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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
1590051 Scintimetry after total knee arthroplasty. Prospective 2-year study of 18 cases of arthros 1992 Apr 33 consecutive patients (18 arthrosis, 15 rheumatoid arthritis), operated on with total knee arthroplasty and randomized to cemented (18 knees) or cementless fixation (15 knees), were investigated with scintimetry 3, 6, 12, and 24 months postoperatively. Migration was evaluated with simultaneous roentgen stereophotogrammetric (RSA) examinations. The scintimetric activity in the ipsilateral femoral diaphysis decreased and the activity in the tibial diaphysis increased during the observation period. Constant and low activity was recorded in front of the femoral component. This region was chosen as a reference. Three months after surgery, high activity was noted under the tibial component in knees with a preoperative varus deformity. After 2 years, the activity had decreased to the same level as in the patients with a valgus deformity. Diagnosis and mode of fixation did not influence the activity. Low postoperative activity was recorded in the tibial metaphyses if no rotatory displacement of the tibial component occurred.
7791182 Progressive multifocal leukoencephalopathy in a patient with rheumatoid arthritis and poly 1995 Apr We describe a young woman who developed postpartum rheumatoid arthritis, polymyositis and small vessel cerebrovascular disease. Subsequently she developed biopsy proven progressive multifocal leukoencephalopathy (due to JC virus infection) which may have been a complication of her immunosuppression. This rare complication of autoimmune rheumatic diseases is discussed.
8447287 Localized pleural microdeposition of type A amyloid in a patient with rheumatoid pleuritis 1993 Mar Decorticated pleural tissue from a 74-year-old man with rheumatoid arthritis, an exudative pleural effusion, and normal left ventricular function contained microscopic deposits of amyloid A protein, localized to the interface between a deep layer of dense fibrocollagen and a layer of granulation tissue beneath a surface fibrin exudate. Previously reported instances of pleural amyloid deposition have occurred in patients with presumed systemic amyloidosis, and most such effusions are the result of congestive heart failure. This patient had no evidence of systemic amyloidosis, and this case appeared to be an example of an unusual form of localized amyloidosis, so-called periinflammatory amyloidosis A. These observations suggest that amyloid in a pleural biopsy should not be construed per se to be diagnostic of systemic amyloidosis.
8156313 A pilot study of the economic cost and clinical outcome of day patient vs inpatient manage 1994 Apr The aims of this pilot study, which compares day patient with inpatient care for management of active RA were (i) to test the feasibility of a trial protocol design including the method of randomization and the practicality of data collection, and (ii) to obtain preliminary information on economic cost and clinical outcome of these two methods of management. Twenty consecutive patients requiring admission for management of active RA were randomized to receive either day patient or inpatient care. All hospital, transport, community and indirect costs incurred over a 6-month period from recruitment were collected for each patient. Disease activity and clinical outcome were assessed using the Ritchie articular index, ESR, Health Assessment Questionnaire, Functional Independence Measure and Hospital Anxiety and Depression Scale. The trial protocol was found to be feasible and no patient allocated to the day patient group requested or required to be transferred to inpatient care. Day care was significantly cheaper than inpatient care despite higher transport costs; the total cost of treating 10 day patients was UK 10,272 pounds compared with 14,528 pounds for 10 inpatients. Clinical outcome was comparable in both groups for all parameters studied and there was no obvious detrimental effect on patients receiving day care. This pilot study demonstrates that day care is feasible and acceptable to patients with active RA. The preliminary data suggest that day care is substantially cheaper than inpatient care and does not apparently compromise clinical outcome.
8706336 Characterization of altered calcium signalling in T lymphocytes from patients with rheumat 1996 Aug Abnormal function of peripheral blood T lymphocytes is characteristic of RA; diminished proliferation and secretion of cytokines following in vitro mitogen stimulation are observed. We have investigated the calcium flux initiating T cell activation in rheumatoid peripheral blood mononuclear cells (PBMC) to determine whether abnormalities in signalling are also present. We have found that both phytohaemagglutinin (PHA-P)- and anti-CD3-stimulated calcium fluxes were much reduced in the patients' PBMC compared with controls, with a mean six-fold difference (P < 0.01) in rate of Ca2+ flux with PHA-P stimulation. When purified T cells were examined with PHA and CD3 stimulation, a reduction in the peak and plateau [Ca2+]i was observed in RA T cells, but the rate of rise of [Ca2+]i was only reduced in those cells stimulated with PHA. These results suggest that alterations in the initiating signal may underlie the functional T cell abnormalities associated with RA, and that there may be an additional extrinsic influence from non-T cells in the PBMC population.
