Search for: rheumatoid arthritis methotrexate autoimmune disease biomarker gene expression GWAS HLA genes non-HLA genes
| ID | PMID | Title | PublicationDate | abstract |
|---|---|---|---|---|
| 9416864 | Risk for periodontal disease in patients with longstanding rheumatoid arthritis. | 1997 Dec | OBJECTIVE: To quantify periodontal disease in rheumatoid arthritis (RA) patients and controls, and to correlate the degree of destruction from periodontal disease and from RA. METHODS: Fifty RA patients were matched for age, sex, smoking status, and oral hygiene with 101 controls. Correlations between indices of chronic destruction in periodontal disease (gingival attachment loss) and in RA (Larsen radiographic score) were determined. RESULTS: Patients with longstanding active RA (mean +/- SD 13 +/- 8 years) who were receiving treatment with disease-modifying antirheumatic drugs (n = 46), corticosteroids (n = 38), or nonsteroidal antiinflammatory drugs (n = 43) had a higher rate of gingival bleeding (increased by 50%), greater probing depth (increased by 26%), greater attachment loss (increased by 173%), and higher number of missing teeth (increased by 29%) compared with controls. No correlation was found between the Larsen radiographic score and gingival attachment. CONCLUSION: Patients with longstanding active RA have a substantially increased frequency of periodontal disease, including loss of teeth, compared with controls. Antiinflammatory treatment interferes with periodontal disease and might have masked a possible correlation between the indices of chronic destruction in RA and periodontal disease. | |
| 9876790 | The role of preoperative cervical spine X-rays in rheumatoid arthritis. | 1998 Dec | The cervical spine is frequently involved in rheumatoid arthritis and yet there exists no consensus on the need to screen for cervical spine subluxations preoperatively. We reviewed retrospectively 77 patients who underwent 132 operations under general or regional anaesthesia over a 44-month period. We found that while the majority of patients had received preoperative X-ray screening for cervical spine instability, a third of the X-ray examinations done had been inadequate. Many anaesthetists did not repeat cervical spine X-rays if there were previously performed views available. We showed that a complete X-ray examination of the cervical spine should include flexion and extension stress views in addition to frontal views of the odontoid and entire cervical spine. Anterior atlantoaxial subluxation was the most common subluxation encountered in our study population. The detection of cervical spine instability was found to significantly affect anaesthetic management, favouring techniques that avoided unprotected manipulations of the neck under anaesthesia. | |
| 9791326 | An examination of individual differences in the relationship between interpersonal stress | 1998 Aug | OBJECTIVE: The effects of interpersonal stress on disease activity were examined for married women with rheumatoid arthritis (RA) who differ in the quality of their relationships with their spouses. METHODS: Measures of interpersonal events were collected weekly for 12 weeks and related to disease activity through a comparison of clinician ratings and immune markers taken at baseline and during a highly stressful week for 20 RA patients. Individual differences in marital relationship variables and illness characteristics were used to predict group differences in how stress affected disease activity. RESULTS: Significant elevations in total T cell activation (DR + CD3 cells), soluble interleukin-2 receptor (sIL-2R), and clinician's global ratings of disease activity were found during a week of significant interpersonal stress. However, women with better spousal relationships did not show increases in disease activity following an episode of interpersonal stress. In addition, patients taking low-dose prednisone showed greater reactivity to stress than patients not currently using glucocorticoid treatment. CONCLUSION: The results are consistent with the hypothesis that disease activity in RA increases following increases in interpersonal stress and that women with stronger marital relationships were less vulnerable to those stressors. | |
| 11308053 | The experience of patients with rheumatoid arthritis admitted to hospital. | 2001 Feb | OBJECTIVE: To describe the experiences of patients with rheumatoid arthritis (RA) when admitted to hospital. METHODS: A selected sample of 9 women with RA of at least 3 years duration, who had experienced at least 5 days of inpatient care within the previous 2 years, underwent unstructured interviews in this qualitative, phenomenological study. Information from the interviews was analyzed using Colaizzi's 6 procedural steps. RESULTS: Five major themes emerged from the study: uncertainty during the first admission to hospital; the process of becoming an experienced patient on subsequent admissions; the evident experience and knowledge of staff; the effect, both positive and negative, of other patients; and the loss of privacy. CONCLUSION: These findings throw important new light on the experience of patients with RA receiving inpatient rheumatologic care and have the potential to significantly advance nursing practice within rheumatology. | |
