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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
8014551 Complications of the use of the Harrison-Nicolle Intramedullary Peg in digital arthrodesis 1994 Apr The Harrison-Nicolle Intramedullary Peg is used for the arthrodesis of digital joints. We report our experience of complications found using this peg in a series of 16 arthrodeses. At review after an average of 2.9 years, three cases had been revised. Only five of the remaining 13 cases showed a bony fusion and in only two of these five was the fusion in an acceptable position. In nine cases the joint became straight or extended; the preset angle of the peg did not determine the final angle of the arthrodesis. In five cases the tips of the peg appeared to be eroding through bone.
9014582 Complement in acute and chronic arthritides: assessment of C3c, C9, and protectin (CD59) i 1996 Dec OBJECTIVES: To investigate the role of complement cascade induced damage and protection against it in acute arthritides compared to rheumatoid arthritis and other chronic joint derangements. METHODS: C3c, C9, and protectin (CD59) were examined by avidin-biotin-peroxidase complex staining. RESULTS: Marked deposits of C3c and C9 were found in synovial vasculature and intercellular matrix of the lining in rheumatoid arthritis and in acute arthritides (including bacterial, reactive, and osteoarthritis flare up). Furthermore, protectin was not visible in synovial lining cells and was relatively weakly expressed in stromal and endothelial cells in rheumatoid arthritis; also in acute arthritides protectin expression was weak. In contrast, C3c and C9 deposits were not found in chronic conditions associated with degenerative diseases (osteoarthritis and osteochondritis dissecans) or mechanical causes (patellar luxation and a ruptured meniscus), in which also the protectin expression was prominent in synovial lining, endothelial and some stromal cells. CONCLUSIONS: Activation of the complement in rheumatoid arthritis and in acute arthritides seems to be associated with a decreased protection of synovial cells against cellular effects and lysis mediated by membrane attack complex.
8829889 A multi-centre, double-blind comparative study of the efficacy and safety of aceclofenac a 1995 A long term multi-centre, double-blind, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (170 patients, 100 mg b.i.d. and placebo once daily) in comparison to diclofenac (173 patients, 50 mg t.i.d.) given for 6 months to patients of both sexes with active rheumatoid arthritis. Efficacy was evaluated in 131 aceclofenac and 130 diclofenac patients at 15 days, 1, 2, 4 and 6 months. Although both treatment groups showed significant improvement in all evaluations of pain and inflammation (assessed by a Visual Analogue Scale and the Ritchie Index) and a progressive reduction in morning stiffness, there were no significant differences between the groups. There was, however, a trend towards greater improvement in hand grip strength with aceclofenac (22% improvement) than diclofenac (17% improvement). Adverse events in both groups were minor, predominantly gastro-intestinal, and fewer patients tended to experience gastro-intestinal events on aceclofenac (13%) than on diclofenac (17%). The overall assessment of tolerance, however, did not differ significantly between groups. In summary, this study supports a therapeutic role for aceclofenac in the treatment of rheumatoid arthritis, and suggests it is an effective and safe NSAID for the treatment of this disease.
1423682 Surgical treatment of temporomandibular joints in patients with chronic arthritic disease: 1992 Jul Twenty-nine temporomandibular joints (TMJs) in 19 patients with chronic arthritic disease were surgically treated. Nine patients had rheumatoid arthritis (including two with juvenile type), six had ankylosing spondylitis and four had psoriatic arthropathy. Using a preauricular approach, diskectomies with synovectomies were performed in 23 joints (14 patients) with chronic arthritic abnormalities. Diskectomies without synovectomies were performed in six joints (five patients), which proved to have internal derangements unrelated to their chronic arthritic disease. Joints with chronic arthritis showed considerable variation in inflammatory reactions, but were characterized by increased vascularization, synovial proliferation to the articulating surfaces and mostly pannus formation and bone resorption. A response in pain relief was seen in 85% of the patients three months postoperatively and in 79% of the patients 12 months postoperatively, indicating that diskectomy with synovectomy may be favorable in patients with severe TMJ problems due to involvement of chronic arthritic disease.
