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ID PMID Title PublicationDate abstract
8693197 [The effect of an antimalarial agent (chloroquine) on acute phase reactants in patients wi 1994 The effect of chloroquine on acute phase reactants and clinical features in rheumatoid arthritis patients was evaluated. The patients had also one of nonsteroid antiinflammatory drugs therapy. Following acute phase reactans were evaluated: erythrocyte sedimentation rate and haptoglobin. The number of swollen and painful joints were also evaluated. All parameters were evaluated before the beginning of the therapy and each 3 months of medication during 9 months. The patients were analyzed by therapy effect and they were divided in 3 groups: all patients, only the patients who responded and the patients who did not respond on antimalarials. Assessed clinical and laboratory parameters were most improved in patients who responded on therapy. Acute phase reactants are markers of activity of illness, better CRP and less other haptoglobin and other parameters erythrocyte sedimentation rate and haemoglobin.
9010088 MRI evaluation of the knee in rheumatoid arthritis. 1996 Dec The knees of forty-three patients suffering from rheumatoid arthritis (RA) were examined using pre- and post-contrast MRI in an attempt to assess the extent and frequency of all abnormalities in the RA knee. Features evaluated by MRI were: synovial thickening, joint effusion, bone destruction, popliteal cysts, periarticular soft tissue swelling, abnormal tendons and bone marrow changes. A scoring system (0-2) was used to determine the relationship between the various signs of RA in order to identify those that may be relevant for the assessment of therapeutic response. It seems that the assessment of inflamed synovium is the major criterion for the determination of disease activity in RA.
7914383 [Study on combined of auranofin, salazosulfapyridine and methotrexate in rheumatoid arthri 1994 Jun Patients with rheumatoid arthritis who did not respond sufficiently to auranofin therapy were divided into three groups to be continued on auranofin monotherapy (1), to be on combination therapy of auranofin and salazosulfapyridine (2) and to be given methotrexate concomitantly with auranofin (3), and clinical responses were compared in a prospective manner. Patients on combination therapy either with salazosulfapyridine or with methotrexate demonstrated higher improvement than those on continued auranofin monotherapy. No unknown side effects associated with monotherapy of any of the three compounds were seen in any of the three groups. The study suggests usefulness of combination therapy either with methotrexate or with salazosulfapyridine for patients who failed to respond sufficiently to auranofin.
8259352 [Peri-ungual capillaroscopy. Value in the diagnosis of systemic diseases]. 1993 Sep 18 The diagnostic value of nailfold capillaroscopy was assessed through blind analysis of a continuous series of 354 examinations. Major and minor dystrophies and capillary bed abnormalities are the best criteria, especially in patients presenting with vascular disorders of the upper extremities. A systemic disease (specificity: 82.7 percent; negative predictive value (NPV): 90.2 percent) and specifically a systemic scleroderma (sensitivity: 97.1 percent and NPV: 99.4 percent) is improbable in case of normal capillaroscopy. First component analysis distinguished patients with definite systemic disease from normal subjects. Its value is dubious in other connective tissue diseases systemic lupus erythematosus, rheumatoid arthritis, Sjögren's disease, etc.).
7552067 The role of T-lymphocytes in rheumatoid arthritis. 1995 Apr The role of T lymphocytes in the pathology of rheumatoid arthritis (RA) is controversial. To some extent this has resulted from contradictory data, but even where specific points of fact are not in dispute, their interpretation often is. Nevertheless, the basic idea of a pathological T cell response in RA receives significant support from the work of several groups who have removed them by thoracic duct drainage, lymphapheresis or total lymphoid irradiation (TLI). Each of these procedures ameliorates RA; in the case of TLI which induces a profound and sustained decrease in CD4+ cells, the effect on synovitis was prolonged. These observations are in line with the general assumption that the strong association of RA with HLA-DR molecules containing a particular conserved region of amino acids implies an important role for T cells in RA, since the physiological role of HLA-DR molecules is to present antigens to T cells. In addition the association with Dw4 and related alleles is strongest for the most severe and persistent forms of disease, arguing that T cells may be important not just in initiation of RA but also in its perpetuation. However, the infiltrating T cells seem to be remarkably inactive and as a population to lack specificity for any particular antigen, leading some to conclude that their role is either passive or irrelevant, while others contend that it is precisely this inactivity which is responsible for the persistence of RA.
