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ID PMID Title PublicationDate abstract
10036638 T cell receptor gene in synovial tissues of rheumatoid arthritis. 1998 Rheumatoid arthritis is a chronic and destructive autoimmune joint disease characterized by inflammation of synovial tissue of unknown aetiology. Studies on TCR genes expressed by infiltrating T cells in synovial tissues have attempted to identify mechanism and specificity of the recruitment. T cell infiltrate in rheumatoid arthritis appears to be an association of a polyclonal non specific infiltrate with dominant clones or clonotypes. T cell repertoire in synovial tissue is biased compared to peripheral blood but no TCR V gene can be identified as commonly over-used. Comparison of motifs found in the CDR3 region of dominant clones from different studies has currently failed to identified a commonly motif. The fact that a number of dominant clones or clonotypes is present in different joints and at different times of the disease suggests a selective expansion of T lymphocytes in rheumatoid arthritis synovial membrane. Further investigations are needed to characterize the specificity of these dominant clonotypes.
9656325 The role of nutrition and diet in rheumatoid arthritis. 1998 May Given the lack of understanding of the nutritional requirements in RA, plus the variability in its clinical course, it is difficult to produce specific dietary recommendations for RA. In general, sufferers should consume as varied a diet as possible, based on current Department of Health (1991) guidelines. Dietary counselling is important to help patients achieve this. Self-imposed elimination diets should be avoided and suspected food intolerance tested under strict clinical supervision. Nutrient megadosing is inadvisable, although dietary supplementation with Ca, vitamin D, folic acid or multivitamins and minerals should be recommended where necessary.
9102954 [Osteoporosis in rheumatoid arthritis]. 1997 Feb 20 In cases of rheumatoid arthritis, osteoporosis may be local or general. The aetiology is multifactorial. Reduced bodily function, synovial inflammation, steroids and menopause are important risk factors. Studies have shown that, in cases of primary osteoporosis, bone mineral density measurements in the distal radius may predict risk of fracture at other sites, such as the neck of the femur and the dorsal vertebrae. Such a connection is not found for rheumatoid arthritis. Bone density measurements in the distal radius may overestimate the risk of fractures due to localised periarticular osteoporosis. Overall bone quality is assumed to be poorer, however, in patients with rheumatoid arthritis, leading to higher risk of fracture than the bone mineral density measurements seem to show. Data are lacking on the effect of antiresorptive drugs on this condition. Treatment with oestrogen and the bisphosphonate pamidronate has been shown to increase bone mineral density. Data are lacking on fractures. As shown in the case of primary osteoporosis, decreased risk of fracture is to be expected also in patients with secondary osteoporosis.
11447699 Infections in systemic lupus erythematosus and rheumatoid arthritis. 2001 Jun Patients with systemic lupus erythematosus have a higher infection rate than the general population. It is estimated that at least 50% of them will suffer a severe infectious episode during the course of the disease. Improvements in the control of the disease are discussed in this article.
10652642 The role of the hypothalamic-pituitary-adrenal axis in rheumatoid arthritis. 1999 Dec It has become clear that there is a bidirectional communication between the neuroendocrine and the immune system and that both systems influence each other and interact under physiological conditions and in response to inflammatory stimuli. The hypothalamic-pituitary axis plays an important role in regulating and controlling immune responses and dysfunction of the axis has been implicated in the pathogenesis of rheumatoid arthritis (RA). Corticotrophin-releasing hormone (CRH), one of the main hormones of the axis, is also released extra-hypothalamically, peripherally at the site of inflammation and may modulate inflammatory responses locally. In this chapter we will discuss the role of the hypothalamic-pituitary-adrenal (HPA) axis and peripheral CRH, its influences on immune function and what is known about the possible pathogenetic role of the HPA axis and peripheral CRH in RA.
11879544 Autoantibody systems in rheumatoid arthritis: specificity, sensitivity and diagnostic valu 2002 The diagnosis of rheumatoid arthritis (RA) is primarily based on clinical symptoms, so it is often difficult to diagnose RA in very early stages of the disease. A disease-specific autoantibody that could be used as a serological marker would therefore be very useful. Most autoimmune diseases are characterized by a polyclonal B-cell response targeting multiple autoantigens. These immune responses are often not specific for a single disease. In this review, the most important autoantibody/autoantigen systems associated with RA are described and their utility as a diagnostic and prognostic tool, including their specificity, sensitivity and practical application, is discussed. We conclude that, at present, the antibody response directed to citrullinated antigens has the most valuable diagnostic and prognostic potential for RA.
