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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
9417759 [Arthroscopic synovectomy of the knee joint in rheumatoid arthritis]. 1997 Jul The role of arthroscopic synovectomy in Rheumatoid arthritis is still in discussion. The evaluation of the available scientific data out of the literature should give a contribution to this discussion. The review of the studies done in only small numbers of patients demonstrates good clinical results for a short or middle lasting follow-up time. The evaluation showed a lot of differences and problems in the study design, amount of usable datas and results. For the scientific rating of the results of arthroscopic synovectomies it is necessary to have prospective studies with sufficient and reliable data on activity of the disease, the pre-, post- and intraoperative findings, standardized surgical procedures and longer lasting follow-up times.
11123031 The genetics of rheumatoid arthritis: influences on susceptibility, severity, and treatmen 1999 Dec There has been an explosion of knowledge of genetic variations among different populations and the influence of genetics on complex diseases such as rheumatoid arthritis (RA). Although class II major histocompatibility complex (MHC) alleles are important contributors, there are likely multiple other genes that modulate the disease phenotype. Genetic markers may allow prediction of response to particular treatments. Given the recent approval of tumor necrosis factors (TNF) inhibitors and the large number of biologic agents currently undergoing clinical trials, pharmacogenetic markers may prove to be clinically useful.
11276800 Epidemiology of rheumatic diseases. 2000 Dec Rheumatic diseases are among the oldest diseases recognized. The classification of rheumatic diseases is sometimes difficult due to unknown aetiology and heterogeneity in their clinical presentation. Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two most common rheumatic diseases, accounting for a large percentage of disability worldwide. The economic and social burden of these diseases is great. Their impact on both individuals and society results from a decreased quality of life, lost productivity and increased costs of health care. Without appropriate approaches to patient management and control of these diseases, this impact can be expected to increase as the population ages. One of the challenges in studying OA and RA, and rheumatic diseases in general, is deriving epidemiological data that can be used to understand better the factors that contribute to the initiation and progression of these diseases. Only with such an understanding can significant progress be made in the diagnosis, treatment and management of patients.
10225811 Diagnostic evaluation of classification criteria for rheumatoid arthritis and reactive art 1999 May OBJECTIVE: To evaluate the diagnostic performance of classification criteria for rheumatoid arthritis (RA) and reactive arthritis (ReA) in an early synovitis outpatient clinic. METHODS: In a prospective two year survey consecutive patients with early synovitis of less than one year duration were documented using a standardised registry and were classified after an expert diagnosis. Of a total of 320 patients 39 (19%) were diagnosed as having RA, 24 (11%) patients had ReA, 117 (54%) patients did not have an unequivocal diagnosis, and were considered as undifferentiated arthritis. RESULTS: The retrospective application of the revised 1987 ACR criteria for the classification of RA in this data set revealed a sensitivity of 90% and a specificity of 90%. The positive predictive value was 0.67, the negative predictive value 0.98. Similarly, the criteria for ReA of the French Society of Rheumatology (FSR) showed a sensitivity of 80% and a specificity of 90% with a positive predictive value of 0.55 and a negative predictive value of 0.97. Both criteria sets had a satisfying likelihood ratio of 9 and 10, respectively. CONCLUSION: Both the 1987 ACR criteria for RA and the criteria of the FSR for ReA have a reasonable diagnostic validity in patients with early synovitis, including a large portion of undifferentiated arthritis.
11480089 [Prosthesis implantation of the rheumatoid arthritis shoulder]. 2001 Jun Omarthritis occurs frequently during the early course of rheumatoid arthritis. Many rheumatoid patients ignore omarthritis because of the good compensation mechanism of the shoulder. Sonography and tomography enable early diagnosis of omarthritis before deterioration is radiologically visible. Arthroplasty gives better results when the musculotendinous rotator cuff is still intact. Therefore, arthroplasty should be performed before severe damage develops. Early indication for cup arthroplasty of the humeral head is justified because of better options in revision surgery. Glenoid components show a high incidence of radiolucency and loosening in rheumatoid patients. Cemented hemiarthroplasties show the lowest rate of loosening.