| 9184267 | The long-term results of ankle joint synovectomy for rheumatoid arthritis. | 1997 May | The clinical and radiological results of synovectomy for rheumatoid arthritis in the ankle joint were investigated in 20 ankles of 15 patients. The average follow-up period after synovectomy was 15 years, ranging from 10 to 25 years. The clinical evaluation at the time of follow-up, found that only two ankles showed recurrence of synovitis, and no patient complained of severe ankle pain disturbing the activities of daily life. During the period between the synovectomy and our investigation, no patients required further surgical procedures for their ankle joints. The radiological evaluation found that in approximately two-thirds of the cases, deterioration of the radiological grade, evaluated with Larsen's criteria, had continued after synovectomy. There was no considerable radiological deterioration in the less-erosive subset patients, classified according to Ochi's criteria (1). In the unilateral synovectomized cases, using the non-operated ankles as the natural-course control, osteoarthritic changes were predominant in the operated ankle joint, and the non-operated ankle demonstrated inflammatory disease changes. These results indicate that: (1) synovectomy for a rheumatoid ankle is still a preferred treatment, lessening the clinical symptom of persistent, marked synovial proliferation resistant to medical treatment. (2) Radiological deterioration continues after synovectomy in many cases. However, a radiogram demonstrates predominant osteoarthritic destruction, which indicates the natural course of rheumatoid destruction in the operated site could be altered by synovectomy. | |
| 11324773 | Quality of life profiles in the first years of rheumatoid arthritis: results from the EURI | 2001 Apr | OBJECTIVE: The aim of this study was to examine the quality of life (QoL) profiles of patients with early rheumatoid arthritis (RA) and to relate these to disease and impairment variables as indicated, respectively, by erythrocyte sedimentation rate (ESR) and by tender joint count (Ritchie Articular Index), fatigue, and pain. METHODS: The present study uses part of the European Research on Incapacitating Disease and Social Support data of 573 patients with recently diagnosed RA (268 from the Netherlands, 216 from Norway, and 89 from France). A series of clinical and psychosocial data were collected on 4 (the Netherlands, France) and 3 (Norway) occasions, with 1-year intervals separating the waves of data collection. RESULTS: Of the disease activity (ESR) and impairment variables (tender joint count, fatigue, pain), fatigue was identified as the consequence of disease that differentiated best on a series of QoL aspects such as disability, psychological well-being, social support, and "overall evaluation of health." Next came pain and tender joint count, and ESR showed by far the least differentiating ability. A principal-component analysis on the QoL measures used in this study yielded one general factor measuring "overall QoL." After rotation, two separate factors were encountered, one referring to the physical domain and the other to the psychological and social domains of QoL. Again, the QoL of RA patients experiencing much fatigue appeared to decline the most. CONCLUSIONS: Because of the highly variable nature of RA, impairments, activities of daily living (ADL) and instrumental ADL restrictions, and psychosocial distress can vary erratically. In particular, "fatigue" as measured over a period of 2 to 3 years distinguished best among RA patients as shown by their QoL profiles. Although the physical domain was most affected, the significant effect of RA on the psychosocial domain should not be underestimated. | |
| 9641511 | When does subluxation of the first carpometacarpal joint cause swan-neck deformity of the | 1998 | The aim of our study was to assess the incidence of subluxation of the first carpometacarpal joint (CMC I) and to evaluate which degree of subluxation produces swan-neck deformity of the thumb in rheumatoid arthritis (RA) occurring over 20 years. The hands of 83 rheumatoid factor (RF)-positive RA patients with recent (< or = 6 months) arthritis were evaluated radiographically at onset and at 1, 3, 8 and 15 years; 68 patients were evaluated at 20 years from entry. Subluxation was assessed in millimetres and compared with the MCP-I angle measurement to evaluate the thumb deformity. A statistical end-point analysis was performed between two different grades of subluxation. Subluxation of 2-3 mm was non-specific and only one third of these thumbs showed swan-neck deformity. At the end-point, subluxation of > or = 4mm was present in 17% of the thumbs, 81% of which had the swan-neck deformity; only five thumbs did not show this deformity, but presented deformed and unstable MCP I and interphalangeal joints. The frequency of swan-neck deformity was highly significantly (p < 0.0001) increased in the thumbs with severe CMC I subluxation (> or = 4 mm) compared with lesser subluxation (< 4 mm). When subluxation of the CMC I exceeds 4 mm, the swan-neck deformity of the thumb is a common consequence. This deformity is often progressive, and the hand function of such patients should be followed up carefully, both clinically and radiographically. | |
