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ID PMID Title PublicationDate abstract
8337194 Group education for patients with rheumatoid arthritis. 1993 May Patients with rheumatoid arthritis must learn to adjust their exercise, rest and medication to the varying activity of the disease. Patient education can help patients in making the right decisions about adjustments in their treatment regimen and in attaining "self-management" behaviors. We developed a group education program based on social learning theory and the 'Arthritis Self-Management Course' developed in the USA by Lorig. Goal of the program is the strengthening of self-efficacy, outcome expectations and self-management behaviors of RA patients which may lead to better health status. The program has been evaluated in an experimental design. We established significant positive effects of the group training on functional disability, joint tenderness, practice of relaxation and physical exercises, self-management behavior, outcome expectations, self-efficacy function and knowledge. After 14 months we still found effects on practice of physical exercises, self-efficacy function and knowledge.
7622181 Collagen induces cytokine production by synovial fluid mononuclear cells in rheumatoid art 1995 Feb Synovial fluid (SF) mononuclear cells (MNC) from 13 patients with rheumatoid arthritis (RA) and 12 patients with other arthritic diseases (OD) including osteoarthritis (OA), gout and spondyloarthritis (SA) were cultured in the presence of collagen types I and II or lipopolysaccharide (LPS) for 24 h. Interleukin-1 (IL-1), IL-6 and tumor necrosis factor-alpha (TNF-alpha) in the SF and culture supernatants were assayed using ELISA. The results showed that one-half of the RA patients with high SF monocyte count had high SF IL-6 levels that coincided with the high spontaneous release of IL-6 by SF MNC. In the other RA patients with lower SF monocyte count, type II collagen induced significantly higher IL-1 beta than the medium control levels by SF MNC (P < 0.01) or that of the other diseases (P < 0.01). Similarly, type II collagen-induced IL-6 and TNF-alpha production rose significantly (P < 0.01) from SF MNC of RA but less from OD (P < 0.05). In addition, type I collagen could also induce IL-1, IL-6 and TNF-alpha in these samples from RA and OD patients but was less potent than type II collagen. Our results indicate that collagen-induced cytokines may be important in the pathogenesis of the disease.
7638655 Natural course of cervical spine lesions in rheumatoid arthritis. 1995 May 15 STUDY DESIGN: This study analyzed the natural course of cervical spine involvement in rheumatoid arthritis by serial radiographs. OBJECTIVES: The purpose was to determine the pattern of progression of cervical spine lesions in rheumatoid arthritis and predictors for the extent of progression. SUMMARY OF BACKGROUND DATA: Subluxation frequently occurs as a result of rheumatoid involvement of the cervical spine. It may be severe in patients with mutilans deformities in the hands and feet. The extent of progression in a given patient is still unpredictable. METHODS: Serial cervical radiographs in 49 patients with rheumatoid arthritis were analyzed. The extent of progression was evaluated by rheumatoid arthritis subset defined previously, which reflected the final extent of joint erosion in this systemic disease and could be roughly classified during early stages of the disease. RESULTS: In the upper cervical spine, reducible anterior atlantoaxial subluxation occurred first. Vertical subluxation of the axis appeared next. Irreducible change of preceding anterior atlantoaxial subluxation was a sign of the start of vertical subluxation. In subaxial lesion, subluxation occurred less frequently (22.4%) than upper cervical lesion (77.6%). The extent of progression was different with the rheumatoid arthritis subset. In the upper cervical spine, none of the subset with least erosive disease developed vertical subluxation, whereas 52% of the subset with more erosive disease and 88% of the subset with mutilating disease advanced to vertical subluxation. The extent of progression was well correlated with the number of joints with erosion. Subaxial subluxation was often seen and became irreducible in mutilating disease and more erosive disease, but not in least erosive disease. CONCLUSIONS: A progressive pattern of the upper cervical subluxations was clarified. That is, upper cervical lesions progressed from reducible anterior atlantoaxial subluxation to irreducible anterior atlantoaxial subluxation with vertical subluxation. This extent of progression was different with the rheumatoid arthritis subset, which was also related to the development of subaxial subluxation. The most aggressive arthritis classification, a subset with mutilating disease, had the more severe subluxation in both upper and subaxial cervical spine.
