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ID PMID Title PublicationDate abstract
11584723 [Rare association of acute febrile neutrophilic dermatosis (Sweet syndrome) with rheumatoi 2001 Aug We report on a 57 year old women with a long-standing course of severe rheumatoid arthritis, developing acute febrile neutrophilic dermatosis (Sweet's syndrome) in an active phase of the arthritis. Sweet's syndrome has been reported with hematologic and solid malignancies, infections and several autoimmunopathies, but in only three cases is there a coincidence with rheumatoid arthritis. We review Sweet's syndrome with regard to pathogenesis and associated disorders.
9188421 How rheumatoid arthritis affects patients and families. 1997 Apr 30 This article looks at the social problems of adults with rheumatoid arthritis. The effects on the family and children are discussed along with the role responsibilities. The role of the nurse in relation to patients and their family is illustrated.
10091015 Determining surgical priorities in rheumatoid arthritis. 1999 Feb Rheumatoid arthritis often affects multiple joints simultaneously with pain, deformity and loss of function. The indications for surgical treatment are presented along with guidelines for determining the surgical priorities along with guidelines for determining the surgical priorities when multiple joints require surgery.
11358411 On the organization of an early arthritis clinic. 2001 Mar Early active treatment with disease-modifying anti-rheumatic drugs has become standard management for patients with recent-onset rheumatoid arthritis. A number of questions, however, remain unresolved for practising clinicians, for example how early and how actively to treat and what the treatment goals should be. This chapter summarizes some recent data that have added important empirical evidence on these issues. It has thus been demonstrated that the formal organization of an early arthritis clinic shortens the referral time from primary care, that a delay in the institution of disease-modifying drug treatment leads to decreased long-term function and that early active treatment with pharmacotherapy as well as team-based care may increase occupational capacity. It is argued that adopting a day care approach in the initial encounter with specialist care may increase the possibility for patients actively to understand the disease and their own potentials to diminish and cope with its effects. The further development of care for early arthritis patients with new, potentially efficient but also expensive drugs will increase the requirement for a structured documentation of outcomes, systems for such documentation being discussed in the chapter.
9266134 From disease modification to disease control in rheumatoid arthritis. 1997 May In the development of therapies to treat rheumatoid arthritis, measurement of response is essential. Such measurement has incrementally advanced from symptom modification through radiological improvement to a requirement for change in inflammation, change in function, and the prevention of further structural damage.
9088524 Evaluation of early rheumatoid arthritis disease activity and outcome. 1997 Feb In rheumatoid arthritis nowadays a more aggressive treatment strategy is followed based on early consistent use of second-line agents frequently given in combination. This approach requires an accurate monitoring of the disease activity to follow the course of the disease and to evaluate therapeutic interventions. International consensus is reached over a core set of disease activity variables, including: a 28-joint count for tenderness and swelling, an acute phase reactant, patient's pain and global disease activity, physician's global disease activity, functional disability and radiographs. Guidelines for measurement techniques need to be further specified. Indices of disease activity are developed to improve the unambiguous interpretation of disease activity and comparability of trial results. These measures can be divided in measures for current disease activity and improvement criteria. Further validation will be necessary to adapt finally a uniform measurement technique. The usefulness of self-administered joint counts needs to be studied further.
