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ID PMID Title PublicationDate abstract
10631551 Rheumatoid arthritis and its animal models: the role of TNF-alpha and the possible absence 1999 Dec Rheumatoid arthritis is an organ-specific inflammatory disease of humans. Recent studies have focused on associations with non-MHC genes, new autoantigens and the role of innate immune responses. The success of anti-TNF-alpha in the majority (but, interestingly, not all) of patients has implications for disease mechanisms but the dangers of long-term therapy are becoming clearer. A number of new models of arthritis have been defined and emphasize the importance of the genetic make-up of the host. Attention has also focused on why the joint is a particularly vulnerable site for inflammatory responses.
11901469 Gene therapy for rheumatoid arthritis. 2001 Dec Advances in understanding the biology of rheumatoid arthritis (RA) have opened new therapeutic avenues. One of these, gene therapy, involves the delivery to patients of genes encoding anti-arthritic proteins. This approach has shown efficacy in animal models of RA, and the first human, phase I trial has just been successfully completed. Hand surgery featured prominently in this pioneering study, as a potentially anti-arthritic gene encoding the interleukin-1 receptor antagonist was transferred to the metacarpophalangeal joints of subjects with RA one week before total joint arthroplasty. This study has confirmed that it is possible to transfer genes safely to human joints. It should pave the way for additional application of gene therapy to arthritis and other orthopaedic conditions.
11358417 Imaging the joints in early rheumatoid arthritis. 2001 Mar Radiography is the most widely utilized imaging modality for early rheumatoid arthritis, determination of radiographic progression remaining a crucial part of the evaluation of therapy. Conventional radiography is, however, insensitive for showing bone damage in early disease and is totally unsuitable for assessing synovial inflammation. The recognition of these limitations has led to intense interest in the multiplanar imaging capabilities of magnetic resonance imaging in rheumatoid arthritis and to an increasing use of ultrasonography for assessing synovitis and bone damage. This chapter discusses the role of radiography in early rheumatoid arthritis and the emerging use and role of magnetic resonance imaging and ultrasonography in evaluating synovitis and bone damage. The relationship between synovitis and bone damage is also addressed in the light of recent magnetic resonance imaging observations.
9455965 Predictive factors in rheumatoid arthritis. 1997 Dec 29 Rheumatoid arthritis (RA), a chronic polyarticular disease affecting about 1% of the adult population of the world, produces significant joint destruction, physical impairment, work disability, and early mortality. Patients with RA may have a slowly or rapidly progressive disease or a self-limited one. To design a rational treatment program for all patients, the clinician must identify early on whether patients are destined to have a rapidly progressive disease. This article reviews socioeconomic, psychological, immunogenetic, and disease-related features that may help to identify such patients.
10608912 Alternative treatments for rheumatoid arthritis. 1999 Dec Conventional treatments for rheumatoid arthritis (RA) present a number of problems, in terms of both safety and efficacy. A number of different alternative therapies have been studied, including dietary modifications, nutritional supplements, botanicals, and antibiotics. While the response to these treatments is variable and often unpredictable, some patients have shown dramatic improvement or even complete and long-lasting remission. Moreover, alternative therapies, with the exception of antibiotics, have a low incidence of adverse effects. Consideration of these treatment options has the potential to benefit many patients with RA.
10822793 The knee joint in rheumatoid arthritis. 2000 Summer Rheumatoid arthritis may present in the knee within a wide spectrum of manifestations. Disease progression, treatment protocols, surgical treatments and the possible complications of these treatments differ distinctly from those of osteoarthritis.
11178115 The genetics of rheumatoid arthritis and the need for animal models to find and understand 2001 The causes of rheumatoid arthritis (RA) are largely unknown. However, RA is most probably a multifactorial disease with contributions from genetic and environmental factors. Searches for genes that influence RA have been conducted in both human and experimental model materials. Both types of study have confirmed the polygenic inheritance of the disease. It has become clear that the features of RA complicate the human genetic studies. Animal models are therefore valuable tools for identifying genes and determining their pathogenic role in the disease. This is probably the fastest route towards unravelling the pathogenesisis of RA and developing new therapies.
