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ID PMID Title PublicationDate abstract
8496857 Methotrexate therapy in rheumatoid arthritis: a life table review of 587 patients treated 1993 Apr To determine whether methotrexate (MTX) maintains its effectiveness in rheumatoid arthritis (RA) in the setting of community based private rheumatology practice we used life table analysis to review the combined experience of a group of these practices. Of 587 patients with RA who started to take MTX, total termination rate at 70 months was 24.4% with most terminations prompted by drug toxicity. Older age (greater than 65 years) was associated with higher rates of toxicity. Treatment termination rates varied substantially between rheumatologists. We conclude that MTX therapy for RA is well tolerated and maintains effectiveness for at least 70 months.
8630638 Tolerability of multiple administration of intramuscular meloxicam: a comparison with intr 1996 Apr This multicentre, randomized, open controlled study compared the local and overall tolerability of i.m. meloxicam with i.m. piroxicam in 211 patients with rheumatoid arthritis (RA) (n = 95) or osteoarthritis (OA) (n = 116). Of these, 210 patients were randomized (2:1) to receive meloxicam 15 mg (n = 144) or piroxicam 20 mg (n = 66) for 7 days. Local tolerability of meloxicam was significantly better than piroxicam with respect to occurrence of redness after the first injection (P = 0.03) and global assessment after the first and final injections (P < 0.05). No rise in creatinine phosphokinase levels (a marker of muscle fibre damage) was observed with meloxicam, in contrast to piroxicam (P = 0.0001). The overall tolerability of both treatments was good. Significant differences in favour of meloxicam were observed for global efficacy assessed by the patient in RA (P < 0.05) and for overall pain intensity in OA patients (P = 0.02). In conclusion, i.m. meloxicam is safe and effective for the treatment of acute rheumatic pain and shows some superiority over piroxicam.
7562750 High levels of antibodies to annexins V and VI in patients with rheumatoid arthritis. 1995 Jul OBJECTIVE: Glucocorticoids are powerful antiinflammatory agents widely used for the treatment of rheumatoid arthritis (RA). Synthesis and/or secretion of annexin I (A-I) is induced by these steroids. Annexins V and VI are also found extracellularly but are not induced by glucocorticoids. Annexins may be potent antagonists of phospholipase A2 (PLA2). Since autoantibodies to A-I have been reported in patients with RA, we studied the reactivity of sera from patients with RA to A-V and A-VI. METHODS: Sera from 26 patients with RA were assessed for anti-A-V and anti-A-VI antibodies and compared with sera from 26 sex/age matched healthy subjects. IgG and IgM antibodies were analyzed in an ELISA: A correlation study with disease activity and corticosteroid treatment schedule was performed. RESULTS: Sera from patients with RA contained significantly higher levels of IgG [anti-A-V and anti-A-VI] autoantibodies than control sera, both being correlated. This rise in antiannexin antibody titers was correlated with the RA activity score, and negatively correlated with the daily dose of corticosteroids. CONCLUSION: High levels of IgG (anti-A-V and anti-A-VI) antibodies were found in sera from patients with RA. We suggest that antiannexin autoantibodies may play a role in the clinical course of RA by impairing the anti-PLA2 effect of annexins.
7784674 [Comparison of 3 quality of life instruments in the longitudinal study of rheumatoid arthr 1995 Quality of life measures take into account the patient's perception of health. Many generic or specific instruments are available. The psychometric properties of such measures should allow for adequately testing the hypothesis of an investigation. We studied the properties of three quality of life measures: the Health Assessment Questionnaire (HAQ) specific for rheumatic diseases, the Nottingham Health Profile (NHP)--a generic measure--and the General Health Questionnaire (GHQ) which measures psychological dimensions. They were applied in a one year cohort study of 111 French rheumatoid arthritis patients set up for determining prognosis factors of quality of life. Criterion validity was established on high correlation between Ritchie index and physical dimensions (r = 0.29 to 0.58, p < 0.01). Internal consistency was good with Cronbach's alpha coefficients over 0.8 for all dimensions. Reproducibility was studied for physical dimensions with Intra-class Correlation Coefficient (ICC) for patients clinically unchanged. It was excellent for the HAQ (ICC = 0.89), good for the NHP (ICC = 0.57 to 0.73) but weak for the GHQ (ICC = 0.13 for somatic dimension). After one year follow-up, a significant change in quality of life could only be evidenced by the HAQ (Standardized Response Mean = 0.4, p < 0.05) in patients with clinical significant change. So among the three instruments, the HAQ should be preferred for longitudinal studies, possibly supplemented with a generic instrument that investigates more dimensions of quality of life.
