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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
11477287 Factors predictive of subsequent deterioration in rheumatoid cervical myelopathy. 2001 Jul OBJECTIVE: To identify the features of rheumatoid cervical spine disease associated with deterioration resulting in the need for surgical intervention or death. PATIENTS AND METHODS: Patients with rheumatoid cervical myelopathy who underwent cervical spine magnetic resonance imaging (MRI) between 1991 and 1996 were identified. Patients requiring immediate surgical intervention were excluded. The remainder were divided into two groups. Deterioration group: patients requiring surgical intervention during the follow-up period and deaths resulting from cervical myelopathy. Conservative group: all other patients. Relevant clinical features and radiology reports were extracted retrospectively from the casesheet. RESULTS: The deterioration group comprised 11 patients (12%), median time to deterioration 15 months (range 4-84 months). The conservative group included 82 patients. Initial clinical features did not differ significantly between the two groups. Sixty per cent of those patients with compression or impingement at the atlanto-axial level on first MRI deteriorated over a median of 12 months (range 4-36 months). CONCLUSION: Deterioration is likely if there is evidence of cord compromise at the atlanto-axial level on MRI regardless of initial clinical and plain X-ray features.
11517740 [Local radiotherapy in combined treatment of rheumatoid arthritis]. 2001 AIM: To study efficiency in rheumatoid arthritis (RA) of local radiotherapy methods: radionuclide synovectomy (RS), x-ray therapy (XRT) and local gamma-therapy (LGT) proposed by the authors. MATERIAL AND METHODS: 175 patients with RA received local radiotherapy on the knee joints. The patients were divided into three groups comparable by age, sex and disease characteristics receiving RS, XRT and LGT. The patients were for the most part women over 45 years with RA (duration 5 years and longer), polyarthritis, the disease x-ray stage II, moderate activity. RESULTS: RS was most effective of the above methods, especially in long-term period. It produces antiinflammatory and immunosuppressive action. The new method, LGT, was effective in more than half the patients. It is antiinflammatory and immunosuppressive. XRT was the less effective of the three methods as it has only nonspecific antiinflammatory action. CONCLUSION: Local radiotherapy enhances efficacy of RA treatment. RS and LGT produce immunosuppressive and antiinflammatory actions while XRT has only antiinflammatory action.
11265533 [New therapy approaches in rheumatoid arthritis. Preventing early joint destruction]. 2001 Feb 22 New perceptions about the cellular and molecular interactions involved in the inflammatory process have created a basis for specific treatment of rheumatoid arthritis. The therapeutic arsenal has now been expanded to include more selective inhibitors of cyclooxygenase, antibodies and antagonists of the cytokines, and an inhibitor of pyrimidine synthesis. Large clinical trials have demonstrated the efficacy of early immunomodulatory treatment aimed at preventing joint destruction, as well as the superiority of the combination therapy over monotherapy with a long-acting antirheumatic agent. To date, uniform criteria for the evaluation of the results of treatment are, however, lacking.
9494244 Knee prosthesis in rheumatoid patients. 1997 Jul Total knee arthroplasty is a reliable means to improve the quality of life not only in osteoarthritis, but also in rheumatoid patients. Specific aspects, like the low mechanical quality of bone tissue, the contemporary damage of several joints and the higher risk of complications, have to be taken into account in rheumatoid arthritis. The experience with 24 prostheses in 21 rheumatoid patients is reported and confirms the efficacy of this operation. Among the technical details discussed, stress is placed on the conservation of the posterior cruciate ligament, the use of cement, the procedure of patelloplasty instead of prosthetic replacement. Careful preoperative planning is required and resections, especially in the tibia, should be economical. The evaluation of the results according to the protocol of the America Knee Society shows a satisfactory increase both of the articular score (average from 36 to 88) and the functional score (average from 34 to 68).