9136288 Gender and psychological well-being of persons with rheumatoid arthritis. 1996 Dec OBJECTIVE: This study examined the relationship of gender and psychological well-being (PWB) in community-dwelling persons with rheumatoid arthritis (RA). METHOD: Data from the first wave of two longitudinal panel studies of persons with RA were examined (93 men and 276 women in panel 1; 60 men and 147 women in panel 2). Subjects completed self-report questionnaires on behavioral aspects of RA. Psychological well-being was assessed in both panels by the Center for Epidemiologic Studies-Depression Scale, using its 4 subcomponents, including positive and negative affect. Panel 2 had additional measures of PWB, namely the Positive and Negative Affect Schedule and the Satisfaction With Life Scale. Potential explanatory variables were then examined in an attempt to account for the observed gender differences. RESULTS: Gender differences were found for negative indicators of PWB, while positive indicators of PWB showed no significant differences by gender. As with other community samples, women reported higher levels of depressive symptoms and negative mood than men. Quality of emotional support, passive pain coping, and physical functional impairment could only partially explain the observed gender differences in this study. CONCLUSION: The relationship of gender to negative indicators of PWB cannot easily be diminished or dismissed. The mechanisms by which gender differentially affects PWB need to be further explored in order to intervene appropriately to help men and women with RA achieve an optimal quality of life.
1616359 Double blind, placebo controlled study of metronidazole as a disease modifying agent in th 1992 Jun Anecdotal reports suggest that metronidazole may have disease modifying activity in the treatment of rheumatoid arthritis. To assess possible beneficial effects a double blind, comparative trial of metronidazole and placebo was performed. Fifty patients with active rheumatoid arthritis were randomly allocated to receive active drug (n = 24) or placebo (n = 26) and reviewed at weeks 0, 1, 4, 8, 12, 16, and 24. Detailed assessment of drug safety, biochemical and haematological parameters, and efficacy was made at these dates. Dose regimen was 400 mg twice daily from weeks 0 to eight, increasing to 400 mg three times a day from weeks nine to 24 provided that no adverse effects were recorded. Most patients were unable to tolerate metronidazole because of side effects or lack of efficacy, with only five (21%) continuing to take the drug at 24 weeks. For those patients attaining 12 weeks of treatment an overall improvement in articular index and morning stiffness was found. No improvement in laboratory indices of disease activity was seen, however. In this study metronidazole did not have disease modifying properties and was unacceptably toxic.
8668961 Effects of methotrexate, sulphasalazine and aurothiomalate on polymorphonuclear leucocytes 1996 The aim of the study was to evaluate the effects of treatment with methotrexate, sulphasalazine and aurothiomalate on polymorphonuclear leucocytes (PMN) in rheumatoid arthritis (RA). Circulating PMNs from 58 RA patients treated with either methotrexate (n = 27), sulphasalazine (n = 16) or aurothiomalate (n = 15) were assayed for their chemotactic capacity and generation of superoxide anions. The expression of CD18/CD11b was measured for 17 RA patients treated with methotrexate. Chemotaxis and generation of superoxide anions were not affected by any of the three drugs. We found no difference in the expression of CD18/CD11b in RA patients treated with methotrexate compared to healthy subjects. Further methotrexate and aurothiomalate did not in vitro alter chemotaxis, generation of superoxide anion or expression of CD18/CD11b on normal PMNs. In conclusion we found no evidence that the effect of methotrexate, aurothiomalate or sulphasalazine in RA can be explained by modulation of chemotactic ability or superoxide anion generation of peripheral circulating PMNs.
