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ID PMID Title PublicationDate abstract
8124915 Pain and fatigue in patients with rheumatic disorders. 1993 Dec The purpose of the study was to investigate whether fibromyalgia patients (n = 50) differed from patients with rheumatoid arthritis (n = 22) and ankylosing sponylitis (n = 31) with respect to pain experience, pain coping and fatigue. A high general pain intensity level was recorded by the McGill Pain Questionnaire (p < 0.01) and the visual analogue scale (p < 0.01) in the fibromyalgia group compared to the other groups. The pain was of continuous duration in the fibromyalgia patients while the rheumatoid arthritis and ankylosing spondylitis patients experienced intermittent pain. A high correlation between sensory and affective pain rating indexes was determined in all patient groups (p < 0.01). No statistically significant difference between the groups in pain coping was recorded. A high frequency of reported gastrointestinal problems (p < 0.01) and high intensity of fatigue (p < 0.01) were seen in the fibromyalgia group compared to the other groups. In the fibromyalgia group there was no correlation between the sleep problems and fatigue intensity. Thus, the fibromyalgia patients differed from the other groups in reporting frequently shoulder and upper arm pain, continuous pain, higher levels of fatigue and pain intensities as well as high frequency of gastrointestinal problems.
8239759 Components of health: an analysis in rheumatoid arthritis using quality of life questionna 1993 Sep OBJECTIVE: To gain insight into the overlap between additional information supplied by recently developed health status instruments for rheumatoid arthritis (RA) and traditional clinical and laboratory tests. METHODS: A cross sectional study of 282 outpatients with RA was made. From each patient, variables of clinical and laboratory measurements were obtained and the modified health assessment questionnaire (MHAQ) and a Dutch quality of life questionnaire, the IRGL, were completed. These variables were analysed for their interrelationship. RESULTS: Clinical and laboratory variables correlated significantly with the scales of the physical dimension and the disease impact scale of the IRGL. Their significant correlations with the IRGL psychological scales were weak. There were no significant correlations between any of the traditional variables and the IRGL social scales. Factor analysis yielded five factors: functionality, pain, depressive mood, social support, and laboratory. The laboratory factor is a measure of the disease process. The other four factors provide a health model. CONCLUSION: The results suggest that the IRGL questionnaire that was studied covers a complete health model that incorporates aspects of health that are not measured by clinical and laboratory tests. A simple questionnaire for the psychological and social dimension of health status, however, would probably be more cost effective and easier to use in clinical practice.
1618169 Adaptation in patients with chronic rheumatoid arthritis: application of a general model. 1992 We derived a model of appraisal, coping, and adaptation in patients with rheumatoid arthritis (RA) from the more general theory of Lazarus and Folkman (1984) and examined this model using a longitudinal data set spanning 4 years and involving 239 RA patients (of whom 157 contributed to the primary analyses, with the remainder contributing to various follow-up analyses). This model attempted to identify the short- and long-term adaptational consequences of coping as well as the antecedents (appraisals, beliefs, social support, disease activity, etc.) that promote particular coping styles. Interrelations among the variables were examined using path-analytic techniques. Many observed relations were consistent with the model. Significant relations were subjected to more stringent analyses examining the ability of hypothesized causal variables to predict changes in outcome variables 1 year later. These analyses provided additional support for many observed relations and suggested the existence of a vicious cycle involving helplessness appraisals, passive coping with pain, and psychosocial impairment that promotes maladaptation in the face of RA. Theoretical implications, strengths, and limitations of the study are discussed.
8098214 Subpopulations of primed T helper cells in rheumatoid arthritis. 1993 May OBJECTIVE: To analyze subsets of primed T helper cells, defined by expression of the CD45RB isoform of the leukocyte common antigen, in the blood and synovial fluid (SF) of patients with rheumatoid arthritis (RA). METHODS: Three-color immunofluorescence was used to study CD45 isoform expression by peripheral blood and SF CD4+ T cells. RESULTS: CD45 isoform expression in the peripheral blood of patients with either RA or reactive arthritis did not differ from that in healthy controls. SF T cells from both RA patients and reactive arthritis patients were almost exclusively primed (CD45RO+) cells. RA SF T cells expressed very low levels of CD45RB; this is the most highly differentiated subset of primed cells. Patients with acute reactive arthritis showed higher levels of CD45RBbright cells in their synovial fluid. CONCLUSION: The highly selected cell population in SF, representing one subset of primed cells, may relate to the apparent functional abnormalities of cells from this site in patients with RA.
