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ID PMID Title PublicationDate abstract
1395297 The management of fixed flexion contractures during total knee arthroplasty. 1992 Nov Fifty-one knees in 40 patients with joint surface degeneration accompanied by fixed flexion contractures (FFC) greater than 20 degrees were treated with total knee arthroplasty using a minimally constrained posterior cruciate ligament retaining prosthesis. Special techniques were employed in an attempt to achieve maximal correction at the time of surgery. The residual FFC measured 3.1 degrees at the completion of the arthroplasty, 10.1 degrees at three months, and 7 degrees at two years. At 55 months postoperatively, the FFC for the osteoarthrotic group had improved from 25.5 degrees to 3.6 degrees, whereas the rheumatoid group improved from 28.7 degrees to 8.6 degrees. The average knee score for the osteoarthrotic group was 89 compared with 81 for the rheumatoid group. Knees that were left with greater residual FFC at the completion of the arthroplasty were found to have greater residual FFC at the latest review.
1529162 [Methotrexate in the therapy of rheumatoid arthritis. Results in 30 patients]. 1992 Jul 30 patients affected by Rheumatoid Arthritis were treated with Methotrexate (5-7.5 mg/weekly) per os and followed up for at least 12 months; 10 patients had a further control at 24 months. 27 subjects were also on corticosteroid and 2 patients did not stop the therapy with second line drugs. Sulindac was allowed. 3 months later it was observed a significant reduction in the number of affected joints, in the duration of morning stiffness, in the dose of steroid and an improvement of the laboratory investigations indicating the activity of the disease. In the following 12 months, in the 25 subjects still in the study, there was a further clinical improvement. In 24-months follow-up, side effects were present in 17 patients (56.7%); only in 4 cases it was necessary to stop therapy with Methotrexate (3 cases for hepatotoxicity, 1 case for leukocytopenia and stomatitis). 3 subjects did not respond to therapy and 3 patients interrupted for psychological distress. This study confirms the efficacy of Methotrexate at low doses in the treatment of Rheumatoid Arthritis and the modest incidence of severe side effects.
7741081 The use of the Crasilneck Bombardment Technique in problems of intractable organic pain. 1995 Apr The Crasilneck Bombardment Technique consists of six diversified methods of hypnotic inductions used consecutively within one hour; it has been used with a series of recalcitrant pain patients. The six sequential systems, used 7 to 10 minutes each, include (1) relaxation, (2) displacement, (3) age regression, (4) glove anesthesia, (5) hypnoanesthesia, and (6) self-hypnosis. The 12 consecutive patients, all of whom manifested severe organic pain problems, had not responded to any form of treatment, including standard hypnosis techniques. Ten of the twelve patients responded positively to the Bombardment Method. One year posttreatment, patient estimates of pain control ranged from 80% for minimal relief to 90% for maximum relief most of the time. The types of intractable pain treated were six headaches, three backaches, one arthritic pain, one postherpetic neuralgia pain problem, and one temporomandibular joint pain.
8548130 Histamine-stimulated production of matrix metalloproteinase 1 by human rheumatoid synovial 1995 The purpose of this study was to investigate the role of histamine in human rheumatoid synovial fibroblasts in the production of factors responsible for tissue remodelling and cartilage breakdown in rheumatoid arthritis. We examined the effects of histamine of tritiated thymidine incorporation, production of matrix metalloproteinase-1 (MMP-1), histamine H1-receptor expression, phosphoinositide metabolism and intracellular calcium ion concentration ([Ca2+]i) in human rheumatoid synovial fibroblasts. Tritiated thymidine incorporation studies demonstrated that histamine markedly stimulated the proliferation of rheumatoid synovial fibroblasts. Immunofluorescence and Northern blot analyses revealed that proMMP-1 production was also stimulated by histamine. The levels of inositol phosphates and [Ca2+]i in the cells were elevated in response to histamine, indicating that the cells expressed histamine H1-receptors; and Northern blot analysis indicated that these H1-receptors were up-regulated by histamine. In in situ hybridization, large amounts of histamine H1-receptor mRNA were also detected in rheumatoid synovial tissue. These results suggest that the interaction between H1-receptor expression in rheumatoid synovial fibroblasts and histamine secretion by mast cells and macrophages in the affected sites is an important event responsible for tissue remodelling and joint destruction in rheumatoid arthritis.