11296970 Cricoarytenoid arthritis with rheumatoid arthritis and systemic lupus erythematosus. 2001 Mar A 56-year-old woman with rheumatoid arthritis (RA) suddenly developed severe respiratory distress and laryngeal stridor, which required endotracheal intubation. She had had RA for 12 years, which had been controlled well with prednisolone (3 mg/day) at the orthopedic clinic. Laryngoscopy revealed cricoarytenoid arthritis. She was finally diagnosed as having overlap syndrome with RA and systemic lupus erythematosus. She was given high dose corticosteroids that improved her clinical symptoms and laryngoscopic findings. She represents the first patient with overlap syndrome who developed an acute airway obstruction due to cricoarytenoid arthritis.
9399444 Clinical course of conservatively managed rheumatoid arthritis patients with myelopathy. 1997 Nov 15 STUDY DESIGN: The clinical course of rheumatoid arthritis patients with myelopathy who do not undergo surgery was studied. OBJECTIVES: To establish a more accurate prognosis for rheumatoid arthritis patients who do not undergo surgery. SUMMARY OF BACKGROUND DATA: Cervical myelopathy has been reported in two thirds of rheumatoid arthritis patients with atlantoaxial dislocation. Atlantoaxial fusion, or occipitocervical fusion, is widely performed on these patients. However, several researchers reported serious complications from the surgery, including nonunion, worsening myelopathy, and high mortality. The natural course of disease in rheumatoid arthritis patients with myelopathy should be known before definitive treatments can be outlined. MATERIALS AND METHODS: Twenty-one rheumatoid arthritis patients with myelopathy resulting from atlantoaxial dislocation were studied. Fourteen of the 21 cases were associated with upward migration of the odontoid process. All of these patients were recommended for surgery, but they refused. Patients were reviewed by direct examination yearly. Radiographic changes and clinical course, including the survival rate, were observed. RESULTS: Atlantodental interval and Redlund-Johnell measurements deteriorated. The patients showed no neural improvement, and deterioration was found in 16 (76%) cases during follow-up. All patients became bedridden within 3 years of the onset of myelopathy. Seven of the 21 patients died suddenly for unknown reasons, 3 died of pneumonia, and 1 died of multiple organ failure. The three sudden-death cases showed progressive upward migration of the odontoid process. The cumulative probability of survival was 0% in the first 7 years after the onset of myelopathy. CONCLUSIONS: The clinical results for rheumatoid arthritis patients with myelopathy treated without surgery are extremely poor. Surgical treatment is recommended for rheumatoid arthritis patients with myelopathy.
11357166 Uncoupling of inflammatory and destructive mechanisms in arthritis. 2001 Apr OBJECTIVE: To update clinicians on recent advances in the differentiation of the mechanisms of inflammation and cartilage destruction in the pathogenesis of rheumatoid arthritis (RA). METHODS: We present analysis of recent published literature and abstracts that elucidates the independent actions of pivotal proinflammatory cytokines. These experimental data provide the framework for understanding the uncoupling of destructive and inflammatory mechanisms in arthritis. RESULTS: Tumor necrosis factor-alpha (TNF-alpha) is an important mediator in the inflammation that occurs in RA. Interleukin-1 (IL-1) has a dominant effect on cartilage destruction that occurs later in the disease process. TNF-independent IL-1 production occurs in many RA model situations. Cytokine balance determines the erosive nature of the disease. CONCLUSION: IL-1 is at least as important as TNF-alpha in promoting the disease process. The pathways by which the inflammatory and destructive changes occur suggest that targeted anticytokine intervention will arrest the cartilage damage that occurs in patients with RA.
