Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
8034409 Evaluation of assistive devices after a course in joint protection. 1994 Spring This study assessed a joint protection education program and investigated the costs and effects of assistive devices. Fifty-three women with seropositive rheumatoid arthritis, whose ages ranged from 29 to 65 years, attended a standardized joint protection course (13 hours). A self-report questionnaire was constructed listing the most common devices, and the subjects were asked to check which devices they had received, which ones they used and did not use, and why. Pain during activities of daily living and when using assistive devices was measured using the visual analogue scale. Results show that the subjects reported great benefits from the joint protection course, assistive devices, and wrist orthosis. The women had tried 663 devices, 91% of which were still being used. Pain decreased significantly (p < .001) when using assistive devices. The utility of 11 devices at a cost of SEK 1,683 per person can be described as increased capacity and ability to work at home, work outside the home, and perform leisure activities with less pain.
1438622 Dysphoria: a major symptom factor in persons with disability or chronic illness. 1992 Sep Depression frequently is diagnosed in persons with chronic illness or following the onset of disability. The overlap of symptoms of many chronic illnesses and disabling conditions with depression may lead to an overestimation of depression in such populations. Some investigators have proposed revised criteria for diagnosing depression in these conditions without an understanding of the contribution of diagnostic criteria in disabling conditions. This study investigated the nature of depressive symptom criteria constellations by individually factor analyzing the Inventory to Diagnose Depression (based on DSM-III diagnostic criteria) in spinal cord injury (n = 134), rheumatoid arthritis (n = 78), student (n = 140), and community (n = 150) groups. A four-factor solution emerged, with the first factor labeled "dysphoria" being represented by symptoms of negative self-evaluations, depressed affect, and suicidal ideation. The results indicate that a core element of the syndrome of depression is dysphoria, which suggests that the contribution of somatic items may be less important to the identification of the depressive syndrome in chronic illness.
8724292 Incidence, target antigens, and clinical implications of antineutrophil cytoplasmic antibo 1996 May OBJECTIVE: To determine the incidence of antineutrophil cytoplasmic antibodies (ANCA) in rheumatoid arthritis (RA), to detect the target antigens of ANCA, and to compare clinical and laboratory data of ANCA+ with ANCA- patients with RA. METHODS: 385 sera of patients with RA were screened for ANCA by indirect immunofluorescence. ANCA+ sera were further analyzed for target antigens by ELISA: The ANCA+ patients were compared to randomly selected ANCA- patients with RA with respect to serological and radiological variables and extraarticular involvement. RESULTS: ANCA were found in 16% of patients with RA (61/385 sera). All sera showed a perinuclear (pANCA) pattern. Antibodies directed against proteinase 3 were not observed. The analysis of ANCA+ and ANCA- patients revealed that the pANCA+ group exhibited significantly higher serological markers of inflammation (p < 0.005) and a higher incidence of rheumatoid factor (p < 0.005). Furthermore, vasculitic involvement was found at a higher frequency (p < 0.05) in the pANCA+ group. Five patients in the pANCA+ group had pulmonary involvement, but none in the pANCA- group. CONCLUSION: pANCA in RA may be a marker for a more aggressive course of disease in respect to serological variables and extraarticular manifestations including rheumatoid vasculitis and lung involvement.
9026417 [Early results of total knee arthroplasty using the GSB endoprosthesis]. 1996 Early results of 20 GSB total knee arthroplasties in 18 patients are presented. Twelve patients had rheumatoid arthritis and 8 suffered from gonarthrosis. Good results were achieved in 18 knees, one knee was rated satisfactory and one poor.
8833054 Combination therapy in rheumatoid arthritis: the animal model perspective. 1996 Mar Attempts to improve antirheumatic agent efficacy have resulted in exploration of treatment protocols with combinations of 2 or more agents. Hypothetically, an ideal combination therapy would have greater efficacy and less toxicity than any of its component agents used individually. However, even a limited number of available drugs can produce a daunting number of possible combination protocols, each requiring clinical evaluation. Intelligent selection of combination protocols, based on a firm understanding of each agent's specific mechanism(s) of action, may help identify potentially useful regimens. Autoimmune animal models of inflammatory synovitis provide a unique opportunity to study the etiology, pathophysiology, and treatment of rheumatoid arthritis (RA). Induction of chronic inflammatory synovitis in susceptible inbred strains can allow for in vivo study under reproducible controlled conditions, using experimental protocols not possible in humans. Although animal models can only approximate human rheumatic disease in its complete form, they are nonetheless important for developing new therapeutic strategies. We review the 3 most common animal models of RA, the streptococcal cell wall, adjuvant, and collagen arthritis rat models. Surprisingly, few published studies evaluate combination therapy in RA animal models. We discuss these investigations, which use interventions aimed at angiogenesis, microtubule function, and immune regulation, as examples of animal models to assess and develop effective therapeutic combinations of antirheumatic agents.