| 11196540 | Magnetic resonance imaging: a valuable method for the detection of synovial inflammation i | 2001 Jan | OBJECTIVE: Clinical assessment of rheumatoid arthritis (RA) based on pain and swelling and physical examination is limited by observer error and interpretation. We compared magnetic resonance imaging (MRI) and clinical examination to detect synovitis in RA. METHODS: Twelve patients with active RA were assessed according to Ritchie index, swollen joint count and score, swollen joint count of hands and wrists [2 wrists, 10 metacarpophalangeal (MCP), 10 proximal interphalangeal (PIP)], morning stiffness, pain intensity, Disease Activity Score (DAS), erythrocyte sedimentation rate, and C-reactive protein. MR images of hands and wrists were obtained with an adapted device, on T1 weighted (T1W) spin echo (SE) coronal images before and after gadolinium DTPA, TIW SE axial images with gadolinium DTPA, T2* gradient echo recall coronal and axial sequences, and assessed by 2 radiologists (O = no synovitis, 1 = synovitis). RESULTS: The swollen joint count on hands and wrists was 59 on clinical examination (mean 5.08 +/- 3.15 per patient; 20/24 wrists, 7/120 MCP, 32/120 PIP) and 162 on MRI (mean 13.50+/- 5.65; 22/24 wrists, 70/120 MCP, 70/120 PIP). Statistically significant correlations were found between MRI synovitis count and swollen joint count (p = 0.015) and score (p = 0.019), Ritchie Index (p = 0.035), DAS (p = 0.02) and morning stiffness (p = 0.07). MRI revealed synovitis significantly more often than clinical examination (162 vs 59; p = 0.00002) [2-fold in PIP (70/32) and 10-fold in MCP (70/7)]. Clinical examination and MRI were concordant for 157/264 joints (59.5%). The association of normal MRI with synovitis on clinical examination was observed in 2 cases, the opposite in 105. CONCLUSION: MRI is more sensitive than clinical examination to detect synovitis of hands and wrists in RA, especially for MCP and PIP joints, and is valuable for assessment of inflammation in hands and wrists in RA. | |
| 11764199 | Serum soluble interleukin 2 receptor levels and radiological progression in early rheumato | 2001 Dec | OBJECTIVE: To investigate the association between serum soluble interleukin 2 receptor (sIL-2R) levels and radiological changes in patients with early rheumatoid arthritis (RA). METHODS: sIL-2R levels from 155 patients with active RA were measured by immunoassay over a 2 year period and the associations with radiological change and other measures of disease activity were analyzed. RESULTS: The area under the curve for sIL-2R is weakly associated with the change in the modified Larsen score over a 2 year period; this is weaker than the association of radiological change with serum C-reactive protein. CONCLUSION: We found no significant association of sIL-2R levels with erosive change in early RA. | |
| 11812021 | Gene therapy in rheumatic diseases. | 2001 Dec | Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint inflammation as well as progressive cartilage and bone destruction. Advances in the understanding of the pathophysiology of RA have led to the development of new therapeutic strategies, including gene therapy. Gene therapy offers a new approach to deliver therapeutic proteins to the joints of arthritis patients. Local as well as systemic gene therapy can be envisaged for the treatment of arthritis. Several viral and non-viral vectors have been used in animal models for rheumatoid arthritis for ex vivo and in vivo delivery of therapeutic genes. Promising pre-clinical data have resulted from the application of these strategies. Using ex vivo gene delivery, successful and safe gene transfer has been demonstrated in the joints of RA patients. Although new insights into the role of cytokines and other mediators of chronic inflammation have provided novel targets for therapeutic intervention, the development of vectors that induce long-term and regulated gene expression remains a challenge. | |
| 9088528 | A practical guide to patient education and information giving. | 1997 Feb | Patient education is accepted as an essential component in the management of rheumatoid arthritis (RA) and this chapter provides an overview of patient education for practising clinicians. It includes an explanation of the need for patient education including the results of studies into what patients already know. The effectiveness of patient education and its benefits to patients are discussed in the light of recent research, reviews and meta-analyses. Alternative methods of delivering patient education are compared including, one-to-one teaching, opportunity education, group teaching and self-management programmes. Topics for inclusion in education programmes are suggested and the merits of written literature, audio-visual and computer assisted learning are explained. Practical guidance is given on methods of ensuring that written information is readily understandable by patients, including the use of readability formulae. | |
