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ID PMID Title PublicationDate abstract
11555732 Infectious agents in chronic rheumatic diseases. 2001 Jul The possible role of infectious microorganisms in the disease process of both arthritis and autoimmunity continue to attract both basic and clinical researchers. However, proving a causal role for these suspects is a very difficult and complicated task. This article provides an update on various mechanisms in which microbes may play roles as inciting or perpetuating factors in the pathogenesis of connective tissue disease. It also focuses on current theories that specific microorganisms may play a role in rheumatoid arthritis and ankylosing spondylitis.
11045172 [Pain and rheumatoid arthritis]. 1999 Jun OBJECTIVE: Chronic pain is an important part of the clinical picture in patients with RA and therefore the authors attempted to assess the relationship of pain of patients with RA to the inflammatory process, articular damage and to predict the variance of pain in relation to psychosocial, demographic factors and functional disability. METHOD: Pain was examined using the Nottingham Health Profile (NHP), psychological health by means of the General Health Questionnaire (GHQ) and disability was assessed by the Health Assessment Questionnaire (HAQ). RESULTS: The authors examined 160 patients with RA with a mean age of 48.34 +/- 12.13 years and persistence of the disease for 21.32 +/- 15.61 months. Pain was significantly related to clinical manifestations of inflammation and articular damage. The relationship between pain and laboratory manifestations of inflammation (CRP, FW) was not very close. The relationship between age and pain and between persistence of the disease and pain was not statistically significant. Pain correlated significantly with functional disability (HAQ) (r = -0.54) and the articular index (RAI) (r = 0.58). Pain did not correlate with manifestations of depression (r = -0.15), but correlated significantly with anxiety (r = -0.35) and social dysfunction (r = -0.36). Among the investigated parameters (demographic factors, GHQ and HAQ) the most marked variation of pain was caused by HAQ (32%), GHQ (8%). Almost unrelated were demographic parameters (0.6%) (age, persistence of disease, education lifestyle, and gender).
11005780 Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERA 2000 Oct OBJECTIVE: To assess how socioeconomic deprivation influences the presentation, treatment, and outcome of patients with rheumatoid arthritis (RA). METHODS: Three year follow up of 869 consecutive patients with RA from nine hospital rheumatology clinics, with patients categorised by the Carstairs deprivation score of their enumeration district of residence. Outcomes included Health Assessment Questionnaire (HAQ), joint and pain scores, grip strength, functional grade, radiological evidence of bony erosions, and medical/surgical interventions. RESULTS: Patients from more deprived enumeration districts presented with more severe disease as judged by the HAQ score and joint scores. An increase from the 5th to the 95th centile of the Carstairs distribution was associated with an odds ratio of 1.87 (95% confidence interval (95% CI) 1.31 to 2.66) for an above-median HAQ score and 1.77 (95% CI 1.23 to 2.54) for an above-median joint score. Statistically non-significant deprivation trends were seen with erythrocyte sedimentation rate, pain score, and grip strength. By three years, despite no important differences in clinical management, socioeconomic differentials had worsened or remained unchanged such that clear deprivation trends were then seen in HAQ (p=0.002) and joint scores (p=0.001), in grip strength (p=0. 008), and in functional grade (p=0.003). The association between deprivation and HAQ at three years was present after adjustment for age, sex, treatment centre, and HAQ at presentation (adjusted odds ratio 1.74, 95% CI 1.1 to 2.74). CONCLUSIONS: Socioeconomic deprivation was associated with a worse clinical course of rheumatoid disease, and this effect was already apparent at presentation, but not with systematic differentials in its treatment. This suggests that individual susceptibility and lifestyle factors contribute to socioeconomic differentials in outcome, an observation that has implications for clinical management.