9636949 Rheumatoid arthritis in Congo-Brazzaville. A study of thirty-six cases. 1998 May OBJECTIVES: To define the epidemiology, clinical features and outcomes of rheumatoid arthritis in a hospital-based population in Congo-Brazzaville. PATIENTS AND METHODS: We retrospectively reviewed the medical records of the 36 subjects seen on an inpatient or outpatient basis at our rheumatology department who met American College of Rheumatology criteria for rheumatoid arthritis. RESULTS: There were 28 women and eight men (male to female ratio, 0.28), with a mean age of 43.5 years. The total number of patients seen at our department during the study period was 3518, yielding a prevalence of 1% for rheumatoid arthritis. Seven per cent of the patients with inflammatory joint disease had rheumatoid arthritis. Mean disease duration was 9.5 years (range, 1-25 years). The onset was gradual in every case and distal joints were affected first in 33 patients. All the patients but one had bilateral symmetric polyarthritis; affected joints included the proximal interphalangeal joints (n: 33), the metacarpophalangeal joints (n: 27), the wrists (n: 27), the metatarsophalangeal joints (n: 20), the knees (n: 26), the elbows (n: 18), the hips (n: 4), the temporomandibular joints (n: 4), and the cervical spine (n: 5). Boutonnière deformity of the fingers was the most common joint deformity (n: 15), followed by ulnar drift (n: 9). Three patients had tenosynovitis, two had tendon rupture, one had carpal tunnel syndrome and one had rheumatoid nodules. Rheumatoid factors were found in 70% of cases. Evidence of chondrolysis was seen on roentgenograms in every case. Gold and chloroquine were the two most commonly used second-line agents. Seven patients were on prednisone, in a mean daily dose of 6 mg. Mean follow-up was 15 months (range: 3-36 months). Steinbrocker's disease activity stage was IV in 14 patients and III in eight patients; Steinbrocker's functional stage was IV in five patients and III in three. CONCLUSION: The features and outcomes of rheumatoid arthritis in Congo-Brazzaville match textbook descriptions except for a lower prevalence of extraarticular manifestations. Similar findings have been reported for East Africa, South Africa, and some countries of West Africa.
11409156 Treating early rheumatoid arthritis in the younger patient. 2001 Jun Early diagnosis and intervention may provide the greatest hope for reducing the disability associated with rheumatoid arthritis (RA). In patients with early RA, accurate diagnosis can be delayed by limited access to a specialist service, slow evolution of the clinical features, and lack of definitive diagnostic criteria. However, acute phase reactants, serologic features including presence of rheumatoid factor, and immunohistologic analysis of synovial tissue can provide the basis for differentiating RA from other forms of arthritis. Factors associated with poorer prognosis in patients with early RA are female sex, larger number of joints involved, elevated levels of acute phase reactants, presence of rheumatoid factor, and radiologic evidence of joint damage. Special treatment considerations in younger persons with RA include issues related to conception, pregnancy, and lactation. Methotrexate, hydroxychloroquine, sulfasalazine, and low dose corticosteroids are usually the mainstays of treatment for younger patients with RA. Recommendations for taking these drugs while considering conception vary with their effect on fertility and on the developing embryo. Sulfasalazine, for example, can be taken during pregnancy but caution is advised for breastfeeding mothers. Leflunomide must be discontinued for 2 years before attempting conception; this time can be shortened if the patient opts for drug washout.
9314163 A comparison of osteoarthritis and rheumatoid arthritis: diagnosis and treatment. 1997 Sep Arthritis is one of the most common chronic illnesses managed in primary care. Osteoarthritis and rheumatoid arthritis are two common types the provider must distinguish between in terms of diagnosis and treatment. Osteoarthritis, the most common form, typically occurs in people more than 60 years of age and involves cartilage destruction. Signs and symptoms are local and include cool, bony joints and arthralgia that worsens with weight bearing. Treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and joint arthroplasty in severe cases. Rheumatoid arthritis is a systemic disease that results in symmetrical joint inflammation along with constitutional symptoms such as fatigue and depression. Current treatment recommendations include early use of disease modifying anti-rheumatic drugs along with NSAIDs. The key to arthritis management is early diagnosis and treatment to prevent further joint destruction and maximize functional ability.