10206568 Cognitive-behavioral treatment in unselected rheumatoid arthritis outpatients. 1999 Mar OBJECTIVE: This trial was performed to evaluate the efficacy of an adjunctive cognitive-behavioral treatment compared with rheumatological treatment alone in unselected rheumatoid arthritis outpatients. DESIGN: A prospective randomized control design was used. Change in medication during treatment was controlled by matching therapy- and control-group subjects according to this change in medication, sex, age, duration of disease, and functional class. SETTING: A rheumatological outpatient clinic, University of Goettingen, Germany. PATIENTS: Fifty-five consecutive outpatients with a diagnosis of rheumatoid arthritis (age 52.7 years, 74.5% female, duration of disease 9.4 years) finished the study. INTERVENTIONS: Subjects received routine care by the rheumatologists and routine medical treatment. Cognitive-behavioral treatment subjects (n = 19) received adjunctive standardized cognitive-behavioral group treatment with 12 weekly sessions. OUTCOME MEASURES: Outcome measures included disease activity variables, pain variables (pain intensity, affective pain), psychological symptoms, and coping. RESULTS: Subjects mostly demonstrated an increasing disease activity during treatment; change in medication during treatment was necessary in some patients. In the cognitive-behavioral treatment group the course of rheumatoid arthritis seemed less progressive than in the control group. The core effects of cognitive-behavioral treatment pertain more to improved coping, emotional stabilization, and reduced impairment than to reduced pain intensity. Passive, emotion-focused coping, helplessness, depression, anxiety, affective pain, and fluctuation of pain are reduced, "Acceptance of Illness" is improved. CONCLUSIONS: Cognitive-behavioral therapy has proven an effective adjunct to standard treatment of rheumatoid arthritis outpatients. These effects were shown in an unselected sample with increasing disease activity and with comparable changes in medication during treatment. We recommend cognitive-behavioral treatment as an desirable adjunct to standard medical treatment of rheumatoid arthritis.
10646482 Targeting of cells involved in the pathogenesis of rheumatoid arthritis. 1999 Nov The pathogenesis of rheumatoid arthritis (RA) is a consequence of the activation of T cells by as yet unknown antigens and the co-stimulatory molecules CD4 and CD28. A number of potential antigens have been proposed for this process, including type II collagen, heat shock proteins and the glycoprotein gp39. Following activation, T cells initiate the inflammatory cascade through secretion of either interleukin 2 (IL-2) or interferon gamma, or through direct cellular interaction with macrophages and synoviocytes. Targeted therapies in RA are predominantly directed against the T cell. Results of several trials of anti-CD4 antibodies are being evaluated, including those of an anti-IL-6 receptor antibody, which showed short-term effectiveness but some toxicity, and an anti-intercellular adhesion molecule 1 antibody that caused dramatic reduction in rheumatoid factor titres. Non-antibody therapies of RA being studied include nasal administration of gp39 and oral administration of type II articular collagen, but the results of these studies have been equivocal.
10703714 Role of reactive oxygen and nitrogen species in etiopathogenesis of rheumatoid arthritis. 1999 Oct Rheumatoid arthritis (RA) is a chronic disease affecting up to 3% of the population in most countries. The causes of RA have not been completely elucidated. This paper aims to review the role of reactive oxygen and nitrogen species in the etiopathogenesis of RA. Reactive oxygen species (ROS), such as superoxide radical, hydrogen peroxide, hydroxyl radical and hypochlorous acid, as well as reactive nitrogen species (RNS), such as nitric oxide and peroxynitrite, contribute significantly to tissue injury in RA. Several mechanisms are involved in the generation and action of ROS and RNS. Superoxide radical, hydrogen peroxide and nitric oxide do not directly damage the majority of biological molecules. They are however converted into the highly reactive hydroxyl radical, which reacts with almost all molecules in living cells. The resulting chronic inflammation process can be reduced with antioxidant therapy. To date, scavenging, preventive, and enzyme antioxidants are available. The most important mode is scavenging of the hydroxyl radical and of hypochlorous acid. Another important way is to inhibit production of RNS and ROS by neutrophils, monocytes, and macrophages. The control of inflammation in arthritic patients by natural as well as synthetic antioxidants could become a relevant component of antirheumatic prevention and therapy.
9714347 Prevalence of rheumatoid arthritis in Belgrade, Yugoslavia. 1998 Jul OBJECTIVE: To determine the prevalence of chronic arthritis with special reference to rheumatoid arthritis. METHOD: A cross-sectional study was performed during the years 1990 and 1991 in a randomly selected sample of the urban population of Belgrade. RESULTS: Out of 2184 participants, > or = 20 yr old, surveyed by questionnaire, 756 (34.6%) reported peripheral joint complaints. Of those with complaints, 621 (82.1%) agreed to undergo detailed examination. Arthritis was diagnosed in four men (one had rheumatoid arthritis and three had spondylarthropathy with peripheral arthritis) and 11 women (three had rheumatoid arthritis, one had B27-positive polyarthritis and seven had undifferentiated chronic arthritis). The prevalence of chronic arthritis in the adult population was 0.69% (0.35% for men and 1.05% for women). The prevalence for rheumatoid arthritis was 0.18% (0.09% for men and 0.29% for women). Re-examination of 15 individuals with chronic arthritis 3 yr later showed changes in diagnosis only in those patients who at baseline examination had undifferentiated chronic arthritis. CONCLUSION: According to the results obtained, the urban population of Belgrade is among populations with a low prevalence of rheumatoid arthritis.