8344677 [Anti-neutrophil-cytoplasmic antibodies in rheumatoid arthritis: specificity and clinical 1993 Apr Sera of 90 patients fulfilling the criteria of the American Rheumatism Association for the rheumatoid arthritis (RA) were screened for antibodies against neutrophil cytoplasmic antigens (ANCA) by an indirect immunofluorescence test. All sera were also tested for rheumatoid factor (Waaler-Rose-Test, WRT), C-reactive protein (CRP), antinuclear autoantibodies (ANA) on HEp-2 cells. 40% of the 90 sera showed ANCA-positive reactions. c-ANCA and p-ANCA types were both observed but the latter was by far more common (91%). The peculiarity of the p-ANCA pattern was a fine granular perinuclear staining. Antibodies against myeloperoxidase (MPO) were negative in all RA sera tested. So far we found a significant relationship between positive ANCA staining, functional Steinbrocker grades, and rheumatoid factor. No significant correlation was observed with extraarticular manifestation, CRP, therapeutic modalities (gold) or MHC antigens. Currently the nature of the neutrophil antigen involved is under investigation.
8668291 [Levels of different metabolites of arachidonic acid in synovial fluid of patients with ar 1996 Mar OBJECTIVE: Clinical and experimental evidence suggests that arachidonic acid metabolism through lipoxygenase and cyclooxygenase pathways may play an important role in the pathogenesis of both inflammatory and degenerative joint diseases. The aim of the present paper was to measure the levels of different arachidonate metabolites in arthrosis or rheumatoid joint effusions. MATERIALS AND METHODS: We studied synovial fluids from 22 patients with arthrosis and 8 patients with rheumatoid arthritis. The levels of TxB2, 6-keto-PGF1 alpha LTB4 and LTC4 were measured by radioimmunoassay. RESULTS: The levels of the different arachidonate metabolites were higher in patients with rheumatoid arthritis than in those with arthrosis and the differences were always statistically significant, except for TxB2 values. Furthermore, in patients with arthrosis the levels of such metabolites were not significantly correlated with one another, with the exception of LTB4 and LTC4 values, while in patients with rheumatoid arthritis these levels were directly and significantly correlated. CONCLUSIONS: In inflammatory joint disease levels of arachidonate metabolites are higher and more directly correlated with one another than in degenerative joint disease. Our data may explain the better efficacy of non-steroidal anti-inflammatory drugs in patients with arthrosis than in those with rheumatoid arthritis and the frequent necessity for steroidal treatment in this last condition.
8732123 [Clinical and experimental study of RA mixture in treatment of rheumatoid arthritis]. 1996 Jan The RA mixture is composed of Tripterygium Wilfordii (TW) and other Chinese medicinal herbs with effect of expelling Wind, activiting blood circulation, invigorating the Kidney and Qi. The authors treated rheumatoid arthritis (RA) patients with RA mixture and compared it with D-penicillamine as control. The two group's therapeutical effect is similar (P > 0.05), but the side effect occuring ratio in treatment group was obviously lower than that of control group (P < 0.01). After treatment with RA mixture, the patient's human lymphocytic antigen-degenerative reaction (HLA-DR+) cell, CD4/CD8 ratio reduced and auto-mixed lymphocytic reaction (AMLR) level enhanced (P < 0.05). The results of animal experiment showed that swelling of RA model mouse's joint could be reduced by both RA mixture and TW. Comparing with TW, RA mixture had stronger effect in controlling the inflammation of synovial cell and fibroid degeneration of fibrocytes. At the same time, RA mixture had stronger effect in protecting the immune organ from atrophy and protecting functions of cellular immunity. All above suggest that RA mixture reduce the syndroms of RA by improving distribution of T lymphocyte subsets and the functions of cellular immunity. The other Chinese medicinal herbs in the RA mixture could enhance TW's therapeutical effect and reduce it's side effect.
7979599 Purine enzymes in rheumatoid arthritis: possible association with response to azathioprine 1994 Sep OBJECTIVE: To study the possible association of purine enzyme activities with response to azathioprine (AZA) treatment in rheumatoid arthritis (RA) and their correlation with parameters of disease activity. PATIENTS AND METHODS: Lymphocyte activities of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT), adenine phosphoribosyltransferase (APRT), purine nucleoside phosphorylase (PNP) and 5'-nucleotidase (5NT), and erythrocyte activities of thiopurine methyltransferase (TPMT) were measured in 14 healthy controls and 36 patients with RA. Eight patients had not previously been treated with AZA. Response to AZA therapy in 28 patients, determined in a prospective trial, was considered good in nine (group 1), insufficient in seven (group 2). In 12 patients AZA was withdrawn because of adverse reactions (group 3). Disease activity parameters were obtained simultaneously with purine enzyme measurements. Purine enzyme levels in the different groups were compared. RESULTS: Levels of 5NT activity were significantly lower in patients with RA than in healthy controls. PNP activity was higher in patients with RA not using prednisone compared with those who did and healthy controls. No clear correlation between purine enzyme levels and disease activity parameters was found. 5NT activities were significantly higher in group one than in group three (p = 0.012; alpha = 0.017), and almost significantly higher than in group two (p = 0.03; alpha = 0.017). CONCLUSIONS: The results indicate that purine enzyme activities in patients with RA differ from healthy controls, are associated with the outcome of AZA treatment and seem not to be associated with disease activity. Our findings may offer a clue to predict the response to AZA therapy in RA.