8344673 [Adhesion molecules and homing in inflamed synovia]. 1993 Apr The role of adhesion molecules for lymphocyte-endothelial interactions in the synovia of rheumatoid arthritis patients was studied using the frozen section assay. Partial inhibition of lymphocyte binding to endothelium of synovial sections could be observed with antibodies against CD44, L-selectin, beta 1 and beta 2 integrins, pointing to the participation of several adhesion molecules in the regulation of lymphocyte immigration into inflamed synovia.
8017981 Low prevalence of rheumatoid arthritis in black-Caribbeans compared with whites in inner c 1994 May OBJECTIVE: To compare the prevalence of rheumatoid arthritis (RA) in Black-Caribbeans and Whites living in the same urban area. METHODS: Cases of inflammatory joint disease were ascertained initially from a postal screening survey of 1851 Black and 1829 age and sex-matched non-Blacks identified from general practice age-sex registers of seven general practices in the Moss Side and Hulme districts of Manchester. The ethnicity of respondents was confirmed using data from a postal screening questionnaire. Those reporting joint swelling or a history of arthritis were reviewed by a rheumatologist at surgeries held in each practice. The clinical records of the questionnaire non-responders and questionnaire-positive non-attenders at surgery were reviewed. RESULTS: In an adjusted denominator population of 1046 Black-Caribbeans and 997 Whites, the cumulative prevalence of RA was 2.9/1000 in Black-Caribbeans and 8/1000 in Whites, representing a prevalence in Black-Caribbeans of 0.36 times that found in Whites (95% confidence interval 0.1-1.3). CONCLUSIONS: Rheumatoid arthritis occurs less commonly in Black-Caribbeans than in Whites. The findings are consistent with published studies showing a low RA prevalence in rural African Black populations.
7697687 Methotrexate: the emerging drug of choice for serious rheumatoid arthritis. 1994 Nov The recently recognized high morbidity and unexpected mortality associated with rheumatoid arthritis (RA) has spurred new interest in more aggressive, early treatment of this disease. Methotrexate (MTX) has rapidly become the rheumatologist's drug of choice for serious RA because of its favorable efficacy to toxicity ratio and rapid onset of action compared with other second-line agents. The initial concerns about hepatic fibrosis and cirrhosis in psoriatic patients has subsided somewhat as long-term liver toxicity data are accumulating in patients with RA. Routine liver biopsy with incremental doses of MTX is no longer recommended. Potential for severe lung, hematologic, and infectious complications exists, mandating careful monitoring of RA patients taking MTX.
1291026 Neurobiology and inflammatory arthritis. 1992 Aug As diagrammed in Figures 1 and 2, the central and peripheral nervous systems, the endocrine system, and immune and inflammatory systems are extensively integrated. The boundaries defining these systems are both anatomically and molecularly blurred. This realization has been driven by the ongoing revolution in molecular biology. Normally the deleterious effects of excessive or persistent inflammation are prevented by homeostatic neuroendocrine feedback loops. Conversely, dysfunction in these counter-regulatory responses may lead to important clinical phenomena such as autoimmunity and chronic inflammation in association with behavioral alterations such as fatigue, depressed mood, and loss of libido. Continued research into the neurobiology of inflammation appears likely to explain some of the fundamental abnormalities in diseases such as RA and lead to new, more effective therapies.
