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ID PMID Title PublicationDate abstract
8573989 Pharmacological intervention in older patients with rheumatoid arthritis. Quality of life 1995 Nov Despite the rather pessimistic outlook regarding the long term effects of pharmacological treatment of patients with rheumatoid arthritis (RA), there is no doubt that drug interventions can affect quality of life (QOL). The disease has a significant impact upon physical, psychological and social function, and QOL optimisation should cover all these dimensions. Swelling of joints and pain are important manifestations in assessing RA since these may result in sleep disturbances as well as depressed mood. This might be particularly significant for older persons with RA. Outcome parameters of RA can be divided into short, intermediate and long term. The long term results are quite disappointing with regard to disability and premature death. However, more intermediate outcome measures related to QOL might improve after pharmacological interventions. Patient preferences and expectations with regard to the outcome of pharmacological interventions are important parameters to assess. When assessing older patients with RA with QOL instruments, it is recommended that questionnaires are fairly short and easy to complete. Adverse effects of pharmacological interventions are important factors to monitor in QOL assessment in older patients with reduced remaining life span.
1303632 The response of 99Tcm-methylene diphosphonate and 99Tcm-hexametazime-labelled neutrophils 1992 Jul The synovial and bone uptake of tracer in the knees of patients with rheumatoid arthritis (RA) was quantified using 99Tcm-hexamethyl propylene amine oxime-labelled leucocytes and 99Tcm-methylene diphosphonate (MDP), respectively. Significant neutrophil migration and MDP uptake occurred in the knees of patients with RA irrespective of the disease duration. In all but one patient neutrophil migration was reduced after intra-articular steroid injection. The change in MDP uptake after steroid injection was variable. There was a significant correlation between the percentage reduction in neutrophil migration and pain score, while the latter correlated poorly with the change in MDP uptake. The quantification of the neutrophil component of the inflammatory process is a sensitive index for monitoring RA activity and response to pharmacological interventions, while quantitative bone scintigraphy should not be employed to monitor changes in joint inflammation in patients with RA.
1586244 Occurrence of (E)-4-hydroxy-2-nonenal in plasma and synovial fluid of patients with rheuma 1992 Apr (E)-4-Hydroxy-2-nonenal (HNE), a cytotoxic propagation product of lipid peroxidation, is present in the synovial fluid (0.54 (0.19) mumol/l; mean (SE), n = 9) and plasma (0.34 (0.09) mumol/l, n = 9) of patients with rheumatoid arthritis. This compound was also found in the synovial fluid (0.24 (0.19) mumol/l, n = 9) and plasma (0.09 (0.03) mumol/l, n = 9) of patients with osteoarthritis. The concentration of HNE in the plasma of patients with rheumatoid arthritis was significantly greater than in patients with osteoarthritis.
1586248 Measurement of whole unstimulated salivary flow in the diagnosis of Sjögren's syndrome. 1992 Apr The criteria for a clinical diagnosis of Sjögren's syndrome remain controversial and vary widely from study to study. With respect to the oral component it is considered necessary to use some form of objective test, but many of those available are not suitable for use in a busy clinical situation. The purpose of this study was to evaluate a simple method for measuring the whole unstimulated salivary flow. Twenty five patients with Sjögren's syndrome, 69 young control subjects, 20 age matched normal older control subjects and 20 patients with rheumatoid arthritis without Sjögren's syndrome had their salivary flows measured. Whole unstimulated salivary flows in the young control subjects were higher than in all other groups. Patients with primary Sjögren's syndrome had lower flows than either the older controls or the rheumatoid patients. Among the patients with Sjögren's syndrome 52% had a flow of 0.1 ml/min or less compared with only 8% of age matched controls. The positive predictive value of this low flow was 81%. It is concluded that whole unstimulated salivary flows of 0.1 ml/min or less are highly specific for xerostomia. When interpreted in the context of all the clinical findings whole unstimulated salivary flows are useful for diagnosing the oral component of Sjögren's syndrome.
8615092 Impacted morsellized allograft and cement for revision total knee arthroplasty: a prelimin 1996 Feb In 3 cases we have revised a failed knee arthroplasty with intramedullary impaction of morsellized allograft similar to the technique described for the hip. Follow-up after 18, 21 and 28 months showed good clinical and radiographic results.