7588952 Beta-particle dosimetry in radiation synovectomy. 1995 Sep Beta-particle dosimetry of various radionuclides used in the treatment of rheumatoid arthritis was estimated using Monte Carlo radiation transport simulation coupled with experiments using reactor-produced radionuclides and radiachromic film dosimeters inserted into joint phantoms and the knees of cadavers. Results are presented as absorbed dose factors (cGy-cm2/MBq-s) versus depth in a mathematical model of the rheumatoid joint which includes regions of bone, articular cartilage, joint capsule, and tissue (synovium) found in all synovial joints. The factors can be used to estimate absorbed dose and dose rate distributions in treated joints. In particular, guidance is provided for those interested in (a) a given radionuclide's therapeutic range, (b) the amount of radioactivity to administer on a case-by-case basis, (c) the expected therapeutic dose to synovium, and (d) the radiation dose imparted to other, nontarget components in the joint, including bone and articular cartilage.
8175838 CT measurement of glenoid erosion in arthritis. 1994 May We studied serial CT scans of 45 arthritic shoulders (34 rheumatoid, 11 osteoarthritic) and 19 normal shoulders, making measurements at three levels on axial images. The maximum anteroposterior diameter of the glenoid was increased in rheumatoid glenoids at the upper and middle levels by 6 mm and in osteoarthritic glenoids at all levels by 5 to 8 mm as compared with normal. In rheumatoid cases, nearly half the available surface of the glenoid was of unsupported bone, mainly posteriorly at the upper and middle levels. In osteoarthritic glenoids, the best supported bone was anterior at the upper level and central at the middle and lower levels. The depth of the rheumatoid glenoid was reduced by a mean of 6 mm at the upper and middle levels and by 3 mm at the lower level. This inclined the surface of the glenoid superiorly. The depth at the middle level in osteoarthritis was reduced by a mean of 5 mm, suggesting central protrusion. Osteoarthritic glenoids were retroverted by a mean of 12.5 degrees, but of rheumatoid glenoids two-thirds were retroverted (mean 15.1 degrees) and one-third anteverted (mean 8.2 degrees). Our findings have important implications for the planning and placement of the glenoid component of total shoulder replacements; CT can provide useful information.
10163417 The cost effectiveness of diclofenac plus misoprostol compared with diclofenac monotherapy 1996 Aug The objective of our study was to estimate the cost effectiveness of treatment with a fixed-dose combination of diclofenac and misoprostol compared with diclofenac monotherapy in the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers in rheumatoid arthritis (RA) patients. A model was used to incorporate estimates of costs, incidence of ulcers and their complications, death rates and the efficacy of misoprostol. The costs per ulcer-free period gained and costs per additional survivor were calculated. Cost effectiveness was calculated for the treatment of all RA patients, and of risk groups only. All costs were measured in 1995 Netherlands guilders (NLG; exchange rate at the time of the study: NLG1 = $US0.60). The analysis showed that if 100 RA patients receive 3 months of treatment with diclofenac plus misoprostol, instead of diclofenac alone, this will lead to overall additional costs of NLG773, while 0.82 symptomatic ulcers and 0.019 deaths will be prevented. If misoprostol is given only to patients at high risk for NSAID-induced ulcer, cost savings will occur instead of additional costs. Univariate sensitivity analysis showed that the outcomes are sensitive to changes in: (i) the percentage of ulcers treated in the ambulatory setting; (ii) the price difference between diclofenac and the fixed-dose diclofenac-misoprostol combination; (iii) the percentage of ulcers with complications; and (iv) the efficacy of misoprostol. In conclusion, it can be stated that treatment with diclofenac-misoprostol is cost saving in RA patients at high risk for NSAID-induced ulcers. For RA patients in general, the cost-effectiveness of this intervention compares favourably with that of other prophylactic treatments.
