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ID PMID Title PublicationDate abstract
8972245 Use of methotrexate in older patients. A risk-benefit assessment. 1996 Dec Methotrexate is eliminated almost entirely by the kidneys. The risk of methotrexate toxicity is therefore increased in patients with poor renal function, most likely as a result of drug accumulation. Declining renal function with age may thus be an important predictor of toxicity to methotrexate. Up to 60% of all patients who receive methotrexate for rheumatoid arthritis (RA) discontinue taking it because of adverse effects, most of which occur during the first year of therapy. Gastrointestinal complications are the most common adverse effects of methotrexate, but hepatotoxicity, haematological toxicity, pulmonary toxicity, lymphoproliferative disorders and exacerbation of rheumatic nodules have all been reported. Decreased renal function as a result of disease and/or aging appears to be an important determinant of hepatic, lymphoproli ferative and haematological toxicity. Concomitant use of low doses of folic acid has been recommended as an approach to limiting toxicity. Interactions between methotrexate and several nonsteroidal anti-inflammatory drugs have been reported, but they may not be clinically significant. However, caution is advised in the use of such combinations in patients with reduced renal function. More serious toxicities (e.g. pancytopenia) may result when other inhibitors of folate utilisation [e.g. cotrimoxazole (trimethoprim-sulfamethoxazole)] or inhibitors of renal tubular secretion (e.g. probenecid) are combined with methotrexate. Before starting low dose methotrexate therapy in patients with RA, a full blood count, liver function tests, renal function tests and chest radiography should be performed. Blood counts and liver function tests should be repeated at regular intervals. Therapeutic drug monitoring of methotrexate has also been suggested as a means of limiting toxicity. Patients with RA usually respond very favourably to low dose methotrexate therapy, and the probability of patients continuing their treatment beyond 5 years is greater than for other slow-acting antirheumatic drugs. Thus, given its sustained clinical utility and relatively predictable toxicity profile, low dose methotrexate is a useful addition to the therapy of RA.
1414040 [Data of two years of the comparative study methotrexate/aurothiomalate in 102 patients]. 1992 Jul 102 patients (pat.) with active erosive rheumatoid arthritis (RA) with a median disease duration of only 14 months without malalignment or deformities entered a randomized study to compare the effects of 15 mg methotrexate (MTX) and 50 mg gold sodium thiomalate (GST) administered intramuscularly once a week. The study was double blind during the first year and open during the second year. Clinical and laboratory evaluations were made every three months. X-rays of hands, wrists and forefeet in standard a.p.-projection were taken at month 0, 6, 12 and 24. 32 joints were evaluated according to Larsen. 17/52 (MTX) and 21/50 (GST) patients were withdrawn for several reasons. Withdrawals for toxicity were significantly more frequent in the GST group. 35 patients in the MTX group and 26 patients in the GST group were evaluated for efficacy. All clinical parameters, ESR and CRP improved by more than 50% in both groups without significant intergroup difference. The greatest improvement was seen already after six months. An > 50% improvement occurred in 57% of pat. in both groups. The Larsen score (sum of the Larsen grades of 32 joints) deteriorated significantly in both groups during the first six months (MTX = 3.0, GST = +4.3), it remained stable thereafter in the MTX group and decreased in the gold group. The number of erosive joints increased significantly in both groups during the first six months. This increase was slowed down after six months in the MTX group, in the gold group a decrease was seen indicating a healing of erosions. All differences between the groups were not significant, however. CONCLUSION: While tolerability was better with MTX, both drugs were similarly effective in the treatment of RA and slowed down radiologic progression.
7699621 Effects of low dose methotrexate therapy on the concentration and the glycosylation of alp 1994 Dec OBJECTIVE: The concentration, and the degree of fucosylation and sialylation of human serum alpha 1-acid glycoprotein (AGP) were investigated for changes during 24-week low-dose methotrexate (MTX) or azathioprine treatment (AZA) in rheumatoid arthritis (RA) patients. METHODS: Serum samples from a longitudinal study were analyzed by crossed affinoimmunoelectrophoresis with the fucose specific Aleuria aurantia lectin. RESULTS: In general, the degree of fucosylation of AGP in RA sera was higher than in control sera, but decreased markedly under the influence of successful therapy with MTX. Concomitantly, the degree of sialylation of AGP increased and the concentration decreased. For alpha 1-protease inhibitor and haptoglobin similar results were obtained. In AZA responders less pronounced changes than in MTX responders were observed. In MTX nonresponders no significant trends were found. As in control sera, large interindividual differences in the AGP values were found. CONCLUSION: The heavy fucosylation of AGP in RA sera reflects disease activity rather than an intrinsic characteristic of people genetically predisposed to RA, since it was found to decrease upon disease improvement. The differences in effects on AGP of MTX and AZA suggest either a gradual difference in a similar mechanism of action, or a different mechanism of action of the drugs. Fucosylated and sialylated AGP could be important in the etiopathogenesis of RA, because these molecules potentially can bind to adhesion receptors (selectins), which could prevent the extravasation of leukocytes into inflamed joints.
