Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
9057801 Positron emission tomography with 11C-D-deprenyl in patients with rheumatoid arthritis. Ev 1997 Seven patients with arthritic disease and with clinical signs of inflammation of the knee joint, were investigated with positron emission tomography (PET) after injection of [N-methyl-11C]-D-deprenyl. Two healthy volunteers were included as controls. In five patients the investigation was repeated after an intra-articular injection of glucocorticoids. All patients showed very high uptake of the tracer in the paraarticular structures of the joint. After treatment there was approximately a 50% reduction of the uptake in the treated knees, both in the high uptake regions and in the surrounding soft tissues. No change was observed in the non-treated knees. In the healthy volunteers, only soft tissue surrounding the joint showed an uptake of the tracer, but at a magnitude which was 6-8 times lower than the high uptake regions in the arthritis patients. Although the mechanisms for the high uptake of 11C-D-deprenyl in affected joints of patients with arthritis is not clear, the present work points to a potential of PET for the assessment of disease intensity and monitoring of treatment.
11508584 The level of inflammation in rheumatoid arthritis is determined early and remains stable o 2001 Aug OBJECTIVE: To determine whether the level of inflammatory activity, determined by the erythrocyte sedimentation rate (ESR), changes over the longitudinal course of rheumatoid arthritis (RA); whether the level of inflammatory activity identified early in RA predicts longterm inflammatory status; and whether RA "bums out" after many years of inflammatory activity. METHODS: A total of 21,866 consecutive ESR determinations from 1,897 patients with RA were analyzed to determine the association of inflammatory activity, as estimated by ESR, with duration of disease. Data were modeled by generalized estimating equations and random selection fractional polynomial regression models, controlling for age, sex, and calendar date. RESULTS: In a nonlinear fashion, ESR decreased by 4 mm/h over the first 10 years of disease, remained stable over the next 25 years, and increased slightly thereafter. Patients treated more recently had lower ESR values. Patients with recent onset of RA, when stratified in quartiles of ESR, maintained their position over time. CONCLUSION: Although ESR decreases by 4 mm/h over the first 10 years of disease, it remains stable or rises thereafter. The course of RA, as modeled by the ESR, appears to be "set" early in the disease and good and bad prognosis groups can be identified within the first 2 years. There is no evidence of general "burned out" RA or a lessening of disease activity with long duration of disease. Our findings tend to suggest that the ("usually treated") natural history of RA prior to introduction of antitumor necrosis factor agents is toward some degree of improvement in the early years. If the newer and combination therapies are indeed substantially better than what has been available, they must show a shifting of the curve downward, not just in the early years where it has occurred historically, but over the entire course of the illness.
11028798 Shoulder rotational strength, movement, pain and joint tenderness as indicators of upper-e 2000 Sep In this study 32 women were investigated in order to elucidate how shoulder rotational muscular strength and upper-extremity impairments are associated with activity limitation in moderate rheumatoid arthritis. A regression analysis was carried out to determine whether these variables could indicate the outcomes of a shoulder-arm disability questionnaire (SDQ) comprising three parts, plus parts of the Health Assessment Questionnaire, the Functional Status Questionnaire and the Sickness Impact Profile. Shoulder-arm and wrist movements were moderate-to-good (r = 0.53, p < 0.01 and r = 0.58, p < 0.01, respectively) in relation to isometric internal rotational strength. The relationship between isokinetic concentric and eccentric internal rotational strength was moderate-to-good (r = 0.59, p < 0.01). Isokinetic eccentric internal rotation strength, shoulder-arm movement, joint tenderness and pain variables together indicated 25-61% (adjusted R2) of the variation in SDQ. Eccentric strength had the highest adjusted R2 (41%) in relation to SDQ 1, covering mainly personal hygiene. Shoulder rotational strength did not indicate the more general instruments. Thus, hand and elbow impairments also are probably important in explaining activity limitations.