8639168 Guidelines for monitoring drug therapy in rheumatoid arthritis. American College of Rheuma 1996 May Drugs used to treat RA may cause death, disability, and diseases, especially if the treatment continues in the setting of undetected toxicity. Prevention of toxicity may be enhanced by pretreatment assessment of individual risk factors for toxicity and by careful patient and physician education about safe use of the drug. Patients and their physicians must be alert to the signs and symptoms of toxicity that should prompt discontinuation of the drug and physician reassessment. Some drug toxicity may be discovered by appropriate laboratory monitoring before serious problems become clinically apparent. The 3 major drug categories for the treatment of RA are the NSAIDs, DMARDs, and glucocorticoids. Most NSAIDs have common GI and renal toxicity that may be averted by careful patient selection and administration of the drug. The individual DMARDs have specific toxicities for which monitoring protocols have been developed. The serious side effects of systemic glucocorticoids are largely related to dose and duration of treatment. The recommendations summarized in Table 1 are for basic monitoring in patients with uncomplicated RA. Additional monitoring may be appropriate for patients with comorbid disease, concurrent medication, or other risk factors.
7548857 Synovial fluid lipids and apolipoproteins: a contemporary perspective. 1995 Jan Normal human synovial fluid contains extremely low concentrations of lipoproteins and apolipoproteins, in sharp contrast to those found in plasma. Increased amounts of cholesterol and other lipids have been found in the synovial fluid of a chronic inflammatory joint disorder, rheumatoid arthritis (RA). More recently, apolipoproteins AI, B and E have also been found in increased amounts in RA synovial fluid. Theories have been proposed to account for this increase in the amount of apolipoproteins and for the source of lipids and lipoproteins in normal synovial fluid; however, the mechanisms have not yet been established. Lipoproteins may play dual roles in synovial fluid: A functional one in normal synovial fluid and, as some suggest, a pathologic one in the abnormal synovial fluid of certain arthritic diseases. The recent data prompt the need to define synovial fluid lipids, lipoprotein particle subfractions and their constituent apolipoproteins, as well as their respective roles in synovial fluid.
1485129 [Current aspects of inflammatory rheumatic diseases in elderly patients]. 1992 Sep Rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR) are the most common rheumatologic diseases encountered in older patients. However, other disorders including spondylarthropathy and a variety of connective tissue diseases also occur in the elderly. PMR and the RS3PE syndrome seem to occur only in the elderly, although their symptoms may be difficult to differentiate from those of other conditions. Late-onset RA and, above all, late-onset spondylarthritis may have unusual presentations responsible for diagnostic mistakes. Pitting edema is typical of RS3PE syndrome but may also occur in other rheumatic diseases. This symptom seems to be associated with advanced age rather than with a specific cause. Because of these many unusual features, rheumatologic diseases in the elderly are often difficult to diagnose and to differentiate from a variety of other rheumatologic or nonrheumatologic conditions.
7797958 Metacarpophalangeal joint prostheses. A review of the clinical results of past and current 1995 Apr The clinical results of past and current hinge, flexible and third generation designs of MP prosthetic joints are reviewed. The hinged prostheses did not achieve acceptable short term clinical results while the silastic and third generation prostheses provided good results with with correction of deformity and adequate range of motion (ROM). These good short term results did, however, get progressively worse with the recurrence of deformities and loss of ROM. It is evident that while most of the existing prostheses can relieve pain and restore appearance, none provide the degree of stability and ROM that is required to restore normal function to the MP joint. The moderate results could be partly due to the stage of the disease at which the surgery is carried out. At present, surgery on patients with rheumatoid arthritis is undertaken at a stage in the disease where the muscles and the ligaments surrounding the joint, and the bone, are generally in a poor condition. Surgery at this stage is really only a salvage procedure.
8215726 Progression of functional disability in patients with rheumatoid arthritis. Associations w 1993 Oct 11 BACKGROUND: To determine whether patients with rheumatoid arthritis and their physicians make appropriate decisions regarding referral to rheumatologists and the need for continuing rheumatology care, we examined the relationship between the progression of functional disability in these patients and their use of rheumatology subspecialty care over time. METHODS: A cohort of 282 patients with rheumatoid arthritis was followed prospectively for up to 10 years. Participants were categorized into three subgroups based on the pattern of care received from rheumatologists over the study period: patients who were never treated by a rheumatologist; patients treated by a rheumatologist only intermittently; and patients treated by a rheumatologist at least once during each 6-month study period. The outcome was the rate of progression of functional disability, measured using the Health Assessment Questionnaire Disability Index. RESULTS: Among the 52 patients who had not been referred to a rheumatologist, 30 (58%) had rates of progression of functional disability that were stable or improving over time (rate < 0.01 Disability Index units per year), while 22 (42%) had rates that were worsening (rate > or = 0.01 Disability Index units per year). Among patients treated by rheumatologists, the average rate of progression was substantially lower among the 69 patients who were treated regularly by a rheumatologist than among 161 patients treated by rheumatologists intermittently (0.008 Disability Index units per year vs 0.020 Disability Index units per year). This difference was associated with more intensive use of second-line antirheumatic medications, and more frequent joint surgeries, among patients treated by rheumatologists on a regular basis. CONCLUSIONS: Most patients with rheumatoid arthritis in this community cohort were treated by a rheumatologist, but 42% of those not referred had progressively increasing functional disability. Among patients treated by rheumatologists, those who had continuing care from rheumatologists experienced lower rates of progression of functional disability than those who had only intermittent care. These results suggest that use of rheumatology subspecialty care is associated with better health outcomes in rheumatoid arthritis.