7668897 Distribution, activation and tryptase/chymase phenotype of mast cells in the rheumatoid le 1995 Jul OBJECTIVE: To determine the distribution, activation, and tryptase/chymase phenotype of mast cells (MCs) in the rheumatoid lesion. METHODS: MC tryptase and chymase were studied by immunohistochemistry using monoclonal antibodies and examination by brightfield, interference, and fluorescent microscopy. Thirty four specimens of cartilage-pannus junction and 26 specimens of rheumatoid synovium, all derived from knee surgery, were examined. RESULTS: MCs were identified in all specimens examined, but their distribution and local concentrations varied, both within and between specimens. As a proportion of total synovial cells, there were more MCs in fibrous synovial tissues than in those with active inflammatory cell infiltrations; MCs usually showed a peripheral distribution around lymphocytic/mononuclear cell infiltrations. Most cartilage-pannus specimens demonstrated local concentrations of MCs at, or close to, sites of cartilage erosion, a significant proportion of which showed extracellular tryptase indicative of MC degranulation. MC degranulation was often associated with localised oedema and disruption of the stromal matrix. Two MC phenotypes were identified: one population contained tryptase alone (MCT) whilst another contained both tryptase and chymase (MCTC). The ratio MCT:MCTC approximated 8:1. CONCLUSIONS: This histological study demonstrated that local concentrations of MCs and their activation/degranulation are commonly observed in the rheumatoid lesion, and especially at sites of cartilage erosion. Such observations add weight to the concept that MCs contribute to the processes of inflammation, matrix degradation and tissue remodelling.
7499627 The moderating effect of demographic variables on coping effectiveness. 1995 Sep In spite of the theoretical recognition regarding the role of coping as a moderator, empirical findings indicate that it has only a modest effect as such. This study was designed, therefore, to examine the moderating effect of demographic variables (DV) on coping effectiveness, i.e. active cognitive coping, avoidance coping and active behavioural coping. The study sample was comprised of 12 male and 65 female patients with rheumatoid arthritis who were treated in three outpatient clinics of large hospitals in Israel. Findings suggest that demographic variables do play an important, and somewhat surprising, role in the effectiveness of coping strategies to temper psychological distress. Of the various demographic variables studied, marital status was found to have a significant effect on active cognitive coping and avoidance coping, and adherence to a religious belief system was found to have a significant effect on avoidance coping. The implications of the results for coping effectiveness are discussed.
7799388 Can observational studies replace or complement experiment? 1994 Sep The therapeutic effects of interventions in patients with rheumatoid arthritis (RA) are frequently modest. In the assessment of treatments effects, variability due to a variety of sources causes problems that are best controlled by randomized clinical trials. Currently most trials give only a short term picture of RA, a chronic disease whose outcome is multidimensional. Inclusion criteria of clinical trials are frequently very strict, raising concern about the external validity of the results. More longterm data is needed to guide clinical practice. Observational studies may contribute to the body of evidence, but have inherent shortcomings. They are liable to bias and supply weaker evidence. There must be creative development of trial designs suitable for evaluating longterm outcomes. Such trials may include many of the positive features of observational studies, but should not omit the principles of randomization and controlled comparison.