7612041 Compartment-directed physical examination of the knee can predict articular cartilage abno 1995 Jul OBJECTIVE: To determine whether physical examination maneuvers that focus on each knee compartment and assess crepitus at several distinct sites can specifically disclose articular cartilage abnormalities in the compartment being assessed. METHODS: Twenty patients with knee pain were examined before needle arthroscopy. Crepitus was sought from the patellofemoral compartment, medial tibiofemoral compartment, and lateral tibiofemoral compartment. Any crepitus felt in the distal tibia during a tibiofemoral stress maneuver was recorded as transmitted bony crepitus (TBC). Needle arthroscopy assessed articular cartilage (5 sites) and both menisci in each knee. RESULTS: Crepitus by conventional assessment revealed patellar cartilage disruption (69% sensitive, 50% specific) and abnormalities of tibiofemoral cartilage (67% sensitive, 40% specific) but could not indicate their location. Tibiofemoral crepitus found cartilage disruption in the compartment at a sensitivity of 22% and a specificity of 100%, and with added tibiofemoral stress, a sensitivity of 65% and a specificity of 94% (the one "false positive" had bare bone in the other compartment). TBC was detected in 7 compartments, all of which had focal bare bone on tibial and femoral surfaces; 6 other compartments had tibial bare bone without TBC. Thus, TBC was 54% sensitive and 100% specific for tibial bare bone, and 88% sensitive and 100% specific for bone-on-bone. CONCLUSION: Compartment-directed physical examination of the painful knee can locate and assess the severity of certain articular cartilage abnormalities that are not reliably found by conventional methods. Transmitted bony crepitus is a specific finding for bone-on-bone in the compartment being assessed.
8785891 Methotrexate and other chemotherapeutic agents used to treat psoriasis. 1995 Oct The oral chemotherapy agent methotrexate remains a mainstay for the treatment of moderate to severe psoriasis after 40 years experience. Extensive usage, both for psoriasis and rheumatoid arthritis patients, has continued the reasonable safety profile for this drug when appropriate precautions are taken. The availability of other treatment modalities for severe psoriasis permits a rotational system with periods of time when methotrexate is not used, thereby lessening the risk of long-term side effects. Other chemotherapeutic agents for psoriasis are described, but they are used infrequently.
1363987 [Gold salt deposits in the conjunctiva in rheumatoid arthritis after gold therapy. A syste 1992 Nov 30 Ocular abnormalities have long been recognized as a potential adverse effect of gold therapy in patients with rheumatoid arthritis. Clinical symptoms and ocular tissue lesions possibly related to use of gold therapy were routinely evaluated in eleven patients. There were few clinical manifestations: only one patient had typical accumulation of gold in the anterior crystalloid. In contrast, routine ultrastructural and microprobe studies of conjunctival biopsy specimens disclosed accumulation of gold salts in every case. Gold was visible as aurosomes in the conjunctival macrophages. Aurosomes were seen in patients treated for as little as one month, occurred even with low doses (0.3 g), and were still visible after several years. Duration of accumulation can be roughly estimated on the basis of the morphologic appearance of aurosomes which are lamellar after a few weeks of gold therapy and rod-shaped beyond one month.
8834285 Long-term results of 56 revision total knee replacements. 1996 Feb Fifty-six consecutive revised total knee arthroplasties (TKA) were followed for an average of 8.3 years (range: 3 to 15 years). The purpose of this study was to evaluate the results of revision TKA to determine any trends in either the good outcomes or the failures. We found that the success rate for revision TKA was comparable to that for primary TKA. Eighty-nine percent of the knees rated at least fair, with 73% of these rating good or excellent, and 4% poor result. Moreover, the findings suggest that if prostheses are aligned correctly at implantation, there is only slight deterioration in their performance over time. Outcome was not affected by the type of prosthesis used in either the previous surgery or the revision. There is a correlation between the number of revisions and the functional knee rating; the more revisions, the less chance for success. There was also a direct correlation between varus knee alignment and significant increased incidence of failure. No appreciable difference was found between degenerative arthritis patients and rheumatoid patients, except that the rheumatoid patients had a higher incidence of delayed infections.