8316770 Longterm physical training in rheumatoid arthritis. A randomized trial with different trai 1993 The objective was to study the long-term effect (2 years) of different training programs in patients with rheumatoid arthritis. The method was a randomized trial with 75 patients participating. The measured variables included morning stiffness, a pain score, number of swollen joints, a health assessment score, a functional score, ESR, Hb, the cost of medicine, and progression using X-rays of hands and feet. The results showed no effect of training on the disease activity or on the progression of the disease. The conclusion is that although most patients are in favour of training, the present study does not support that training lessons per se affect the disease activity or the progression of the disease.
1450799 Sibship size does not increase the risk of developing rheumatoid arthritis. 1992 Nov Although the cause of rheumatoid arthritis (RA) is unknown, one hypothesis is that an infectious episode may trigger the disease and this may occur in childhood. Observational studies performed at least 25 years ago have suggested that the incidence of RA is increased in individuals from large families. We therefore tested this hypothesis using data from a case-control study of 218 females with RA aged 35-70 (mean 58.9 years) and 210 similar aged osteoarthritis (OA) females. Information was obtained by postal questionnaire on sibship size, position in family and sex ratio of siblings. No significant differences were found between the cases and controls for any of these variables. This study did not support the hypothesis that early childhood infection as a consequence of overcrowding is an important factor in the development of RA.
1643919 Increase in translaryngeal resistance during phonation in rheumatoid arthritis. 1992 Aug Laryngeal involvement by RA is a common finding, but there have been no studies of laryngeal function in RA patients. This study was undertaken to determine if patients with rheumatoid arthritis have functional abnormalities of the upper airway during phonation which may be the result of synovitis of the laryngeal joints caused by RA. Translaryngeal resistance was measured in six patients with RA and six matched control subjects using an interrupter method to measure PSG and V during vocalization. Patients with RA had a higher R (65.0 +/- 8.15 cm H2O/L/s) than control subjects (38.4 +/- 7.43 cm H2O/L/s [p less than 0.05]). This was the consequence of lower V rates during phonation at similar PSG. We conclude that abnormalities of the larynx in RA patients are common and cause measurable physiologic abnormalities.
8630632 A six-month double-blind trial to compare the efficacy and safety of meloxicam 7.5 mg dail 1996 Apr Meloxicam is a new non-steroidal anti-inflammatory drug (NSAID) which preferentially inhibits cyclooxygenase-2 over cyclooxygenase-1. A double-blind parallel-group trial compared meloxicam 7.5 mg once daily (n = 199) with naproxen 750 mg (n = 180) in rheumatoid arthritis. There was no significant difference between the groups regarding the primary efficacy variables (global efficacy assessment by patient and investigator, number of painful/tender and swollen joints) and eight of the ten secondary efficacy endpoints. Only the swollen joint severity index and the number of discontinuations due to lack of efficacy favoured naproxen 750 mg significantly over meloxicam 7.5 mg. Meloxicam was better tolerated in the gastrointestinal (GI) tract, with fewer GI adverse events in the meloxicam-treated group (30.3%) than in the naproxen-treated group (44.7%), where two patients developed ulcers. No ulcers were seen in meloxicam patients. Significantly more patients discontinued due to GI adverse events in the naproxen group. Additionally, there was a significant decrease in haemoglobin and a significant increase in serum creatinine and urea in the naproxen group compared with the meloxicam group. In conclusion, meloxicam 7.5 mg once daily is a promising treatment in rheumatoid arthritis, with efficacy comparable to naproxen 750 mg. Meloxicam has the advantage of a significantly lower incidence of GI and renal side effects.