9780479 [Indication for a modern therapy of rheumatoid arthritis]. 1998 Mar The treatment of rheumatoid arthritis is currently based on pathogenesis and pathophysiology, being the etiology still unknown. At cognition and activation phase of rheumatoid arthritis, there is a number of potential therapeutic approaches, still in development and in early trials. At inflammation and even more at invasive phase of rheumatoid arthritis, the treatment should take into consideration the parallel activation of several different processes, sustained by the heterogeneity of cells in the inflamed synovium. The early detection of potential severe rheumatoid arthritis patients is crucial, in order to be able to adjust the treatment according to the severity of disease in each patient. Evaluation of genetic and clinical markers for severe disease within the sixth month and in any case no later than the third year of disease is recommended. As far as pharmacotherapy is concerned, it is useful to distinguish anti-rheumatic agents in symptom-modifying drugs (SM-ARDs) and disease-controlling therapy (DC-ART). Discovering the causal agent of rheumatoid arthritis could dramatically change the treatment of rheumatoid arthritis. In the meantime, one can envisage a further development of immuno-pharmacotherapy and the introduction in the clinical practice of specific or selective immunotherapy.
11759233 [Clinical quality management in rheumatoid arthritis]. 2001 Oct Clinical quality management in rheumatoid arthritis (RA) aims at reducing inflammatory activity and pain in the short term and damage and disability in the long term. In the "Swiss Clinical Quality Management in rheumatoid arthritis" (SCQM) project, which started in 1997, a measurement-improvement system with feedback reports allows the rheumatologists to follow their RA patients with the aim of improving the quality of outcome. Inflammatory activity is measured with the Disease Activity Score (DAS28) and the Rheumatoid Arthritis Disease Activity Index questionnaire (RADAI), damage with an X-ray score and disability with the Stanford Health Assessment Questionnaire (HAQ). The feedback is used by the individual rheumatologist to optimize the therapy of his/her RA patients. Beside the aim of improving the quality of treatment, the SCQM projects wants to build a Swiss cohort of RA patients, to improve the collaboration of rheumatologists in the clinic and in practice and to establish standards of treatment in RA. In this paper we describe the SCQM project in detail, we show two cases illustrating the usefulness of the SCQM in the management of individual RA patients, and we present the cross sectional analysis of the first 1223 RA patients included in the project.
10813284 Craniocervical junction involvement in rheumatoid arthritis: a clinical and radiological s 2000 May OBJECTIVE: To make a comparative evaluation of different imaging techniques for studying the craniocervical junction involvement in patients with rheumatoid arthritis (RA). Upper cervical spine involvement was compared with clinical and immunological data. METHODS: Patients (n = 47) underwent plain radiographs and computerized tomography (CT) and magnetic resonance (MR) study of the craniocervical junction. Neurological examination following clinical signs of possible atlantoaxial involvement was performed in all patients following the Ranawat classification. RESULTS: Radiographic and MR images showed craniocervical involvement in 41.3% and 61% of the patients, respectively. Immunological data were not correlated with imaging findings, whereas Ranawat class II and III of neurological involvement seem to be predictive of atlantoaxial alteration. CONCLUSION: Conventional radiography allowed us to detect 41.3% of patients with craniocervical involvement, but only in advanced stages of the disease. MR imaging had the unique potential of direct and detailed synovial visualization, especially in the gadolinium enhanced axial images, resulting in the early diagnosis of craniocervical RA.
10473144 The Simmen classification of wrist destruction in rheumatoid arthritis. Experience in pati 1999 Aug In this radiological study, bilateral radiographs of the wrist in 48 patients with early rheumatoid arthritis (RA) were graded by the Simmen classification, at different times, to determine its potential use in early disease. Interobserver agreement was good. The Simmen classification of wrist destruction in RA could be applied to the radiographs of approximately 50% of patients with early disease. It has some consistency over time.