7522058 Successful treatment of chronic wound infection in neutropenia and rheumatoid arthritis wi 1994 Sep A 73-year-old woman was diagnosed with seropositive destructive rheumatoid arthritis in 1981. She was treated with cortisone, chloroquine, and cyclophosphamide (Sendoxan) in 1982 and 1984 and contracted severe neutropenia. After that she only received cortisone. During 1991, again low neutrophilic counts were registered, especially granulocytopenia. At first, B-cell lymphoma was suspected, but later Felty's syndrome was established. The patient was treated with high-dose cortisone with some success and had a few minor septic episodes. In May 1992 she contracted a traumatic wound on the back of the lower leg. Conservative treatment resulted in a worsening of the condition and an increased wound area, most likely related to the neutropenic condition. In mid July the patient was hospitalized. Bacterial isolates yielded mixed gram-negative enteric bacteria from the wound. Parenteral antibiotic treatment was started, followed by oral drugs, rhG-CSF (filgrastim) was given subcutaneously once a day, starting 3 days after admission. This resulted in increased numbers of peripheral granulocytes. The ulcer started to heal and by mid August the patient received a transplant with autologous skin grafting. In mid September the wound was completely healed. It is concluded that the combination of antibiotics, skin transplantation, and G-CSF was necessary for the successful result. Actually, the bacterial growth did not call for antibiotics, but it was considered necessary to cover for staphylococci. No worsening of the underlying arthritis was observed.
10163521 Total hip replacement arthroplasty in patients with inflammatory arthritis. 1995 Jul 1. Hip involvement in inflammatory arthritis is a relatively common entity. 2. Total hip replacement offers the most reliable surgical treatment option for pain relief and the restoration of hip function when medical management is exhausted. 3. Preoperative evaluation and perioperative medical management should focus on the particular medical problems of patients with systemic rheumatologic conditions. 4. In patients without protrusio deformity, cemented total hip replacement with modern cement technique offers excellent long-term functional results.
8484679 Serum interleukin 6 levels in rheumatoid arthritis: correlations with clinical and laborat 1993 Mar In rheumatoid synovium interleukin 6 (IL-6) is the most abundantly expressed cytokine. Increased serum levels have been previously reported in patients with rheumatoid arthritis (RA). In this study serum IL-6 levels were measured in a well defined cohort using a bioassay (B9 cells) and levels were correlated with conventional clinical and laboratory indices of disease activity. Levels were significantly higher in serum from patients with RA (median 55 IU/ml; interquartile range 28-139) compared with serum from disease (median 7 IU/ml; 1-23) and normal controls (median 10 IU/ml; 7-12). No difference was observed between men and women. Levels did not correlate with disease duration. Significant associations were observed between IL-6 and C reactive protein and between the Ritchie articular index and duration of morning stiffness. No other correlations were observed. The value of these findings in the monitoring of RA and as an indicator of response to second line treatment needs to be established.
8282807 Evidence of antigen receptor-influenced oligoclonal B lymphocyte expansion in the synovium 1994 Jan Plasma cell infiltration of synovium is common in longstanding rheumatoid arthritis (RA). The mechanism(s) underlying synovial B cell proliferation remains unclear. One theory invokes nonspecific polyclonal stimuli; another implicates antigen as the driving force. Antigen-driven repertoires are characteristically enriched for related sets of V gene segments containing similar sequence in the antigen binding site (complementarity-determining regions; CDRs). To study the forces shaping B cell proliferation, we analyzed V kappa transcripts expressed in the synovium of an RA patient. We found Humkv325, a developmentally regulated V kappa III gene segment associated with autoantibody reactivity, in > 10% of randomly-chosen synovial C kappa cDNAs. Two sets of sequences contained identical charged amino acid residues at the V kappa-J kappa join, apparently due to N region addition. We generated "signature" oligonucleotides from these CDR3s and probed PCR amplified V kappa products from the synovium and PBLs of the same patient, and from PBLs and spleen of individuals without rheumatic disease. Significant expression of transcripts containing these unique CDR3 sequences occurred only in the patient's synovium. Thus, in this synovium there is expansion of a limited set of B cell clones expressing antigen receptors that bear evidence of antigen selection.