11249596 Oral toleragens in rheumatoid arthritis. 2000 Sep Rheumatoid arthritis (RA) is a common inflammatory and destructive arthropathy. Its precise pathogenesis remains unknown but there is evidence to suggest it is an autoimmune disease. Recently, a number of candidate autoantigens have been identified in RA. Modulating the immune response to the autoantigens by oral tolerance may lead to safer and more effective treatment. Oral tolerance is a state of systemic immune suppression to an antigen induced by oral feeding of the same antigen. In animal models, oral feeding with pathogenic antigens prevents and reduces the severity of autoimmune diseases. Even in diseases where the pathogenic autoantigens are unknown, bystander suppression can be induced using antigens present in the anatomical vicinity. Hence, oral tolerance has been advocated as a treatment strategy for autoimmune diseases including RA. Clinical trials of chicken and bovine type II collagen, a major constituent of articular cartilage, produced conflicting results in RA. This review examines the scientific basis of oral tolerance, discusses the apparent discrepancy in clinical trial results and looks at the future prospect.
10627721 Soft tissue surgery in rheumatoid arthritis of the hand. 1999 Sep All surgery in patients with rheumatoid arthritis of the hand involves careful consideration and planning of the soft tissue component of the disease. The planning must include acknowledgment of the patient's functional requirements and surgical requirements. Multiple surgeries are common in patients with rheumatoid disease and must be planned carefully to avoid conflicting postoperative rehabilitation programs. Joint replacement and other surgery are only an adjunct to the soft tissue treatment. The progressive nature of rheumatoid arthritis is not a barrier to early surgery and may prolong the function of the patient. The logical approach to the surgical requirements is discussed and specific soft tissue surgeries are described. Some details of specific surgical techniques also are included.
11327271 Recent rheumatoid arthritis clinical trials using radiographic endpoints--updated research 2001 Apr Recent randomized controlled trials of traditional and newly developed therapies provide evidence that we have interventions that potentially slow or prevent structural damage in active rheumatoid arthritis, as measured using radiography. These trials also provide a unique opportunity for exploratory data analysis to generate hypotheses apropos the pathogenesis and determinants of radiographic progression and functional disability; they also facilitate further study of the methodological issues regarding imaging measurement.
9710882 The use of Neoral in rheumatoid arthritis. 1998 Aug Neoral (a microemulsion-based formulation) is an immunomodulator that possesses a more predictable and improved absorption than the conventional oral formulation (Sandimmun). The increased bioavailability of Neoral could result in improved efficacy. The pharmacokinetics of cyclosporin and efficacy of cyclosporin in rheumatoid arthritis are reviewed in this article. Current guidelines for the use of Neoral in the treatment of rheumatoid arthritis patients are outlined.
11094424 p53 in rheumatoid arthritis: friend or foe? 2000 The knowledge of transcription factors and proto-oncogenes has influenced the understanding of cell regulation, cell cycle, and apoptotic cell death in rheumatoid arthritis (RA) synovium. In addition, the development of normal synovial fibroblasts into transformed-appearing aggressive synovial fibroblasts may be triggered by the lack of antiproliferative factors, such as p53, p53-associated molecules, other tumor suppressors, as well as by upregulation of anti-apoptotic genes. Therefore, data derived from experiments such as those performed by Tak and colleagues in this issue of Arthritis Research not only enrich the intensive discussion addressing the impact of p53 on RA pathophysiology, they also may facilitate development of novel therapeutic approaches including p53-targeted gene therapy.