11358415 How does one assess early rheumatoid arthritis in daily clinical practice? 2001 Mar In past years, consensus has been reached on the assessment of rheumatoid arthritis in clinical trials. Next to a core set of disease activity variables, response criteria have been developed and validated. These criteria are, however, of limited value in daily clinical practice. In this situation, emphasis should be paid to accurate measurement of disease activity on a continuous scale using the lowest possible number of core set variables. Different studies have shown that the DAS28 is a valuable instrument for this purpose. Many factors have been identified to possess a prognostic value; however, the IgM rheumatoid factor is still the only one which is of any importance in daily clinical practice.
10652641 Pathogenesis of joint damage in rheumatoid arthritis: evidence of a dominant role for inte 1999 Dec Chronic arthritis is characterised by persistent joint inflammation and concomitant joint destruction. Although joint swelling is a major clinical feature, destruction of bone and cartilage may be dissociated from inflammation. It is therefore important to understand fully all elements of the destructive process. Tumour necrosis factor (TNF) and interleukin-I (IL-I) are considered pivotal cytokines in the process of human rheumatoid arthritis (RA), with a claimed cascade of TNF inducing most of the IL-I production. Studies in experimental models have revealed that TNF is indeed a pivotal cytokine in acute joint swelling, yet IL-I beta is the dominant cartilage destructive cytokine and its production may occur independently of TNF alpha. This was found with anti-TNF/IL-I neutralising antibodies and the observations were recently supported by similar findings in arthritis models in TNF and IL-I knock-out mice. In RA, early clinical studies suggested a correlation between levels of IL-I beta and measures of joint damage. In vitro studies have also demonstrated regulatory effects of IL-I beta on both cartilage degradation and cartilage invasion by synoviocytes. A randomised clinical trial has suggested a significant reduction in the rate of joint damage following IL-I beta inhibition by IL-I receptor antagonist. Clinical trials of TNF alpha blockade have demonstrated a marked reduction in the clinical manifestations of inflammation but, to date, an effect on the rate of joint damage awaits confirmation.
10652646 Multidisciplinary patient care in rheumatoid arthritis: evolving concepts in nursing pract 1999 Dec Multidisciplinary patient care is essential in the management of rheumatoid arthritis (RA), a chronic potentially disabling, multisystem disease. Concepts of multidisciplinary care continue to evolve. While all team members can make valuable contributions to patient care, this chapter focuses in particular on continuing and changing aspects of team management. Of the many disciplines associated with rheumatology, nursing has undergone the most radical change in recent years. New roles have been defined and the nursing profession is now emerging with additional skills to support patients and their families. Concepts of patient education also continue to evolve. As the beneficial effects of education are demonstrated, a patient education programme should be seen as essential to the management of rheumatoid arthritis. Finally, the importance of counselling skills is emphasised.
11060754 Tetracyclines for the treatment of rheumatoid arthritis. 2000 Jul In this review the rationale for the possible beneficial effect of tetracycline derivatives for the treatment of rheumatoid arthritis is discussed. Early studies (Sanchez, Skinner et al. and Brown et al. ) and the two open trials of the 1980s are briefly discussed. The three double-blind studies conducted in the 1990s (Kloppenburg et al. , The Netherlands; the MIRA trial, USA and the O'Dell et al., USA) are described in detail. The baseline clinical and demographic data for these patients, as well as the efficacy and toxicity data are described in the text and summarised in tables. The long-term data of the O'Dell et al.'s trial is described. Finally, side effects not observed during the conduct of these trials, but reported to occur in other patients, for example those receiving minocycline for the treatment of acne, are also listed.
9702834 [Gene therapy in rheumatoid arthritis--an already feasible therapeutic principle?]. 1998 Jun Based upon our increasing knowledge of mechanisms underlying tissue destruction in RA patients, new therapeutic principles have been developed, aimed at blocking proinflammatory cytokines or using antiinflammatory cytokines. Both principles, however, have proven to be very effective. In addition, the availability of the methodology to transduce cells with genes has initiated first experiments in animal models to test whether gene therapy for arthritis is suitable, followed by a first, very carefully formulated protocol for human RA. Gene therapy for RA has to still be considered as an experimental form of therapy in a very early stage, not allowing even now any serious treatment offer to RA patients. Several problems, such as the question of a suitable vector system have not yet been solved. With more experiments this therapeutic principle might become available and might prove effective even in a disease with a systemic character like RA in the coming years.