11881576 Improvement in hand grip strength in normal volunteers and rheumatoid arthritis patients f 2001 Jul The present study aimed at assessing the effects of a set of yoga practices on normal adults (n = 37), children (n = 86), and patients with rheumatoid arthritis (n = 20). An equal number of normal adults, children, and patients with rheumatoid arthritis who did not practice yoga were studied under each category, forming respective control groups. Yoga and control group subjects were assessed at baseline and after varying intervals, as follows, adults after 30 days, children after 10 days and patients after 15 days, based on the duration of the yoga program, which they attended, which was already fixed. Hand grip strength of both hands, measured with a grip dynamometer, increased in normal adults and children, and in rheumatoid arthritis patients, following yoga, but not in the corresponding control groups, showing no re-test effect. Adult female volunteers and patients showed a greater percentage improvement than corresponding adult males. This gender-based difference was not observed in children. Hence yoga practice improves hand grip strength in normal persons and in patients with rheumatoid arthritis, though the magnitude of improvement varies with factors such as gender and age.
10788534 Familial vs sporadic rheumatoid arthritis (RA). A prospective study in an early RA incepti 2000 Mar OBJECTIVES: To study potential differences in demographic, process and outcome variables between familial and sporadic rheumatoid arthritis (RA) in an early RA inception cohort. METHODS: In 1998, we ascertained the familial status of all collaborative patients in a large early RA inception cohort at our department. Familial RA was defined by the presence of at least two siblings fulfilling the American College of Rheumatology criteria for RA. Baseline demographic data and prospectively recorded disease activity variables, therapies and radiological damage during the first 6 yr of disease were included in the analysis. A regression analysis was performed to assess whether familial clustering is a prognostic factor. RESULTS: We identified 142 patients with sporadic and 36 with familial RA. The most striking difference between these groups was the larger sibship size in multicase families (8.2 +/- 2.5 vs 5. 5 +/- 2.8; P < 0.0001). Age at onset was similar in both groups, although males with familiar RA were younger at disease onset than those with sporadic RA (median 50 vs 57 yr; P=0.03). No differences were found in gender, presence of rheumatoid factor (RF), antinuclear factor and HLA-DR typing or in disease activity, interventions and outcome over 6 yr of follow-up. Early radiological damage and disease activity, but not familial history of RA were prognostic for X-ray damage. CONCLUSION: We show that sibship size is the only relevant risk factor for familial RA. No differences in genotypic and phenotypic characteristics, disease severity or radiological damage were observed among familial and sporadic RA. Familial history of RA is not a poor prognostic factor. This prospective study confirms previous cross-sectional findings in the Dutch population.
10319211 Effect of race and ethnicity on outcomes in arthritis and rheumatic conditions. 1999 Mar Examination of racial and ethnic differences in outcome from arthritis and rheumatic conditions can provide important clues to cause. This article reviews literature dealing with ethnic differences in the outcomes of disability, pain and pain coping, psychological adjustment and dysfunction, quality of life, and work disability. Future studies that acknowledge the interactive effects of ethnicity and socioeconomic, biologic, and sociocultural influences and that include growing segments of the population, such as Hispanics and Asians, can advance understanding of mechanisms behind racial and ethnic differences. Although ethnic comparisons of outcome across different studies can be helpful, comparability is enhanced when racial or ethnic groups are examined within the context of the same study with identical ascertainment of disease, measurement of risk factors and outcomes, and analytic strategy.
9093767 Comparable histological appearance of synovitis in seropositive and seronegative rheumatoi 1997 Jan OBJECTIVE AND METHODS: To compare the histological characteristics of the synovium between seropositive and seronegative rheumatoid arthritis (RA), synovial tissue was obtained from 19 patients with rheumatoid factor-positive (RF+) RA, 11 with rheumatoid factor-negative (RF-)RA and 11 non-RA controls. RESULTS: There were no differences in the frequency of each histological feature or histological scores between RF+ and RF-RA. However, significant differences in the frequency of histological findings such as lining cell proliferation and inflammatory cell infiltration were found both between RF+ RA and non-RA controls, and between RF-RA and non-RA controls. Analysis of clinical parameters and histology in all RA patients revealed that the level of serum C-reactive protein and the erythrocyte sedimentation rate were directly correlated with the inflammatory cellular infiltration score. Immunohistological staining using a monoclonal antibody against IgM rheumatoid factor (RF) was positive in some plasma cells in the synovium of both RF+ and RF-RA patients, while no IgM-RF-positive cells were observed in the synovium of non-RA controls. CONCLUSION: RF serostatus does not necessarily reflect the histology of synovial inflammation.