7685227 The validity of surrogate markers in rheumatic disease. 1993 Jun Although RA is an inflammatory disease primarily affecting the synovial joints it also has marked systemic consequences. Pro-inflammatory systemically active cytokines are produced within the joint, found in the serum and are capable of inducing the hepatic synthesis of acute-phase proteins. Initially it was believed that the acute-phase response was elicited by the cytokine, interleukin-1 alone. However, it is now clear that there is a complex interaction between the cytokines with interleukin-6 predominant, but also involving interleukin-1, tumour necrosis factor and a group of recently described cytokines including interleukin-11, leukaemia inhibitory factor and oncostatin M all of which influence the levels of acute-phase proteins. In clinical practice CRP is frequently used as a marker of the acute-phase response. It has a short half-life and consequently is a sensitive measure of cytokine-induced protein synthesis. The rate of appearance of bony erosions early in disease correlates with the mean serum concentration of CRP in some studies. It has been suggested that a weak correlation probably reflects the fact that joints in which erosions most frequently occur, namely the small joints of the hand, produce smaller amounts of cytokine than the large joints such as the knee. A recent study examining the rate of spinal trabecular bone loss in the first year of rheumatoid disease found a strong correlation between bone loss and serum CRP concentrations. It appears that CRP concentrations reflect the level of 'systemic osteoclast-activating factor' and are, therefore, a good measure of the general catabolic state of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)
8036553 [Renal damage in rheumatoid arthritis]. 1994 Mar Renal damage is not uncommon in rheumatoid arthritis, but the causative role of the disease per se is not well defined yet. In this paper the updated literature data are reported and our own experience as well. In particular, we describe renal syndromes associated with non-steroidal antiinflammatory drugs, remission-inducing agents (gold and penicillamine) and cytotoxic drugs, secondary amyloidosis, systemic rheumatoid vasculitis, glomerular and tubulo-interstitial nephritis not related to drug therapy.
8977918 [Biological rhythm, inflammation and non-steroidal anti-inflammatory agents]. 1996 Sep The inflammation is characterized by a multifrequency time structure described both in the edematous reaction and in the migration of neutrophilic polymorphonuclear (PMN) in the inflammatory site. The circadian rhythm of PMN migration appears to be similar when the migration was induced by BCG, LPS or carrageenan. The corticosteroids play an important role in the mechanisms in the circadian rhythm of PMN, but recent data in intact and castrated mice indicated that testosterone is also involved in these mechanisms. In arthritic patients, the signs and symptoms of the diseases varied as a function of time of day and of the type of arthritic diseases. Human data with indomethacin, ketoprofen and piroxicam indicated that it is possible to find an optimal time of day for the administration of these non-steroidal anti-inflammatory agents (NSAID). Clinicians can use these chronopharmacological data to maximize the analgesic effect and to minimize the side effects of the NSAID. The research on biological rhythms in inflammation and in the effects of NSAID lead to a better understanding of the mechanisms of inflammation and to the rational use of the drugs in arthritic patients.
8587070 Lack of correlation between pharmacokinetics and efficacy of low dose methotrexate in pati 1995 May OBJECTIVE: To determine if the variability in the efficacy of methotrexate (MTX) in rheumatoid arthritis (RA) is correlated with its pharmacokinetics. METHODS: MTX pharmacokinetics was evaluated in 46 patients with RA starting a weekly intramuscular low dose MTX treatment. The patients were divided into 32 responders and 14 nonresponders to MTX according to the clinical response in the 6 months after the pharmacokinetic study. MTX plasma (at T0, 0.25, 0.5, 0.75, 1, 2, 4, 6, 8, 12 and 24 h) and urine concentrations were measured with the TDx Abbott fluorescence polarization immunoassay. RESULTS: The MTX dosage, age, sex, RA duration, hepatic and renal functions of responders and nonresponders were not different. No difference was found either in peak concentration, residual 24th hour concentration, area under the curve, total body clearance, renal clearance, and terminal T1/2 life of MTX in responders and nonresponders. Surprisingly, patients with adverse reactions had higher total body and renal MTX clearances than those without side effects during the study. CONCLUSION: These data suggest that plasma MTX measurements are not helpful in defining an optimal treatment regimen.
8211807 [The level of serum thymic activity in patients with rheumatoid arthritis and systemic lup 1993 Thymic serum activity (TSA) has been studied in 52 healthy subjects, 48 rheumatoid arthritis patients and 17 sufferers with systemic lupus erythematosus aged from 18 to 70. TSA was compared in patients under and over 40 years. In those under 40 TSA appeared significantly inhibited, while in older subjects it did not differ from age-matched control. No correlations were reported between TSA levels and clinical characteristics. Changes in TSA levels may be related both to low content of thymic hormones and formation of inactive complexes from thymic mediators with inhibitors.