9062810 A study on physiological changes in certain psychosomatic disorders with reference to cort 1996 Apr Plasma cortisol, blood glucose, serum lipids and lipoproteins were estimated in diseased human subjects and normal control volunteers. Serum triglyceride (Tg) total cholesterol (Tc) and cholesterol content of very low density lipoprotein (VLDLc), low density lipoprotein (LDLc) and high density lipoprotein (HDLc) were assayed under lipid profile. Clinical investigations were carried out on 115 subjects which involved 30 control, 25 irritable bowel syndrome (IBS), 30 bronchial asthma and 30 rheumatoid arthritis patients. The results of this preliminary study showed a significant change in the levels of all the biochemical parameters in diseased subjects in comparison with controls. Increased levels of atherogenic lipids, Tg, VLDLc and LDLc were found in rheumatoid arthritis subjects. This suggests that arthritis subjects are relatively at higher risk of developing coronary heart disease. Furthermore hypercholesterolemia may aggravate the risk condition in arthritis patients by artereosclerosis. The significant elevation in the levels of plasma cortisol reveals the fact that rheumatoid arthritis is a stabilized and chronic psychosomatic disorder, since, homeostatic competence is disrupted following decline in the tendency of stress-response to return to normalcy.
7901172 An enzyme linked immunosorbent assay for detection of anti-aorta antibodies in Takayasu ar 1993 Jul 15 Thirty cases of clinically and angiographically proven non-specific aortoarteritis with appropriate controls were studied. Antiaorta antibody titres were estimated using enzyme linked immunosorbent assay (ELISA) method. The controls included patients of vascular diseases other than non-specific aortoarteritis, autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosis), and normal healthy individuals. An absorbance value at 492 nm at a dilution of 1:500 of patients' sera was expressed as the antiaorta antibody titre. There was a significant difference (P < 0.005) between the mean value of the antibody titre of non-specific aortoarteritis patients (0.471 +/- 0.073) and patients of other vascular diseases (0.209 +/- 0.056), autoimmune disease patients (0.143 +/- 0.024) and controls (0.108 +/- 0.012). Collagenase treatment of the aorta resulted in the fall of the antibody titre of aortitis patients (0.162 +/- 0.036) suggesting that the collagen might be one of the components responsible for autoantigenecity of the aorta resulting in aortitis. The precise nature of the antigen needs to be identified.
8948308 A comparison of disease status in rheumatoid arthritis patients attending and not attendin 1996 Nov The objective was to test the hypothesis that rheumatoid arthritis (RA) patients currently not receiving specialist care have milder and less active disease than clinic attenders. The subjects were recruited from a media campaign aimed at identifying RA patients for a nationwide twin study. All subjects were interviewed at home and examined. Data from serological and radiological investigations were obtained. Data were also obtained about any specialist care, including the date, where relevant, of the most recent hospital appointment. For subjects reporting ever attending a specialist clinic, the current status (discharged/under current care) and the date of their most recent appointment were verified from hospital records. Data from 149 patients were analysed, of whom 114 (76%) were current hospital clinic attenders at the time of interview, 10 (7%) had never attended and 25 (17%) were ex-attenders. There was a similar proportion with current morning stiffness (> 1 h) in all three groups (60%). The median number of (i) swollen (S) joints, (ii) tender (T) joints and (iii) swollen and tender (ST) joints was almost identical-current attenders: (S) 7, (T) 9, (ST) 11; ex-attenders: (S) 5, (T) 8, (ST) 10; never attenders: (S) 7, (T) 14, (ST) 17. There were similar proportions with radiological erosions in the current and ex-attenders (79 and 72%, respectively). Current attenders were, however, substantially more likely to be taking disease-modifying drugs. In these volunteer patients, those currently managed entirely in primary care did not have less severe or active disease.
8187443 Effects of total hip replacement on quality of life in patients with osteoarthritis and in 1994 Mar The effects of total hip replacement (THR) on quality of life were investigated in 62 patients with osteoarthrosis (OA) and 35 patients with rheumatoid arthritis (RA). Patients eligible for a first hip joint replacement were enrolled consecutively and examined at home before the operation and 3, 6, and 12 months after surgery. The IRGL (Influence of Rheumatic Diseases on Health and Lifestyle), a Dutch version of the AIMS (Arthritis Impact Measurement Scales), was used to operationalize quality of life in a questionnaire. Pain and mobility scores showed significant improvement among both OA and RA patients. The general mood of the OA patients also improved significantly, but the RA group showed only a favourable tendency in this respect. The interference of OA in several areas of life almost disappeared, whereas the impact of RA was only slightly reduced. There was no discernible effect on the social dimension in either group. A single THR apparently solves the main problem of most OA patients, but only one of a number of joint problems for most RA patients. The IRGL is complex and time-consuming and contains irrelevant scales. Its multidimensional evaluation of the quality of life is more informative than a purely somatic evaluation.