7487369 Contrasting effect of oral and intravenous cyclophosphamide treatment on phenotypes of hum 1994 Twenty three rheumatoid arthritis (RA) patients treated with cyclophosphamide (CTX) were observed for 6 months. Eight patients received CTX in a single intravenous dose (group I) and 15 orally in a single daily dose (group II). The surface antigens of lymphocytes, isolated from peripheral blood, were determined using immunofluorescence method. The clinical improvement was observed both in group I and in group II of patients. However, in patients receiving CTX intravenously amelioration of the disease appeared quicker. The percentage of CD3+ and CD8+ T cells remained unchanged. In group I we observed decrease in the number of CD4+ T cells (60.1 +/- 11.5% and 43.8 +/- 12.5%, before and after treatment respectively, p < 0.01), in group II this level remained unchanged. In both groups the percentage of CD19+ B cells decreased (14.7 +/- 9.2% and 8.0 +/- 6.1%, before and after treatment respectively in group I, p < 0.01; 17.4 +/- 12.3% and 11.0 +/- 7.1%, before and after treatment respectively in group II, p < 0.01). Moreover, the percentage of activated T cells (CD25+ cells and HLA-DR+ cells) was reduced in both groups.
7478745 Direct erosion of lumbar spine by an abdominal aortic aneurysm, resulting in paraparesis: 1995 Aug Abdominal aortic aneurysm is a condition affecting nearly 4% of the elderly population. It has a potential for producing a wide range of symptoms, including abdominal pain and back pain. The latter is particularly difficult to interpret in patients with chronic rheumatological conditions, and delayed diagnosis may be associated with a poor outcome. We present a patient with rheumatoid arthritis and chronic low back pain, who developed bilateral leg weakness and hesitancy of micturition, due to an abdominal aortic aneurysm invading the spine.
1297316 Assistive technology device use in patients with rheumatic disease: a literature review. 1992 Feb Occupational therapists often prescribe assistive technology devices (ATDs) to assist persons with disabilities in performing daily living tasks. Estimates suggest that although most ATDs are used, a substantial proportion are never used or are discarded shortly after they are obtained. A review of the literature on ATDs was carried out to identify factors that contribute to ATD use and disuse. The review focused on persons with osteoarthritis and rheumatoid arthritis, because such persons are frequent users of ATDs. Although the literature review highlighted person-, environment-, and ATD-related factors as relevant to ATD use, it also underscored the dearth of scientific study of the prescription, provision, and use of ATDs. A model is proposed to guide empirical research aimed at identifying non-device users from the outset of treatment so that interventions to improve ATD use may be initiated or alternative interventions implemented. The variables comprising the model pertain to the patient, the patient's living environment, the therapist prescribing the device, and the device itself.
8591649 Innovative treatment approaches for rheumatoid arthritis. Combination therapy. 1995 Nov It is accepted that combination DMARD therapy is a useful tool in current rheumatological practice. However, well-designed, large, long-term, controlled clinical trials are needed to determine which combinations, dosage schedules, and sequences of administration are most beneficial and least toxic. Until we develop treatment regimens that reliably induce and sustain acceptable control of disease manifestations in all patients for the rest of their natural lifespan, daily oral prednisone will continue to be a troublesome component of 'bridge' therapy, as it becomes the sole surviving constant in complex regimens whose other components are eventually discontinued because of toxicity, lack of efficacy, or non-compliance. We have often seen patients in whom the replacement of a well-tolerated but presumable ineffective DMARD with another DMARD has led to worsening of disease, when the modest benefits of the discontinued DMARD were lost before the hoped for onset of benefit from its replacement became evident. Since the toxicity of combinations of DMARDs has not appeared to be excessive, one can reasonably add the second DMARD to the first, while carefully monitoring for adverse effects and planning ton continue the combination until increased benefit occurs. Subsequently, if the second DMARD is not tolerated, the partial benefit from the first has not been given up, and a longer duration of treatment with the initial DMARD is sometimes associated with satisfactory improvement. If better control of rheumatoid arthritis is evident after 3-6 months of treatment with the combination of DMARDs, one must still decide whether to stop the first DMARD, stop the second, or continue with the combination. In the absence of major toxicity, we are most likely to choose to continue the combination if the patient has had a good response, thus inadvertently embarking on prolonged combined DMARD therapy (Paulus, 1990). Of course, other drugs besides those discussed above are available to control different aspects of joint damage; they should be considered in any combination therapy. Drugs which potentially protect cartilage from damage, such as orgotein, glycosaminoglycan polysulphate (Arteparon), and Rumalon, may prove useful in rheumatoid arthritis; they have been studied in osteoarthritis, but there is evidence that they protect cartilage from breakdown by inflammation in some animal models. As one of the many goals of treatment in rheumatoid arthritis is to protect cartilage, these chondroprotective agents might also be considered as part of the combinations to be studied. The combination of modest clinical efficacy with minimal toxicity reported with minocycline treatment of rheumatoid arthritis make this another potentially interesting addition to combination therapy regimens (Tilley et al, 1995). It is also important to continue the development of so-called 'biological agents', such as interleukin-2 receptor antibodies, anti-CD4 antibodies, anti-TNF-alpha agents and anti-thymocyte globulin. Combinations which include such agents have not yet been evaluated, although is seems logical considering that these agents offer the possibility of precise intervention directed at specific steps of the immuno-inflammatory process; their combination may thus be more effective than the use of single agents alone. While we await results of well-designed studies of these newer agents in RA therapy, we should continue to consider creative ways of using drugs that are already available.