7731111 [Pulmonary complications in patients with rheumatoid arthritis]. 1995 Feb Pulmonary manifestations of rheumatoid arthritis were studied in 26 patients. Pulmonary complications could be divided into four subgroups: Interstitial pneumonia/Pulmonary fibrosis (n = 18), Bronchiolitis Obliterans Organizing Pneumonia (n = 4), Bronchiolitis Obliterans (n = 2), and Pleuritis/Pericarditis (n = 1). Analysis of cells in broncho-alveolar lavage fluid (BALF) revealed abnormally high percentages of lymphocytes in one-half of the patients and abnormally high percentages of neutrophils in one-third of the patients. The percent of BALF cells that were neutrophils was higher with higher chest radiograph grades. Analysis of soluble constituents of BALF indicated local production of IgG in two cases, but IgM-rheumatic factor was not detected. In 18 of 26 patients corticosteroid or immunosuppressive drugs were needed, and most of the patients responded to the therapy and had good outcomes. The conditions of 6 patients with interstitial pneumonia/pulmonary fibrosis deteriorated and 4 patients died of progressive respiratory failure. The subclassification of rheumatoid lung was useful for predicting its outcome.
7906259 HLA-DR1-positive patients suffering from rheumatoid arthritis are at high risk for develop 1993 Oct Population studies suggest an association between RA and, depending on the ethnic background, HLA-DR1 and/or -DR4. One standard regimen for the treatment of RA is the use of gold compounds like SATM to arrest progression of the disease. In the present study, the immunogenetic background of RA patients developing side effects upon SATM treatment was determined. A total of 53 patients under SATM therapy were tested for their HLA-DRB and -DQ alleles by DNA typing; a significantly higher frequency of HLA-DR1 (p < 0.004, uncorrected) was observed in patients presenting with mucocutaneous side effects (MCT) when compared with patients without MCT. The RR was 6.85. Thus, HLA-DR1 seems to be a marker for the susceptibility of gold adverse reactions.
8156284 Reduced activity of serum creatine kinase in rheumatoid arthritis: a phenomenon linked to 1994 Mar In a case-controlled study, serum creatinine kinase (CK) activity was significantly lower in 40 patients with RA than in 40 age- and sex-matched patients with non-inflammatory arthropathies [mean 37.6 (S.D. 29.2) vs 77.7 (S.D. 45.3) IU/l respectively P < 0.0001]. In contrast, serum levels of aldolase and myosin were not significantly lower in RA patients. A significant inverse correlation between CK activity and ESR, CRP and platelet count was observed in RA. There was also a positive correlation between haemoglobin levels and CK values. No correlation was found between CK activity and a meager mass index, disease duration and radiological erosion. No inhibitor of CK activity in the sera of RA patients was found. CK serum activity was markedly reduced in RA, and is related to the inflammatory activity of the disease. This finding may stimulate further exploration on the effect of inflammatory response in muscle metabolism.
8789876 Adult seronegative arthritis with antinuclear antibodies: a distinct group of patients wit 1996 May To determine whether patients with rheumatoid factor (RF)-negative, antinuclear antibody (ANA)-positive oligo/polyarthritis are clinically and immunogenetically distinct from RF-positive rheumatoid arthritis (RA) and whether this subset of patients is the adult counterpart of early-onset pauciarticular juvenile chronic arthritis (EOPA JCA), we retrospectively studied 20 adult patients with RF-negative, ANA-positive arthritis. After a median duration of 3.25 years, only half of our patients had active synovitis. Seventy-five per cent were completely or reasonably self-sufficient according to the HAQ index. In contrast to the results in a group of 30 RF-positive RA patients, the percentage of patients having at least one of the susceptibility alleles (HLA DR1 or HLA-DR4) was not significantly higher in patients with RF-negative, ANA-positive arthritis than in controls. Furthermore, none of our RF-negative, ANA-positive patients had two susceptibility alleles, whereas 16.5% of RF-positive RA patients had both DR1 and DR4 or DR4 homozygosity. In conclusion, our results show that patients with RF-negative, ANA-positive oligo/polyarthritis are immunogenetically distinct from RF-positive RA and tend to have a better articular prognosis. The absence of typical ocular features and of the characteristic HLA-DR markers suggests that these patients cannot be considered as the adult counterpart of EOPA JCA.