9275811 Transitions in chronic illness: rheumatoid arthritis in women. 1997 Jul This article describes transition theory as it relates to a qualitative study of women with rheumatoid arthritis (RA) and the importance of this theory in nursing practice. Rheumatoid arthritis is prototypical of many chronic illnesses because it has a profound impact on activities of daily living. It frequently occurs during a person's most productive years and continues throughout life. Because a person with RA typically experiences a number of exacerbations and remissions over the course of many years, transition theory was chosen as a framework for this study. The study sample consisted of 30 women with RA, who were interviewed about their experiences of living with this chronic illness. The women described four distinct phases in learning to live with RA, which began with awareness and proceeded to mastery. These findings are consistent with the stages of transition described by other investigators.
10782452 [Clinical characteristics of familial rheumatoid arthritis in Spain. A study of 73 familie 2000 Jan 15 OBJECTIVE: To describe clinical characteristics and the homogeneity of disease expression between involved members in multicase Spanish rheumatoid arthritis (RA) families. PATIENTS AND METHODS: 73 families with two or more siblings with RA were found, with a total of 149 patients distributed in 79 pairs (70 sib pairs, and 3 sib trios). Demographic, clinical and radiological characteristics were recorded in a standard questionnaire. RESULTS: Clinical characteristics were similar to those of sporadic RA with a high frequency of women (78%), positive rheumatoid factor (RF) (86%), erosions (89%) and a 25% of the patients having extraarticular disease. The most important variable in disease severity was disease duration. The concordance between family members of the same age and calendar year of disease onset, and the pattern of disease expression, was not higher than expected, showing that the disease is heterogenic. CONCLUSION: Environmental factors seem to be more important in RA susceptibility. Clinical characteristics of familiar RA in Spain do not seem to be different from sporadic RA, although differences were found in disease expression within families that may be due to variation of genetic or environmental factors, responsible for the susceptibility and disease duration.
11040071 Grafting of fibroblasts isolated from the synovial membrane of rheumatoid arthritis (RA) p 2000 Nov The objective of this study was to verify whether isolated rheumatoid arthritis (RA) synovial fibroblasts induce chronic arthritis in SCID mice, in analogy to whole tissue pieces. Fibroblasts were isolated from the synovial membrane of four RA patients (or controls) by out-growth and repeated-passage culture. Following flow-cytometry characterization, 2x10(6)cells were transferred into the left knee joint of SCID mice. The development of arthritis was assessed by joint swelling and histological changes. Human and murine cytokines were measured in vitro in co-cultures (or Transwelltrade mark systems) of human and murine cells. Purified RA synovial fibroblasts, but not healthy synovial or skin fibroblasts, induced hu/mu arthritis within 6 weeks. In-vitro secretion of murine and human interleukin(IL)-6, as well as murine tumour necrosis factor (TNF)-alpha, indicated cross-activation between murine macrophages and human RA fibroblasts. Soluble-factor mechanisms proved more effective than cell-contact mechanisms. Purified RA fibroblasts can, alone, induce hu/mu SCID arthritis. The cytokine profile suggests that xenogeneic interaction between human fibroblasts and murine macrophages may determine the sequence of events leading to hu/mu arthritis.
9623222 [One hundred years of orthopedics in the Netherlands. VI. Surgical treatment of rheumatoid 1998 May 9 The prevalence of rheumatoid arthritis is about 1%. Loss of independence during daily activities is closely related to the multiple joint involvement of these patients. Also, chronic systemic autoimmune diseases and the extra-articular lesions cause considerable comorbidity. Goal of medical treatment is to reduce disease activity and local joint destruction. The surgical treatment consists of joint protective surgery and joint reconstructive surgery. The former procedure inhibits rapid progression of joint destruction by eradicating the bulk of synovial tissue. The latter procedure compensates for functional loss of an extremity by arthroplasties (both endoprostheses and arthrodeses) to increase the patient's independence. The perfect long-lasting functional prosthesis is available for some joints (hip and knee), but still in development for other joints (e.g. finger joints). In case of surgical reconstruction, a plan for possible complications (e.g. loosening) and their functional implications for the specific patient, should be part of the surgical indication policy. The outcome after a surgical procedure is closely related to preoperative patient factors (e.g. joint destruction) and the surgical expertise. Co-ordination of the treatment plan has to be done by the rheumatologist in close conjunction with the orthopedic/rheuma surgeon.