8406279 [Incidence of Lyme borreliosis in a rheumatologic patient sample. Study of 153 patients of 1993 Aug 30 PROBLEM: Arthritis of the large joints is considered a typical manifestation of Lyme disease. With an estimated incidence in the population of about 2%, Lyme disease arthritis would be expected to be a fairly common diagnosis in a rheumatology unit. METHODS: In 153 successive patients seen in a rheumatology clinic of the University Hospital Frankfurt am Main, who had historical or clinical evidence of arthritis, the IgG antibody titers against Borrelia burgdorferi in the serum were compared with the clinical presentation. RESULTS: Twelve patients had positive or borderline positive antibodies titers. In three of the 153 patients, the diagnosis of Lyme disease-associated arthritis appears possible, although not probable. CONCLUSIONS: At least in the greater area of Frankfurt, Lyme disease as a differential diagnosis of arthritis is apparently of no great significance.
7918717 Cognitive-behavioral treatment of rheumatoid arthritis pain: maintaining treatment gains. 1993 Dec OBJECTIVE: This paper critically reviews research studies examining the long-term effects of cognitive-behavioral therapy interventions for managing pain in rheumatoid arthritis patients. METHODS AND RESULTS: The first section of the paper evaluates long-term results obtained in studies of cognitive-behavioral therapy, arthritis education interventions, and combined cognitive-behavioral therapy-arthritis education interventions. These studies show that although some rheumatoid arthritis patients are able to maintain initial improvements in pain and disability, other rheumatoid arthritis patients do not. In the second section of this review, a cognitive-behavioral model of maintenance of pain coping skills is presented. This model may be useful in increasing our understanding of the relapse process and in planning interventions to enhance and prolong cognitive-behavioral therapy treatment gains. The final section of this paper addresses important future directions for research. The need for empirical studies of relapse and maintenance processes is underscored. CONCLUSIONS: Controlled studies are needed to test the utility of new cognitive-behavioral interventions designed to enhance the long-term maintenance of treatment gains in RA patients. We suggest that a focus on issues of relapse and maintenance may be just as important for medical and surgical interventions for rheumatoid arthritis pain, as it is for cognitive-behavioral therapy interventions.
8546722 Cutaneous lymphocyte antigen-positive T lymphocytes preferentially migrate to the skin but 1996 Jan OBJECTIVE: To investigate whether T cell migration into different sites of inflammation (skin and synovium) within the same individual is principally regulated by tissue-specific homing or by more general mechanisms related to inflammation. METHODS: Expression of cutaneous lymphocyte antigen (CLA) and its ligand, E-selectin, was analyzed by immunohistochemistry and immunofluorescence using paired skin and synovial membrane (SM) samples from patients with psoriatic arthritis (PsA). To investigate disease specificity, delayed-type hypersensitivity (DTH) skin lesions, induced by tuberculin purified protein derivative, and SM from patients with rheumatoid arthritis (RA), were studied as controls. To directly examine cell migration in in vivo, the proportion of CLA+ T lymphocytes migrating into suction-induced skin blisters was assessed by flow cytometry. Using the same technique, levels of paired peripheral blood and synovial fluid (SF) T cells were also analyzed. RESULTS: CLA+ T cells preferentially accumulated in the skin, but not in the joint, of patients with PsA. Similarly, CLA+ T lymphocytes predominated in the DTH skin lesions of RA patients, but were very rare in the SM of RA patients, and were scarcely represented in the SF of patients with several chronic inflammatory arthropathies. In addition, CLA+ T lymphocytes preferentially migrated into epidermal skin blisters. This preferential pattern of CLA+ T cell accumulation was not related to the selective expression of E-selectin, since this was similar in the skin and SM of both PsA and RA patients. CONCLUSION: The distinct pattern of T cell infiltration into sites of inflammation within the skin and synovium is regulated by both organ-specific homing and general inflammation-related mechanisms.