7474590 [Aortic valve replacement for rheumatoid aortic valve regurgitation]. 1995 Sep Valve replacement for aortic regurgitation in patient with rheumatoid arthritis was rare in Japan. We report a successful case in which aortic regurgitation necessitated aortic valve replacement. A 62-year-old woman was admitted for shortness of breath, chest pain and progressive edema. She had been treated for rheumatoid arthritis for more than ten years using steroids. The aortic valve was successfully replaced by a prosthetic mechanical valve. The histopathological examination of the excised aortic valve demonstrated rheumatic nodules in the right- and non-coronary cusp. It was supported that these changes caused shrinkage of cusp and resulted in aortic regurgitation. This patient was discharged on the 20th postoperative day. There was no evidence of detachment of the prosthetic valve.
1386549 T gamma delta cells and their subsets in blood and synovial fluid from patients with rheum 1992 Aug We have determined the distribution of T gamma delta cells in the peripheral blood of 44 patients with rheumatoid arthritis and in 36 healthy controls. In addition, paired blood and synovial fluid samples were obtained from seven patients with RA. The monoclonal antibodies A13, BB3 and Ti gamma A, which are specific for the V delta 1, V delta 2 and V gamma 9 gene products respectively, were used to define T gamma delta subsets. T gamma delta + cells expressed as a percentage of CD3+ lymphocytes were reduced in RA peripheral blood compared with the control group (3.9% +/- 0.5 versus 5.7% +/- 0.7; P less than 0.0001). There was a reduction in the V gamma 9/V delta 2+ subset (from 5.6% +/- 1.2 to 1.7% +/- 0.4) leading to a change in the mean ratio of V delta 2/V delta 1+ cells from 4.3 in normal subjects to 1.1 (P less than 0.002). No statistical difference was observed in T gamma delta cell numbers in synovial fluid compared with the paired blood samples (4.0% +/- 1.1 in blood and 4.4% +/- 1.4 in synovial fluid). Also the distribution of V delta 2+ and V delta 1+ cells was similar in the two compartments and a similar alteration in subset distribution was found in blood and synovial fluid. These findings do not indicate a selective accumulation of a specific T gamma delta subset in RA synovial effusions.
9035934 CKS knee prosthesis: biomechanics and clinical results in 42 cases. 1996 Jul From 1991 to 1993 a total of 42 CKS prostheses were implanted for the following reasons: osteoarthrosis (34 cases), rheumatoid arthritis (7 cases) tibial necrosis (1 case). At follow-up obtained after 17 to 41 months the results were: excellent or good: 41; the only poor result was probably related to excessive tension of the posterior cruciate ligament. 94% of the patients reported complete regression of pain, 85% was capable of going up and down stairs without support. Mean joint flexion was 105 degrees. Radiologically the anatomical axis of the knee had a mean valgus of anatomical axis of the knee had a mean valgus of 6 degrees. The prosthetic components were always cemented. The posterior cruciate ligament was removed in 7 knees, so that the prosthesis with "posterior stability" was used. The patella was never prosthetized. One patient complained of peri-patellar pain two months after surgery which then regressed completely.
7734033 Non-linkage of a T-cell receptor gamma chain microsatellite (D7S485) to rheumatoid arthrit 1995 Feb A highly informative microsatellite marker, D7S485, from the T-cell receptor gamma (TCRG) locus, has been used to study segregation of TCRG genes in 26 multiplex rheumatoid arthritis (RA) families. We used the sib-pair method to assess excess identity-by-descent sharing among affected members in these families and the LINKAGE package of programs was used to calculate two-point lod scores for the D7S485 marker. There was no evidence for segregation of TCRG genes with RA in affected siblings and significantly negative lod scores were obtained from linkage analyses using both autosomal dominant and recessive models of inheritance.