9177928 Crohn's disease associated with seropositive rheumatoid arthritis. 1997 May We report two cases of rheumatoid arthritis (RA) associated with Crohn's disease (CD). The first case was a 60-year-old man with longstanding CD who next developed a seropositive, nodular RA. This patient also had bilateral sacroiliitis, but without positive HLA B27. The second was a 65-year-old female with a 15-year history of seropositive RA who presented secondarily a CD. No sacroiliitis or nodules were found in this patient. Both patients were DR1 (DRB1* 0101). Gold salts were only given in the second case and were stopped many years before the gastrointestinal symptoms. A similar case report has been previously described consisting in an ulcerative colitis complicating a seronegative HLA-B27 RA with sacroiliitis. The gastrointestinal involvement in RA may be broad and includes many causes: drug-induced colitis (including gold enterocolitis) vasculitis and amyloidosis located in the gut, associated bowel disease such as collagenous colitis, and also infectious agents. In addition, erosive polyarthritis associated with gastrointestinal manifestations can present a problem in the differential diagnosis between RA and an enteropathic arthritis. Finally, the coexistence by chance of inflammatory bowel disease and RA is suggested by the low occurrence of these two conditions in the same patient.
9088531 Clinical guidelines for management. 1997 Feb Guidelines provide explicit recommendations and seek to influence practice using a formal process to disseminate advice on most effective management in the light of scientific evidence. They provide a framework for the evaluation and treatment of common clinical problems, but are not intended to replace clinical judgement. There is considerable variation in rheumatology practice, fueled by uncertainty about the optimal measurement of disease outcome. Guidelines can help identify and eliminate ineffective or unnecessary care as they are systematically developed statements to assist practitioners and patients' decisions about appropriate health care. There are North American guidelines for the initial evaluation of adult patients with acute musculoskeletal symptoms, the management of rheumatoid arthritis and the management of osteoarthritis. These are discussed together with proposed guidelines for the management of early rheumatoid arthritis and areas of research into the value of guidelines. It is recommended that future work in this area should: (i) identify aspects of current guidelines which are directly related to outcome; (ii) educate clinicians in these aspects of care; (iii) ensure they are introduced into practice and the outcome of care subsequently improves; (iv) regularly update the guidelines to reflect current opinion. Present guidelines that give broadly similar recommendations from North American and UK perspectives. However, the available evidence all points to large variations between how clinicians practise and how they make their decisions and it may be unlikely that laying down exact recipes for practice will necessarily influence the clinician. Guidelines may appear relevant but they could prove to have very limited utility.
9035580 [Rheumatoid arthritis in the elderly]. 1997 Jan 1 Opinions differ as to whether late onset rheumatoid arthritis (RA) represents a clinical subset and whether age at onset involves differences in therapy and prognosis. In this retrospective study we compared 23 patients with early onset RA (average onset 52.8 years; 91.3% of them women), with 36 with late onset (average onset 70.3 years; 67% of them women). No statistically significant differences were found as to demographic, clinical, laboratory or radiographic characteristics.
9132331 The rheumatoid wrist: bilateral MR analysis of the distribution of rheumatoid lesions in a 1997 Jan In this case-control study, we analyzed 146 wrists: a) to search for the distribution pattern of the rheumatoid lesions and, b) to correlate the distribution pattern of these lesions with the clinical parameters. Thirty-one patients with rheumatoid arthritis (RA) and 42 controls-all women-were examined by means of a bilateral MR fast field echo (FFE) sequence, in axial plan. The wrist was divided into three regions: metacarpal (level I), carpal (level II) and radioulnar (level III). Erosions were present in thirty (97%) patients and in six (14%) controls. They were asymmetrically distributed at all levels, mainly at level II. Marrow infiltration and bone destruction were seen in 35% of the patients in an asymmetrical pattern at level I and II, respectively. These lesions were absent in the control group. Subchondral cysts were asymmetrically present in both groups-in 48% of the patients at levels II and III, and in 11% of the controls at level II. In the patient group, this asymmetrical pattern of the lesions correlated with the disease duration at levels I and II (p = 0.011 and p = 0.013, respectively). Most lesions were found at the radial force-bearing column of the wrist, more in the right side. Synovial hypertrophy and hyperintense median nerve were evident in 96% and 70% of the patients, respectively. We concluded that contrary to common belief rheumatoid damages to the carpal bones become rather asymmetrical as the disease progresses. The line of force along the radial side of the wrist possibly influences the distribution pattern of the rheumatoid lesions.