8313931 Comparison of two glucocorticoid preparations (deflazacort and prednisone) in the treatmen 1993 Different glucocorticoid preparations modify the immune reaction in different ways. In this paper, the therapeutic efficacy of two glucocorticoids, deflazacort (DFZ) and prednisone (PDN), are discussed in relation to a group of 30 patients with systemic lupus erythematosus (n = 12) or rheumatoid arthritis (n = 18). The disease sub-groups were divided into two arms, one of which was treated with DFZ and one with PDN in a double-blind protocol. The results of this study indicate that DFZ and PDN induced a clinical remission within 1 month which was maintained until the 6th month. Nevertheless, certain immunological modifications, including a significant reduction of the circulating T lymphocyte level and of the CD4/CD8 ratio, which was between 1 and 1,5 during the DFC treatment and between 1 and 2 during the PDN treatment, are more pronounced and more stable with DFZ than with PDN. Moreover, DFZ has a smaller effect on calcium and glucose metabolism than PDN since the serum glucose and calcium level of patients treated with PDN increased respectively from 90 up to 130 mg/dl and from 9,5 to 11,5 mg/dl whereas those of patients treated with DFC remained within the normal range. These findings indicate that DFZ may have advantages over PDN in the treatment of immune-mediated diseases.
8833065 Effectiveness and toxicity considerations in outcome directed therapy in rheumatoid arthri 1996 Mar New paradigms of disease modifying antirheumatic drug based treatment strategies for rheumatoid arthritis (RA) raise new questions of sequencing of medications and employment of combination therapy. A broader view of chronic illness indicates that nonbiologic and self-management factors influence disease course and necessitate inclusion of patient oriented outcome measures such as disability and pain. I discuss these and related issues, present a broad model of disease progression in RA, introduce the concept of the "therapeutic segment," describe the dependence of clinical results on immediately prior therapy, and suggest a new research approach into the merits of combination therapy. Effectiveness is not necessarily increased by addition of a 2nd drug, nor is toxicity necessarily increased by combination therapy.
1529802 Effects of androgens in models of rheumatoid arthritis. 1992 Mar Testosterone and its metabolite 5 alpha-dihydrotestosterone (DHT) were compared with dexamethasone 21-acetate in two different animal models of arthritis and found to have effects on cartilage breakdown and inflammation. In the mouse air pouch, at the three dose levels used, significant effects were obtained with DHT and were more pronounced on cartilage breakdown than on inflammation. At the lowest dose of 0.3 mg kg-1 there was a 64% inhibition of collagen breakdown and 18% inhibition of glycosaminoglycans (GAGs) breakdown. In the antigen-induced arthritis mouse model testosterone had significant inhibitory effects on inflammation (synovial hyperplasia) and cartilage erosion.
8908315 Quantitative histopathologic discrimination of rheumatic disorders using nuclear measureme 1996 Oct OBJECTIVE: To use several nuclear quantitative estimators of synoviocytes and advanced statistical tests to discriminate between rheumatic disorders with the purpose of providing an objective histopathologic differentiation and to illustrate the difficulty of establishing the implications of the vague diagnosis of chronic nonspecific synovitis. STUDY DESIGN: Synovial histologic material from 48 patients, including a control group and those diagnosed with osteoarthritis, rheumatoid arthritis and chronic nonspecific synovitis, was analyzed. Both morphometric and stereologic nuclear measurements were assessed in each case, and several stepwise discriminant analyses were performed to obtain linear discriminant functions. RESULTS: Differences in the nuclear size parameters were found between rheumatoid arthritis and the normal and osteoarthritis groups and between normal and chronic nonspecific synovitis. The volume-weighted mean nuclear volume was the most significant parameter. No differences were demonstrated between osteoarthritis and normal and chronic nonspecific synovitis or between rheumatoid arthritis and chronic nonspecific synovitis except for nuclear volume. Using stepwise discriminant analysis, 94% of the cases were correctly classified when differentiating the normal, osteoarthritis and rheumatoid arthritis groups. The overall accuracy of diagnosis decreased to 83% when chronic nonspecific synovitis samples were included. The misclassified samples were related mainly to normal cases and to osteoarthritis and chronic nonspecific synovitis cases. CONCLUSION: This study emphasized that nuclear quantitative features of synoviocytes may be useful in differentiating rheumatic disorders objectively, especially in combination with discriminant analysis. Thus, nuclear changes in the synovium in chronic nonspecific synovitis show a closer similarity to normal and osteoarthritis than to rheumatoid arthritis.
