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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
10327497 Rheumatoid arthritis and multiple sclerosis in the same patient. Two case-reports. 1999 Mar We report on two new patients with both rheumatoid arthritis and multiple sclerosis. In one patient, the first manifestations of multiple sclerosis occurred eight years after onset of seronegative rheumatoid arthritis without extraarticular manifestations. The other patient had a 20-year history of multiple sclerosis when she developed seropositive, nodular rheumatoid arthritis. Neither patient had evidence of systemic lupus erythematosus. A lip biopsy was done in one patient, with normal results; the other patient was free of clinical symptoms of sicca syndrome and had a negative Schirmer's test. The paucity of similar cases in the literature is surprising since multiple sclerosis and rheumatoid arthritis are both autoimmune diseases and share many pathophysiologic and etiologic features. Although chance alone may explain the occurrence of both conditions in the same patient, the existence of shared etiologic factors should in theory increase the likelihood of the association.
9649673 Rheumatoid vasculitis in a patient with seronegative rheumatoid arthritis. 1998 Jun We report on a 47-year-old woman with a 10-year history of seronegative rheumatoid arthritis (RA) who had experienced an episode of bilateral aseptic pleuritis, and in whom livedo reticularis and ulcers had developed on both lower extremities. Histological examination revealed rheumatoid vasculitis. In rheumatoid vasculitis, high titers of rheumatoid factors are commonly observed. In our case, however, there have been no characteristic laboratory findings throughout the course of the disease so far, despite the active RA. This report describes a rare case of seronegative RA with systemic rheumatoid vasculitis.
9741127 [Rheumatoid pannus of the wrist]. 1998 Mar Presentation of the destructive mechanisms provoked by rheumatoid pannus at the level of ligaments, joints and bones of the wrist. Evaluation of the wrist problems requiring surgical solution, in particular at the radio-carpal and distal radio-ulnar joints. Review of the most useful surgical techniques for soft tissue and bone surgery.
10474926 [The current methods for predicting the course of rheumatoid arthritis]. 1999 Apr One of the lines of inquiry into rheumatoid arthritis (RA) is a quest for markers capable of prognosticating the course of the illness. It is only genetic factors, the presence of rheumatoid factor, and activity of the illness that are most significant prognostic criteria. Showing much promise among the current approaches is DAS (Disease Activity Score) which relies on four variables (Richey index, number of swollen joints, ESR, and health index). The baseline and cumulative DAS values over a certain period of time can be used as prognostic factors. It is these criteria that the European League Against the Rheumatic Diseases Committee on Standardization of Clinical and Therapeutic Investigations have given approval to. They have been termed EULAR criteria.
10944644 Quality of care for patients with rheumatoid arthritis. 2000 Aug 23 CONTEXT: Patients with rheumatoid arthritis are at risk for substantial morbidity because of their arthritis and premature mortality due to comorbid diseases. However, little is known about the quality of the health care that these patients receive. OBJECTIVE: To assess the quality of the health care that rheumatoid arthritis patients receive for their arthritis, comorbid diseases, and health care maintenance and to determine the effect of patterns of specialty care on quality. DESIGN, SETTING, AND PARTICIPANTS: Historical cohort study of 1355 adult rheumatoid arthritis patients enrolled in the fee-for-service or discounted fee-for-service plans of a nationwide US insurance company. Patients were identified and followed up through administrative data between 1991 and 1995. MAIN OUTCOME MEASURES: Quality scores for arthritis, comorbid disease, and health care maintenance were developed from performance on explicit process measures that related to each of these domains and described the percentage of indicated health care processes performed within each domain during each person-year of the study. RESULTS: During 4598 person-years of follow-up, quality scores were 62% (95% confidence interval [CI], 61%-64%) for arthritis care, 52% (95% CI, 49%-55%) for comorbid disease care, and 42% (95% CI, 40%-43%) for health care maintenance. Across domains, care patterns including relevant specialists yielded performance scores 30% to 187% higher than those that did not (P<.001) and 45% to 67% of person-years were associated with patterns of care that did not include a relevant specialist. Presence of primary care without specialty care yielded health care maintenance scores that were 43% higher than those for patterns that included neither primary nor relevant specialty care (P<.001). CONCLUSIONS: In this population, health care quality appears to be suboptimal for arthritis, comorbid disease, and health care maintenance. Patterns of care that included relevant specialists were associated with substantially higher quality across all domains. Patterns that included generalists were associated with substantially higher quality health care maintenance than patterns that included neither a generalist nor a relevant specialist. The optimal roles of primary care physicians and specialists in the care of patients with complex conditions should be reassessed. JAMA. 2000;284:984-992