| 10770885 | Orbital myositis and rheumatoid arthritis: case report. | 2000 Mar | Orbital myositis implies orbital inflammation confined to one or more of the extraocular muscles. The acute form responds well to high doses of oral corticosteroids tapered gradually, but it may recur or become chronic. We describe a 38 years old female who has been suffering from rheumatoid arthritis for six years. She developed diplopia as a result of a paralysis of the right and left rectus medialis muscle. MRI showed inflammatory process and thickness of the referred muscles. The patient had a total recovery with oral use of 80 mg methylprednisolone daily. Two months after the first episode she developed a bilateral ophthalmoplegy. The patient improved with oral use of steroids the second time, but a paresis of the left rectus lateralis muscle remained. From the 156 cases we reviewed only three have been related to rheumatic diseases and none has been previously related to rheumatoid arthritis. | |
| 11262775 | Bone mineral density after total joint arthroplasty of lower extremities in rheumatoid art | 2001 | We studied the effects on the axial bone mass of total joint arthroplasty (TJA) for lower extremities in 48 female rheumatoid arthritis (RA) patients by using dual-energy X-ray absorptiometry (DXA). Twenty-nine postmenopausal RA patients treated only with nonsteroidal anti-inflammatory drugs (NSAIDs) served as controls. They were studied for an average duration of 63 months. The reduction in the bone mineral density (BMD) of the lumbar spine (L2-4) was significant in both groups (p < 0.01-0.05), but it was not statistically different between the two groups. The BMD of the femoral neck decreased significantly in both groups (p < 0.01-0.05) after 2 years, but it was not statistically different between the two groups. Our data suggest that TJA slowed the rapid axial bone loss usually associated with advanced RA. | |
| 11501728 | Physical and exercise therapy for treatment of the rheumatoid hand. | 2001 Aug | OBJECTIVE: To study the short-term effects of physical therapy (ice massage or wax packs, thermal baths, and faradic hand baths) and exercise therapy on the rheumatoid hand. METHODS: The effect of individual physical therapy and exercise therapy programs was evaluated in 50 randomly selected rheumatoid arthritis inpatients (38 women and 12 men). Mean patient age (+/- SD) was 47.94 +/- 11.22 years, and mean disease duration was 5.04 +/- 4.80 years. The control group consisted of 50 randomly selected rheumatoid arthritis outpatients (37 women and 13 men; mean age 48.46 +/- 10.65 years, mean duration of disease 5.23 +/- 4.89 years) who at the time of the investigation were not receiving any physical or exercise therapy. The clinical indices used for evaluation of inflammation included erythrocyte sedimentation rate (ESR), pain intensity, proximal interphalangeal (PIP) joint size, and Ritchie articular index. Hand grip strength, palmar tip-to-tip and key pinch finger strength, finger range of motion, and activities of daily living (ADL) were the parameters used to assess the functional hand status. The study was single-blinded and of 3 weeks duration. RESULTS: In the physical therapy treated group, there was an improvement for most of the observed indices from baseline parameters that achieved statistical significance (P < 0.01 and P < 0.005) after the 3-week study period. ESR and PIP joint size improved clinically but failed to reach statistical significance. Patients had a more significant improvement in hand pain, joint tenderness, and ADL score (P < 0.005) than in range of motion (P < 0.01). All parameters in the control group slightly deteriorated over the study period. CONCLUSION: At least in the short term, physical and, particularly, exercise therapy produce a favorable improvement in the functional status of the rheumatoid hand. | |
| 10621071 | The burden of rheumatoid arthritis. Based on a presentation by Frederick Wolfe, MD. | 1999 Sep | The direct, indirect, and intangible costs of rheumatoid arthritis (RA) represent an enormous burden to patients, clinicians, and to society in general. Quality of life is consistently worse--at any age--for RA patients and they tend to die at younger ages. Lessening the burden may be possible through more accurate and careful measurement of quality of life, disease progression, and therapeutic outcomes. Predicting the likely progression of RA and determining which patients will show improvement and which can expect disability is important in discovering which therapeutic approaches are the most useful in ultimately lessening the burden of RA. | |