9572637 Evaluation of a structured multidisciplinary day care program in rheumatoid arthritis. A s 1998 The present study evaluated a multidisciplinary structured day-care programme in patients with rheumatoid arthritis of less than 2 years (n = 41) and more than 2 years disease duration (n = 46). During the 3 week intervention, outcome measures reflecting disability (HAQ, SOFI), the patient's perception of disease and pain (VAS for patient's global assessment and pain), Ritchie articular index (RAI), a 44 swollen joint count, and overall disease activity (DAS) improved significantly in the group as a whole. The improvements remained significant after 15 weeks and were of a similar magnitude in the patient groups with short and long disease duration. At week 3 and 15, the ACR and the EULAR criteria for individual response, for the total study group was fulfilled by 28% and 26%, and 36% and 52% respectively. Evaluation of a subgroup 6 weeks prior to admission indicated that the outcome measures were stable at the time of the intervention. Furthermore, administration of intraarticular glucocorticosteroids (GC) could only partly explain the observed improvement. This uncontrolled observational study supports that a multidisciplinary day-care rehabilitation program is beneficial and feasible for patients with rheumatoid arthritis of both short and long duration.
10913222 Multiple epidermal inclusion cysts in a patient with rheumatoid arthritis: a case report. 2000 Jul A construction worker with rheumatoid arthritis presented with multiple soft tissue masses on the volar surface of the palm and digits. A misdiagnosis of rheumatoid nodules was made secondary to the patient's history of rheumatoid arthritis. Subsequent excision confirmed multiple epidermal inclusion cysts, which was not entertained in the preoperative differential diagnosis. Follow-up evaluation 3 years later revealed no evidence of local recurrence. Based on our literature review, multiple epidermal inclusion cysts is a rare entity and has not been reported in a patient with rheumatoid arthritis.
11550974 Treatment of collagen induced arthritis by proteolytic enzymes: immunomodulatory and disea 2001 Sep OBJECTIVE: To investigate the efficacy of a novel therapy (proteases) in an animal model of rheumatoid arthritis, and to investigate the mechanisms of arthritogenesis. METHODS: We induced progressive arthritis in male DBA/1 mice by immunization and boosting with Type II collagen; groups of mice were treated orally twice daily with either ibuprofen or proteases, or were left untreated. After 2 weeks, joints were scored for clinical, radiographic, and histologic changes. In addition, we measured serum levels of IgG anti-collagen II, the glycosylation of circulating total and anti-collagen II IgG, and cytokine production by lymphocytes isolated from lymph nodes. RESULTS: Amelioration of joint inflammation, and accentuation of a prototypical Th2 cytokine (interleukin 5) were similar in the ibuprofen and protease treatment groups. However, protease treatment protects and preserves articular cartilage, normalizes the sialylation of IgG and anti-collagen antibody, and fully restores Th1 (interferon-gamma) synthesis, distinct from ibuprofen. CONCLUSION: Protease therapy has antiinflammatory efficacy in the early (inflammatory) phase of collagen induced arthritis, similar to ibuprofen. The immunomodulatory effects of proteases, not seen with ibuprofen, may underlie a correction of aberrant IgG glycosylation and/or contribute to the increased capacity of protease to delay or forestall erosive and destructive arthritis or ankylosis. Similar effects may apply to spontaneous RA in humans.
10627715 Uncemented total hip arthroplasty in patients with rheumatoid arthritis. 1999 Sep Total hip arthroplasty has become a successful way of treating the painful and destroyed hip joint in the patient with rheumatoid arthritis. Because of the underlying disease, it still is controversial whether the implants selected should be used with bone cement, or whether uncemented devices will give equally good results in this population. Fifteen patients suffering from rheumatoid arthritis underwent 21 hip arthroplasties. The followup period averaged 3.3 years (range, 2.5-6.8 years). All but one patient were taking medication at the time of surgery for their underlying disease. Clinical evaluation was based on a modified Harris hip score that showed significant improvement in pain and function preoperatively compared with pain and function at the most recent followup. Radiographic analysis revealed five cases of minor migration of the acetabular components, and three cases of distal migration of 2 mm or less in the femoral components. Complications consisted of heterotopic ossifications in one patient, and an intraoperative femoral fracture in one patient. There were no infections, and there were no deep vein thromboses. The results in these patients suggest that cementless total hip arthroplasty might become a successful way of treating the destroyed hip joint in the patient with rheumatoid arthritis.
