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ID PMID Title PublicationDate abstract
7767406 Marriage, social support, and adjustment to rheumatic disease. 1995 May The family is an important source of support for the patient with RA. At the same time, the illness creates stresses for family members that may affect their well-being or inhibit their ability to provide support to the patient. In designing support interventions, one cannot assume that difficulties in adjusting to chronic illness reflect a lack of support from the family or that the patient should be the sole target of intervention.
8574633 Superantigens in autoimmune disease. 1995 Oct The recent identification of superantigens (of retroviral origin in mice and bacterial origin in humans) has given rise to several hypotheses linking superantigens to autoimmune responses. The most compelling argument in support of such a link is restricted V beta gene usage by lymphocytes in rheumatoid joint fluid and Sjögren's syndrome salivary tissue. However, a substantial body of evidence from mouse models militates against a link between the presence of self-superantigen-reactive T-cells and the development of autoimmune disease. Nevertheless, superantigens are powerful instruments for investigating tolerance.
8100752 Experience with a chimeric monoclonal anti-CD4 antibody in the treatment of refractory rhe 1993 Mar We have used a chimeric monoclonal anti-CD4 antibody (cM-T412) in a phase I trial involving patients with refractory RA. The objectives of this initial study were to evaluate the safety, immunogenicity, and biologic effects of cM-T412. Twenty-five patients with active refractory RA (all taking methotrexate concomitantly) were treated with incremental doses (10 to 700 mg) of cM-T412 in an open-label, escalating dose phase I trial. Levels of circulating CD4+ T-cells decreased rapidly post-infusion and remained significantly depressed even at 18 months following treatment. Repopulation of CD4+ T cells consisting of increased CD45RA+ (naive) and CD45RO+ (memory) CD4+ T-cells was observed in approximately 1/3 of the patients between day 14 and 6 months post-infusion. Proliferative responses of peripheral blood lymphocytes to mitogens and recall antigens were generally diminished following cM-T412 infusion, with mitogen responses normalizing more rapidly than responses to recall antigens. Adverse events during the first 6 months of follow-up included fever, often associated with myalgias, malaise, and asymptomatic hypotension; these symptoms were self-limited and appeared to correlate with transient elevations of interleukin-6. Negligible human antibody responses to the cM-T412 variable region were observed; indeed, only 2 patients developed transient low levels of antibodies reactive with cM-T412. Non-blinded assessment indicated that 43% of patients exhibited > or = 50% improvement in tender joint counts at 5 weeks, and 33% at 6 months post-infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
7479260 [Overdose of methotrexate with a fatal outcome in a patient with rheumatoid arthritis]. 1995 Apr A 52-year old female patient with rheumatoid arthritis (RA) had mistakenly taken 112.5 mg methotrexate (MTX) over a period of five days. As a result, extensive erosions along with necrotic changes occurred in the oral cavity, the groins and vulva mucous membrane. Haemorrhages in the gastrointestinal tract, dermal xanthochromia, interstitial pneumonia and progressive renal insufficiency, as well as hair loss, also followed. Laboratory examination showed peripheral blood agranulocytosis, a decrease in the overall number of blood platelets, anaemia, an increase in the level of transaminases and bilirubin, along with megakaryocyte deficiency. Cultivated dermal specimens initially developed bacteria, then Candida albicans. The patient died on the 22nd day after the overdose from pneumonia and extensive mycosis.
1523524 [A case report of rheumatoid arthritis patient with thoracic myelopathy]. 1992 Jun The authors report a 39-year-old woman with rheumatoid arthritis associated with myelopathy at the thoracic level. X-ray films of thoracic spine showed scoliosis which had its apex at T6. Myelography demonstrated incomplete block at the level of T6. Computerized tomogram revealed destruction of left pedicle of the sixth thoracic vertebra and dislocation of the sixth rib into the spinal canal which compressed cord at T6 level. Hemi-laminectomy at T5-T7 level and decompression were performed. Pathological investigations of soft tissue around the cord and dura mater showed infiltration of small round cells. We concluded that the synovitis of costo-transverse joint or costovertebral joint led to the destruction of the pedicle. As a result, dislocation of the rib, scoliotic deformity and thoracic myelopathy occurred.