8336305 Measurement of gold treatment effect in clinical practice: evidence for effectiveness of i 1993 May OBJECTIVE: To determine the extent of efficacy of intramuscular (im) gold in clinical practice. METHODS: Ninety-eight patients who received im gold treatment for at least 1 year were assessed during ordinary clinic visits over the 12 month period following gold initiation. Assessments included joint counts, erythrocyte sedimentation rate (ESR), morning stiffness, visual analog scale (VAS) patient pain, VAS patient global, grip strength, prednisone dose, hemoglobin, and Stanford Health Assessment Questionnaire (HAQ) disability index. RESULTS: All outcome measures showed significant improvements at one year by standardized pretest posttest differences (effect size) and by measurement of the area under the curve (AUC). Important improvement (at least 50% improvement) was common: joint count (63.3%), global severity (41.1%), ESR (48.2%), grip strength (42.7%) HAQ disability (45.3%), and morning stiffness (72.2%). Effect sizes were substantial, even after correcting for placebo effect and withdrawals. Overall improvement was clinically significant, amounting to the equivalent of 2 months without pain or disability. CONCLUSION: Patients receiving gold for 12 months improved significantly and importantly in all measures studied. Improvement was clinically significant, amounting to the equivalent of 2 months without pain or disability. The degree of improvement was similar to, but somewhat greater, than that seen in controlled clinical trials, and could not be explained by regression to the mean.
8222313 The suppressive effect of gelatin-conjugated superoxide dismutase on disease development a 1993 Nov We studied the effect of superoxide dismutase (SOD) on murine collagen-induced arthritis (CIA), an animal model of human rheumatoid arthritis (RA). Among SOD derivatives studied, only gelatin-SOD conjugate which has prolonged half life in vivo was effective to suppress the development of CIA, while native SOD or gelatin carrier alone was ineffective. Interestingly, pyran polymer-conjugated SOD which also has a long half life showed no suppressive effect on the disease. No significant effect on immune response against type II collagen (CII) was found in any of the experimental groups. In addition, induction of suppressor cells was not detected in spleen or lymph node cells of the gelatin-SOD-treated group. Therefore, these results suggest that oxygen radicals may have an important role in the effector phase of the immune response to manifest this chronic autoimmune polyarthritis. Thus, the use of appropriate antioxidants for the treatment of human RA may be rationalized.
8759767 Biochemical characterization and microsequencing of a 205-kDa synovial protein stimulatory 1996 Aug 15 Synovial fluid (SF) was found to possess stimulatory capacity for the proliferation of T cell clones derived from patients with rheumatoid arthritis (RA) when cultured together with IL-2. Using chromatography technique and gel electrophoresis, a synovial fluid protein with an apparent m.w. of 205 kDa (p205) was isolated that demonstrated a bioactivity analogous to that obtained with native synovial fluid. After electroelution, p205 dissociated into 70-kDa fragment(s). Upon IEF, it appeared as a single band with an isoelectric point of 6.5, suggesting a noncovalently bound trimer complex. Amino acid sequences of the whole protein and of tryptic peptides were determined by N terminal sequencing. The N terminal amino acid sequence of the 70-kDa fragment and of the tryptic peptides showed no identity to recently described protein sequences. One peptide matched, in 11 amino acid residues, with the human IgG1-4 constant heavy chain and rheumatoid factor (RF) binding region. The p205 induced the proliferation of peripheral blood T cells and long term T cell cultures that had been raised by alternate stimulation with IL-2 and p205. In a similar approach, synovial lining cells were shown to release a protein with biochemical characteristics similar to the synovial fluid-derived p205. Western blot analysis revealed the binding of RF-containing sera to p205, which was diminished by absorption with an RF reagent. These observations suggest that p205 is expressed by synovial cells and may be a target for T and B cells in RA.
8116216 IgM and IgA rheumatoid factors in canine polyarthritis. 1993 Dec IgM and IgA rheumatoid factor (RF) were detected by ELISA using a purified dog IgG as antigen in normal controls (N = 84), dogs with unclassified polyarthritis (N = 95), dogs with rheumatoid arthritis (RA) (N = 22), dogs with systemic lupus erythematosus (SLE) (N = 35), dogs with leishmaniasis or heart worm disease (N = 20) and dogs with pyometra (N = 16). Frequency and titre of IgM and IgA RF are low and comparable (P < 0.05) in dogs with unclassified polyarthritis or RA: respectively 24.2% and 27.3% for IgM RF and 21.0% and 18.2% for IgA RF; the mean titre being respectively 0.781 +/- 0.581 and 0.649 +/- 0.365 for IgM RF, and 0.774 +/- 1.331 and 0.740 +/- 1.169 for IgA RF. The frequencies of IgM and IgA RF are a little higher in dogs with SLE (IgM RF: 37.1%, IgA RF: 25.7%) and higher in dogs with leishmaniasis or heart worm disease (45.0% and 30.0%), especially in dogs with pyometra (68.7% and 37.5%). So, although dogs can produce IgM and IgA RF, these auto-antibodies are uncommon in dogs with RA. Furthermore, when RF are present their titre is much lower than in human RA.