8171275 Serum transferrin receptor levels in anaemic patients with rheumatoid arthritis. 1994 Feb The value of s-Transferrin Receptor (s-TfR) measurements in recognizing simultaneous iron deficiency in anaemia of chronic disease was examined in 35 anaemic patients with active rheumatoid arthritis. Based on a quantification of stainable bone marrow (marrow iron grade 0-4) and serum ferritin concentrations (levels < 60 micrograms l-1) compatible with iron deficiency) the anaemia was found to be aggravated by iron deficiency in 19/35 or 54% of the patients. There was no significant difference between the mean s-TfR concentrations in patients with adequate iron in comparison to patients with iron depletion [2.9 (1.6) mg l-1 v. 2.7 (1.4) mg l-1; t = 0.273; p = 0.786; Student's t-test]. Mean s-TfR levels in both patients with adequate iron and depleted iron stores were within the normal range, but tended to be higher than in normal individuals [mean (SD): 1.54 (0.43) mg l-1]. In patients with no stainable marrow iron (MIG 0; N = 15) a significant inverse correlation was found between s-TfR concentrations and s-ferritin levels (r = 0.57; p < 0.05). 5/15 patients with MIG = 0 exhibited significantly raised concentrations of s-TfR values > 3.05 mg l-1 (the highest normal value of the normal range). Increases of s-TfR levels were consistently moderate, and never exceeded a level of 7 mg l-1, which is markedly lower than concentrations measured in patients with iron deficiency anaemia.(ABSTRACT TRUNCATED AT 250 WORDS)
1502567 Cyclosporine: nephrotoxic effects and guidelines for safe use in patients with rheumatoid 1992 Jun Renal abnormalities occur frequently in patients with rheumatoid arthritis; they may be complications of the rheumatoid disease process itself (amyloidosis) or may result from various therapies including gold compounds, D-penicillamine, analgesics such as aspirin or phenacetin used long term, and nonsteroidal anti-inflammatory drugs. Cyclosporine, a highly effective immunosuppressive agent currently under investigation as a treatment for RA, is also known to produce renal dysfunction. Some forms of functional and structural tubular changes appear readily reversible. Others associated with renal vasculopathy and interstitial fibrosis can lead to irreversible nephrotoxicity. A clear understanding of the pharmacology, drug interactions, and types of renal side effects encountered with cyclosporine can lead to a reduction of adverse renal reactions. Similarly, an understanding of which patients are at high risk for renal dysfunction can lead to safer and more efficacious use of this potent immunosuppressive agent.
8724206 Expression of basic fibroblast growth factor and angiogenin in arthritis. 1995 Angiogenesis is an integral component of the vasculoproliferative phase of rheumatoid arthritis (RA). We examined the distribution of two angiogenic factors, basic fibroblast growth factor (bFGF) and angiogenin (ANG) in arthritic diseases. We used an enzyme-linked immunosorbent assay and immunohistochemical analysis to determine the levels of bFGF and ANG in synovial fluid (SF) and their distribution in synovial tissue (ST), respectively. Most SF contained little or no detectable bFGF ( < 5 pg/ml). ANG in RA SF was 248.7 +/- 17.4 ng/ml, which did not differ significantly from levels found in osteoarthritis (OA; 305.9 +/- 23.1 ng/ml). Synovial lining cells, macrophages, endothelial cells, and vascular smooth muscle cells were immunopositive for bFGF and ANG; however, their expression was not up-regulated in RA ST compared to ST from OA and normal subjects. Though bFGF and ANG are present in the joints of patients with arthritic diseases, they are not up-regulated in RA. These results suggest that not all angiogenic mediators are up-regulated in RA compared to normal subjects and subjects with other arthritic diseases. It may be that some of these mediators, like ANG, play a role in the physiology of normal synovium.
8372739 Limitations to standard randomized controlled clinical trials to evaluate combination ther 1993 Randomized controlled clinical trials provide the cornerstone of modern research concerning medical therapies. However, important limitations intrinsic to clinical trials may restrict the generalizability of results to usual clinical practice. Limitations which appear particularly prominent in studies of combination therapies in inflammatory rheumatic diseases include: a) appropriate attention to group data which does not address variability of individual patient responses to specific agents; b) exclusion criteria to enter the clinical trial; c) small numbers with insufficient statistical power to identify clinically important trends; d) a time frame too short to recognize clinically meaningful differences between treatment regimens which may emerge over long periods. These limitations present problems in interpretation of studies in polymyositis, systemic lupus erythematosus, and rheumatoid arthritis. Strategies to improve accurate assessment of therapies include meta-analyses, clinical trials over at least five years, and long-term databases concerning consecutive patients seen in usual care.