1282754 [Pathogenetic therapy of spontaneous corneal perforation after extracapsular cataract extr 1992 May The author presents a case with spontaneous perforation of the cornea after extracapsular cataract extraction in a female patient with rheumatoid arthritis. Systemic disorganization of the connective tissue and elevated collagenase activity essentially contribute to the pathogenesis of corneal perforation. Therefore, besides antibacterial drugs, collagenase inhibitors, 3% aqueous solution of cysteine, antimeasles gamma-globulin, and a regeneration stimulant, 5% ascorbic acid aqueous solution, were used in the treatment. The pathogenetic therapy was conducive to early healing of the corneal defect and helped save the eye and preserve its good function (0.8 s + 10.0 diopters).
8053950 Effects of glucocorticoids in rheumatoid arthritis. Diminished glucocorticoid receptors do 1994 Aug OBJECTIVE: Lymphocytes of patients with rheumatoid arthritis (RA) have diminished receptor density; thus, patients with RA should show partial resistance to glucocorticoids. We investigated the glucocorticoid sensitivity of lymphocytes in RA patients compared with healthy subjects. METHODS: We determined the effects of glucocorticoids on lymphocyte proliferation and cytokine release. RESULTS: Proliferation and cytokine release were inhibited in RA patients to the same extent as in healthy controls. CONCLUSION: Diminished receptor density in RA patients does not result in glucocorticoid resistance.
8514235 [Immunogenetic analysis of rheumatoid arthritis in the Japanese population]. 1993 Feb To reveal immunogenetic factors involved in the pathogenesis of rheumatoid arthritis(RA), two hundreds and four unrelated Japanese patients with RA were typed for HLA by both serologic typing and DNA typing using polymerase chain reaction-sequence specific oligonucleotide probe (PCR-SSOP) method. Serologic HLA typing data showed that frequencies of HLA-A11, DR4, DR53, and DQ4 were increased and those of DR8, DR52, and DQ1 were decreased in the patient group. The HLA-DNA typing has defined more precisely the disease-associated HLA-class II alleles and revealed that DRB1*0405, DQA1*03, and DQB1*0401 were strongly associated with the disease susceptibility whereas DRB1*0803, DQA1*0103, and DQB1*0601 showed negative association with RA. Comparison of amino acid sequences of DRB1*0405 with other DRB1 alleles suggested that the risk for RA was closely associated with particular amino acid residues of DR beta chain, i. e. glycine residue at the 86th position in addition to the residues between 70th and 74th position. The significant decreased frequency of DRB1*0803 in the DRB1*0405 positive patient group suggests that DRB1*0803 may control resistance to RA as a dominant genetic trait. In addition, the observation that the frequency of DPB1*0201 was increased in the DRB1*0405 negative patient group may indicate that the disease susceptibility to RA is controlled by the HLA-DP region in the minority of the patients. The polymorphism of TAP2 gene and TCR genes showed no significant association with RA, suggesting that the contribution of these genes to the susceptibility is relatively small, if any.
7637973 [Experience with long term low dose methotrexate treatment in rheumatoid arthritis and art 1995 Jul 16 The clinical efficacy and the side effects of a long term (max. 42 months, min. 5 months) weekly pulse methotrexate treatment (10 mg/week) were investigated in 31 rheumatoid arthritis patients and in 14 with psoriatic arthritis. A reduction in the number of inflamed joints and diminished duration of morning stiffness could be observed together with a decrease of pain and of the erythrocyte sedimentation rate in rheumatoid arthritis. In patients with psoriatic arthritis the intensity of joint pain was not influenced considerable and the decrease of the erythrocyte sedimentation rate was not as great as in rheumatoid arthritis patients. Ineffectivity of the methotrexate treatment occurred in one rheumatoid arthritic patient. The methotrexate treatment could not be carried on in two rheumatoid arthritic patients because of adverse side effects.