9324027 Outcome of rheumatoid arthritis and psoriasis following autologous stem cell transplantati 1997 Sep Based on successful results in animal models, it has been proposed that high-dose myeloablative therapy followed by autologous bone marrow or stem cell transplantation (ABMT/ASCT) may cure autoimmune disease. The coexistence of autoimmune disease and hematologic malignancy provides an opportunity to examine the response of autoimmune disease to ABMT or ASCT. We describe 4 patients with autoimmune disease (3 with psoriasis and 1 with rheumatoid arthritis) and hematologic malignancy. In each patient, the autoimmune disease remitted posttransplantation, but, in 4 patients with long-term followup, it recurred at 8-24 months. The earliest relapse occurred in a patient treated with interferon-alpha. Our experience suggests that a single autograft with unpurged stem cells is unlikely to cure autoimmune disease, but that other strategies building on this approach are worthy of investigation.
11600748 Characteristics of handicap for patients with recent onset rheumatoid arthritis: the valid 2001 Oct OBJECTIVES: To investigate the applicability of the Disease Repercussion Profile (DRP) in the assessment of people with recently diagnosed rheumatoid arthritis. Previous research using this instrument has been confined to chronic samples. METHODS: Fifty-three patients with recent onset rheumatoid arthritis completed the DRP and other commonly used clinical outcome measures. RESULTS: The life areas of the DRP were highly interrelated, with the exception of finance. The total DRP score was associated with joint function, disability, subjective pain and coping, but was most highly associated with emotional disturbance, particularly depressive symptoms. No associations were found between measures of disease or demographic variables and DRP subscales. Activity was the area most often affected, with social life, emotions and appearance all more strongly endorsed than finances and relationships. However, whenever any of the areas was endorsed as affected, its impact was inevitably rated as very important. The pattern of self-perceived handicap was different from that reported in people with chronic arthritis. CONCLUSIONS: These results offer evidence that the DRP provides a valid measure of handicap for patients with early illness even with relatively low levels of disability. However, handicap in early rheumatoid arthritis may be more highly associated with psychological distress than in later stages of the illness.
12029718 Functional performance in rheumatoid arthritis. 2000 Oct Patients with rheumatoid arthritis experience varying patterns of disease activity, which can result in irreversible joint damage. The disease requires a multidisciplinary approach to care to suppress the disease process and maintain functional ability. The assessment process must be easy to use, thorough, yet concise.
11808990 Coexisting pseudo-xanthoma elasticum and rheumatoid arthritis. three cases and review of t 2001 Dec Pseudo-xanthoma elasticum (PXE) is an inherited disorder of the connective tissue characterized by cutaneous, ocular and vascular lesions. Coexisting PXE and rheumatoid arthritis (RA) is rare because three cases have only been described. We report three new cases of this association. Analysis of these six cases failed to show any particular biological or clinical features of rheumatoid arthritis associated PXE. The possible association of PXE and RA is discussed.
10419871 Early referral, diagnosis, and treatment of rheumatoid arthritis: evidence for changing me 1999 Aug OBJECTIVES: To study the delay in starting disease modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA), and any changes in medical practice between 1980 and 1997. METHODS: 198 consecutive RA patients attending the rheumatology clinics at a teaching hospital, for routine review, had their case sheet reviewed. The dates of symptom onset, general practitioner (GP) referral, first clinic appointment and first use of DMARD were recorded. Data were collected on the erythrocyte sedimentation rate, C reactive protein, rheumatoid factor, and the presence/absence of erosions at the first clinic assessment. Patients were split into four groups according to the date of their first clinic assessment-before 1986, 1987-9, 1990-3, and 1994-7. RESULTS: There was a sharp drop in the delay between symptom onset and GP referral (before 1986, 21 months; 1987-89, 23 months; 1990-3, 7 months; 1994-7, 4 months, p<0.03), and in the delay between first assessment at the rheumatology clinic and the start of DMARD treatment (before 1986, 32 months; 1987-89, 21 months; 1990-1993, 8 months; 1994-7, 1 month, p<0.001). The number of patients given DMARD treatment within six months of symptom onset increased from 5% (before 1994) to 44% (1994-7). Seventy three per cent of patients waiting more than a year from symptom onset to first clinic appointment already had erosive change, compared with 34% of patients seen within a year. CONCLUSIONS: Patients are being referred earlier in their disease, and DMARDs are prescribed sooner in the disease course. There has been a substantial increase in the proportion of patients treated with a DMARD within six months of symptom onset.