7639798 Levels of circulating collagenase, stromelysin-1, and tissue inhibitor of matrix metallopr 1995 Aug OBJECTIVE: To measure serum levels of matrix metalloproteinase-1 (MMP-1), matrix metalloproteinase-3 (MMP-3), and tissue inhibitor of MMP-1 (TIMP-1) in patients with rheumatoid arthritis (RA) and in age-matched control subjects, and to determine how these correlate with serum levels of antigenic keratan sulfate (KS) and other biochemical and clinical indicators of disease activity. METHODS: Immunoassays were used to measure levels of MMP-1, MMP-3, TIMP-1, and antigenic KS. Radiologic and functional joint scores were based upon Steinbrocker's criteria. Erythrocyte sedimentation rates (ESR) and levels of C-reactive proteins (CRP) were measured. RESULTS: In RA patients, levels of MMP-3 and TIMP-1 were significantly increased, and strongly correlated with the ESR and CRP levels but not with radiologic or functional joint scores. Levels of antigenic KS were significantly lower in RA patients and correlated negatively with systemic parameters of inflammation and serum levels of TIMP-1. CONCLUSIONS: The increase in serum levels of MMP-3 and TIMP-1 appears to reflect systemic inflammation in RA. The inverse correlation between serum levels of TIMP-1 and antigenic KS suggests that an upregulation of TIMP-1 synthesis might be responsible for the apparent suppression of cartilage aggrecan catabolism in patients with severe inflammatory changes.
8239758 Abnormal plasma fibrinolysis in patients with rheumatoid arthritis and impaired endothelia 1993 Sep OBJECTIVES: (a) To assess plasma fibrinolytic parameters in patients with rheumatoid arthritis (RA) and to determine whether there are differences between patients with RA alone and those with RA complicated by vasculitis. (b) To determine if patients with RA respond differently to venous occlusion compared with normal subjects and to assess whether such a response differs in patients with RA alone and those with rheumatoid vasculitis. (c) To determine the extent of vascular damage in patients with rheumatoid vasculitis and if this correlates with the levels of plasma fibrinolytic parameters. METHODS: Sixty three patients with RA (38 had RA only and 25 had evidence of rheumatoid vasculitis) were recruited. Plasma levels of tissue plasminogen activator antigen (t-PA Ag), plasminogen activator inhibitor (PAI) activity, and factor VIII von Willebrand factor (vWF) were measured before and 10 minutes after venous occlusion. RESULTS: Patients with RA, with or without rheumatoid vasculitis, had higher baseline PAI levels than control subjects. The difference was statistically significant for patients with RA alone but was not statistically significant for patients with rheumatoid vasculitis. After venous occlusion, t-PA Ag levels increased significantly in normal subjects and patients with RA alone, but not in patients with rheumatoid vasculitis. Plasma levels of vWF were significantly higher in patients with rheumatoid vasculitis than in normal subjects and those with RA alone. In patients with RA alone, baseline vWF correlated positively with t-PA Ag levels, whereas a negative correlation was found between these two parameters in patients with rheumatoid vasculitis. A negative correlation between vWF and t-PA Ag levels after venous occlusion was also found in patients with rheumatoid vasculitis. CONCLUSIONS: Patients with rheumatoid vasculitis showed evidence of vascular damage with increased levels of vWF and impaired t-PA Ag release after venous occlusion, a useful measurement of endothelial reserve to remove fibrin. This may be of pathophysiological importance in the development of vasculitis in these patients.