8533041 The value of the ACR 1987 criteria in very early rheumatoid arthritis. 1995 We assessed the sensitivity and specificity of the ACR 1987 revised criteria for rheumatoid arthritis (RA) in 121 patients with recent-onset (< or = 6 months) RA, 68 with reactive arthritis (ReA), 19 with ankylosing spondylitis (AS), and 13 with psoriatic arthritis (PsA). The sensitivity of each single criterion ranged 8.3-90.9% and specificity 52.0-100%. The sensitivity of four fulfilled criteria was 83.5% and specificity 86.0%. In ReA 11.8%, AS 5.3%, and PsA 38.5% of patients fulfilled four criteria respectively. Thus at the beginning of RA, 83% of patients could be diagnosed correctly by using the ACR 1987 criteria, and the remaining 17% had seropositive and/or erosive arthritis at the onset. The suitability of the radiographic ACR criteria is discussed.
1630032 [Clinicopathological study of membranous glomerulonephritis in patients with rheumatoid ar 1992 Mar Of 103 patients with membranous glomerulonephritis proved by renal biopsy, 11 (10.7%) had rheumatoid arthritis. Nine of these 11 patients received systemic treatment with anti-rheumatic remedies including gold, D-penicillamine and bucillamine. Two others were administered only token of nonsteroidal antiinflammatory drugs. Renal function of the patients was well maintained and within normal limits. Four patients showed nephrotic syndrome, while mild to moderate proteinuria was found in the other 7. Hematuria was minimal to mild, and it was not a major symptom. Six patients resolved proteinuria completely and 2 patients incompletely after discontinuation of chrysotherapy. Nine cases of the membranous lesion in patients with rheumatoid arthritis were stage 1. Thus it was often difficult to identify the glomerular change only by light microscopy. IgA nephropathy and AA amyloidosis were associated in one patient respectively. Our data lead us to conclude that chrysotherapy would cause membranous lesions, but rheumatoid arthritis itself also induce membranous glomerulonephritis.
9098456 TNF Nco-I RFLP is not an independent risk factor in rheumatoid arthritis. 1994 Dec The human TNF genes are located within the MHC class-III region on chromosome 6. The presence or absence of an Nco-I restriction site in the 5' non-coding sequence of the TNF beta gene defines two alleles (TNFB*1 and TNFB*2). The segregation of these alleles has been associated with levels of TNF alpha or TNF beta production in systemic lupus erythematosis (SLE), insulin-dependent diabetes mellitus (IDDM) and in healthy control individuals. Rheumatoid arthritis (RA) is characterized by high levels of TNF alpha within the synovial fluid and to address the question of whether this could be brought about by a genetic predisposition to high TNF production by RA individuals, we examined the distribution of this Nco-I polymorphism in 98 healthy volunteers and 123 patients with active rheumatoid arthritis. No difference was observed between the normal and RA groups with respect to haplotype segregation or allelic frequency. Furthermore, no difference was observed between DR4+ or DR4- individuals in the control or RA groups. These data demonstrate that the high level of TNF alpha seen in the joints of RA patients is unlikely to be due to a genetic predisposition of these patients to high TNF alpha production, as defined by the TNF Nco-I restriction fragment length polymorphism (RFLP).
1418003 High-dose immunoglobulin therapy as an immunomodulatory treatment of rheumatoid arthritis. 1992 Oct OBJECTIVE: To investigate the efficacy of high-dose intravenous immunoglobulin (IVIg) in the treatment of refractory rheumatoid arthritis (RA). METHODS: Ten patients with active, severe RA that was unresponsive to first- and second-line agents were administered IVIg monthly, for 6 months. RESULTS: Following IVIg treatment, there was significant improvement in both subjective and objective parameters of disease activity in all 9 patients who completed the protocol. This improvement was noted to occur as early as after the second infusion of IVIg. After discontinuation of the treatment, all patients had a relapse of the disease within a few weeks. CONCLUSION: Since the reduction in clinical activity paralleled a decrease in the CD4+CDw29+:CD4+CD45RA+ cell ratio, some of the therapeutic benefits associated with IVIg may be due to a direct influence on the CD4+CD45RA+ subset. Although the possibility of carrying out further controlled studies on a larger scale is limited by the high cost of the treatment, IVIg appears to be an effective therapy for refractory RA.