9921005 [Occurrence of subcutaneous rheumatoid nodules in patients with rheumatoid arthritis in Cr 1998 The subcutaneous rheumatoid nodules (RN) have been recognized by the American Rheumatism Association, both in 1958 and in 1987, as one of the diagnostic criteria (ARA criteria) among other rheumatoid arthritis (RA) symptoms. The aim of this research has been both to provide the incidence of occurrence of RN in patients with RA in Croatia and to determine its significance in making the RA diagnose. The test group comprised 233 patients (182 women and 51 men) with RA, their average age being 48.3 years in the range of 18 to 77. Both the anamnesis and the clinical examination have determined the occurrence of RN in 54 (23.2%) of 233 patients. The range of occurrences was more evident in men (31.4%) than in women (20.8%), though this difference was statistically irrelevant. The most common localization of benign rheumatoid nodules was the exterior side of elbow and PIP hand joints. The obtained results prove that the incidence of RN in our tested patients with RA can be compared with those of the earlier researches done in Croatia (18.1% Jajić, Vlak; 20-25% Jajić), as well as with those obtained in the western European countries (20% Doherty, George; 25% Ziff; 20-25% Miehle; 21% Wolf et al.).
10342629 Sensitivity and specificity of anti-Sa autoantibodies for rheumatoid arthritis. 1999 Feb OBJECTIVE: To assess the sensitivity and specificity of the recently described anti-Sa autoantibodies in order to determine their potential usefulness for the diagnosis of rheumatoid arthritis (RA). METHODS: Sera from 67 patients with RA (including 31 patients with early RA of <3 months duration), from 180 patients with other rheumatic diseases and from 30 healthy control subjects were investigated by immunoblotting employing partially purified Sa antigen. Additionally, all sera were tested for rheumatoid factor (RF), anti-A2/RA33, antinuclear antibodies (ANA) and ANA subsets. RESULTS: Twenty-one (31%) of the 67 patients with RA, but only four of the 180 control patients, were anti-Sa positive; therefore, anti-Sa was approximately 98% specific for RA. Anti-Sa was not associated with either RF or with anti-A2/RA33. The latter antibody was present in 21 RA sera, only eight of which also contained anti-Sa. Thus, 34 RA sera (51%) showed at least one of these two autoantibodies and, importantly, 18 of these sera were RF negative. Furthermore, of the 31 patients with early RA, 12 (40%) were anti-Sa and/or anti-A2/RA33 positive. CONCLUSION: Although the numbers studied remain small, taken together, these data suggest that anti-Sa may represent a promising novel serological marker with high specificity for RA.
9053603 [New therapeutic methods against rheumatoid arthritisp6. Antibodies against TNFalpha signi 1997 Jan 8 This review, which is the second part of an abstract from a book-length work in English, describes the great advances made in the treatment of rheumatoid arthritis. After the failure of anti-CD4 therapy, the macrophage has gained prominence as the prime mover in rheumatoid synovitis. The proinflammatory, macrophage-derived cytokine tumor necrosis factor alpha has in particular been implicated as an important therapeutic target. The clinical trials carried out with antibodies against this cytokine, as well as various approaches towards cytokine-modulating gene therapy in rheumatoid arthritis, are described.
10803752 Formation of calcium pyrophosphate crystals: biologic implications. 2000 May The formation of calcium pyrophosphate dihydrate (CPPD) crystals in articular cartilage marks the earliest known phase of CPPD deposition disease. Although the exact mechanisms through which these crystals form remains unknown, work over the last year has added useful details to our current paradigms of crystal nucleation and growth. Key advances include (1) progress in understanding pyrophosphate elaboration and its modifiers, (2) further characterization of the enzymes responsible for pyrophosphate elaboration, and (3) the discovery of an association between two seemingly unrelated metabolic risk factors for CPPD deposition disease.