10627720 Rheumatoid arthritis of the wrist. Classification related to the natural course. 1999 Sep The authors introduce a new functional classification of rheumatoid arthritis of the wrist. Unlike the classifications used today, it includes the aspect of the natural course of rheumatoid arthritis. The goal of this paper is to identify radiologic indicators that will classify rheumatoid arthritis into stable forms of the disease (Types I and II) and unstable forms of the disease (Type III). Of 144 wrists examined, the first available radiograph and the radiograph obtained at the time of the first surgery were assessed. The indicators measured were: carpal height ratio, ulnar translocation, radial rotation, and scapholunate dissociation. Noting the changes that occurred each year in these indicators, it was possible to identify a significant difference between stable forms (Types I and II) and unstable forms (Type III) for the parameters carpal height ratio, ulnar translocation, and scapholunate dissociation. The distribution of the indicators allowed the definition of three values: the 100% value, the cut off point, and the lower threshold value. Combining the three radiologic parameters at those values markedly enhanced the possibility to classify rheumatoid arthritis of the wrist. With the help of the three radiologic indicators carpal height ratio, ulnar translocation, and scapholunate dissociation, it is possible to classify wrists with an early stage of rheumatoid arthritis according to the Schulthess classification. The early identification of destabilizing forms of rheumatoid arthritis becomes possible, making the choice and timing of the surgical intervention easier. Wrists with a progressive unstable form of rheumatoid arthritis may be stabilized earlier.
9481230 Measures of activity and damage in rheumatoid arthritis: depiction of changes and predicti 1997 Dec OBJECTIVE: To analyze various quantitative measures of inflammatory activity and joint damage, including articular, radiographic, laboratory, questionnaire, and physical function measures, in regard to changes in status in surviving patients and prediction of mortality in non-survivors over 5 years in a cohort of patients with rheumatoid arthritis (RA) monitored in the mid-1980s and early 1990s. METHODS: A comprehensive evaluation, which included a complete joint count, radiograph, laboratory tests, physical measures of function, and self-report questionnaire scales, was performed at baseline and 5 years later in 210 consecutive patients with RA. RESULTS: Five years after baseline, 206 of the 210 patients were accounted for: 37 had died, 130 had a comprehensive repeat assessment, and 39 had a more limited repeat assessment. In surviving patients, most measures of activity were generally unchanged or somewhat better, including joint tenderness, pain on motion, and swelling; erythrocyte sedimentation rate and rheumatoid factor; as well as questionnaire scores for pain, global status, helplessness, and difficulty in performing 8 activities of daily living (ADL) according to a modified Health Assessment Questionnaire (MHAQ). By contrast, measures of damage, including joint deformity, grip strength, walk time, and radiographic scores, indicated worse status. Mortality over 5 years was predicted significantly in univariable analyses by American College of Rheumatology (formerly the American Rheumatism Association) Functional Class, limited joint motion, scores for MHAQ, global status, helplessness, grip strength, walk time, button time, and number of comorbidities and duration of diseases, as well as the sociodemographic measures of age and formal education. In multivariable Cox regressions, age, comorbidities, MHAQ, and other measures of functional status were the most effective predictors of 5-year mortality. CONCLUSION: In patients with RA, most measures of inflammatory activity were unchanged and sometimes better, while measures of damage indicated worse status in the same patients over 5 years. Measures indicating functional disability, as well as age and comorbidities, predict 5-year mortality more effectively than radiographic and laboratory data. Measures of inflammatory activity may underestimate long-term outcomes in RA, and long-term studies should include measures of damage.
10036636 Human T cell leukemia virus type-I and rheumatoid arthritis. 1998 HTLV-I is a retrovirus known as an oncogenic virus for human. This virus, initially found as a causative agent for adult T cell leukemia, has been lately focused as a causative virus for several autoimmune disorders. Here we described the characteristics of polyarthritis in HTLV-I careers, which is indistinguishable from idiopathic rheumatoid arthritis (RA). The relationship between arthritis and this virus was clearly proved by epidimiological study. Moreover, we presented transactivating gene of this virus, tax, is responsible for proliferation of synovial cells. This was proved by Tax transgenic mice, which present chronic destructive arthritis resembling human RA. Other autoimmune disorders, such as Sjögren's syndrome and uveitis, are also reviewed.
11438039 Genetic epidemiology. Approaches to the genetic analysis of rheumatoid arthritis. 2001 The basis of susceptibility to rheumatoid arthritis (RA) is complex, comprising genetic and environmental susceptibility factors. We have reviewed the available approaches to the investigation of the genetic basis of complex diseases and how these are being applied to RA. Affected-sibling-pair methods for nonparametric linkage analysis, linkage-disequilibrium-based approaches, transmission disequilibrium testing, and disease-association studies are discussed. The pros, cons, and limitations of the approaches are considered and are illustrated by examples from the literature about rheumatoid arthritis.