| 10788536 | The incidence and clinical characteristics of peripheral arthritis in polymyalgia rheumati | 2000 Mar | OBJECTIVE: To evaluate the incidence and characteristics of peripheral arthritis in polymyalgia rheumatica and temporal arteritis, and to ascertain the incidence of rheumatoid arthritis among such cases. Patients and methods. In total, 231 patients were selected from a prospective population-based study. All patients were clinically examined on several occasions and followed until cessation of therapy and permanent disease remission. RESULTS: Of the 231 cases, 38.5% presented peripheral arthritis either at diagnosis or during the disease course. At diagnosis, peripheral arthritis was not observed among patients with temporal arteritis. Peripheral arthritis occurring during the disease course was more often polyarticular and needed additional treatment more frequently than joint inflammation presenting at diagnosis. Only one case had distal pitting oedema. Rheumatoid arthritis developed in 4.8% of the cases and exclusively among patients with polymyalgia rheumatica. CONCLUSION: Aetiopathogenic differences may exist between polymyalgia rheumatica and temporal arteritis as peripheral arthritis and the development of rheumatoid arthritis were observed among the former patient group only. | |
| 9195262 | Recovery of full flexion after total knee replacement in rheumatoid arthritis--a follow-up | 1997 | Twenty-three of 327 patients with rheumatoid arthritis (38 out of 509 knees) had primary Yoshino-Shoji total knee replacements between 1984 und 1990 and were able to squat fully in the Japanese style after the procedure. Seven had died of conditions unrelated to their operations. Of the remaining 16, 5 were able to squat fully at follow-up; 2 were unable to do so, but had full passive flexion; 9 were unable to squat and did not have full flexion. The cumulative survival rates of patients able to squat were 82.2%, 65.7% and 47% at 2, 5 and 8 years after operation. At follow-up, 3 were able to walk out of doors for less than 30 min, 6 for 30 min or more and in 7 walking was unlimited. These results suggest that daily exercises are important in maintaining full flexion. The absence of complications may be due low body weight and limited activity due to the disease. patients with rheumatoid arthritis and low body weight can be encouraged to regain full flexion after total knee replacement if they wish to do so. | |
| 9281016 | [Heart transplantation in a patient with rheumatoid arthritis]. | 1997 May | A 56 year-old woman with rheumatoid arthritis was diagnosed with idiopathic dilated cardiomyopathy. She developed progressive heart failure that was refractory to conventional medical management. Heart transplantation was performed bearing in mind the controversy that surrounds its use in patients with a systemic disease. Transplant and rheumatoid arthritis were favorable at 33 month evolution. The immunosuppressive therapy required for the transplant helped the control of her articular disease. | |
| 11001375 | Functional disability and quality-of-life assessment in clinical practice. | 2000 Jun | Functional disability and quality of life in rheumatoid arthritis (RA) are key outcomes that determine patients' demand for care, and influence their compliance and satisfaction with treatment. In the past decade, there has been a shift from physician-focused assessment toward methods based on the postulate that patients can better report their perceptions of health impairment. There are several disease-specific and generic instruments available that have proven valuable in outcome testing in RA. While there are several obvious advantages to patient self-assessment, clinicians may be reluctant to adopt these measurements. Functional assessment testing will be easier to implement if physicians have access to computer resources for quantitation of disease outcomes and if normative data can be provided to make interpretation clear. Despite current limited access to computer resources and normative data, functional disability and quality of life assessment of RA should be encouraged in clinical practice because it fosters better patient-physician relations and provides much needed long-term outcome information on drug therapy beyond clinical trials. | |
| 11166484 | A blind, randomized, controlled trial of cognitive-behavioural intervention for patients w | 2001 Jan | This study examined the efficacy of a cognitive and behavioural intervention (CBT) for patients with recent onset, seropositive rheumatoid arthritis. Fifty-three participants with a diagnosis of classical or definite rheumatoid arthritis, who were seropositive and had less than 2 years of disease history were recruited into the trial. All participants received routine medical management during the study, although half were randomly allocated to receive an adjunctive psychological intervention. All pre- and post-treatment assessments were conducted blind to the allocation. Analyses were conducted of treatment completers and also by intention-to-treat. Significant differences were found between the groups at both post-treatment and 6-month follow-up in depressive symptoms. While the CBT group showed a reduction in depressive symptoms, the same symptoms increased in the Standard group. At outcome but not follow-up, the CBT group also showed reduction in C-reactive protein levels. However, the CBT group did show significant improvement in joint involvement at 6-month follow-up compared with the Standard group, indicating physical improvements above those achieved with standard care. These results indicate that cognitive-behavioural intervention offered as an adjunct to standard clinical management early in the course of RA is efficacious in producing reductions in both psychological and physical morbidity |