1485814 Continuation of long term treatment with hydroxychloroquine in systemic lupus erythematosu 1992 Dec BACKGROUND: Hydroxychloroquine is used for the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Long term studies have shown a high rate of termination of hydroxychloroquine treatment in patients with RA. Although it has been shown that discontinuation of treatment with hydroxychloroquine is associated with exacerbation of SLE, long term maintenance rates of treatment with hydroxychloroquine in patients with SLE have not been investigated. METHODS: Hydroxychloroquine use in patients with RA and SLE in a group of patients in a single community rheumatology practice was studied. Information was drawn from a computer drug use database containing details of the beginning and end of treatment. Data were analysed using life table methods. RESULTS: Four hundred and three treatment episodes (366 patients with RA, 37 patients with SLE) were observed over eight years. In patients with RA, the cumulative probability of discontinuing treatment was 37% at 12 months and 54% at 24 months. In contrast, hydroxychloroquine treatment of patients with SLE continued over significantly longer periods of time (p < 0.001); the discontinuation probabilities at 12 and 24 months were 8 and 24% respectively. Treatment terminations were predominantly for inefficacy; terminations for toxicity were limited to the first 19 months of treatment. No ocular toxicity was observed. CONCLUSIONS: Treatment of patients with RA in a community rheumatology practice with hydroxychloroquine has a low probability of long term continuation, mostly because of inadequate control of disease manifestations rather than toxicity. In patients with SLE, treatment with hydroxychloroquine has a significantly higher probability of long term continuation.
1420999 Regulation of synovial cell growth: basic fibroblast growth factor synergizes with interle 1992 Sep Cytokines have been implicated in the regulation of eicosanoid synthesis and synovial cell proliferation. To further define these mechanisms, we have compared the effects of basic fibroblast growth factor and platelet-derived growth factor on cell growth, prostaglandin E2 (PGE2) production and phospholipase A2 enzyme activity in long-term cultures of synovial cells from rheumatoid arthritis (RA) patients capable of proliferating in serum-free medium. Compared with serum-free medium alone, RA synovial cell growth was significantly enhanced by adding either basic fibroblast growth factor (bFGF) or platelet-derived growth factor (PDGF) to the culture medium. Growing RA synovial cells for 14 days in serum-free medium plus bFGF caused them to spontaneously release significant amounts of PGE2, an effect not seen if cells were grown in serum-free medium alone, or serum-free medium plus PDGF. Enhanced release of PGE2 occurred when arachidonic acid was added to bFGF but not PDGF-treated RA synovial cells, suggesting that bFGF increased cyclooxygenase enzyme activity in these cells. Moreover, phospholipase A2 (PLA2) enzyme activity was found to be significantly greater in RA synovial cells grown for 14 days in serum-free medium containing bFGF alone, or bFGF plus interleukin 1 beta (IL-1 beta) compared with cells grown in either serum-free medium alone, or serum-free medium plus PDGF. Similarly, bFGF plus IL-1 beta-stimulated release of PLA2 activating protein, a novel mammalian phospholipase stimulator found in high concentrations in RA synovial fluid.(ABSTRACT TRUNCATED AT 250 WORDS)
1441932 Craniomandibular disorders in rheumatoid arthritis, psoriatic arthritis, and ankylosing sp 1992 Oct Sixty-one subjects with rheumatoid arthritis, 61 with psoriatic arthritis, 61 with ankylosing spondylitis, and 61 healthy controls were examined with regard to subjective symptoms and clinical signs of craniomandibular disorders (CMD). The frequencies of most subjective and clinical variables were higher in all three disease groups than in the control group. Subjects with rheumatoid arthritis and psoriatic arthritis showed more frequent and severe signs and symptoms than subjects with ankylosing spondylitis. It is concluded that subjective symptoms and clinical signs of CMD are common in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and are mainly caused by the respective general joint disease. None of the signs and symptoms is pathognomonic for rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
1450830 Direct coronal computed tomography of the temporomandibular joint in patients with rheumat 1992 Nov Direct coronal computed tomography (CT) of the temporomandibular joint (TMJ) was performed in 26 patients with rheumatoid arthritis (RA) and 26 control subjects. Erosions and cysts of the mandibular condyle had a significantly higher frequency in the RA group than in the control group (p < 0.05) but there was no significant difference in the incidence of other abnormalities. Bone changes were bilateral in RA. A wide range of CT abnormalities was present in patients with RA and in the control group. There are no CT abnormalities specific for RA, but the incidence of erosions and cysts of the mandibular condyle was significantly higher in the RA group and should suggest the diagnosis.