8566007 Role of tumor necrosis factor-alpha in the regulation of activated synovial T cell growth: 1995 Dec To characterize the role of tumor necrosis factor (TNF)-alpha in regulating synovial T cell growth, cell cycle progression associated with TNF-alpha in mitogen-activated synovial T cells of patients with rheumatoid arthritis (RA) were analyzed. After mitogen stimulation, the majority of synovial T cells in RA patients accumulated in S-phase. Anti-human TNF-alpha monoclonal antibody and soluble recombinant human TNF receptor (rhTNFR) can block S-phase accumulation. Furthermore, synovial fluid (SF) from RA patients was able to inhibit the proliferation of these S-phase-accumulated T cells. These data indicate that TNF-alpha could regulate activated synovial T cell growth by driving them into S-phase. Combined with the activities of other components of SF, TNF-alpha seems to play an important role in down-regulating activated synovial T cells in RA patients. In addition, the elevated level of soluble TNFR in the SFof disease-active RA patients is believed to be associated with the promotion of synovial T cell responses.
7647570 Prospective studies of thyroid function in patients receiving gold therapy. 1995 Apr Gold inhibits the Type I deiodinase that provides the bulk of circulating T3 in humans. We prospectively studied thyroid function in patients receiving increasing parenteral cumulative gold doses. Eight consecutive euthyroid patients with rheumatoid or psoriatic arthritis who were initiating intramuscular gold therapy were enrolled. Serum thyroid hormone levels (total T4, T3, and rT3) and TSH were measured for each subject at various levels during gold therapy. For analysis, the free T4 and free T3 indices, TSH concentrations, and T4/T3 ratios were correlated with cumulative gold dose. Neither individual nor pooled linear regressions showed a significant correlation between cumulative gold dose and any of the thyroid function parameters. Thyroid function is not affected in patients receiving up to 1500 mg of gold compounds. The most likely explanation for this is that gold principally accumulates in the Kupffer cells and renal cortex and these cells do not express Type I deiodinase.
7904086 A disease activity index: its use in clinical trials and disease assessment in patients wi 1993 Oct Measuring disease activity is important in the assessment of patients with rheumatoid arthritis (RA). The value of composite indices in determining activity is discussed. A validated index, the Stoke index, has been used in clinical trials of combination therapy in patients with RA, both to evaluate efficacy and to stratify response to single-agent therapy before randomization to combination treatment. Disease activity determines the use of disease-modifying antirheumatic drugs. Should these drugs be used in mild RA when disease activity is low? Results of a study comparing hydroxychloroquine with placebo in this situation suggest that they should. Finally, the outcome of suppressing disease activity over a 5- to 10-year period is unknown. Measured either radiologically or functionally, preliminary data suggest that the lower the mean disease activity over time, the more favorable the outcome.
8014550 The A1 pulley in rheumatoid flexor tenosynovectomy. To retain or divide? 1994 Apr We report a detailed comparative evaluation of flexor tenosynovectomy in 55 fingers in which the A1 pulley was divided and 45 fingers in which the A1 pulley was retained. The metacarpophalangeal joint subluxed volarly in 49% when the A1 pulley was divided, compared to 11% when the pulley was preserved. Bowstringing occurred in 7% and only when the A1 pulley was divided. Ulnar deviation was 7 degrees worse when the pulley was divided. Active range of movement was limited in both groups. It was 11 degrees less when the A1 pulley was divided.