9266129 Prognostic criteria in rheumatoid arthritis: can we predict which patients will require sp 1997 May Longitudinal studies of rheumatoid arthritis (RA) have shown that joint damage often occurs early in the disease. Therefore, the early treatment of RA with "disease modifying" drugs is gaining acceptance. However, many patients presenting with inflammatory polyarthropathy will follow a benign course. Rheumatologists need to be able to target the use of potentially toxic drugs to those cases where the benefits clearly outweigh the risks. This approach requires reliable assessment of the prognosis at an early stage in the disease process. We have critically evaluated a large number of published studies which claim to provide clinically useful information regarding the prognosis of RA. CONCLUSION: The majority of studies have methodological flaws which limit their value. A small number of published studies exist which provide useful data about estimating the prognosis of RA. Currently evaluated prognostic indicators are only moderately successful and there is an urgent need for methodologically sound research in this area.
9843218 Genetic control of arthritis onset, severity and chronicity in a model for rheumatoid arth 1998 Dec Rheumatoid arthritis (RA) is a chronic and genetically complex inflammatory disorder that leads to erosive destruction of peripheral joints. The use of animal models mimicking RA, such as pristane-induced arthritis (PIA) in rats, should facilitate its genetic analysis. Pristane is a non-immunogenic synthetic oil that, after a single subcutaneous injection into DA rats, induces arthritis restricted to peripheral joints with a chronic relapsing disease course. To identify genes involved in the control of chronic arthritis, we made crosses between susceptible DA rats and resistant E3 rats and analysed the progeny with microsatellite markers covering the entire rat genome. Our results show that different arthritis phenotypes are associated with different chromosomal loci. Loci on chromosomes 4 and 6 (Pia2 and Pia3) influence arthritis onset, whereas a locus on chromosome 12 (Pia4) is associated with severity and joint erosion. We found that chronicity is associated with a different set of loci, one on chromosome 4 and the other on chromosome 14 (Pia5, Pia6). These findings demonstrate for the first time that different phases of a chronic self-perpetuative disease which mimics RA are associated with distinct sets of genes.
11084942 Stress and rheumatic diseases. 2000 Nov This study was done to review the literature concerning the influence of minor and major stress factors on onset and course of rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), systemic lupus erythematosus (SLE), and fibromyalgia syndrome (FS). Major life events and chronic minor stress seem to be very important factors in JCA and are significantly associated with the onset of the disease. With respect to RA and FS, stress may be a provoking factor but the data in the literature are equivocal. However, during the course of the disease, minor stress aggravates SLE, FS, JCA, and RA. Patients with FS and RA may profit from psychological therapies. Optimistic and confronting coping strategies were found most frequently and perceived to be most effective. Very important for psychological function is the social background, especially the functioning of the family is of outstanding importance for clinical and psychological outcome.
10420370 [Central corneal diseases]. 1999 May BACKGROUND: Central corneal pathologies can lead to an irreversible decrease of best corrected visual acuity if not diagnosed and treated appropriately. This article reviews the differential diagnosis of central corneal opacities in the newborn, of central infectious corneal ulcers, and the therapy of sterile, central keratolysis. MATERIAL AND METHODS: Authors' personal experience and review of the literature. RESULTS: Flow charts for diagnosis and treatment strategy have been elaborated. CONCLUSIONS: Corneal opacities in newborns create an emergency situation. In order to treat successfully and avoid or diminish amblyopia, it is imperative to rule out congenital glaucoma. The aetiology of central corneal ulcers should always be confirmed by positive cultures to be able to treat specifically. When the standard topic therapy fails, one has to consider rare bacteria, parasites, virus, or patients' compliance. The treatment of central sterile keratolysis in rheumatoid arthritis must be intensive and immunosuppression has to be performed early enough in the course of prevent the formation of a descemetocoele or spontaneous corneal perforation.