7670784 The planovalgus rheumatoid foot--is tibialis posterior tendon rupture a factor? 1995 Jul The purpose of this study was to assess gross tibialis posterior tendon (TPT) integrity in a series of patients with a planovalgus foot deformity secondary to rheumatoid arthritis. This was done by means of contrast tenography. Our findings of an intact tendon in all of the seventeen patients studied suggest that complete rupture of the TPT is not the primary aetiology in the planovalgus rheumatoid foot.
1582218 Corneal complications after cataract surgery in patients with rheumatoid arthritis. 1992 Mar Peripheral ulcerative keratopathy and necrotizing scleritis have been reported in rheumatoid arthritis patients after cataract surgery, but the incidence of these complications during the immediate postoperative period is unknown. We retrospectively studied 70 patients with rheumatoid arthritis who underwent a total of 86 cataract extractions between 1973 and 1988. Only 15 of the patients had a preoperative history of keratoconjunctivitis sicca. The best corrected postoperative visual acuity was greater than or equal to 20/30 in 81% of eyes. No episodes of scleritis or peripheral ulcerative keratopathy occurred during the 8-week postoperative period. Three patients (all from the sicca group) developed diffuse superficial punctate keratopathy and/or filamentary keratitis. Results suggest that serious corneal complications after cataract surgery are uncommon in rheumatoid arthritis patients similar to the population found in our study (95% Poisson confidence interval 0-6.6%).
7735925 Non-steroidal anti-inflammatory drugs associated with gastroduodenal injury and Helicobact 1994 Dec OBJECTIVE: To clarify the relationship between non-steroidal anti-inflammatory drug (NSAID)-associated gastroduodenal mucosal injury and Helicobacter pylori infection. DESIGN AND METHODS: The incidence of H. pylori infection was determined in a group of patients treated with NSAID for rheumatoid arthritis for > or = 3 months and in a control group of patients with mainly abdominal symptoms but without rheumatoid arthritis and not being treated with NSAID. The incidence of H. pylori infection was also determined in patients treated with different NSAID and antirheumatic drugs. In addition, the minimum inhibitory concentration of several NSAID against H. pylori was investigated. RESULTS: The incidence of H. pylori infection in the NSAID group tended to be lower than in the control group, and was significantly lower in patients with gastric ulcers. The incidence of infection did not differ between patients treated with one or with more than one NSAID. Differences in the infection rate were found between individual NSAID, with indomethacin being associated with a particularly low rate. No differences in the infection rate were found between different antirheumatic drugs. The minimum inhibitory concentration of ibuprofen was low. CONCLUSION: H. pylori appears to have little effect on gastroduodenal mucosal injury associated with long-term NSAID administration.
8385584 Tumour necrosis factor soluble receptors behave as acute phase reactants following surgery 1993 Apr Tumour necrosis factor-alpha (TNF-alpha) is involved in diverse biological processes including immune and inflammatory reactions and the response to surgical stress. Two soluble TNF receptor protein fragments, TNF-sR55 (from the p55 kD TNF receptor) and TNF-sR75 (from the p75 kD TNF receptor), are released by cells during inflammation and may modulate the e effects of TNF-alpha. We have studied the kinetics of secretion of TNF-alpha, TNF-sR55 and TNF-sR75 in the sera of patients with rheumatoid arthritis (RA) and control subjects with osteoarthritis (OA) or chronic osteomyelitis (OM) before and after major surgery. Significantly higher pre-operative levels of TNF-sR55 and TNF-sR75 were found in RA and OM as compared with OA (P < 0.02). Following surgery, TNF-sR55 increased within 24 h in RA, OM and OA (P < 0.05), whereas TNF-sR75 increased significantly only in OM and OA patients (P < 0.05). By contrast, no TNF-alpha was detectable before and after surgery in any of the subjects, but this may have been due to impaired detection (by ELISA) of TNF-alpha when it is bound to TNF-sR. These findings suggest that TNF-sR55 and TNF-sR75 may be further markers of the host's reaction to inflammatory insults. They may also play a role in modulating the immune and inflammatory reactions by inhibiting the systemic effects of TNF-alpha.