8415328 When the lungs are involved by connective tissue disease. 1993 Oct Pulmonary involvement by a connective tissue disease can result in clinically important complications. Pathogenic mechanisms vary from granulomatous reaction and interstitial inflammation to primary vasculitis and immune complex-mediated disease. Understanding the pulmonary complications of connective tissue diseases is challenging in that several distinct patterns of involvement are associated with the same disease but the same lung abnormalities are found with several different diseases. Early recognition and treatment of pulmonary involvement may offer the patient a better chance of recovery from serious conditions that often carry a grim prognosis if undetected.
8453081 [Turbo(fast) spin echo at 0.5 T: effect of echo distance and echo number on image contrast 1993 Mar Signal intensities, signal-to-noise ratios (S/N), and contrast-to-noise ratios (C/N) in dependence on the echo distance and echo number of the new turbo (fast) spin-echo technique are analysed by phantom, volunteer and patient measurements. With increasing echo number (3 to 15 echoes), signal intensities increase (25 to 50%), S/N varies between different tissues, and C/N of fat to water decreases (70%). A high echo number, although it shortens the imaging time, is thus not always the best choice since the fat/water contrast is lost. However, a high fat/water contrast is advantageous for several MR applications.
7562768 Mononuclear cell (MNC) subtypes in osteoarthritis synovial fluid. Comparison with MNC subt 1995 Jul OBJECTIVE: To examine mononuclear cell (MNC) subtypes in osteoarthritis (OA) synovial fluid (SF) and compare these results with MNC subtypes in SF from patients with rheumatoid arthritis (RA). METHODS: MNC were obtained from SF by gradient centrifugation with Ficoll-Hypaque. MNC subtypes were identified using color immunofluorescence with monoclonal antibody pairs and flow cytometry. RESULTS: Significantly lower percentages of CD3+ (p < 0.01) and CD4+ cells (p < 0.01) were found in patients with OA. No differences were noted between CD8+ cells and the CD4/CD8 ratio. Significantly higher percentages of CD14+ (p < 0.001) and CD16+/CD56+ (p < 0.001) were found in patients with OA. CONCLUSION: Significant differences in MNC subtypes in OA and RA were noted that may reflect differences in pathophysiologic mechanisms operational in each disease.
8072863 [Ultrasonography in the joints of hands with rheumatoid arthritis]. 1994 Jul 25 The findings of preoperative ultrasonography (US) in 37 joints of 12 patients with rheumatoid arthritis (RA) were evaluated and compared with clinical staging and operative findings. By US, synovial proliferation in the joints was observed as hypoechoic solid tumor. By dynamic examination of the metacarpophalangeal (MP) joints, the developmental process of joint immobilization could be detected through a close study of the relationship between the proliferated synovium and extensor tendons, synovial bursa, sagittal bands, and expansion hoods. As the cartilage and heads of the metacarpal bones and proximal phalanges could be demonstrated by dorsal scanning of the articular space of the over-flexed MP and proximal interphalangeal (PIP) joints, small synovial proliferation and irregular border of the cartilage could be detected during the early stage of inflammation. The findings of the present study showed that the application of preoperative US to RA patients was very useful for early diagnosis and for the selection of treatment, including operative methods.