11235778 Prospective X-ray densitometry and ultrasonography study of the hand bones of patients wit 2001 Feb OBJECTIVE: Bone demineralization observed in early rheumatoid arthritis is not easily measured. To measure bone loss and to discriminate between rheumatoid arthritis and other rheumatic diseases, we used two methods: dual-energy X-ray absorptiometry and ultrasonography. METHODS: From a population-based recruitment, 32 patients with early peripheral polyarthritis (median disease duration: 4 months) were studied. Clinical, laboratory, functional, hand-bone assessments were made at the entry an at months 6 and 12. Bone X-ray densitometry measurements were made on 16 areas of the hand. Speed of sound was measured across the proximal phalanges of the four fingers. X-rays of both hands were scored according to the modified Sharp's score. At 12 months, patients were classified as rheumatoid arthritis (N = 15; 9 F) or as other rheumatic diseases. RESULTS: We found: 1) significantly decreased bone mineral density (BMD) of the whole hand, in the rheumatoid arthritis group versus the other rheumatic diseases group, at 6 and 12 months (P < 0.05); 2) no significant decrease of bone mineral density (BMD) in other areas in the rheumatoid arthritis group; 3) no significant change of ultrasounds in either group; and 4) no significant correlation between the decrease of BMD in the rheumatoid arthritis group and clinical, biological or radiologic parameters, except for IFNgamma, whose production in whole blood cell culture was lower at entry in the rheumatoid arthritis group. CONCLUSION: DEXA bone assessment in rheumatoid arthritis was able t detect bone loss in the whole hand at 6 months.
11665965 The inheritance of rheumatoid arthritis in Iceland. 2001 Oct OBJECTIVE: Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis. Although there is a large body of evidence suggesting that RA is immune mediated, the etiology remains unresolved. Twin studies have shown disease concordance rates of approximately 15% in monozygotic twins and 4% in dizygotic twins, while the estimated risk ratio for siblings of RA patients ranges from 5 to 8. Our goal was to use genealogic data from Iceland to further investigate the genetic component of RA. METHODS: Data were obtained from a population-based, computerized genealogy database that was developed to examine multigenerational relationships among individuals in the relatively homogeneous population of Iceland. Using an algorithm, the minimum founder test, we calculated the least number of founders required to account for a list of RA patients, and compared it with 1,000 sets of same-sized matched control groups. In addition, we estimated the kinship coefficient and risk ratios for relatives of the RA patients. RESULTS: Several familial clustering tests demonstrated that the RA patients were more related to each other than were the average control set of Icelanders. A significantly fewer number of founders was necessary to account for our patient list than for the random sets of matched controls (P < 0.001), and the average pairwise identity-by-descent sharing was greater among the patients than among the control sets (P < 0.001). In addition, there was an increased risk of RA in first- and second-degree relatives of the patients; e.g., for siblings, the risk ratio was 4.38 (95% confidence interval 3.26-5.67), and for uncles/aunts, the risk ratio was 1.95 (95% confidence interval 1.52-2.43). CONCLUSION: The familial component of RA is shown to extend beyond the nuclear family, thus providing stronger evidence for a significant genetic component to RA.
11501718 Development of an instrument to measure pain in rheumatoid arthritis: Rheumatoid Arthritis 2001 Aug OBJECTIVE: To develop a valid and reliable clinical instrument for measuring pain in adult patients with rheumatoid arthritis. The resulting Rheumatoid Arthritis Pain Scale (RAPS) is a quantitative, single-score, self-report 24-item instrument. METHODS: Psychometric evaluation of RAPS was conducted following estimation of content validity and a pilot study. The actual study used a convenience sample of 120 adults, 18 years of age or older, with pain of at least 3 months duration. The setting was a large rheumatology private practice in a metropolitan southwestern city. The gate control and affective motivational theories of pain served as a framework guiding the development of RAPS, which includes items suggestive of the multidimensional pain experience in rheumatoid arthritis. Four subscales, physiological, affective, sensory-discriminative, and cognitive, evaluated numerous pain factors. RESULTS: Findings indicate a high estimate for internal consistency for the total scale and a moderate to high estimate of internal consistency for projected subscales. Data were analyzed using Cronbach's coefficient alpha, Pearson product-moment correlation coefficients, and exploratory factor analysis. Using Cronbach's coefficient alpha, RAPS showed an internal consistency reliability coefficient of 0.92, a strong indicator of reliability. Reliability assessments for the 4 subscales also indicate reliability, with Cronbach's coefficients ranging from 0.65 to 0.86. Exploratory factor analysis yielded 3 factors with criteria for factor loadings > or = 0.4. CONCLUSION: The study's findings provided support for RAPS as a reliable and valid measurement of rheumatoid arthritis pain. Assessment of rheumatoid arthritis pain and its relationship to treatment outcomes could significantly impact the treatment interventions.