1616358 Anaemia of chronic disease in rheumatoid arthritis: effect of the blunted response to eryt 1992 Jun Anaemia in rheumatoid arthritis (RA) is a common and debilitating complication. The most common causes of this anaemia are iron deficiency and anaemia of chronic disease. Investigations have suggested that interleukin 1 (IL-1) or tumour necrosis factor (TNF), or both, from monocytes associated with chronic inflammation are responsible for the anaemia of chronic disease. On bone marrow examination anaemia of chronic disease is characterised by the diversion of iron from the erythropoietic compartment into marrow macrophages. This phenomenon is termed failure of iron utilisation. In this study, CFU-E (colony forming unit erythroid; late red cell precursors) and BFU-E (burst forming unit erythroid; early red cell precursors) stem cells were cultured from 10 normal marrow samples and 12 marrow samples from patients with RA with iron deficiency anaemia and 10 samples from patients with RA with failure of iron utilisation. All patients with RA were anaemic (haemoglobin less than 100 g/l), Potential accessory or inhibitory cells of erythropoiesis (CD4, CD8, or CD14 positive cells) were removed before culture. Control marrow samples were studied in a similar manner. Normal marrow samples yielded 377 (17) CFU-E and 133 (6) BFU-E (mean (SD)) colonies for each 2 x 10(5) light density cells plated. CD4 ablation caused reductions of 62 and 100% in CFU-E and BFU-E colonies respectively. CD14 removal resulted in considerable but lesser reductions of 46% for CFU-E and 25% for BFU-E. In both groups of patients with RA, CFU-E colony numbers were significantly lower than those seen in normal control subjects, 293 (17) for patients with iron deficiency anaemia and 242 (35) for patients with failure of iron utilisation. BFU-E colony numbers were 102 (13) and 108 (20) respectively. In patients with RA, CD4 removal caused a significantly greater loss of CFU-E colonies compared with normal control subjects. Cytolysis of CD14 positive cells caused a reduction in CFU-E colonies in the two RA groups which was similar to that seen in normal subjects. In conclusion, patients with RA seem to have fewer CFU-E progenitors but essentially normal numbers of BFU-E stem cells. Our data suggest a stimulatory role for marrow CD4 and CD14 cells in erythropoiesis in patients with RA. Monocytes-macrophages (CD14 positive) are known to be producers of IL-1 or TNF, or both, however, the predicted increase in the CFU-E colonies on removal of CD14 cells is not seen. Therefore, if IL-1 or TNF, or both, are responsible for the impairment of erythropoiesis in patients with RA, marrow macrophages are unlikely to be the source. Moreover, these results indicate the probability of erythropoietin resistance on the basis of diminished CFU-E colony formation in patients with RA.
7864687 Sociodemographic factors and the outcome of rheumatoid arthritis in young women. 1994 Dec OBJECTIVE: To investigate the impact of sociodemographic factors on the outcome of rheumatoid arthritis (RA). METHODS: A group of 138 women with RA of recent onset and a mean duration of follow up of 5.8 years was studied. Additional information on sociodemographic variables at disease onset (level of formal education, marital status and employment status) was related to the initial disease severity and various outcome measures. RESULTS: Patients with lower levels of education showed a trend towards a worse outcome, according to Health Assessment Questionnaire (HAQ) score, erosion score and the patient's and physician's assessment of outcome at the last visit. However, we also found a trend towards an association between lower levels of education and more severe disease at onset, as measured by HAQ score, erosion score and the number of painful and swollen joints. The association between lower levels of education and poorer outcome of RA was weakened after correction for the initial disease severity. Results of other sociodemographic variables were equivocal. CONCLUSIONS: Differences in severity of RA between patients with different levels of education develop or are present in the early stages of the disease.