7833164 Ultrasonography in arthritis of the knee. A comparison with MR imaging. 1995 Jan Ultrasonography (US) of the knee in gonarthritis was evaluated with gadolinium-DTPA-enhanced MR imaging as a reference. The study included 13 patients with gonarthritis, 2 patients with osteoarthritis and 5 healthy controls. Compared to MR, US identified 100% (12/12) of joint effusions, 100% (5/5) of Baker's cysts, 57% (8/14) of the synovial membranes of the suprapatellar recess and 38% (3/8) of bone erosions. No MR or clinical findings characterized the patients with ultrasonographically identifiable synovial membranes. Quantitative MR- and US-estimates of effusion, synovial membrane and cartilage thicknesses were correlated. The Spearman correlation coefficients were 0.87, 0.86 and 0.82, respectively. US reliably demonstrated joint effusions and Baker's cysts but showed lack of sensitivity for demonstration of the synovial membrane and bone erosions. When the synovial membrane was identifiable, the measurements of synovial thickness by US appeared precise. Cartilage evaluation by US seemed dependable. The clinical value was limited, because the weight-bearing areas were inaccessible.
8820057 [Radionuclide diagnosis of local inflammation in patients with rheumatoid arthritis]. 1995 Radionuclide scintigraphy with osteotropic radiopharmaceuticals labelled 99Tc proved highly sensitive in assessment of local inflammation. Osteoscintigraphy allows detection of preclinical and pre-x-ray lesions in the joints in RA and assessment of the treatment efficacy. Characteristic signs of the radionuclide distribution and accumulation can serve as a prompt in differential diagnosis of RA, DOA, reactive and gouty arthritis.
8996470 Clinical outcome after one year following samarium-153 particulate hydroxyapatite radiatio 1996 The clinical outcome and tolerability following treatment with samarium-153 particulate hydroxyapatite was evaluated in patients with persistent rheumatoid knee synovitis. The clinical review of 18 patients treated with intra-articular samarium-153 particulate hydroxyapatite combined with triamcinolone hexacetonide who had failed to obtain more than 4 weeks symptom relief from a prior intra-articular glucocorticoid injection was undertaken. No unwanted effects from the treatment were observed. Symptom relief was maintained in 56% patients at 6 months and in 44% of patients at 12 months following treatment. Median duration of symptom relief was 9 months. There was a significantly higher mean baseline Ritchie Articular Index in patients relapsing within 3 months and a trend towards earlier relapse in patients with higher indices of disease activity at the time of treatment. There was a trend towards earlier relapse in patients with a poor range of knee flexion at baseline and with worse indices of intra-articular radiopharmaceutical distribution. Samarium-153 particulate hydroxyapatite knee synovectomy is well tolerated and may be an effective treatment for carefully selected patients with persistent rheumatoid knee synovitis.
8583067 Salvage of the failed Darrach procedure. 1995 Nov Six patients (5 post-traumatic, 1 rheumatoid) underwent a three-component reconstruction for correction of dorsal instability and radioulnar impingement following failure of a Darrach resection of the entire distal end of the ulna. The technique was devised to prevent simultaneous coronal and sagittal instability. The procedure used longitudinal intramedullary tenodesis of the extensor carpi ulnaris tendon, dorsal transfer of the pronator quadratus through the interosseous space, and temporary percutaneous pinning to maintain corrected distal radioulnar relationship. The were evaluated for 11 to 39 months (average, 20 months) following reconstruction. The preoperative wrist extension-flexion arc was preserved following surgery; there was a minimal loss of radial and ulnar deviation. The arc of forearm rotation increased 24 degrees to a range equal to 95% of the rotational arc of the opposite, unoperated wrist. Postoperative grip strength improved to an average value of 65 lb., two and one half times the preoperative value, representing 80% of the value for the opposite extremity. Four patients were able to return to their previous employment. All patients achieved pain-free forearm rotation and relief of their preoperative complaints of painful mechanical popping, clicking, and catching.