8984938 Purine enzyme activities in recent onset rheumatoid arthritis: are there differences betwe 1996 Oct OBJECTIVE: Purine enzyme activities may predict the effectiveness of azathioprine treatment and be associated with increased deaths from infectious diseases. In rheumatoid arthritis, patients show variable responses to azathioprine and a higher percentage of death is caused by infections. The aim of the study was to investigate possible rheumatoid arthritis associated abnormalities of purine enzyme activities by measuring several of these enzymes in patients with recent onset rheumatoid arthritis before treatment with disease modifying antirheumatic drugs or prednisone. METHODS: 23 patients with recent onset rheumatoid arthritis and 28 healthy controls were studied. Activities of the enzymes 5'-nucleotidase, purine nucleoside phosphorylase (PNP), hypoxanthine guanine phosphoribosyltransferase (HGPRT), and thiopurine methyltransferase (TPMT) were measured. Assessment of disease activity and blood sampling for routine measurements and HLA typing were done simultaneously. RESULTS: Purine enzyme activities did not differ between patients and healthy controls. Enzyme activities had no significant relations with indices of disease activity or rheumatoid factor titre or with the rheumatoid arthritis associated HLA types. Activity of 5'nucleotidase decreased with age (P < or = 0.05) and was lower by about 27% (P = 0.007) in males than in females. CONCLUSIONS: In rheumatoid arthritis patients, neither the variability in azathioprine effectiveness nor the increased death rate from infections can be explained by pre-existing abnormalities in the activities of the purine enzymes 5'-nucleotidase, PNP, HGPRT, or TPMT at an early stage of the disease, before disease modifying antirheumatic drugs or prednisone treatment. Besides adjustment for age, results of studies involving purine 5' nucleotidase activity should also be adjusted for sex.
8744012 NMR studies on human, pathologically changed synovial fluids: role of hypochlorous acid. 1996 Jun Recently, it has been reported that hypochlorous acid (HOCl), a special product of neutrophil myeloperoxidase, degrades N-acetyl groups of N-acetylglucosamine, chondroitin sulfate, hyaluronic acid, and minced articular cartilage via a transient product to acetate. This work concerns 1H NMR investigations of synovial fluids of patients with rheumatoid arthritis (RA). Synovial fluids of patients with severe forms of this disease are characterized by enhanced 1H NMR signals for N-acetyl groups (approximately 2.0 ppm) and acetate (1.90 ppm) and the appearance of a broad but less intense signal at 2.35 ppm. It is likely that this signal corresponds to the transient, chlorinated product of degradation of N-acetyl groups by hypochlorous acid. Moreover, 1H NMR signal intensities of N-acetyl groups and acetate strongly correlate with the myeloperoxidase activities in synovial fluids from patients with rheumatoid arthritis. These results have been confirmed by treatment of native sheep synovial fluid with sodium hypochlorite, resulting in the formation of the same resonances as observed in pathologically changed synovial fluids from humans. Thus, it is concluded that HOCl plays an important role for the cartilage degradation during rheumatoid arthritis.
7866377 The economic impact of musculoskeletal disorders. 1994 Dec Musculoskeletal disorders have a major impact on society in terms of morbidity, long-term disability and economics. As populations increase and age, payment for medical care and indirect costs from loss of earnings will increase. Both rheumatoid arthritis and low back pain have a great economic impact on society, and the costs of these are escalating problems. Statistics are analysed from various studies in the United States and Canada, and these highlight the need for more rational and effective health care management strategies.
8730113 A cost effectiveness analysis of cyclosporine in rheumatoid arthritis. 1996 Apr OBJECTIVE: To perform a cost effectiveness analysis of cyclosporine (CyA) in the treatment of rheumatoid arthritis (RA). METHODS: Five randomized controlled parallel group clinical trials were selected for metaanalysis. A fixed effects model was used to calculate the treatment effects among the studies. An incremental economic analysis was performed from both a societal perspective and the perspective of Ontario Ministry of Health (MOH). A placebo comparison and 2 head to head comparisons were performed. The total treatment cost was calculated for a typical patient based on a modified intent to treat approach modelled over a one year period. RESULTS: CyA produced a 25% or greater improvement in tender joint account in 35% of the patients relative to 17% of patients receiving placebo. There was no significant difference in improvement between CyA and azathioprine (Aza) or D-penicillamine (D-Pen). From the perspective of the Ontario MOH, the annual incremental cost of achieving the same level of improvement between CyA and Aza was found to be $1,473, and between CyA and D-Pen, $1,618; the annual incremental cost effectiveness ratio per patient improved of adopting CyA over placebo was $11,547. From a societal perspective, the incremental cost of CyA was $2,886 and $3,731 between Aza and D-Pen, respectively. The annual incremental cost effectiveness ratio against placebo was $20,698. CONCLUSION: Given budgetary constraints on provincial drug plans, guidelines identifying patients in whom the cost effectiveness of CyA may be expected to be most favorable need to be explored. When CyA is the last option available to alleviate RA, whether it is "good value for money" depends upon the importance placed on patient improvement by the patients and/or by society, and on the alternative uses of the same scarce resources.