8368022 [Possibilities and relevance of three-dimensional reconstruction of the sacroiliac joint]. 1993 May The sacroiliacal joint is difficult to evaluate clinically due to its complex form and its topographical position, deep in the body and surrounded by other skeletal structures. We evaluated the potential role of three-dimensional reconstruction and segmentation of CT data of this joint. A total of five patients were examined (age range 24-60 years). In three of these only surface reconstructions were obtained; in the other two, segmentation was obtained as well in order to directly visualize the joints surfaces of the sacroiliacal joint. Compared to conventional radiographs and standard CT, three-dimensional reconstruction and segmentation of the sacroiliac joint did not add significant information. The subtle skeletal findings occurring in inflammatory and degenerative disease were obscured by the process of segmentation. Therefore, radiographs and, in selected cases, CT remain the imaging methods of choice for the evaluation of sacroiliac pathology.
7541445 Genetic influence in rheumatoid arthritis. 1995 May Development of rheumatoid arthritis is influenced by genetic and environmental factors. Over the years intense interest has been focused on analysis of genetic factors contributing to pathogenesis and it appears that the major histocompatibility complex class II genes make a major contribution. Utilizing epidemiological data as well as molecular techniques, an epitope located on a number of HLA-DR molecules (class II) seems to be associated with an increased susceptibility to development of the condition. Furthermore, the disease may be more severe among individuals homozygous for the disease-associated DR types. The specific immunological mechanisms accounting for these findings are not known but are likely related to the ability of class II molecules to bind autoantigens and stimulate the appropriate T cells which can lead to joint damage. A search for additional genetic factors contributing to disease development should be high on the list of objectives and would help to further elucidate the pathogenesis of this complex disorder.
8443958 Augmented lymphocyte binding to cultured endothelium in psoriasis. 1993 Mar Lymphocyte binding to cultured human umbilical vein endothelial cells was evaluated using a modified centrifugation binding assay in 15 patients with psoriasis and compared with three patients with atopic dermatitis, 11 patients with rheumatoid arthritis and 28 normal controls. Patients with psoriasis demonstrated 61% augmented lymphocyte binding compared with normal controls (P < 0.0001), which was not explained by differences in age and sex or an effect of psoriatic sera. In serial studies of six patients, this difference was found to be reversible with treatment and clinical improvement. Lymphocytes from patients with atopic dermatitis demonstrated decreased binding to endothelium (P < 0.005), while those from patients with rheumatoid arthritis were not different from normal controls. This is the first skin disease described in which augmented lymphocyte binding to endothelium occurs, and may represent a mechanism by which lymphocytes are targeted to psoriatic skin.
8348281 Methotrexate--the relationship between dose and clinical effect. 1993 Aug Methotrexate (MTX) is an effective anti-rheumatic drug. Despite its frequent use, the relationship between different MTX doses and clinical effects remain unclear. In a randomized double-blind study in patients with RA, the effects of four MTX doses (5 to 20 mg) was studied. MTX (5 mg) induced a significant effect on the Ritchie joint index, morning stiffness, pain, ESR and C-reactive protein. The effect of MTX on those variables was related to the dose in the range from 5 to 20 mg MTX weekly. Interindividual differences in dose-response curves were observed. The study shows that MTX doses should be adjusted individually for each patient in order to improve efficacy and decrease dose-dependent side effects.
8668981 [Methotrexate treatment of rheumatoid arthritis]. 1996 Apr 27 Weekly low dose methotrexate has a beneficial efficacy: toxicity ratio compared to other disease-modifying antirheumatic drugs. Methotrexate shows one of the most pronounced effects on disease activity, with improvement of functional status and slowing of radiological progression of joint destruction. In addition, the short- and medium-term withdrawal rate is low and due to usually minor side effects. However, major complications such as interstitial pneumonitis, hepatic fibrosis and osteopathy deserve special attention, in particular during long-term treatment. Careful patient selection and monitoring, in close cooperation between the rheumatologist and general practitioner, contribute to optimal security of methotrexate treatment. The present overview summarizes scientific data and makes practical recommendations.