8220938 Effects of fish oil supplementation on non-steroidal anti-inflammatory drug requirement in 1993 Nov Maxepa contains eicosapentaenoic acid (EPA) (171 mg/capsule) and docosahexaenoic acid (DHA) (114 mg/capsule). EPA acts as an alternative substrate to arachidonate, leading to the formation of the less proinflammatory prostaglandins ('3' series) and leukotrienes ('5' series). If Maxepa has anti-inflammatory properties it could be expected to reduce the requirement for NSAIDs in patients with RA. This has not been investigated nor has Maxepa therapy been studied over a full 1-yr period. Sixty-four patients with stable RA requiring NSAID therapy only were studied. Patients received either 10 Maxepa or air-filled placebo capsules per day for 12 months. All then received placebo capsules for a further 3 months. Patients were reviewed at 3-monthly intervals. NSAID requirement at entry visit for each patient was assigned as 100%. Patients were instructed to slowly reduce their NSAID dosage providing there was no worsening of their symptoms. Clinical and laboratory parameters of RA activity were also measured. There was a significant reduction in NSAID usage in patients on Maxepa when compared with placebo from month 3 [mean (95% C.I. for mean) requirement--71.1 (55.9-86.2)% and 89.7 (73.7-105.7)%, respectively]. This effect reached its maximum at month 12 [40.6 (24.5-56.6)% and 84.1 (62.7-105.5)%, respectively] and persisted to month 15 [44.7 (27.6-61.8)% and 85.8 (60.5-111.1)%, respectively] (P < 0.001, ANOVA). These patients were able to reduce their NSAID requirement without experiencing any deterioration in the clinical and laboratory parameters of RA activity.
7986217 Relationship between alpha 1-antitrypsin inactivation and tumor necrosis factor alpha conc 1994 Dec OBJECTIVE: To examine the relationship between alpha 1-antitrypsin (alpha 1AT) specific activity and tumor necrosis factor alpha (TNF alpha) concentration in synovial fluid from 48 patients with rheumatoid arthritis. METHODS: The specific activity of alpha 1AT was calculated from the measurement of alpha 1AT concentration (by rocket immunoelectrophoresis) and elastase inhibitory capacity. TNF alpha was detected by enzyme-linked immunosorbent assay. RESULTS: TNF alpha concentrations correlated with the extent of alpha 1AT inactivation. CONCLUSION: Our findings are consistent with a role of elastase in TNF alpha release within the inflamed joint.
1563753 [Complement activation by C-reactive protein in various inflammatory diseases (in vitro)]. 1992 Feb C-reactive protein (CRP)-mediated complement activation can be tested on cryostat sections of the rat kidney by indirect immunofluorescence (C3-IFT). In contrast to a positive C3-IFT regularly obtained with sera of patients with polymyalgia rheumatica, we found unexpectedly negative C3-IFT results in 5/18 patients with seropositive rheumatoid arthritis and in 11/14 patients with bacterial endocarditis in spite of elevated CRP and normal hemolytic complement in these sera. Differential diagnostic and pathophysiological aspects of these findings are addressed.
1489768 A comparison of pain perceptions in women with fibromyalgia and rheumatoid arthritis: rela 1992 Dec Two studies were conducted to characterize the pain of fibromyalgia syndrome (FMS); to compare it to rheumatoid arthritis (RA) pain; and to examine the relationships between depression, pain extent, and pain description. Two methods of administering the McGill Pain Questionnaire (MPQ) were used. When the MPQ was administered in the standard manner, FMS pain could not be distinguished from RA pain. When participants were allowed to select as many words from an adapted MPQ as they wished, significant differences in word choice emerged. Depression and pain extent were major predictors of group differences in the evaluation of pain. However, depression scores contributed only 50% of the explanation for the differences in pain extent, with group membership contributing the other 50%. These findings suggest that the character and extent of pain in FMS are at least partially due to peripheral sensory components and not simply centrally controlled pain amplification secondary to depression.