8791962 High-dose ranitidine for the prevention of recurrent peptic ulcer disease in rheumatoid ar 1996 Jun BACKGROUND: Continuous therapy with low-dose ranitidine (150 mg b.d.) is known to be effective for the prevention of recurrent nonsteroidal anti-inflammatory drug (NSAID)-associated duodenal ulcer but not for gastric ulcer. AIM: To investigate, in a double-blind placebo-controlled study, the preventive effect of a high dose of ranitidine (300 mg b.d.) on the recurrence of both duodenal ulcers and gastric ulcers in rheumatoid arthritis patients with a continuous need for NSAIDs. METHODS: Rheumatoid arthritis patients with a history of peptic ulcer disease were randomized to receive either ranitidine 300 mg b.d. or placebo for 12 months. Endoscopy was performed at study entry and after 6 and 12 months. End-point was the recurrence of gastric or duodenal ulcers. RESULTS: The study was stopped after a blinded interim analysis; at that time 10 of the 15 included patients in each treatment group were evaluable. Recurrent duodenal ulcers had occurred in four patients treated with placebo and none of the patients treated with ranitidine (Fisher's exact one-tailed P = 0.04; 95% CI, - 0.70 to -0.10). Recurrent gastric ulcers had occurred in six patients in the placebo group and three patients in the ranitidine group (Fisher's exact one-tailed P = 0.18; 95% CI, -0.72 to 0.12). Two patients in the placebo group had developed both duodenal ulcers and gastric ulcers. No adverse events were observed. CONCLUSIONS: High dose ranitidine is effective for the prevention of recurrent duodenal ulcer but not for recurrent gastric ulcer in rheumatoid arthritis patients taking NSAIDs.
1354392 Treatment of rheumatoid arthritis with single dose or weekly pulses of chimaeric anti-CD4 1992 Aug The aetiology of rheumatoid arthritis is unknown but CD4+ T cells are known to be involved in its pathogenesis. Because of this, anti-CD4 monoclonal antibody has been used in open studies with clinical benefit in up to 60% of patients. We have used a chimaeric anti-CD4 monoclonal antibody (cM-T412, Centocor) in a randomized, double-blinded, placebo controlled trial as treatment for rheumatoid arthritis. Nine patients with active rheumatoid arthritis resistant to traditional disease-modifying drugs were recruited. Four received an intravenous 50 mg bolus of antibody, and three received 50 mg weekly for four consecutive weeks. Two patients received placebo. Despite a marked reduction (P less than 0.001) in peripheral blood CD4+ lymphocytes, there was no significant clinical improvement in any of these patients. The decrease in CD4+ lymphocyte number lasted one week after a single 50 mg dose of cM-T412 but was more prolonged in the patients who received four infusions. CD8+ T cells, CD16+ cytotoxic cells and CD14+ monocytes showed only a transient reduction. It may be concluded that the therapeutic efficacy of anti-CD4 therapy is not directly related to CD4+ T-cell lymphopenia.
1485130 [Antiperinuclear antibodies and corrisponding antigens]. 1992 Sep Antiperinuclear factors (APF) are directed to epithelial cell "kerato-hyaline granules". Standardization of the APF test has been achieved, but the way to express the results is still debatable. APF were found to be present in 76% of rheumatoid arthritis (RA) patients: thus the sensitivity and the specificity for RA were 76 and 97%, respectively. No clinical or serological associations were substantiated in RA. The antigens targetted by these auto-antibodies are extremely variable from one to another donor.
7856689 Genital tract abnormalities and female sexual function impairment in systemic sclerosis. 1995 Feb OBJECTIVE: Our purpose was to determine the involvement of the female genital tract and its functional consequences on menstrual and sexual aspects in systemic sclerosis. STUDY DESIGN: Sixty women with systemic sclerosis and 23 age- and disease duration-matched women with either rheumatoid arthritis or systemic lupus erythematosus were surveyed with a comprehensive questionnaire addressing problems before and after disease onset. Fourteen systemic sclerosis patients also had gynecologic evaluations. RESULTS: Vaginal dryness (71%), ulcerations (23%), and dyspareunia (56%) were significantly more frequent in patients with systemic sclerosis after disease onset than before and also in comparison with control subjects. Vaginal tightness and constricted introitus were present in 5 of 60 systemic sclerosis patients. More than half of systemic sclerosis patients reported a decrease in the number (p = 0.04) and intensity (p = 0.02) of orgasms, compared to < 20% of control subjects. The desire and frequency of coitus and the sexual satisfaction index were impaired equally in each group. Skin tightness, reflux-heartburn, and muscle weakness adversely affected sexual relations more in systemic sclerosis than in control subjects. On gynecologic examination 5 of 11 systemic sclerosis patients had small-sized uteri, and 3 of them had early menopause at 29, 38, and 43 years. Seven of 16 (44%) women with systemic sclerosis, compared with 6% of normal women in the United States, attained natural menopause before age 45. CONCLUSIONS: Although impairment in various indexes of sexual function occurs in a number of autoimmune diseases, decreased orgasmic function appears to be limited to systemic sclerosis. Vaginal involvement and other systemic sclerosis-related systemic symptoms adversely influence sexual relations. Menstrual abnormalities, including early menopause, affect many patients. Genital tract involvement occurs in a substantial proportion. Prospective longitudinal studies are warranted.