11296971 Lumbar pannus presenting as cauda equina syndrome in a patient with longstanding rheumatoi 2001 Mar Relatively little attention has been paid to lumbar spine involvement in rheumatoid arthritis (RA), and indeed it is generally considered to be an uncommon and usually clinically minor manifestation of the disease. We describe a case of acute right lower extremity weakness secondary to compression of multiple lumbar nerve roots by a large interforaminal rheumatoid pannus, and review the literature on this complication and other lumbar spine involvement in RA.
9545714 [The value of roentgen pictures in rheumatoid arthritis]. 1997 Sep 6 Rheumatoid arthritis leads to many abnormalities in radiographs as a result of irreversible destruction of cartilage or underlying bone. Radiographs of hands and feet provide the most useful information. Erosions and joint space narrowing in particular can be assessed reliably, and give a good impression of the destruction of the joints. Several validated scoring methods are available to assess the severity and progression of joint damage. Abnormalities are already present shortly after onset of the disease. About 70% of the patients develop erosive disease and in the majority of the cases erosions are present one year after onset. Patients who are rheumatoid factor positive in particular develop erosions. Damage occurs earlier and is often more severe in the joints of the feet than in joints of the hands. The early occurrence of irreversible joint destruction and the availability of treatment effective in reducing this damage necessitates early treatment of patients with RA.
11729429 Economic and quality-of-life impact of rheumatoid arthritis. 2001 Jul Although RA is a disabling disease with increased mortality and an unknown cure, early treatment with DMARD therapy improves patient outcomes. The economic and humanistic effects of this disease are substantial, with patients becoming increasingly disabled from RA. It is extremely encouraging to the rheumatology community that leflunomide provides significant and sustained improvements in clinical signs and symptoms, and offers practicing physicians an additional option in the treatment of RA. It improves and maintains physical function and HRQoL. Leflunomide's effects were consistent across three studies over two years of treatment. It has been demonstrated to improve physical function as measured by the HAQ DI, and HRQoL as indicated by the SF-36 data, two instruments held up as the gold standard for the assessment of patient outcomes in RA clinical trials.
10402176 Rheumatoid arthritis associated with myelodysplastic syndrome: a case report. 1999 Jun Myelodysplastic syndromes (MDS) are a group of refractory anemias resulting from a clonal stem cell disorder often associated with cytogenetic abnormalities. There is increasing recognition of immunological abnormalities in patients with MDS, including defective B- and T-cell function, hyper- or hypogammaglobulinemia and monoclonal gammopathy. MDS have been associated with Sjögren's syndrome, polymyalgia rheumatica, relapsing polychondritis and systemic lupus erythematosus. Although there may be various rheumatologic features, including acute arthritis in MDS, chronic inflammatory arthritis is uncommonly combined. There have been a few reports that described cases of rheumatoid arthritis (RA) concurrent with MDS, but advanced rheumatoid arthritis with typical joint deformities has rarely been reported. We report a case of rheumatoid arthritis with atlantoaxial subluxation combined with refractory anemia in a 31-year-old woman.