8316908 [Two cases of pneumococcal septic arthritis complicating rheumatoid arthritis]. 1993 Apr It is reported that most of the causative organisms of suppurative arthritis complicating rheumatoid arthritis (RA) is Staphylococcus aureus and that Streptococcus pneumoniae is rare, representing less than 5% of cases of suppurative arthritis complicating RA. We here report two cases of pneumococcal septic arthritis complicating RA. Both were female, and 68 and 64 years old, respectively. They had active, long-standing RA with destructed changes. Infected joints included both knees (case 1) and right knee (case 2). Pain and loss of motion in the septic joints were prominent. On admission, the physical examination showed severe redness, swelling and tenderness of the septic joints and the range of motion of those was markedly decreased. The radiograph of affected joints showed stage III. Laboratory data showed markedly elevated ESR of 127 mm/hr (case 1) and 142 mm/hr (case 2) and C-reactive protein of 49.91 mg/dl (case 1) and 30.36 mg/dl (case 2). Aspirate of the left knee of case 1 showed numerous neutrophils. Cultures of the joint fluid grew S. pneumoniae. Grossly purulent material was aspirated from the right knee of case 2 and cultures also grew S. pneumoniae. They were started on intravenous antibiotics with a good response and the function of involved joints returned to preseptic condition. The source of infection on case 1 was presumed to be otitis media because she had discharge from left ear concurrently with the exacerbation of joint symptoms. Case 2 had productive cough and cultures of sputum also disclosed S. pneumoniae when pain of right knee joint developed. The suggested source of infection was upper respiratory tract.(ABSTRACT TRUNCATED AT 250 WORDS)
8129455 A randomised controlled trial of the effect of hormone replacement therapy on disease acti 1994 Feb OBJECTIVE: To assess the effects of hormone replacement therapy (HRT) on disease activity in postmenopausal rheumatoid arthritis (RA). METHODS: Two hundred postmenopausal outpatients (aged 45-65 years) were admitted into a single blind randomised placebo controlled trial of transdermal oestradiol (50 micrograms daily) over six months. Patients continued with routine antirheumatic medications. Compliance with HRT was monitored using serum oestradiol (E2) levels. Disease activity was monitored at entry, three and six months using erythrocyte sedimentation rate (ESR), articular index (AI), visual analogue pain scale (VPS) and early morning stiffness (EMS). RESULTS: Ninety one and 77 patients completed six months treatment with placebo and HRT respectively. There were no significant differences in baseline characteristics between the groups and no overall effects of treatment. However, 35 patients (41.6%), who completed HRT, failed to achieve serum E2 levels > 100 pmol/l at either three or six months and were considered 'poor-compliers'. In the remaining HRT 'compliers' (58.4%) there were significant improvements after six months in articular index (28.9%; p < 0.01) and pain score (21.7%; p < 0.05) compared with placebo, as well as reductions in ESR (8.9%; NS) and morning stiffness (25.2%; NS). Comparisons between HRT 'compliers' and 'poor-compliers' confirmed significant improvements in articular index (p < 0.001), pain score (p < 0.05) and morning stiffness (p < 0.001) in the 'compliers'. CONCLUSIONS: This study did not show an overall effect of HRT on disease activity when used as an adjunct therapy in postmenopausal patients. A subgroup of patients, who had greater increments in serum E2 whilst taking HRT, demonstrated improvements in some parameters of disease activity, suggesting a potential beneficial effect with good compliance and higher dose HRT. Most importantly, in the treatment of RA associated bone loss, HRT can be prescribed without fear of a disease flare up.
8164203 Detection of cytomegalovirus DNA in cells from synovial fluid and peripheral blood of pati 1993 Sep OBJECTIVE: To study the role of cytomegalovirus (CMV) in the etiology of rheumatoid arthritis (RA). METHODS: Polymerase chain reaction (PCR), immunoperoxidase staining for CMV specific antigens, virus isolation and antibody assays were applied to study samples from patients with RA of less than one year's duration. RESULTS: By PCR, CMV DNA was detected in granulocytes from 3 of 24 synovial fluid (SF) samples and in 10 of 43 peripheral blood samples of patients with RA. These figures are not significantly different from those observed for the control groups (reactive arthritis, other arthropathies, healthy individuals). By immunoperoxidase staining, no evidence for the CMV antigens was observed in the SF cells. All the virus isolations were negative, and the level of CMV specific circulating antibodies in RA was not different from that in the other groups. CONCLUSION: In spite of the negative results, the potential role of CMV in the etiology of RA cannot be totally excluded on the basis of these results; the mutual contribution of the triggering agent and the host response in genetically susceptible individuals is discussed.