11358420 How can the risk of long-term consequences of rheumatoid arthritis be reduced? 2001 Mar The long-term natural history of rheumatoid arthritis includes early radiographic damage and progression, severe functional declines, work disability and increased mortality rates. Emerging evidence suggests that this natural history may be favourably affected by disease-modifying anti-rheumatic drugs (DMARDs), which slow the radiographic progression and functional decline. It is necessary to document both the efficacy of these drugs in randomized controlled clinical trials and their long-term effectiveness in clinical observational studies. Although a 20% improvement in inflammatory measures in the American College of Rheumatology Core Data Set (ACR20) distinguishes DMARDs from placebo in clinical trials, it is not clear that a control of inflammation at this level, or even at 50%, is sufficient to prevent long-term damage. There is limited financial support for long-term observational studies, which depend on data from the clinical experience of rheumatologists. Quantitative databases from clinical care, can be developed to document long-term outcomes in patients with early rheumatoid arthritis to include additional physical, radiographic, laboratory and patient questionnaire quantitative data. Patient self-report questionnaires appear to provide the least expensive and most effective measures toward this goal.
9355210 Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. 1997 Oct OBJECTIVE: To review epidemiological studies dealing with the temporal and geographic variability in the occurrence of rheumatoid arthritis (RA) and clinical studies that address the variability of severity and manifestations among populations. METHODS: An extensive search of the literature, including a Medline search, was completed. Studies addressing the origin, history, and trends in the occurrence of RA were reviewed first. Next, studies of the prevalence and incidence of RA in different populations were reviewed, and occurrence rates compared. Standardization was attempted by tabulating adult prevalence rates of studies using equivalent sets of criteria. Studies comparing RA patients from two populations were sought next. Finally, studies dealing with explanations of the presumed variability were reviewed. RESULTS: Temporal variability is indicated by paleopathological evidence that RA has existed in the New World since 4000 BC, whereas there is no evidence that it occurred in Europe before the 17th century, or in Africa before the 20th century. Epidemiological studies show a possible trend of decreasing incidence of RA in the United States and Western Europe, whereas reports from Africa note a rising incidence. In white populations of Europe and America, prevalence is approximately 1%, and incidence is 0.03%. Significantly higher rates are found in some North American Indians, and significantly lower rates in some Asian and African populations, even when the different population structures are taken into account. In the latter populations, different patterns of occurrence from those observed in whites emerge, such as greater female preponderance and a much younger peak age at onset. Direct standardized comparisons of two diverse populations of RA patients showed some differences in expression, severity, or manifestations of RA between populations. CONCLUSION: The occurrence and manifestations of RA are temporally and geographically variable.
10090190 Conceptual issues in scoring radiographic progression in rheumatoid arthritis. 1999 Mar Radiographic scoring systems for rheumatoid arthritis (RA) should be based on current understanding of disease pathology. Evidence suggests that there may be at least two intraarticular pathologies that may result in change in different radiographic features. There is therefore a strong argument for devising a radiographic score based on the observation of features rather than broad categorizations of the total radiographic change. Features may subsequently be amalgamated in relation to other criteria such as sensitivity, specificity, and responsiveness to change, and may be related to subsequent developments in understanding the biology of RA. A second challenge is in elucidating the relationship between radiographic change and the longterm consequences of RA for the patient. Current practice is predicated on the assumption that in the longterm radiographic change correlates well with functional loss and possibly noninflammatory, endstage joint pain. Although hand and feet radiographs broadly represent destructive change in all joints, in cross sectional studies they correlate only moderately with late stage functional loss. The issue may be resolved by longterm observational studies of radiographic change and functional loss. It is recommended that specific radiographic features relevant to joint pathophysiology be used to create a radiographic damage index for comparison with current scoring systems and that longterm observational studies specifically address the relationship between radiographic joint damage and functional outcome.
11327270 Links between radiological change, disability, and pathology in rheumatoid arthritis. 2001 Apr The relationship between the development of radiographic joint destruction in rheumatoid arthritis and its longterm consequences for the patient is not well understood. Two objectives for further research have been identified: elucidating this relationship and relating pathological processes to the features visible on radiographs. Extrapolation from a proposed model suggests that if radiographic progression is suppressed early in the disease, it might take many years before the benefit can be clearly appreciated against a background of variation within individual patients. Two approaches have recently been brought to bear on this issue, including a detailed modeling of medium term observations from a single dataset and a review of a large number of published studies. There are a number of reservations about the notion of a minimum clinically important change, but one possibility for defining such a change for radiographs is in relation to longterm functional outcome.
11642505 Nonmyeloablative allogeneic hematopoietic cell transplants: any role for rheumatoid arthri 2001 Oct Recent studies have suggested limited efficacy of high dose cyclophosphamide and autologous stem cell transplant as a treatment for severe rheumatoid arthritis. Preclinical data and anecdotal evidence from human transplants suggest that greater efficacy and possible cures might be achieved through use of allogeneic transplants. Newer less intensive methods of allogeneic transplantation have been introduced that reduce morbidity and mortality of the procedure. This article reviews the possible role of the so-called nonmyeloablative transplants in the treatnent of RA.