10230280 The clinical role of nuclear medicine in rheumatoid arthritis patients. A comparison with 1999 Mar In patients with rheumatoid arthritis (RA) synovitis activity is the dominant clinical variable that determines the therapeutic approach. At present, the amount of painful and swollen joints assessed by physical examination, is generally used to measure the degree of synovitis activity. A gold standard for the assessment of synovitis activity is not available. The availability of an objective and reproducible method to evaluate synovitis activity in RA would be of great value in patient management and in examination of therapeutic effects. An advantage of the use of radiopharmaceuticals in detection of arthritis activity, compared with other imaging techniques, is the possibility to depict all joints in a single image. Furthermore the technique may image joints which are difficult to assess clinically or radiographically and may also detect joint inflammation in an early phase. In this overview different scintigraphic techniques are compared with each other and with other diagnostic imaging modalities.
9266137 Adverse drug reactions of DMARDs and DC-ARTs in rheumatoid arthritis. 1997 May Comprehensive meta-analyses have revealed that survival on DMARD therapy in rheumatoid arthritis can be classified according to several factors: the number of adverse drug reactions, the percentage of drop-outs, and the duration of usage, which is clearly linked to both drug efficacy and drug toxicity. When taking into account of all of these issues, the impact of each DMARD can be scored differently, but certainly the length of time on a given DMARD gives us a conclusive, clinically important overview of its overall efficacy and safety. On these grounds, studies lasting two years or more have demonstrated that, while sulphasalazine can be employed for a median length of 12 months, methotrexate treatment can be maintained for more than 5 consecutive years. Severe and life-threatening complications have been observed with all conventional DMARDs.
9544591 Outcomes for persons with rheumatoid arthritis with a rheumatologist versus a non-rheumato 1998 Apr OBJECTIVE: The authors compared outcomes among persons with rheumatoid arthritis (RA) with a rheumatologist versus a non-rheumatologist as the main physician for this condition. METHODS: A cohort of 1,025 persons with rheumatoid arthritis were followed for as long as 11 years. The principal measures were obtained from an annual structured telephone interview conducted by a trained survey worker. All persons with rheumatoid arthritis originally were selected from a random sample of community rheumatologists, but some subsequently had migrated to the practices of non-rheumatologists. The main outcome measures included the number of painful and swollen joints, extent of morning stiffness, a global pain rating, functional status, and a measure of global improvement. RESULTS: The persons with rheumatoid arthritis treated by rheumatologists reported significantly better functional status, fewer painful joints, and a lower overall pain rating, although the magnitude of these differences was small. A significantly greater proportion of the persons with rheumatoid arthritis treated by rheumatologists also reported improvement in a global measure of rheumatoid arthritis outcome and simultaneous improvement in all outcome measures. On all other outcome measures, the point estimate favored those with a rheumatologist as the main rheumatoid arthritis physician, although the differences did not reach statistical significance. CONCLUSIONS: The evidence suggests an advantage for persons with a rheumatologist as the main rheumatoid arthritis physician, but on several of the measures of outcome, the magnitude of the advantage was small. Because the present study was an observational design, the possibility that the advantage among persons with a rheumatologist as the main rheumatoid arthritis physician is an artifact of selection bias cannot be ruled out.
9291858 Quality of life in rheumatoid arthritis. 1997 Aug Patient-completed health status instruments currently available for use with rheumatoid arthritis (RA) patients lack adequate reliability and responsiveness, making them unsuitable for use as outcome measures in clinical trials. A search of the literature failed to identify a quality of life (QoL) instrument specific to RA. The present study was designed to be the first stage in the development of such a measure. Qualitative interviews were held with 50 RA patients, 25 in the UK and 25 in The Netherlands. The interviews indicated that RA has a detrimental effect on many areas of life, including moods and emotions, social life, hobbies, everyday tasks, personal and social relationships, and physical contact. Transcripts of the interviews formed the source of items for the RAQoL, the first RA-specific QoL instrument.
10983055 Patient perceptions of rheumatoid arthritis. 1999 Oct 6 Rheumatoid arthritis is rarely seen as a serious public health issue, yet it is the single largest cause of disability in the UK (Badley and Tennant 1993). In this qualitative study patients were interviewed about the physical and social effects of the disease.
11337244 Meniscal tearing and rheumatoid arthritis. 2001 Jun We report five cases of meniscal tears in patients who were subsequently found to have rheumatoid arthritis (RA) and discuss the management priorities with regard to symptom relief.