9855209 Hip involvement in seropositive rheumatoid arthritis. Survivorship analysis with a 15-year 1998 In a prospective survey of recent arthritis 96 patients had erosive and seropositive rheumatoid arthritis (RA). Severe radiological changes in the hipjoint (Larsen grade 3-5) were observed in 31 (32%) and acetabular protrusion in five (5%) patients 15 years after the onset of arthritis. At the end of follow-up Larsen score 0-100 of peripheral joints (p < 0.015), HAQ (p < 0.001), ESR (p < 0.001), and CRP (p < 0.01) were significantly higher in patients with hip joint destruction than in those without. Secondary amyloidosis was found in eight patients with and in three patients without hip involvement (p = 0.002). In survivorship analysis (the Larsen 0-2 grade hips) an overall predicted rate of survival was 80% after 14 years of rheumatoid arthritis. When analyzed according to HLA-B27 the rate of radiological survival for the patients with a positive test was 62% and 87% for the others (p = 0.02). In conclusion, RA patients with high number of destructive peripheral joints (Larsen score) and high ESR or CRP should be carefully monitored due to the increased risk of hip destruction.
9706434 Is there an indication for HLA-DR typing for individual patients with rheumatoid arthritis 1998 Jul The clinical expression of rheumatoid arthritis (RA) varies considerably among individual patients. Genetic variations in human leucocyte antigen (HLA) may influence susceptibility to RA and the severity of the disease. The literature concerning the association of HLA-DR with the susceptibility to and the clinical expression of RA is reviewed here, taking into account the different populations studied and different typing techniques. An association between the 'shared epitope' and RA susceptibility is present on a group level and may be of some pathophysiological interest. However HLA-DR typing is not useful as a diagnostic test for individuals. The reported associations between HLA-DR and RA severity are various, which might be due to the different typing techniques used. Results from most studies using genomic techniques for HLA-DR typing show an association between HLA-DR4+, DR1+ and a more severe disease course in patient groups. However, this association is too weak to be relevant for individual patients. Therefore, with our current typing techniques, HLA-DR typing is not a useful prognostic test for individual RA patients.
10524691 Persistence of mild, early inflammatory arthritis: the importance of disease duration, rhe 1999 Oct OBJECTIVE: To determine the factors that predict clinical outcome at 6 months for patients with mild, early inflammatory arthritis. METHODS: Sixty-three patients with mild, untreated, early arthritis were given a single dose of corticosteroids at presentation. Administration was intramuscular if disease was polyarticular (n = 53) or intraarticular if patients had <5 synovitic joints (n = 10). The primary outcome measure was clinical disease remission or persistence of arthritis at 6 months following injection. RESULTS: At 6 months following injection, 49 of the 63 patients (78%) had persistent inflammatory joint disease. The other 14 (22%) had clinical disease remission. Regression analysis showed that only disease duration was significantly associated with persistent arthritis (P < 0.05). The other significant factor (by chi-square test) was the presence of the shared epitope (SE). Of the patients fulfilling the American College of Rheumatology (ACR) criteria at presentation (51% of the total), 53% with disease duration of < or = 12 weeks at presentation had persistent disease 6 months later, compared with 94% of those who presented with disease duration of >12 weeks. CONCLUSION: The strongest predictor of persistent disease was a disease duration of >12 weeks. Rheumatoid factor and SE were also predictors to a lesser extent. Patients who both fulfilled the ACR classification criteria for rheumatoid arthritis (RA) and had a short disease duration included some with an excellent prognosis. Therefore, 12 weeks may be a more appropriate disease duration to use for the RA classification criteria. Administering a bolus of corticosteroids may be a useful diagnostic/therapeutic approach.