11071583 Pyarthrosis in patients with rheumatoid arthritis: a detailed analysis of 10 cases and lit 2000 Oct OBJECTIVES: 1) To analyze the clinical features and outcome of patients with rheumatoid arthritis and pyarthrosis seen in a rheumatology department during a 9-year period; 2) To review the available literature about this association in the last decade. METHODS: From the database of our department, we collected all hospitalized cases of infectious arthritis in native joints between January 1990 and December 1998. In 10 cases (27%), pyarthrosis occurred in patients with rheumatoid arthritis. A detailed analysis of each patient was performed. The literature was reviewed by using MEDLINE from 1990 to 1999. RESULTS: The mean age of patients was 63.2 years; six were female. Most patients had long-standing disease and poor functional class, and all received glucocorticoid treatment. Mean diagnostic delay was 7.3 days. Causative organisms were Staphylococcus aureus (4 cases), gram-negative bacilli (3 cases), anaerobic bacteria (2 cases), and Streptococcus pneumoniae (n = 1). Two patients died. In all but two patients who survived, joint function worsened. CONCLUSIONS: Rheumatoid arthritis is a relevant host-related risk factor for septic arthritis. Pyarthrosis in these patients is associated with considerable morbidity and mortality.
10948762 Elderly onset rheumatoid arthritis: clinical aspects. 2000 Jul The presentation, severity and prognosis of rheumatoid arthritis (RA) differ depending on the age of disease onset. Elderly onset RA (EORA: age of onset > 60 years) has been reported to differ from younger-onset RA (YORA) by a more balanced gender distribution, a higher frequency of acute onset often associated with systemic features, more frequent involvement of the shoulder girdle and higher disease activity. To add to our knowledge of this disease, 101 EORA and 88 YORA patients, not previously treated with DMDARs or steroids, were studied and compared, paying particular attention to the onset. The female to male ratio was higher in the YORA group (4.4:1 vs 1.6:1; p < 0.05). The disease duration was similar: 5.6 +/- 3.3 months in EORA and 7.9 +/- 3.8 months in YORA. EORA presented a more frequent acute onset (33.6% vs 13.6%; p < 0.05) especially if rheumatoid factor was absent. This subset also showed more frequent polymyalgic onset. Constitutional symptoms (fever, weight loss, fatigue) were more frequent in EORA patients without differences between seropositive and seronegative patients. The distribution of involved joints showed a significantly higher frequency of shoulder involvement in EORA (64% vs 38%; p < 0.05) and of feet involvement in YORA (25% vs 52%; p < 0.05). Hands and wrists were the most frequently involved joints in all patients.
9543572 Reclassifying the pathogenesis of rheumatoid arthritis: from the susceptibility to the deg 1998 Jan Rheumatoid arthritis is a heterogeneous disease in which different pathogenic mechanisms have been suggested. Recent advances in immunology and immunogenetics have contributed to a better understanding of this complex illness. Several stages have been previously described, based on clinical and radiological findings, and proposing different therapeutic options. We have analysed previous classification schema, making some changes and incorporating new knowledge. Our classification system includes a susceptibility stage and a degenerative stage. Therapeutic options are described for each stage. We hope that this will provide useful guidelines in the future for clinicians and researchers.
9666411 New insights in the pathogenesis of rheumatoid arthritis. 1998 Jul Recent advances in molecular technology as well as clinical research findings have enabled the identification of distinct cell subsets, cell surface markers, and cell products that contribute to the immune mediated inflammation observed in rheumatoid arthritis (RA). However, the lack of definitive insight into the disease etiology has resulted in various hypotheses about the roles of these cells or molecules in the pathophysiology of RA. This review summarizes arguments for and against the central role played by T cells in the initiation and perpetuation of RA. Although the available data do not exclude a role of any particular inflammatory mechanism, understanding of immunoregulatory functions of various T cell subsets may lead to more targeted and effective interventions.