8342110 [Radiosynoviorthesis]. 1993 Jul Intraarticular therapy using radionuclides seems to be the best conservative local treatment of chronic synovitis as a generally accepted alternative to surgical synovectomy. If the indication is carefully considered and the technique properly applied, the success rate of treatment is as high as it is with surgery, whereas the risk involved is comparatively low.
9070665 Ezrin, radixin and moesin are possible auto-immune antigens in rheumatoid arthritis. 1996 Oct In order to deduce which cellular molecules react with the sera from patients with rheumatoid arthritis (RA), human and mouse cellular extracts were fractionated stepwise, by ethanol precipitation and their reactivity analysed by Western blotting. It was found that three cytoplasmic molecules with molecular weights of 80,000, 81,000 and 77,000 were immunoreactive and they were identified as ezrin (E), radixin (R), and moesin (M), respectively, by partial amino acid sequencing. Using cDNA clones of these human molecules, recombinant proteins were produced in Escherichia coli and used to enable the antigens to detect the antibodies in the sera of patients with RA. Of 71 sera tested, 24 sera (33.8%) reacted with at least one of three recombinant antigens, although there was no significant correlation between the presence of the antibodies and clinical manifestations, such as disease duration or stage. There was also no discernible relationship to other auto-antibodies such as antinuclear antibodies (ANA) and rheumatoid factor. The results suggest that ERM proteins are possible novel auto-immune target antigens for RA.
7598454 Class II antigens and disease susceptibility. 1995 The role for HLA typing in autoimmune disease is changing with the recognition that HLA markers can identify patients with poor prognosis in some autoimmune disease. Aggressive therapeutic intervention in patients with such HLA prognostic markers has the potential to improve or prevent progressive disease outcomes in a select group of patients.
8912502 gamma-Linolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled t 1996 Nov OBJECTIVE: To assess the clinical efficacy and adverse effects of gamma-linolenic acid (GLA), a plant seed oil-derived unsaturated fatty acid that suppresses inflammation and joint tissue injury in animal models, in the treatment of active rheumatoid arthritis (RA). METHODS: Fifty-six patients with active RA were randomized to treatment groups in a 6-month, double-blind trial of GLA versus placebo. This was followed by a 6-month, single-blind trial during which all patients received GLA. Patients were treated with 2.8 gm/day of GLA as the free fatty acid or with sunflower seed oil (placebo) administered in identical capsules. RESULTS: Treatment with GLA for 6 months resulted in statistically significant and clinically relevant reductions in the signs and symptoms of disease activity in patients with RA. Overall meaningful responses (at least 25% improvement in 4 measures) were also better in the GLA treatment group (14 of 22 patients versus 4 of 19 in the placebo group; P = 0.015). During the second 6 months, both groups exhibited improvement in disease activity. Thus, patients taking GLA during the entire study showed progressive improvement during the second 6 months. In this group, 16 of 21 patients showed meaningful improvement at 12 months compared with study entry. CONCLUSION: GLA at doses used in this study is a well-tolerated and effective treatment for active RA. GLA is available as a component of several plant seed oils and is usually taken in far lower doses than were used in this trial. It is not approved in the United States for the treatment of any condition, and should not be viewed as therapy for any disease. Further controlled studies of its in RA are warranted.
7799337 In vivo analysis of disease modifying drug therapy activity in rheumatoid arthritis by seq 1994 Sep OBJECTIVE: To assess sequential changes of synovial membrane interleukin 1 beta (IL-1 beta) in patients with rheumatoid arthritis receiving chrysotherapy and glucocorticoids. METHODS: Sequential synovial biopsies taken before and after 2 and 12 weeks of treatment were analyzed by immunohistological techniques. RESULTS: Significant decreases in IL-1 beta staining occurred in biopsies taken after 12 weeks' chrysotherapy, while mononuclear cell numbers were unchanged. Results were similar in patients receiving glucocorticoid and gold, and in those receiving gold alone. CONCLUSION: These data suggest that chrysotherapy reduces IL-1 beta production in vivo, a property that has been shown in vitro, and that this change precedes changes in synovial membrane mononuclear cell numbers.