7953973 Synovial fluid and plasma levels of cartilage matrix glycoprotein in arthritis. 1994 Aug As cartilage matrix glycoprotein (CMGP) is a prominent matrix constituent, we analyzed the relationship of levels in plasma (CMGPP) and synovial fluid (CMGPS) to each other, to clinical diagnosis, and to degree of radiographic cartilage degeneration. CMGP was measured in matched synovial fluid and plasma specimens from 67 patients with various forms of arthritis using an ELISA technique. CMGPS consistently exceeded CMGPP, CMGPP levels correlated significantly with CMGPS levels, and CMGP retention in joint fluid, as calculated by the ratio CMGPS: CMGPP, was significantly higher in patients whose synovial fluids contain basic calcium phosphate crystals. No correlation of CMGPP or CMGPS with diagnosis or degree of cartilage degeneration was observed. CMGP measurements are not useful diagnostically in patients with chronic arthritis and do not predict degree of radiographic degeneration. The association of basic calcium phosphate crystals with intraarticular retention of CMGP warrants further study.
7787964 Orthotic treatment of the hand. What's new? 1995 Jun Keeping abreast of the latest orthotic products is challenging. Commercial orthoses need to be critically evaluated for their applicability to the person with rheumatic disease. Custom-made orthoses play an invaluable role in achieving a wide range of therapeutic goals: improving function and pinch, stabilizing individual joints, preventing positional contractures, protecting joints from trauma, stretching the intrinsic muscles, correcting joint- and soft-tissue contractures, and controlling inflammation.
1642654 Inhibition of the production of proinflammatory cytokines and immunoglobulins by interleuk 1992 Aug OBJECTIVE: To assess the spontaneous production of proinflammatory cytokines and immunoglobulins in rheumatoid arthritis (RA) synovitis and modulation by interleukin-4 (IL-4). METHODS: We developed an ex vivo model of RA synovitis using pieces of RA synovium, and have studied the regulation of the production of IL-1 beta, IL-6, tumor necrosis factor alpha (TNF alpha), IgM, and IgG. RESULTS: Spontaneous production of proinflammatory cytokines in vitro was active, with prolonged cytokine gene transcription and translation. IL-6 was produced at higher levels than either IL-1 beta or TNF alpha, and explants produced more IgG than IgM. In contrast, IL-4 and interferon-gamma were undetectable. When pieces of synovium were incubated in the presence of IL-4, reduction of spontaneous proinflammatory cytokine and Ig production was observed. CONCLUSION: These results extend the observations of the antiinflammatory properties of IL-4 to an ex vivo situation, and provide the rationale for the clinical use of IL-4 in RA.
8655286 Downregulation of silicone-induced chronic arthritis by gastric administration of type II 1995 Nov We previously demonstrated that intra-articular injection of silicone in rats induced acute arthritis followed by chronic destructive joint inflammation in which T cells played a role. To investigate whether the model of T cell-mediated chronic silicone-induced arthritis (SIA) is modified by oral administration of type II collagen (CII), rats were fed CII either before or after intra-articular injection of silicone. We found that feeding CII either before or after intra-articular injection of silicone markedly suppressed the development of chronic arthritis. The early phase of acute joint inflammation was not affected by the oral antigen. There were no proliferative responses to CII of lymph node cells from rats with SIA. The proliferation to CII of lymph node cells from CII-primed rats was markedly suppressed by the addition of spleen cells from animals fed CII. Furthermore, the proliferative response to keyhole limpet hemocyanin (KLH) of KLH-sensitized lymph node cells was also suppressed by the addition of CII plus spleen cells from CII-fed animals. Injection of the spleen cells into rats followed by intra-articular injection of silicone inhibited the development of chronic SIA. These results indicate that T cell-mediated chronic arthritis may be downregulated by oral administration of CII and that the downregulation of joint inflammation may be due to the generation of CII-specific regulatory lymphocytes that react to CII abundant in cartilage.