8439636 Gastric and duodenal mucosal blood flow in patients receiving non-steroidal anti-inflammat 1993 Feb Using laser Doppler flowmetry, we measured gastric and duodenal mucosal blood flow in 70 patients who had taken non-steroidal anti-inflammatory drugs (NSAIDs) for longer than 4 weeks, and studied the correlation with demographic factors, ulceration, and Helicobacter pylori. Blood flow was also measured in 17 other subjects not taking any drugs. Measurements were taken from healthy-looking mucosa in the gastric antrum and the first part of the duodenum. Both gastric and duodenal blood flow values were significantly lower in patients taking NSAID than in those who did not. In the NSAID group, the median duodenal mucosal blood flow was 150 perfusion units in smokers (n = 29) compared with 175 in non-smokers (P = 0.024), 123 units in patients with duodenal ulcers (n = 12) compared with 160 in those without duodenal ulcers (P = 0.020), 135 units in patients with H. pylori (n = 30) compared with 168 in patients without H. pylori (P = 0.033), and 118 in smokers infected with H. pylori compared with 175 units in non-smokers not infected with H. pylori (F = 13.4, P = 0.0005). There was no correlation with age. Gastric blood flow was not significantly influenced by any of the above variables. These results suggest that chronic NSAID intake is associated with reduced blood flow in both the stomach and duodenum. However, amongst NSAID patients, duodenal, but not gastric, mucosal blood flow is reduced in smokers, and in those with duodenal ulcers and H. pylori.(ABSTRACT TRUNCATED AT 250 WORDS)
8318038 Restricted cytokine expression in rheumatoid arthritis. 1993 Jul OBJECTIVE: To determine the cytokine profile of the phenotypically activated T cell in rheumatoid arthritis (RA) synovium. METHODS: Interleukin-2 (IL-2), IL-2 receptor (IL-2R), IL-6, IL-4, and interferon-gamma (IFN gamma) gene expression was examined in T cells from freshly isolated synovial fluids (SF) and synovial tissues (ST) from patients with RA. Estimates of baseline expression were determined using unstimulated peripheral blood (PB) T cells from healthy individuals. The corresponding positive controls were phytohemagglutinin-activated tonsil T cells. RESULTS: In studies of paired PB and SF T cell samples from 17 RA patients, IL-2 messenger RNA (mRNA) levels in only 1 PB and 3 SF samples were more than 2 standard deviations above the mean of levels in unstimulated PB from healthy donors. Similarly, only 5 PB and 7 SF samples exhibited elevated IL-2R mRNA levels. IFN gamma gene expression was not detected in any of the paired RA PB or SF samples. Fractionated T cells from 12 RA ST were screened with similar results: Only 1 of 12 samples exhibited IL-2 mRNA levels more than 2 standard deviations above levels in baseline controls. IL-2R mRNA levels were low or not detected, and IFN gamma mRNA was absent. Subsequent studies showed that IL-4 and IL-6 gene expression levels were also low in RA tissues compared with tonsil T cell-positive controls. CONCLUSION: These data provide evidence for restricted cytokine expression in the T cell population in RA tissues.
8317340 Corticotropin releasing hormone and the hypothalamic-pituitary-adrenal axis in the regulat 1993 Hypothalamic secretion of corticotropin releasing hormone (CRH) triggers the secretion of pituitary ACTH and antiinflammatory adrenal corticosteroids. CRH is also secreted in local inflammatory sites such as the arthritic joint, but its action appears to be proinflammatory. This review notes the complex interrelationships of the nervous, endocrine, immune and inflammatory systems and suggests that abnormalities in these interactions may play a role in susceptibility to rheumatoid arthritis and various animal models of autoimmune diseases.
