previously documented. Second, by comparing across methodologies, we illustrate that different conclusions can be drawn from the same data. Since the literature around these variables is largely cross-sectional, our understanding of students’ engineering attitudes is limited. Our longitudinal analyses show variation in engineering attitudinal beliefs that are obscured when data is only examined cross-sectionally. These analyses revealed an overall downward trend within students for all beliefs that changed significantly—losses which may foreshadow attrition out of engineering. These findings provide an opportunity to introduce targeted interventions to build engineering utility value, engineering self-efficacy, and engineering interest for student groups whose means were lower than average.

scholarly journals Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Åsa Kettis ◽  
Hanna Fagerlind ◽  
Jan-Erik Frödin ◽  
Bengt Glimelius ◽  
Lena Ring
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Significant Difference ◽  
Patient Reported ◽  
Health Related Qol ◽  
Health Related ◽  
Secondary Outcomes ◽  
The Impact ◽  
Over Time

Abstract Background Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice. Methods In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes. Results There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded. Conclusions Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

Adaptors and Innovators: Selection versus Induction

1991 ◽  
Vol 68 (3_suppl) ◽  
pp. 1283-1290 ◽  
Author(s):  
P. A. Holland ◽  
I. Bowskill ◽  
A. Bailey
Keyword(s):  
Cognitive Style ◽  
Past Research ◽  
Significant Shift ◽  
Occupational Groups ◽  
Significant Difference ◽  
The Mean ◽  
New Entrants ◽  
Innovative Cognitive Style ◽  
Over Time ◽  
Established Group

The hypothesis that predictable differences would exist between the mean cognitive style of new entrants and those of the longer serving “established” employees in certain departments while not in others was tested. Data from 99 employees from four departments of a large British pharmaceuticals company who completed the Kirton Adaption-Innovation Inventory provided results broadly in line with the expectations of adaption-innovation theory and past research. The mean innovative cognitive style of new entrants to adaptive departments regressed towards the mean of the establishment and the occupational mean over time. In departments where there was no initial significant difference between the mean cognitive style of the new entrants and the established group, no significant shift was shown over time. Implications of these findings are suggested. The data also indicated norms for two occupational groups where previously they did not exist.

scholarly journals POS0495 LARGE JOINT DISEASE IN RHEUMATOID ARTHRITIS AND THE ROLE OF RHEUMATOID FACTOR. RESULTS FROM THE EARLY RHEUMATOID ARTHRITIS STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 480-480
Author(s):  
S. S. Zhao ◽  
E. Nikiphorou ◽  
A. Young ◽  
P. Kiely
Keyword(s):  
Rheumatoid Arthritis ◽  
Rheumatoid Factor ◽  
Treatment Strategies ◽  
Treat To Target ◽  
Joint Involvement ◽  
Aggressive Treatment ◽  
Joint Surgery ◽  
Large Joint ◽  
Significant Difference ◽  
Over Time

Background:Rheumatoid arthritis (RA) is classically described as a symmetric small joint polyarthritis with additional involvement of large joints. There is a paucity of information concerning the time course of damage in large joints, such as shoulder, elbow, hip, knee and ankle, from early to established RA, or of the influence of Rheumatoid Factor (RF) status. There is a historic perception that patients who do not have RF follow a milder less destructive course, which might promote less aggressive treatment strategies in RF-negative patients. The historic nature of the Ealy Rheumatoid Arthritis Study (ERAS) provides a unique opportunity to study RA in the context of less aggressive treatment strategies.Objectives:To examine the progression of large joint involvement from early to established RA in terms of range of movement (ROM) and time to joint surgery, according to the presence of RF.Methods:ERAS was a multi-centre inception cohort of newly diagnosed RA patients (<2 years disease duration, csDMARD naive), recruited from 1985-2001 with yearly follow-up for up to 25 (median 10) years. First line treatment was csDMARD monotherapy with/without steroids, favouring sulphasalazine for the majority. Outcome data was recorded at baseline, at 12 months and then once yearly. Patients were deemed RF negative if all repeated assessments were negative. ROM of individual shoulder, elbow, wrist, hip, knee, ankle and hindfeet joints was collected at 3, 5, 9 and 12-15 years. The rate of progression from normal to any loss of ROM, from years 3 to 14 was modelled using GEE, adjusting for confounders. Radiographs of wrists taken at years 0, 1, 2, 3, 5, 7, 9 were scored according to the Larsen method. Change in the Larsen wrist damage score was modelled using GEE as a continuous variable, while the erosion score was dichotomised into present/absent. Surgical procedure data were obtained by linking to Hospital Episodes Statistics and the National Joint Registry. Time to joint surgery was analysed using multivariable Cox models.Results:A total of 1458 patients from the ERAS cohort were included (66% female, mean age 55 years) and 74% were RF-positive. The prevalence of any loss of ROM, from year 3 through to 14 was highest in the wrist followed by ankle, knee, elbow and hip. The proportion of patients at year 9 with greater than 25% loss of ROM was: wrist 30%, ankle 12%, elbow 7%, knee 7% and hip 5%. Odds of loss of ROM increased over time in all joint regions, at around 7 to 13% per year from year 3 to 14. There was no significant difference between RF-positive and RF-negative patients (see Figure 1). Larsen erosion and damage scores at the wrists progressed in all patients; annual odds of developing any erosions were higher in RF-positives OR 1.28 (95%CI 1.24-1.32) than RF-negatives OR 1.17 (95%CI 1.09-1.26), p 0.013. Time to surgery was similar according to RF-status for the wrist and ankle, but RF-positive cases had a lower hazard of surgery at the elbow (HR 0.37, 0.15-0.90), hip (HR 0.69, 0.48-0.99) and after 10 years at the knee (HR 0.41, 0.25-0.68). Adjustment of the models for Lawrence assessed osteoarthritis of hand and feet radiographs did not influence these results.Figure 1.Odds of progression to any loss of ROM (from no loss of ROM) per year in the overall population and stratified by RF status.Conclusion:Large joints become progressively involved in RA, most frequently affecting the wrist followed by ankle, which is overlooked in some composite disease activity indices. We confirm a higher burden of erosions and damage at the wrists in RF-positive patients, but have not found RF-negative patients to have a better prognosis over time with respect to involvement of other large joints. In contrast RF-negative patients had more joint surgery at the elbow, hip, and knee after 10 years. There is no justification to adopt a less aggressive treatment strategy for RF-negative RA. High vigilance and treat-to-target approaches should be followed irrespective of RF status.Disclosure of Interests:None declared

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