9549029 The use of self-management strategies by people with rheumatoid arthritis. 1998 Feb OBJECTIVE: To investigate seven common arthritis self-management methods used by people with rheumatoid arthritis (RA) by studying their frequency of use and the patients' belief in their benefits. Also to look at how people obtained information about such methods. DESIGN: Cross-sectional survey. SUBJECTS AND SETTING: Forty-one people with RA attending a rheumatology outpatient department at a large district general hospital. RESULTS: Twenty-three recalled receiving some self-management advice from rheumatology team members, but most stated the commonest source of information was arthritis books and leaflets (n = 29). Two-thirds used technical aids and rest on a daily basis, half used exercise and heat (half doing so daily). A quarter to a half used relaxation, joint protection and working splints (half doing so daily). CONCLUSION: People with RA reported using three or four self-management methods simultaneously to help control symptoms. In the main, believing a method to be beneficial was strongly related to its use. However, exercise and joint protection, whilst widely believed to be beneficial, were less used. People reported problems with knowing how to do these correctly, having insufficient time to practise sufficiently and difficulty in establishing habits.
9825646 [Tumors in rheumatoid arthritis]. 1998 Oct 25 Benign (bTu) and malignant tumours (mTu) were studied in a randomised autopsy material of 161 patients with rheumatoid arthritis (RA). The tissue specimens were fixed in 8% formaldehyde solution at pH 7.6 and embedded in paraffin. The tumours were diagnosed histologically and confirmed by immunohistochemical methods. Five benign (3.1%), and thirteen malignant tumours (8.1%) found observed in 18 (11.2%) of 161 cases. There was no significant difference between laboratory parameters of patients with malignant tumours and without tumours. One benign (0.62%) and seven malignant (4.35%) tumours led to death in 8 (4.97%) of 18 cases altogether. Neoplasms were detected clinically in 8 of 18 cases (44.4 rel%). None of tumorous patients received immunosuppressive treatment and only five had gold (Tauredon) therapy. Paraneoplastic syndromes with rheumatoid complaints may be excluded by the onset and duration of RA and tumours. Benign neurogenic tumours and malignant bronchioloalveolar carcinoma were frequently associated with RA not treated by immunosuppressive drugs. Our data do not support the assumption of a high risk of malignant lymphomas associated with RA treated with immunosuppressive therapy.
9619893 Active conservative treatment of atlantoaxial subluxation in rheumatoid arthritis. 1998 Apr Twenty patients with rheumatoid atlantoaxial subluxation (AAS) underwent an active conservative treatment programme, aiming at relieving the symptoms and influencing the natural course of AAS. The treatment consisted of intensive multiprofessional intervention in the hospital for a fortnight, and control and motivational visits 6 and 12 months later. The patients self-evaluated the symptoms several times, and the cervical spine radiographs were taken at the first and last visit. Seventeen of the 20 patients adopted the instructions well and undertook the exercise programme at least weekly, even after a 12 month follow-up. Cervical pain was significantly reduced (P < 0.001) during the first intervention, and the favourable effect continued at least 12 months. Promising changes were also seen in some cervical radiographs. It is possible to educate and motivate AAS patients to take active care of their neck, and to relieve their chronic neck pain significantly. Atlantoaxial instability may also be reduced during active conservative treatment.
9417493 [Selenium concentration in erythrocytes of patients with rheumatoid arthritis. Clinical an 1997 Sep 15 PATIENTS AND METHODS: Seventy patients with definitive rheumatoid arthritis were matched to built 2 groups, which were double-blind and randomized allocated to supplementation with sodium-selenit 200 micrograms/d or placebo for 3 months, each. Both groups were given fish oil fatty acids (30 mg/kg body weight), DMARDS were continued throughout the study, while variations in steroids or NSAD were admitted. RESULTS: Selenium concentrations in erythrocytes of patients with rheumatoid arthritis were 85.1 +/- 26 micrograms/l, and significantly lower than found in an average German population (123 +/- 23 micrograms/l). During the observation period of 3 months normal selenium concentrations were not restored, despite supplementation higher than RDA. At the end of the experimental period the selenium supplemented group showed less tender or swollen joints, and morning stiffness. Selen-supplemented patients needed less cortisone and NSAD than controls. In accordance with clinical improvement we found a decrease of laboratory indicators of inflammation (C-reactive protein, alpha 2-globuline, prostaglandin E2). CONCLUSION: No side effects of supplementation with selenium were noted, which can be considered as adjuvant therapy in patients with rheumatoid arthritis.