8935567 [Urinary acidification and rheumatoid arthritis]. 1996 The aim of this study was to investigate subclinical abnormalities in renal function suggestive of incomplete distal renal tubular acidosis (DRTA) in patients with rheumatoid arthritis (RA), using the gradient between PCO2 in urine and blood (U-B PCO2 gradient), which is a simple and sensitive test. We prospectively selected 45 patients in three groups (G). G 1 (n = 15p), with RA, mean age 44 years and mean disease duration 6.5 years. G2 (n = 10 p), with RA and Sjögren's syndrome (SS), mean age 47 years and mean disease duration 6.6 years. G 3 (n = 20) healthy volunteers, no history neither renal nor rheumatic diseases, mean age 37 years. Patients in G1 and G2 had no history of concurrent disease affecting renal parenchyma, their acid-base status and renal function were normal (Creatinine clearance above 70 ml/min/1.73m2). All patients received NSAIDs but none gold salts and/or D-Penicillamine. The ability to acidify the urine was evaluated in all cases by U-B PCO2 gradient, after a 500 ml NaHCO3 continuous infusion 1 molar solution through a peripheral vein. U-B PCO2 lower than 30 was considered pathological and diagnostic for DRTA. The urinary specimen for pH and PCO2 were kept under mineral oil and processed within 5 minutes of excretion. The blood samples for PCO2 were obtained from a peripheral vein and measured after obtaining a urinary pH 7.8 or above, pH and PCO2 were measured with a BMS 3 MK2 Radiometer, Copenhagen Denmark electrode and analizer. The U-BPCO2 results were (mean 2 sd): G1 = 47 +/- 26; G2 = 49.8 +/- 8.4; G3 = 52.5 +/- 12.2. There were no statistical differences among the three groups (F = 1.228727). In the G1, a single patient presented U-B PCO2 lower than 30 (U-B PCO2 = 5), having a long active disease at the evaluation time. In G2 and G3 no gradient alterations were recorded. We conclude, in spite of the fact that U-B PCO2 gradient is a very useful and sensitive tool for detecting dRTA, that there was no correlation between incomplete type dRTA and RA or between incomplete dRTA and RA associated to SS. In addition, no association was found between NSAID intake and dRTA.
7738941 The effect of age and renal function on the efficacy and toxicity of methotrexate in rheum 1995 Feb OBJECTIVE: To evaluate whether age and renal impairment affect the rate of side effects or expected efficacy of methotrexate (MTX) in rheumatoid arthritis (RA). METHODS: Data was pooled from 11 MTX clinical trials containing 496 patients treated with MTX. We evaluated those patients less than 60 years old and those in 5-year groupings of age over age 60. Using serum creatinine, weight, and age, we calculated creatinine clearance and placed patients into quartiles based on their baseline creatinine clearance. To evaluate efficacy, we used changes in American College of Rheumatology core set efficacy measures available in these trials. To quantify side effects, we scored each side effect based on a modified Fries toxicity score and assigned each patient a score based on the worst side effect experienced during the trial. We also separately evaluated liver toxicities (twice normal elevation of AST or ALT), respiratory toxicity and severe toxicities. Intent-to-treat analyses were performed, adjusting for study of origin. Results were confirmed by placebo controlled trials, comparing MTX and placebo treated patients. RESULTS: Neither age nor renal impairment had any effect on the efficacy of MTX. Those in the oldest age groups (65-69 years, > or = 70 years) were not at higher risk of side effects from MTX. However, patients with renal impairment had a higher overall rate of toxicity and were at higher risk of severe and respiratory toxicities than those whose creatinine clearances were at least 99.8 ml/min (reference group). The odds of severe toxicity were increased roughly 4-fold in those with renal impairment. CONCLUSION: Among clinical trial patients, age does not affect MTX efficacy or the rate of side effects. Renal impairment, however, increases the risk of side effects.
7481247 [Methotrexate treatment in non-cancerous disorders]. 1995 Jul Weekly administration of low doses methotrexate (7.5 mg to 25 mg a week) is considered as one of the most important progresses in the management of rheumatoid arthritis. Its efficacy has also been demonstrated for the treatment of other inflammatory processes such as psoriasis arthritis and, more recently, Crohn's disease. We here review the indications, the limits and the side effects of such therapeutic approach in various inflammatory and/or autoimmune diseases.