8465580 Anti-rheumatic treatment in the elderly. 1993 Jan The elderly are more liable to problems from drugs used systemically. An accurate diagnosis may reveal conditions in which drug treatment is not required, especially those due to faulty habits and environmental problems, and local conditions susceptible to injections or surgery. Obesity, sepsis, hypothyroidism, osteomalacia, unsuspected fractures and drug side-effects may give correctable rheumatological problems. Use of analgesic anti-inflammatory drugs needs great care in the elderly; use analgesics instead when possible. Rheumatoid arthritis in the elderly demands maximum use of nonpharmacological treatment and local treatment. Analgesic anti-inflammatory drugs should be used carefully and sparingly. Use slow-acting drugs as in younger patients.
8023392 Use of recombinant human erythropoietin to assist autologous blood donation by anemic rheu 1994 Jun BACKGROUND: In rheumatoid arthritis (RA) patients undergoing orthopedic surgery, anemia is the major factor in the use of allogeneic blood. STUDY DESIGN AND METHODS: To determine whether recombinant human erythropoietin (rHuEPO) could allow preoperative autologous blood procurement and reduce allogeneic blood exposure, 11 RA patients who were unable preoperatively to deposit blood for autologous use because of their anemia (baseline hematocrit < 34% [0.34]) and who were scheduled for primary total hip replacement or total knee replacement were treated intravenously with 300 U per kg of rHuEPO in combination with intravenous iron saccharate (100 mg), given twice weekly for 3 weeks. The transfusion treatment was compared with that in 12 control patients with comparable baseline hematologic values who underwent the same operation. RESULTS: Control patients could not preoperatively deposit any blood for autologous use, while all but one of the rHuEPO-treated patients deposited 2 or more units (mean, 2.6 +/- 0.6; range, 2-4) (p < 0.001). The control group received more allogeneic units (2.6 +/- 1.6 vs. 0.8 +/- 0.8) (p = 0.009). Moreover, 50 percent of the rHuEPO-treated patients, as compared with 8 percent of controls, completely avoided allogeneic transfusion. CONCLUSION: Recombinant human erythropoietin is safe and effective in stimulating erythropoiesis, allowing preoperative donation of blood for autologous use, and reducing exposure to allogeneic blood for RA patients who are unable preoperatively to deposit blood because of anemia.
8337196 Health status, adherence with health recommendations, self-efficacy and social support in 1993 May A study was performed in 86 patients with rheumatoid arthritis (RA) to assess their health problems, the problems they experience in adhering to health recommendations and the relationships of these problems with self-efficacy and social support. Feeling dependent, disability and pain were the most important health related problems. The results showed self-efficacy to be related to the subjective experience of health status as measured by DUTCH-AIMS. Social emotional support was not related to health status, and contrary to what we expected social instrumental support was positively related to health status. The majority of the patients (55%) experienced adherence problems with health recommendations. These problems were not related to functional incapacity, pain or other aspects of health status but to the patient's self-efficacy expectations about coping with arthritis. Our conclusion is that to improve the self-management of disability and pain and adherence to health recommendations, patient education should be aimed at strengthening self-efficacy expectations in which social emotional support might be a motivating factor.
8443359 [Rheumatoid arthritis of the wrist. Dynamic Gd-DTPA enhanced MRT]. 1993 Feb 21 patients with rheumatoid arthritis of the wrist diagnosed according to the criteria of the American Rheumatism Association were examined by dynamic MRT before and after the i.v. injection of Gd-DTPA (0.1 mmol/kg). The results were correlated with the clinical and radiological findings. The increased signal intensity of the pannus was 1.17 +/- 0.45%/sec and this differed significantly (p < 0.001) from bone marrow (0.16 +/- 0.11%/sec) and from muscle (0.25 +/- 0.16%/sec). Blood sedimentation rate correlated with the gradient of synovial proliferation (p < 0.05). There were no further statistically significant correlations between the clinical, radiological and MRT findings and the change in signal intensity from synovial proliferation as shown by dynamic MRT.