10633529 Physical activity in the life of the patient with rheumatoid arthritis. 1999 BACKGROUND AND PURPOSE: Physical activity is an important tool used by patients with rheumatoid arthritis (RA) in order to reduce inflammation and pain as well as preserve and improve function. The aim of this study was to investigate how patients with RA perceive and relate to physical activity in everyday life. METHODS: Ten patients diagnosed with RA were interviewed. The data collected were transcribed and analysed for categories of meaning and main themes. Inter-judge reliability was tested and showed an 81.5% agreement. RESULTS: Three themes were identified. The first represented a 'driving force' and included two positively loaded categories 'satisfaction' and 'support', and two negatively loaded categories 'keep at bay' and 'intimidation'. The second theme was 'hindrance' and included the categories 'internal barrier' and 'external barrier' and, finally, the third theme 'physical activity' included the categories 'organized activity' and 'everyday activity'. CONCLUSION: Physical exercise was an important strategy for patients with RA and was promoted primarily by patients' own experiences, positive as well as negative. A salutogenic (explaining health) approach to patient education, as well as an increased use of everyday activities as additional exercise, is advocated.
10325661 Does the age of onset of rheumatoid arthritis influence phenotype?: a prospective study of 1999 Mar OBJECTIVE: To identify factors affecting prognosis in patients with late-onset rheumatoid arthritis (RA). METHODS: A total of 400 patients with RA fulfilling the American College of Rheumatology criteria for diagnosis were prospectively recruited from two hospital rheumatology centres. Of these patients, 214 had disease onset above age 65 yr (LORA) and 186 below age 65 yr (YORA). Follow-up clinical, functional, laboratory and radiological assessments were compared. The Ritchie articular index (RAI) and joint erosions were used as markers of disease activity and damage, respectively. Disability was assessed using the Stanford Health Assessment Questionnaire (HAQ). RESULTS: At median follow-up of 3.6 yr, the frequency of joint erosions was similar (YORA, 51.6%; LORA, 54.2%). The remission rate was greater in the LORA group (YORA, 20.4%; LORA, 45.8%, P < 0.01). Factors associated with the development of erosions were: IgM rheumatoid factor (RF) seropositivity [odds ratio (OR) = 4.24, 95% confidence interval (CI) 2.56, 6.94], HLA DR4 (OR = 2.07, 95% CI 1.28, 3.35) and elevated inflammatory markers (OR = 1.81, 95% CI 1.04, 3.14). Continuous steroid use >3 months for the LORA group was associated with increased erosions (OR = 4.09, 95% CI 1.81, 9.27). LORA patients (OR = 2.99, 95% CI 1.77, 5.02) were more likely to go into remission and IgM RF-seropositive patients less likely to go into clinical remission (OR = 0.47, 95% CI 0.28, 0.77). Female patients with a high HAQ score at presentation experienced a poor functional outcome (female OR = 3.01, 95% CI 1.59, 5.68; high HAQ OR = 3.02, 95% CI 1.98, 4.62). CONCLUSION: LORA can be as damaging as classical RA and joint erosions are often observed at presentation. Being RF seropositive, DR4 positive, and having elevated inflammatory markers at onset, were associated with poor radiological outcome irrespective of age of onset. Being female and having marked disability at presentation were associated with poor functional outcome in both groups. These findings suggest that treatment approaches used in classical YORA should be instituted with equal vigour in patients with LORA.