8835298 Arthritis diagnosis based upon the near-infrared spectrum of synovial fluid. 1995 Synovial fluid aspirates have been characterized by measuring their visible/near-infrared spectra (400-2500 nm). The hypothesis tested in this study is that the spectra contain sufficient information to serve as an aid in the diagnosis and/or staging of arthritic disorders. The concentrations of all major constituents are carried implicitly in the spectra, and in this sense this approach is similar in spirit to conventional synovial fluid analysis. The distinguishing feature of this method is that we have not converted the raw data (spectra) explicitly to analytical information. Rather, we have used automated pattern recognition methods to identify significant characteristics of the spectra themselves. A total of 109 spectra were measured and split into three classes according to the disease (osteoarthritis, rheumatoid arthritis, or spondyloarthropathy) affecting the patient from whom the synovial fluid sample was taken. An automated classification method was then trained by correlating features derived from these spectra to the clinical diagnoses. The robustness of the classification was validated using the leave-one-out cross-validation method, i.e., by training on all but one of the spectra and using the resulting model to predict the classification for the spectrum that is left out. The result derived by following this procedure for each of the spectra was that 105 of the 109 predicted classifications correctly matched the clinical diagnosis. These results suggest that the near-infrared spectrum of synovial fluid is sufficient to allow diagnosis of the disease affecting the joint from which the aspirate is drawn.
1292640 Direct stimulation of cytokines (IL-1 beta, TNF-alpha, IL-6, IL-2, IFN-gamma and GM-CSF) i 1992 Nov Rheumatoid arthritis (RA) is an immune disease in which the pathological immune reaction is thought to be initiated by the presentation of an (auto) antigen or superantigen by MHC class II positive cells to CD4 T cells. These successive immunological events can be studied by the cytokines produced at the different stages. Cytokine secretion by stimulated cells in autologous diluted whole blood has allowed the study of the immune profile characteristic of rheumatoid arthritis. The pattern of RA patient whole blood cells cultured in autologous blood is characterized by hyperactivity of the mononuclear cells with high secretion of IL-1 beta, TNF-alpha and IL-6 and low production of IFN-gamma, in comparison with the normal (N) and osteoarthrosis (OA) populations. The IL-2 secretion pattern is unique, arising from production followed by consumption. This production-consumption turnover is the most elevated in the RA group. The T cells are indeed activated in rheumatoid arthritis but regulatory events suppress some of their functions. A correlation was found between the inflammatory proteins and mediators of cellular immunity and macrophagic function: IL-1 beta and the sedimentation rate; IL-6 and fibrinogen; TNF-alpha and the number of blood monocytes. The secretion of OA-stimulated whole blood cells was similar to RA for two monokines (overproduction of TNF-alpha and IL-6) and different for IL-1 beta, not different from normal in OA. Stimulated whole blood cell cytokine secretion profile from RA and OA groups, was the same as previously observed in synovial fluid.(ABSTRACT TRUNCATED AT 250 WORDS)
1578645 [Malignant lymphoma with gastrointestinal amyloidosis, developing in the course of rheumat 1992 Mar A autoimmune diseases complicated by malignant lymphoma have attention recently. studies in the international literature have demonstrated a significant complication of rheumatoid arthritis (RA) with malignant lymphoma. The authors report a case with a 15-year history of RA complicated with B cell lymphoma and gastrointestinal amyloidosis. A 66-year-old-woman was presented with easy fatigability and weight loss. with fever above 38 degrees C (100 degrees F). Clinical examination revealed marked abdominal tenderness and deformed joints of both hands and fingers. Rheumatoid factor was weakly positive. A diagnosis of malignant lymphoma (follicular large, B cell type) was made by inguinal lymph node biopsy and endoscopic biopsy which revealed amyloid (AA type) deposition in the stomach and duodenum. The case showed a remarkable increase of a specific antibody titer against Epstein-Barr (ER) virus, which has been suggested to cause RA or lymphoma. The complications of the diseases in this case suggests a similar causative mechanism for the two different diseases.
8858425 The development of the Pain Management Inventory for patients with arthritis. 1996 Aug The initial development of the Pain Management Inventory (PMI), a precise clinical index of pain management methods intended for use with patients with arthritis, is reported. The PMI differs from available instruments in its intent to assess specific methods that the individual is currently using for arthritis pain management and the perceived helpfulness of these methods, thus providing information to be used in combination with other clinical indicators for planning and evaluating ongoing pain self-management. Sixteen of 17 items, or methods, initially demonstrated content validity. Using methods appropriate for an index of independent items, psychometric testing with a sample of 82 persons having a primary diagnosis of osteoarthritis or rheumatoid arthritis then focused on estimating the construct validity and test-retest reliability of each item. Findings assist in better understanding how various methods relate to overall pain management when it is defined as successfully taking care of or handling the pain as viewed within a cognitive-behavioural framework. Findings suggest that there are eight items that represent valid and reliable pain management methods. These items should be used and evaluated with additional arthritis samples to determine whether the findings replicate.