1310022 The B cell repertoire in rheumatoid arthritis. III. Preferential homing of rheumatoid fact 1992 Jan OBJECTIVE: We sought to compare the frequencies of precursors producing IgM rheumatoid factors (IgM-RFs) in synovial fluid and peripheral blood B cells from patients with rheumatoid arthritis (RA). METHODS: We used limiting-dilution analysis of Epstein-Barr virus-activated B cells from seropositive and seronegative patients. B cell precursors producing IgM against insulin, an irrelevant autoantigen, were also assessed for comparison. RESULTS: On average, IgM-RF-producing precursors were 15-fold higher in the synovial fluid than in the peripheral blood of seropositive RA patients, but not in seronegative RA patients. The frequency of B cell precursors producing IgM against insulin was lower in the synovial fluid than in the peripheral blood of both the seropositive and the seronegative patient groups; moreover, the concentrations were similar in both groups. CONCLUSION: The findings provide evidence against a nonspecific accumulation of IgM-producing cells in the synovial fluid, and suggest that there is an active attraction of the RF-producing B cell precursors toward sites of inflammation in RA.
7492750 Efficient immortalization of rheumatoid synovial tissue B-lymphocytes. A comparison betwee 1995 In this study, B-cells isolated from rheumatoid synovial tissue were immortalized, without prior in vitro stimulation, by means of electric-field induced fusion and conventional PEG fusion in order to compare the efficiency of these methods. Two myeloma cell lines were used as fusion partners, the murine myeloma Ag8 and the murine-human heteromyeloma HAB-1. The results of seven fusion experiments performed simultaneously with identical cell populations showed that fusion frequencies obtained by electrofusion were 4 to 35 times higher than by the PEG fusion technique. The morphological and immunohistochemical evaluation of synovial tissues used for fusion showed that only tissues exhibiting a follicular distribution of B-cells with a high percentage of CD 22-positive lymphocytes gave rise to high fusion yields and produced B-cell clones, whereas synovial tissues with the same percentage of plasma cells but lower percentages of CD 22 lymphocytes yielded very low fusion rates. In conclusion, electrofusion is more efficient for immortalizing small amounts of synovial tissue B-lymphocytes than PEG fusion, since high fusion frequencies could be obtained by this technique without the need for prior in vitro stimulation. Synovial tissue exhibiting a follicular distribution of B-lymphocytes with high percentages of CD 22-positive lymphocytes gave rise to high hybridoma yields and therefore an ideal source of human rheumatoid B-cell clones.
1588523 Enlarged epitrochlear lymph nodes: an old physical sign revisited. 1992 Apr Few doctors routinely examine the epitrochlear glands as part of their physical examination of a patient. No palpable epitrochlear nodes were detected in 140 healthy subjects, but palpable epitrochlear nodes were present in 27% of 184 patients with diseases in which lymphadenopathy occurs. Whilst epitrochlear nodes are commonly enlarged in specific acute, subacute, and chronic infections, they are not enlarged in the mild, transient, non-specific febrile illnesses with cervical lymphadenopathy of children and young adults. Enlarged epitrochlear glands provide a useful discriminatory sign in the diagnosis of glandular fever. Enlargement of these nodes is common in most of the lymphoproliferative disorders except Hodgkin's disease. In rheumatoid arthritis their palpability indicates activity of hand joints. The examination of epitrochlear nodes should form part of the routine physical assessment of any ill patient.
1286976 Functional deficiency of antigen-presenting cells in the synovial fluid of rheumatoid arth 1992 Oct In our study of rheumatoid arthritis (RA) patients, we observed a decrease of tetanus toxoid antigen-presenting capacity of synovial fluid (SF) adherent cells to autologous T cells of either SF or peripheral blood. Additionally, we found a higher capacity of adherent synovial cells to stimulate autologous T-lymphocytes. Our results suggest that antigen-presenting cells of the SF of RA patients have defects that may play a role in defective presentation of antigens in joints and may account for other abnormal functions important in the pathogenesis of RA.
8849386 Nonsteroidal antiinflammatory drug-induced enteropathy and severe chronic anemia in a pati 1996 Feb This report describes the case of a woman who was admitted to the hospital with severe anemia and refractory rheumatoid arthritis. She had been transfusion dependent for 8 years and was receiving a combination of indomethacin and naproxen. An indium-111 white blood cell scan revealed small bowel inflammation. Salsalate was substituted for her previous nonsteroidal antiinflammatory drugs (NSAIDs), and metronidazole was initiated. This resulted in maintenance of a normal hemoglobin level for at least 1 year after discharge. Small intestine inflammation and bleeding (enteropathy) due to NSAIDs must be considered in the evaluation of anemia in patients with arthritis.