11899851 [Cytokines in rheumatoid arthritis. II. Anti-inflammatory cytokines]. 2001 Dec In this review the role of anti-inflammatory cytokines in the pathogenesis of rheumatoid arthritis is presented. We describe their expression in synovial tissue, synovial fluid and in serum and correlation with disease activity. Special attention was paid to the possibilities of the alternative therapies modifying the balance of cytokine network, in the rheumatoid arthritis patients, towards anti-inflammatory state. Several such approaches have shown significant clinical benefits with mild side effects.
11227380 [Clinical and genetic heterogeneity of rheumatoid arthritis]. 2000 The diagnostic category of rheumatoid arthritis, a syndrome of chronic inflammatory disease of the synovial membrane and of extraarticular tissues, covers a broad spectrum of clinical phenotypes. Here we propose that distinct combinations of disease risk genes produce heterogeneity of rheumatoid disease. Recognition of this genetic and clinical heterogeneity has immediate implications as it provides the opportunity to develop selective therapies for the different variants of disease.
9342119 Magnetic resonance imaging of Achilles tendon in patients with rheumatoid arthritis. 1997 Oct RATIONALE AND OBJECTIVES: The authors characterize the appearance of the Achilles tendon in patients with rheumatoid arthritis and differentiate this appearance from degenerative tendinopathy in patients with chronic pain of the heel using magnetic resonance (MR) imaging. METHODS: Thirty patients with rheumatoid arthritis and 28 patients with chronic pain of the heel underwent MR imaging of the ankle and foot. Three radiologists independently assessed the MR images with respect to size, shape, and intratendinal signal characteristics of the Achilles tendon. The Achilles tendon was considered abnormal on MR imaging when intratendinous signal alterations or an anteroposterior measurement greater than 8 mm was seen. Physical examination of the Achilles tendons was accomplished in both groups. Operation confirmed the diagnosis of 13 patients in the second group with chronic pain of the heel. RESULTS: The Achilles tendon of 83% of patients with rheumatoid arthritis demonstrated various intratendinous patterns (longitudinal, reticular, nodular) of intermediate signal intensity on all pulse sequences on MR imaging. Ninety percent of patients with rheumatoid tendinopathy showed no enlargement of the anteroposterior diameter of the Achilles tendon. In addition, all patients with rheumatoid arthritis had findings compatible with an inflammation of the retrocalcaneal bursa on MR imaging, whereas none of the patients with tendinopathy associated with chronic heel pain had retrocalcaneal bursitis. All patients, however, had enlargement of the anteroposterior diameter of the Achilles tendon. Seventy-nine percent showed various intratendinous lesions of intermediate signal intensity on all pulse sequences. Twenty-one percent of patients had an enlargement of the Achilles tendon without intratendinous changes. CONCLUSIONS: Rheumatoid tendinopathy can be distinguished from degenerative tendinopathy in patients with chronic pain of the heel with MR imaging. Inflammation of the retrocalcaneal bursa and the absence of enlargement of the tendon combined with the presence of intratendinous signal alterations are characteristic findings of rheumatoid tendinopathy.
11094416 Mechanisms of bone loss in inflammatory arthritis: diagnosis and therapeutic implications. 2000 Rheumatoid arthritis represents an excellent model in which to gain insights into the local and systemic effects of joint inflammation on skeletal tissues. Three forms of bone disease have been described in rheumatoid arthritis. These include: focal bone loss affecting the immediate subchondral bone and bone at the joint margins; periarticular osteopenia adjacent to inflamed joints; and generalized osteoporosis involving the axial and appendicular skeleton. Although these three forms of bone loss have several features in common, careful histomorphometric and histopathological analysis of bone tissues from different skeletal sites, as well as the use of urinary and serum biochemical markers of bone remodeling, provide compelling evidence that different mechanisms are involved in their pathogenesis. An understanding of these distinct pathological forms of bone loss has relevance not only with respect to gaining insights into the different pathological mechanisms, but also for developing specific and effective strategies for preventing the different forms of bone loss in rheumatoid arthritis.