8676114 Cementless total knee arthroplasty in rheumatoid arthritis. A report on 51 AGC knees follo 1996 Jan Fifty-one primary consecutive cementless AGC 2000 (Anatomically Graduated Components, Biomet, Warsaw, IN) total knee arthroplasties were performed during 1985 through 1990 in 40 patients with rheumatoid arthritis. Forty-one knees (32 patients) were available for clinical and radiologic follow-up analysis after 24 to 76 months (median, 54 months). There was no pain in 33 knees and mild pain in the rest. Median range of motion was 110 degrees (range, 50 degrees-130 degrees). Median knee score was 90 (range, 71-97), and all knees were rated good or excellent. Radiolucencies greater than 1 mm were found under five tibial components, but no obvious migrations were seen. One tibial component was revised due to aseptic loosening. The cumulative success rate after 4 to 5 years was 97% (lower limit of 95% confidence interval, 91.8%). The medium-term results are considered to compare favorably with reported cemented series.
1348021 IgG and IgA autoantibodies to C1q in systemic and renal diseases. 1992 Jan Antibodies to the collagen-like region of C1q have been described in patients with SLE and rheumatoid vasculitis. In this study the prevalence of both IgG and IgA C1qAb was assessed in serum samples of 385 patients with different systemic and renal diseases. The results demonstrate that the prevalence of IgG and IgA C1qAb is not restricted to the diseases in which they were originally described. C1qAb can also be demonstrated in patients with MCTD, Felty's syndrome, ankylosing spondylitis, polyarteritis nodosa, mixed cryoglobulinaemia, membranoproliferative glomerulonephritis, glomerulosclerosis, and patients with anti-glomerular basement membrane nephritis. The widespread occurrence of C1qAb of both immunoglobulin classes in systemic and renal diseases may provide insight into the mechanisms that lead to C1qAb formation.
7586979 Complement-activating properties of IgM rheumatoid factors reacting with IgG subclasses. 1995 Jul To estimate the complement-activating property (CAP) of IgM rheumatoid factor (RF), which was purified from synovial fluids of patients with rheumatoid arthritis, in a reaction with each IgG subclass, the activation and binding of C4 in the classical pathway of complement by IgM RF was measured in an enzyme-linked immunosorbent assay using biotinylated F(ab')2 antibody to human C4. The CAP of IgM RF reacting with IgG3 was significantly higher than that of IgM RFs bound to the other IgG subclasses (P < 0.01). These results suggest that IgM RF reacting with IgG3 in synovial fluid could induce a greater degree of complement-dependent inflammation in RA synovium than IgM RF reacting with other IgG subclasses.
8205401 Longitudinal bone mineral density changes in early rheumatoid arthritis. 1994 Jun A prospective longitudinal study of patients with early RA was performed to examine the influence of disease duration, disease activity and physical activity on bone loss. Sixty-seven patients with non-steroid treated RA of less than 5 yr duration, including 16 patients with disease duration less than 6 months, had BMD measurements of the femoral neck and the lumbar spine over a 12-month period using dual energy X-ray absorptiometry. The BMD changes were compared with values from 72 control patients and were also correlated with serial measurements of disease activity (measured by the Stoke Index) and disability [measured by the Health Assessment Questionnaire (HAQ) score], at 3-monthly intervals over the 12-month period. No significant differences in BMD changes were found between RA patients and controls overall. Patients with disease duration of less than 6 months had significantly greater loss of BMD at the femoral neck (-3.9%, S.E.M. 1.5) than the remainder of the cohort (-0.2%, S.E.M. 0.7) (P = 0.02) and controls (-0.8%, S.E.M. 0.6). Lumbar spine BMD changes correlated with the initial Stoke Index (Rs-0.373, P = 0.01) but not mean Stoke Indices. There was no correlation of BMD changes with age or HAQ scores. These findings suggest that significant bone loss occurs within the first few months of disease in patients with RA.