10652645 Synovial tissue analysis in rheumatoid arthritis. 1999 Dec In rheumatoid arthritis, synovial tissue is easily accessible for systematic analysis. Blind needle biopsy is a simple and safe procedure, but is restricted to smaller tissue samples. Arthroscopic biopsy is also safe but is more complicated as it allows access to most sites in the joint and provides adequate tissue for extensive laboratory investigations. Synovial tissue analysis has been successfully applied to studies of disease mechanisms, response to treatment and prognosis. The immuno-histological features in synovial tissue have consistently reflected disease status. Synovial tissue analysis has been particularly informative in the study of novel therapeutic agents.
10777119 New treatment possibilities in rheumatoid arthritis. 2000 It is very difficult to predict future treatment modalities especially in diseases like rheumatoid arthritis (RA) with unknown etiology and pathogenesis. In the near future, traditional disease-modifying antirheumatic drugs (DMARD) alone, in combination with each other, or together with cyclosporine, FK506, Rapamycin, or Leflunomide, will probably be the main treatment for RA. Currently biological anti-TNFalpha agents like humanized MAb and recombinant TNF-receptor constructs are now launched in the market. This therapy alone, or in combination with methotrexate is very effective in RA patients. There are, however, concerns over increase in serious infections. Autologous stem cell transplantation will probably be used in certain patient with serious autoimmune diseases.
9088522 What is early rheumatoid arthritis?: definition and diagnosis. 1997 Feb The diagnosis of early rheumatoid arthritis (RA) has inherent difficulties. It requires assessment, not only of the current clinical picture, but of the potential for change. As the pathognomonic feature of RA, is persistence it is not surprising that the American College of Rheumatologists criteria perform better in predicting persistence than severity. An adequate histological/imaging method of diagnosing RA is awaited. In the interim, a pragmatic approach to defining disease has been suggested, which takes a homogeneous group of patients with persistent inflammatory small joint synovitis and secondarily stages them for severity. This proposal is currently being assessed for clinical usefulness.
11001376 Prognostic factors in early rheumatoid arthritis. 2000 Jun The current paradigm for rheumatoid arthritis suggests that persistent synovitis leads to erosive joint damage, progression of which results in functional disability. Studies of X-ray progression followed for 1-9 yr have shown that 40-83% of subsequent progression can be predicted by a combination of prognostic factors such as joint involvement, high levels of C-reactive protein and rheumatoid factor (RF) positivity. There are similar findings for predictors of functional disability in studies followed for 2-15 yr. The most consistent prognostic feature is RF positivity, which is equally important in predicting joint damage and functional disability. Immunoglobulin A RF and the co-presence of RF with anti-keratin or anti-filaggrin antibodies may increase levels of prediction. Added value of genetic predictors over that of RF remains inconclusive. Therefore, therapeutic management should be individualized. Cases with active disease and seropositive RF tests merit aggressive therapy; conversely, cases with little synovitis and seronegative tests require conservative management.
11437676 Role of B cells in the pathogenesis of rheumatoid arthritis: potential implications for tr 2001 In patients with rheumatoid arthritis, chronic inflammation in affected joints may lead to the development of tertiary lymphoid tissue. A micro-environment is generated in the synovial membrane which supports the activation and differentiation of B cells into plasma cells. Through a process of affinity maturation, plasma cells may be generated locally which secrete antibodies of high affinity. Rheumatoid arthritis is characterised by autoantibodies specific for self immunoglobulin. These rheumatoid factors form large antigen/antibody complexes which may enhance the process of joint destruction. The poor prognosis of rheumatoid factor-positive patients is indicitive of the critical role of immunoglobulin complexes in the continuous stimulation of the immune system and thus of the inflammatory processes. In general, treatment of patients with rheumatoid arthritis aims at suppressing inflammation. The currently most successful reagents are those which interfere with the network of cytokines, such as tumour necrosis factor or interleukin-1 receptor antagonists. Only recently have immunosuppressive therapies targeted directly at the B cell response been developed. These first studies suggest that therapies which directly affect the humoral immune response are of great therapeutic potential in the treatment of patients with rheumatoid arthritis.