8970037 Diclofenac combined with cyclosporine in treatment refractory rheumatoid arthritis: longit 1996 Dec OBJECTIVE: (1) To characterize potential changes in diclofenac pharmacokinetics and renal function in patients with rheumatoid arthritis (RA) treated with diclofenac and cyclosporine; (2) to prospectively collect longitudinal safety data during use of this drug combination. METHODS: Twenty patients with severe, treatment refractory RA were sequentially treated with stable doses of diclofenac (100-200 mg/day) for one month followed by diclofenac combined with cyclosporine (3 mg/kg/day) for one month. Pharmacokinetic profiles of diclofenac were obtained at the end of each treatment period. Combined therapy was continued for an additional 5 months, during which doses of both drugs could be individually titrated and safety data collected. RESULTS: During co-administration, diclofenac exposure doubled, as shown by an average 104% increase in the area-under-the-curve. Diclofenac half-life was not altered. Serum creatinine was significantly elevated from a baseline value of 0.8 +/- 0.1 mg/dl on diclofenac alone to 1.0 +/- 0.3 mg/dl after one month co-administration with cyclosporine. The magnitude of creatinine elevation was not correlated with that of change in diclofenac exposure, suggesting the pharmacokinetic interaction per se may not additionally contribute to the effect on renal function resulting from this drug combination. During longterm treatment with both medications, prospectively collected safety data indicated that renal function could be stabilized when drug doses were individually titrated in response to serial clinical and laboratory evaluations. The overall pattern of adverse events and laboratory abnormalities in the study population were similar to those reported in patients with RA treated with other nonsteroidal antiinflammatory agents and concomitant cyclosporine. CONCLUSION: Diclofenac can be safely combined with cyclosporine in the management of RA when appropriate clinical monitoring and dose titrations are performed. Due to the pharmacokinetic interaction that increases diclofenac systemic exposure, it would be prudent to start combination therapy with diclofenac doses at the lower end of the therapeutic dose range.
1415303 Interaction of cyclosporine A and nonsteroidal anti-inflammatory drugs on renal function i 1992 Oct PURPOSE: To determine the additive renal effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclosporine A (CYA) in patients with rheumatoid arthritis (RA) and to determine the effects of CYA on active RA. PATIENTS AND METHODS: Eleven patients with RA refractory to other agents were treated separately for 2-week periods with an NSAID (sulindac or naproxen), CYA (5 mg/kg/d), and NSAID plus CYA in combination (NSAID/CYA). The NSAID/CYA combination was continued for an additional 20 weeks. Clinical parameters of RA, electrolytes, renal function, and the renin-aldosterone system were evaluated at each interval to determine the potential interaction of these two agents. RESULTS: Combined therapy was effective in suppressing many measures of active RA in 9 of the 11 patients. Adverse drug reactions were common, but withdrawals were limited to hirsutism (one) and peripheral neuropathy (one). In about half of the patients, CYA or NSAID resulted in a decrease in the glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), with a mild reduction in the filtration fraction. With NSAID or CYA, early morning renin-aldosterone system values were mildly suppressed, and their response to ambulation/intravenous (IV) furosemide was not blunted. When combined, NSAID/CYA caused more marked reductions of GFR and ERPF at 2 weeks, and this persisted at 20 weeks. The morning renin-aldosterone system values during administration of NSAID/CYA were suppressed, with an added blunted response to ambulation/IV furosemide. CONCLUSION: As previously suspected, the impairment of renal function when CYA and NSAID are combined is greater than that obtained with either agent alone. This hemodynamic effect was reversible and appeared to be, at least in part, due to renal vasoconstriction.
9010090 Contrast-enhanced MRI of rheumatic joint disease. 1996 Dec Early MR diagnosis of inflammatory rheumatic joint disease relies on the detection of the proliferating synovium. Several studies have shown that reliable visualization of the inflamed synovium is dependent upon the enhancement provided by intravenously injected paramagnetic contrast media. This presentation discusses the role of contrast-enhanced MRI in the assessment of inflammatory rheumatic joint disease. It is concluded that the method may aid in early diagnosis, and that it has a great potential in the assessment of disease severity and inflammatory activity.
1588743 [Intra-articular injection therapy in patient with rheumatoid arthritis]. 1992 Mar For RA, intra-articular injection therapy can be said to be a bridge between systemic therapies, such as pharmacotherapy and rehabilitation, and invasive treatment such as arthroplasty. Precise intra-articular injection with strict aseptic procedure and understanding of joint anatomy is required. Drugs to be injected include steroids, aiming at anti-inflammation and analgesia, and radioisotope and osmate, aiming at synovectomy. Injection is indicated in cases in which pharmacotherapy is ineffective and too early for arthroplasty. Unnecessary frequent injections may increase joint destruction and make proper timing of the operation difficult. Injection should be performed with full understanding of the advantages and disadvantages of RA therapy.