7482313 [Corticosteroid therapy and aseptic bone necrosis in patients with rheumatoid arthritis]. 1995 Two groups of RA patients were compared: 102 patients with osteonecrosis of the head of the femur (group 1) and 50 patients free of it (group 2). Group 1 patients had bilateral lesion of the hip joints (28% of cases), unilateral osteonecrosis of knee joint in 14.5% and bilateral in 2.9% of the patients. Unilateral humeral osteonecrosis occurred in 17.6%, bilateral in 4.9% of patients. Extra-articular manifestations of RA (lymphadenopathy, renal lesions and Cushing's syndrome) were diagnosed more frequently in group 1. Progression of osteonecrosis is related to a mean maximal day dose of prednisolone in the first month of therapy.
9036721 [Low dose methotrexate therapy in chronic polyarthritis--an update]. 1996 Since the early eighties methotrexate (MTX) has become of increasing importance in long-term therapy of rheumatoid arthritis (RA) as a disease modifying drug (DMARD). Nowadays it is probably the most frequently prescribed DMARD for RA and can be regarded as the gold standard in long-term therapy. MTX can be administered orally or parenterally, the bioavailability shows high individual differences, but is about 70% after oral administration on average. Its protein-binding amounts to 50%, the main pathway of elimination is renal tubular secretion, to a smaller extent also biliary excretion. MTX polyglutamates are stored intracellularly. Its mode of action in RA is not completely elucidadet yet, besides inhibition of dihydrofolatereductase and consequently inhibition of thymidilate synthesis, some antiinflammatory effects, such as stimulation of Adenosine release from neutrophils, may contribute to the therapeutical effects. MTX' efficacy could be proven by several controlled trials, some of them lasting for more than five years. During long-term therapy with MTX a folate deficiency may occur, which can lead to some side effects. Most important but rarely occurring is pneumonitis, moreover hepatotoxicity and hematological features have to be intensively considered. The risk of the development of osteopenia or an increased incidence of malignancies during MTX therapy is currently investigated. In case of clinical and laboratory controls at regular intervals and patient education MTX therapy can be regarded as effective, well tolerable and considerably safe for patients with rheumatoid arthritis.
7473464 HLA-DRB1 genotyping in patients with rheumatoid arthritis in Taiwan. 1995 Aug OBJECTIVE: To investigate the relation of HLA-DR alleles to the development of rheumatoid arthritis (RA) and the correlations between HLA-DR alleles and clinical manifestations of patients with RA in Taiwan. METHODS: The HLA-DRB1 alleles were studied in 144 patients with RA and 154 healthy controls using polymerase chain reaction/sequence specific oligonucleotide probe methods. The subtypes of HLA-DR4 were detected by cloning sequencing. RESULTS: The prevalence of HLA-DR4 was significantly higher in patients with RA (46.53%) than in healthy controls (25.97%). HLA-DRB1*0405 was more common in patients than in controls (83.58 vs 50%), while the prevalence of DRB1*0403 in patients (4.48%) was significantly lower than in controls (27.5%). There was no significant difference in frequencies of HLA-DR alleles between DRB1*0405 negative patients and DRB1*0.05 negative controls. We also noted a positive correlation in patients between HLA-DR4 and bone erosion, but not HLA-DR4 and age of onset, seropositivity, or extraarticular involvement. There was no significant difference in seropositivity, extraarticular involvement, and bone erosion between homozygous and heterozygous DR4 patients. CONCLUSION: HLA-DRB1*0405 is related to the development of RA in Taiwan, while DRB1*0403 was a negative risk factor. HLA-DR4 was associated with bone erosion in patients.
8187436 Parvovirus infection causing red cell aplasia and leukopenia in rheumatoid arthritis. 1994 Mar A case of acute parvovirus B19 infection causing fever, anaemia, leukopenia, and red cell aplasia, in a patient with chronic rheumatoid arthritis is described. The patient had received low doses of corticosteroids for several years, and a small dose of methotrexate recently. There was no evidence of haemolytic anaemia, iron deficiency or drug toxicity. Recovery was associated with the development of antibodies against parvovirus B19, and clearance of viraemia as detected by the polymerase chain reaction. Possible mechanisms for the development of leukopenia are discussed, but there was no evidence for haemophagocytosis.