8269781 [Serum soluble interleukin 2 receptor levels in patients with diffuse connective tissue di 1993 Aug Soluble interleukin 2 receptor (SIL-2R) levels in serum appear to reflect the status of lymphocytic activation and proliferation. We examined the levels of serum SIL-2R in 65 patients with diffuse connective tissue diseases by using ELISA method. The mean levels of serum SIL-2R were respectively 0.46 U/L, 0.53 U/L, 0.46 U/L in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and dermatomyositis during disease activity and were significantly higher than those in healthy controls (0.25 U/L). The levels of serum SIL-2R were 0.62 U/L and 0.60 U/L respectively in a patient with mixed connective tissue disease and a patient with systemic sclerosis. The levels of SIL-2R were respectively 0.24 U/L and 0.29 U/L in SLE and RA patients during clinical remission, being significantly lower than during disease activity. SLE patients with high SIL-2R levels were associated with high levels of 125I-DNA rate and erythrocyte sedimentation rate and lower levels of C3 complement components. The measurement of SIL-2R levels may be an useful indicator for monitoring disease activity in SLE and RA patients. Moreover it is a noninvasive method.
1546386 Methylprednisolone hemisuccinate and metabolites in urine from patients receiving high-dos 1992 Feb A reversed-phase high-performance liquid chromatographic (RP-HPLC) method for the measurement of methylprednisolone hemisuccinate (MPHS) and its metabolites methylprednisolone (MP), 20-alpha- (20a-HMP), and 20-beta-hydroxymethylprednisolone (20b-HMP) in urine is described. The metabolites were extracted from urine samples using Extrelut columns and eluted with ethylacetate. The mobile phase for RP-HPLC comprised methanol:citrate buffer:tetrahydrofuran (30:65:5, vol/vol/vol) with UV detection at 251 nm. Fractions were collected, pooled and the metabolites present were identified by gas chromatography-mass spectrometry and normal-phase HPLC (NP-HPLC). By RP-HPLC 30 +/- 7.3% (mean +/- 1 SD) of the dose was detected in the 0-24 h urine sample following a 1 g MPHS infusion to patients with rheumatoid arthritis; MPHS contributed 9.9 +/- 5.0%, MP 12.1 +/- 2.9%, 20a-HMP 7.8 +/- 2.2%, and 20b-HMP 1.0 +/- 0.3%, respectively. A further 1.0 +/- 0.9% of the administered dose was detected in urine collected 24-48 h postinfusion.
8877920 Self-assessment of disease activity by patients with rheumatoid arthritis. 1996 Sep OBJECTIVE: To determine the reliability of self-assessment of disease by patients with rheumatoid arthritis (RA), with a particular emphasis on the assessment of articular swelling. METHODS: A questionnaire was developed using components from validated instruments. Information was obtained on global function, global joint tenderness/swelling, and joint pain (10 cm visual analog scales), duration of musculoskeletal morning stiffness (grade 1-6), ACR functional score (grade 1-4), tender joint count (0-20), tender joint score (0-60), swollen joint count (0-20), and swollen joint score (0-60). Data were collected prospectively on 61 patients with RA in a teaching clinic or office practice by 4 staff rheumatologists. Patient questionnaires were completed within 24 h before physician assessments. Followup assessments were carried out on 27 patients after a mean interval of 3 months (range 0.5-6). RESULTS: At the initial assessment there was a significant correlation between patient and physician assessments for global function (r = 0.83; p = 0.01) [intraclass correlation coefficient (ICC) = 0.83; p < 0.01], global joint tenderness/swelling (r = 0.83; p < 0.01) (ICC = 0.83; p < 0.01), global joint pain (r = 0.83; p < 0.01) (ICC = 0.81; p < 0.01), duration of morning stiffness (r = 0.83; p < 0.01) (ICC = 0.85; p < 0.01), ACR functional score (r = 0.61; p < 0.01) (ICC = 0.62; p < 0.01), tender joint count (r = 0.57; p < 0.01) (ICC = 0.31; p < 0.01), and tender joint score (r = 0.60; p < 0.01) (ICC = 0.35; p < 0.01). However, there was poor correlation between patient and physician assessments for both swollen joint count (r = 0.16; p > 0.05) (ICC = -0.02; p > 0.05) and swollen joint score (r = 0.24; p > 0.05) (ICC = 0.12; p > 0.05). Longitudinal analysis indicated significant correlation between changes in patient and physician assessments in all variables except swollen joint count and score. CONCLUSION: Although there was good correlation between most variables for patient and physician assessments of disease activity in RA, there were substantial differences in the assessment of joint swelling. This objective determinant of disease activity cannot be ascertained in self-report measures of health status.