8995921 Neuropeptides in the arthritic TMJ and symptoms and signs from the stomatognathic system w 1995 Summer The contribution of the nervous system to the pathophysiology of rheumatoid arthritis has been proposed to be mediated by certain neuropeptides. Neuropeptide Y, calcitonin gene-related peptide, substance P, and neurokinin A are considered modulators of inflammatory joint disease. Parameters of pain, as well as occlusal signs of tissue destruction from the arthritic TMJ and the corresponding neuropeptide concentrations in TMJ synovial fluid, were investigated in patients with various inflammatory joint diseases. The patients with rheumatoid arthritis were also examined in a separate diagnostic group. Visual analog scale, palpatory tenderness, maximal voluntary mouth opening, and anterior open bite were correlated to neuropeptide-like immunoreactivities of the above four neuropeptides. It was found that high concentrations of calcitonin gene-related peptide and neuropeptide Y in TMJ fluid are associated with pain, impairment of mandibular mobility, and occlusal signs of TMJ destruction in patients with rheumatoid arthritis. The results indicated neuropeptide involvement in rheumatoid arthritis, proposing a potentiation of the symptoms and signs by the inflammatory action of calcitonin gene-related peptide and neuropeptide Y.
8727714 In situ hybridization of stromelysin mRNA in the synovial biopsies from rheumatoid arthrit 1996 Mar We examined the expression of stromelysin mRNA (SL mRNA) in synovial biopsy specimens from 12 cases of rheumatoid arthritis (RA) and 2 cases of osteoarthritis (OA) using in situ hybridization. The study demonstrated that positive cells with high levels of SL mRNA were mostly (85%) found in the synovial lining layer. The positive cells were abundant in the synovium of RA which presented well developed lymphoid follicles with massive inflammatory cells. On the other hand, the synovium of OA contained no positive cells for SL mRNA. In addition, low yet positive levels of SL mRNA were detected in the endothelial cells and vascular myocytes, and interstitial cells in the deeper layer of the synovium. Karyometric studies showed that cells positive for SL mRNA had significantly larger and more spherical nuclei than weakly positive or negative cells. The SL mRNA positive cells did not demonstrate any immunoreactivity to markers of bone marrow origin, such as Leu M1, Leukocyte Common Antigen (LCA) and lysozyme antigen. Electron microscopy of a case with many SL mRNA positive cells showed that most had well developed rough endoplasmic reticulum and numerous processes on the cell surface, and some had also well developed rough endoplasmic reticulum but without processes indicating that they may be AB and/or B synoviocytes.
8049356 Evidence for GM-CSF receptor expression in synovial tissue. An analysis by semi-quantitati 1994 Jan Granulocyte macrophage colony stimulating factor (GM-CSF) is one of the main cytokines involved in tissue damage during rheumatoid arthritis (RA). To investigate the expression of the GM-CSF receptor (GM-CSF-R) in the synovial tissue of osteoarthritic (OA) and RA patients, biopsy specimens were obtained ex vivo during therapeutic arthroscopy. A semi-quantitative polymerase chain reaction (PCR) technique was performed using specific primers for the alpha chain of the GM-CSF-R and for beta-actin. The PCR products were analyzed after slot-blotting and hybridization with specific cDNA probes. Both RA (n = 11) and OA (n = 7) samples were positive. No significant overexpression correlating with the clinical or histological disease status of the patients was observed. In conclusion, GM-CSF-R could be detected in the synovial tissue where it can mediate the effects of this cytokine locally produced during RA inflammation.