9844060 Cartilage oligomeric matrix protein (COMP)-induced arthritis in rats. 1998 Dec In rheumatoid arthritis peripheral cartilaginous joints are inflamed and eroded. One driving factor may be an immune response towards proteins in the cartilage. Here it is shown that cartilage oligomeric matrix protein (COMP), expressed specifically in cartilage, is arthritogenic in the rat. Both native and denatured rat COMP induced severe arthritis in selected rat strains. The arthritis occurred only in peripheral joints which were attacked by an erosive inflammatory process similar to that seen in the human disease. The disease was self-limited and no permanent destruction of joints was seen macroscopically. Disease development appeared to be dependent on an immune response to autologous (rat) COMP and not on cross-reactivity to other cartilage rat collagens (types II, IX and XI). The disease and the immune response to COMP were genetically controlled by the MHC; the RT1u and RT1l haplotypes were more susceptible than the a, c, d, f and n haplotypes. Both LEW and E3 gene backgrounds were highly permissive for disease induction. These findings suggest that the induction of arthritis with rat COMP represents a unique pathogenesis which is controlled by different genes compared with collagen-induced arthritis or adjuvant-induced arthritis.
9851273 Progression in early erosive rheumatoid arthritis: 12 month results from a randomized cont 1998 Nov OBJECTIVE: To compare radiographic outcomes in patients with active early erosive rheumatoid arthritis (RA) who were treated with methotrexate (MTX) and gold sodium thiomalate (GSTM). METHODS: A total of 174 patients from two centres were randomly assigned to receive weekly i.m. injections for 12 months of either 15 mg MTX or 50 mg GSTM in a double-blind fashion. Radiographic evaluations including standardized scoring of 38 joints of the hands, wrists and forefeet, and count of eroded joints, were carried out at baseline and after 6 and 12 months in all patients, including withdrawals. RESULTS: An intention-to-treat analysis revealed no statistically significant difference in the progression of radiographic scores between treatment groups after 6 months (3.4 with MTX vs 2.6 with GSTM, P = 0.66) and after 12 months (6.0 vs 4.8, P = 0.44). A similar pattern was observed for the number of joints with erosions. The slope of radiographic progression was significantly reduced in the second half-year compared to the first 6 months in both groups. Erythrocyte sedimentation rate and C-reactive protein at baseline, and the presence of rheumatoid factor (RF), were the main predictors of progression in bivariate analysis. RF remained as the only predictor for radiographic outcome in multivariable analysis. CONCLUSION: In parallel to clinical improvement, both GSTM and MTX reduce the slope of radiographic progression in patients with active erosive RA.
11263766 Indirect medical costs in early rheumatoid arthritis: composition of and changes in indire 2001 Mar OBJECTIVE: To investigate 1) the magnitude of indirect costs, 2) changes in cost components, and 3) correlations between changes in cost and social, clinical, and occupational variables within the first 3 years of rheumatoid arthritis (RA). METHODS: We evaluated the indirect costs per person-year in 133 consecutive gainfully employed out-patients with early RA, in a prospective multicenter followup study. Costs due to RA-related sick leave, work disability, and other work loss were assessed using the human capital approach. Variables associated with reduction in lost productivity were tested by multivariate logistic regression analysis. RESULTS: Mean +/- SEM annual indirect costs were $11,750 +/- 1,120 per person. During the 3-year period of observation, a marked reduction in the costs associated with sick leave was seen, which exceeded the increase in costs due to work disability and other work loss. This phenomenon resulted in an overall reduction in indirect costs of 21%. The final logistic regression model of reduced loss of productivity included 3 variables: no problems with standing (odds ratio [OR] 7.1), no problems with working speed (OR 4.1), and no problems with outdoor work (OR 3.1). CONCLUSION: High indirect costs in early RA were demonstrated. An overall decrease of costs can be seen in the first 3 years, due to the reduction in sick leave. Since the absence of problems due to strenuous working conditions was found to be associated with a reduction in indirect costs, it is assumed that early intensified vocational rehabilitation, apart from controlling disease activity by adequate treatment, might help to reduce indirect costs.