9308527 Total wrist arthroplasty in rheumatoid arthritis. A long-term clinical review. 1997 Sep Fourteen total wrist arthroplasties performed in 13 patients with rheumatoid arthritis between 1978 and 1982 were reviewed to evaluate long term outcome. Most patients had Stages III or IV rheumatoid arthritis at the time of surgery. Pain was the primary presenting complaint in 87%. Average followup was 6.5 years (range, 3.5-11.5 years). Pain relief was achieved in 86% of patients. Using objective data obtained from their wrist scores, 72% of the patients had a good result, 14% had a fair result, and 14% had a poor result. No patient had an excellent result. Twenty-seven percent suffered postoperative complications related to their surgical procedure. Although these results help confirm the usefulness of total wrist arthroplasty as an alternative to arthrodesis of the wrist, it is a technically demanding procedure, and should be reserved for the patient who has severely involved arthritis. Additional improvements are needed to decrease the currently high complication and failure rate.
11847684 Caring needs of patients with rheumatoid arthritis. 1999 Apr The goal of this study was to identify, through the application of Watson's 10 carative factors, the caring needs specific to the human experience of having rheumatoid arthritis and undergoing acupuncture treatment. The study was conducted at a large university hospital in Stockholm, Sweden. Interviews were conducted during manual acupuncture treatment employing a conversation guide derived from Watson's theory of caring. Six women had 20 sessions each over an 11-week period. A thematic analysis of the resulting 120 audiotaped sessions revealed four predominant themes: seeking help, searching for meaning, uncertainty, and fear of being disappointed. These four phenomena captured the complexities of the physical, emotional, social, and existential experiences of the patients.
10473058 Ankle arthrodesis in rheumatoid arthritis using an intramedullary nail with fins. 1999 Aug We describe an intramedullary nail with fin-like longitudinal ridges that we have developed for arthrodesis of the ankle in rheumatoid arthritis. Four fins with sharp tips were attached to the distal part of a cylindrical nail to stabilize the tibiotalar and subtalar joints. We used this nail in 15 feet of 15 patients with rheumatoid arthritis who were followed for an average of 34.9 months. Postsurgery, 13 patients were allowed to bear weight immediately, as tolerated, without immobilization. By 3 weeks, these patients were able to bear weight fully. Solid fusion of the ankle joint in an acceptable position and good clinical results were obtained in all patients. The only complications were two cases of delayed wound-healing.
9254375 [The diagnostic value of IgG galactosylation in rheumatoid arthritis]. 1997 Jun 15 Glycosylation is the main posttranslational modification of protein molecules. Human immunoglobulin G (IgG) is unique among serum glycoproteins because it is associated with at least 30 different biantennary oligosaccharide moieties. Elevated ratio of circulating IgG molecules lacking galactose from the oligosaccharides on the CH2 domain correlates with severity of the disease in a number of different autoimmune illnesses. Moreover, it may be helpful in differential diagnosis of rheumatoid arthritis (RA). By that we may try to predict outcome of RA. Its seems that agalactosyl IgG is distinctively connected with rheumatoid arthritis and may be involved in its immunopathogenesis.
10378463 Spondyloarthropathy identified as the etiology of Nubian erosive arthritis. 1999 Jun Slight variation in manifestation of different diseases may allow a single individual with one disease to mimic the "classic" appearance of another, as evidenced by the frequent confusion of spondyloarthropathy with rheumatoid arthritis. Analysis of population occurrence of arthritis (rather than isolated skeletons) facilitates more precise diagnosis. Northeast Africans living around 2,000 years before present were clearly afflicted with a form of spondyloarthropathy. Lack of inclusion of spondyloarthropathy in the differential diagnosis of erosive arthritis led to past misclassification of Nubians as having rheumatoid arthritis. While evidence of spondyloarthropathy abounds in the literature of human skeletal disease, pre-Columbian Old World rheumatoid arthritis is still elusive. The current study further documents the absence of rheumatoid arthritis in Nubians, supporting the hypothesis that rheumatoid arthritis began in the New World.