8316771 A double-blind comparative study of hydroxychloroquine and dapsone, alone and in combinati 1993 Eighty patients with active rheumatoid arthritis (RA) entered a double-blind randomized study of 24 weeks duration, to compare the efficacy and toxicity of hydroxychloroquine, dapsone, and a combination of both drugs in treatment of RA. Evaluation of changes in clinical, laboratory and radiologic variables was based on 63 patients completing the trial. There was no clear difference between the three therapy groups in most inflammatory variables after 24 weeks. However, only patients receiving the combination therapy improved significantly in all clinical and laboratory variables. Nine patients in the combination group and four in each single drug group discontinued during the trial, mainly because of toxicity. Four patients taking the combination therapy withdrew because of hemolytic anemia, and none in the dapsone group. These findings suggest that hydroxychloroquine in combination with dapsone is somewhat more effective and less tolerated than single drug treatments.
1623644 A controlled study of lymphocyte subsets in rheumatoid arthritis. 1992 Jun The purpose of this study was to determine if patients with rheumatoid arthritis (RA) exhibited unique patterns of peripheral blood lymphocyte (PBL) subsets in comparison to patients with osteoarthritis (OA) and, further, if such differences related to disease activity or nondisease factors. Data from 63 RA patients and 47 OA patients revealed that the RA patients had lower absolute numbers of CD2+ and CD4+ lymphocytes. Small differences also were found in selected B-cell subsets and subsets of lymphocytes expressing CD16 and/or CD57 antigens. Further analysis revealed that these differences were due primarily to the effects of cytotoxic medications in the RA group. However, there were also alterations in some subsets independent of medication groups. PBL subsets in RA patients did not relate to chronic low-dose prednisone or measures of disease activity. This study demonstrated the need to control carefully for variables such as age and medication in immunophenotypic investigations of RA.
7763099 Illness behaviour in patients with arthritis. 1995 Apr OBJECTIVES: To determine if there are specific patterns of illness behaviour in patients with arthritis, and if abnormal patterns of illness behaviour are associated with withdrawal from trials of anti-inflammatory drugs, and to examine which aspects of illness behaviour are perceived by rheumatologist to be related to the disease process. METHODS: The illness behaviour questionnaire (IBQ) was administered to 211 patients with rheumatoid arthritis (RA) and 107 patients with osteoarthritis (OA) participating in five drug trials of NSAIDs at the beginning of the studies, and was commented upon by 17 clinical rheumatologists. RESULTS: Factor analysis of 211 patients with RA produced a unique factor solution. RA patients were more preoccupied with their illness and its effects and worried more about their health than patients with OA. Patients who withdrew from drug trials showed behaviour patterns similar to those of chronic pain patients, and different from those of patients who completed the studies. When asked to account for a rheumatoid patient's response to the IBQ, rheumatologists focused on physical symptoms and did not recognise some of the psychological issues which patients saw as being relevant. CONCLUSIONS: We have demonstrated differences in illness behaviour between patients with OA and with RA. Patients withdrawing from drug trials of NSAIDs showed differences in illness behaviour compared with those successfully completing the trials. Rheumatologists underestimated the impact of the disease on their RA patients' psychological well being.
1616357 Response of anaemia in rheumatoid arthritis to treatment with subcutaneous recombinant hum 1992 Jun Eleven patients with chronic inflammatory arthritides and haemoglobin concentrations less than 105 g/l with symptoms from their anaemia were treated with a dose of 250 IU/kg/week of recombinant human erythropoietin for six weeks. The treatment was given as subcutaneous injections five days a week. All patients had active inflammatory disease. Nine patients responded to treatment with an increase in haemoglobin of more than 15 g/l. The mean (SD) haemoglobin concentration increased from 93.0 (8.0) g/l before treatment to 115.0 (12.0) g/l after six weeks. There was no correlation between the initial serum concentration of erythropoietin and the response. It was concluded that anaemia in chronic inflammatory arthritides responds to treatment with subcutaneous injections of recombinant human erythropoietin.
8081676 Digital vasculitis associated with joint sepsis in rheumatoid arthritis. 1994 Sep Digital vasculitis complicating RA is not infrequent and is usually benign but may herald the onset of systemic vasculitis. A case is reported of a man with longstanding seropositive RA who developed digital vasculitis in association with septicaemia and multiple joint sepsis. Awareness that the onset of digital vasculitis in RA may be related to infection is important. This is especially so since aggressive immunosuppressive therapy is often used in patients with systemic vasculitis.