10422541 Vision of the future in arthritis care. 1999 Demographic changes during the next 10-20 years will significantly affect the future of arthritis care. Not only will the prevalence of chronic diseases increase among an increasingly aging population, but so will their incidence. The management of chronic diseases will become the primary clinical challenge for many physicians, especially rheumatologists. Patients will present to their rheumatologists expecting an accurate diagnosis to be made at the onset of their symptoms. To do so, clinicians will have to establish the pathophysiologic bases of the different types of arthritis, most likely through the use of sophisticated imaging techniques, such as high-resolution ultrasound. Treatment approaches will become more targeted. Agents that specifically inhibit the cyclooxygenase-2 (COX-2) isozyme will likely be used for symptomatic relief in arthritis patients. Other therapies will be targeted toward cartilage regeneration. suppression of the inflammatory process, and inhibition of metalloproteinases.
10685795 Incidence of glenohumeral joint involvement in seropositive rheumatoid arthritis. A 15 yea 2000 Feb OBJECTIVE: To evaluate the incidence of involvement and nature of destruction of glenohumeral (GH) joints in a prospectively followed cohort of 74 patients with seropositive and erosive rheumatoid arthritis (RA). METHODS: At the 15 year followup radiographs of 148 GH joints were evaluated, and the grade of destruction was assessed by the Larsen method. RESULTS: Erosive involvement (Larsen grade 2) was observed in 71/148 (48%) GH joints in 41/74 (55%) patients; 30 patients had bilateral and 11 unilateral involvement. The incidence of mild erosions (Larsen grade 2) was 401148 (27%), and of severe (Larsen 3-5) 31/148 (21%). The 11 most severely involved (Larsen grade 5) joints were seen in 6 (8%) patients. Erosions were most often (61/71 joints) observed on the superolateral articular surface of the humerus. Glenoidal involvement was less common (28/71 joints). The Larsen score (0-100) for peripheral joints correlated significantly with the GH joint Larsen grade on both sides (p < 0.001). CONCLUSION: After 15 years more than half the patients with RA showed definite involvement and 1 in 4 had severe destruction of the GH joint. The greatest destruction was almost always bilateral.
9375868 Radiographic changes in the feet of patients with early rheumatoid arthritis. GRISAR (Grup 1997 Nov OBJECTIVE: To assess the value of radiographs of the feet of patients with early rheumatoid arthritis (RA) in the evaluation of RA classification and outcome. METHODS: Within a multicenter therapeutic trial, baseline and 12 month radiographs of the hands, wrists, and feet of 284 patients with early RA (< or = 4 years; mean 1.4; median 0.6) were scored according to a modified Larsen-Dale method by an independent radiological reading committee, blinded to the treatment, clinical, and laboratory data. RESULTS: Thirty-two patients (11%) had only foot erosions at baseline. Twelve month progression in the eroded joint count was more frequent in the patients with foot erosions than in those without (63% CI 55 divided by 71 vs 42% CI 35 divided by 50). CONCLUSION: Foot radiographs facilitate the identification of patients with early erosive RA. Foot involvement is indicative of more aggressive disease. Assessment of foot radiographs allows the most adequate therapeutic strategy to be adopted.
9338925 Multidisciplinary day hospital treatment of rheumatoid arthritis patients. Evaluation afte 1997 Jul The availability of multidisciplinary care for rheumatoid arthritis is still limited. The Raoul Dufy Program offered by the Saint-Antoine Teaching Hospital in Paris provides one-on-one personalized care in a day hospital setting as an adjunct to conventional medical follow-up. Listening and providing information and education are major objectives of the nurse, rheumatologist and physical therapist participating in the program. The team also includes a social worker, a surgeon, a dietician, a podiatrist and a psychologist, who intervene as needed. Seventy patients attended the program between December 1993 and September 1995 and were asked to complete a baseline and a three-month questionnaire designed to evaluate the effects of the program in terms of new therapeutic interventions, patient knowledge and quality of life. The patient knowledge score increased significantly (P < 0.0001). Many therapeutic interventions were initiated after program attendance, especially in the fields of podiatry, psychology and physical therapy. However, the quality of life score failed to improve. These results and the substantial patient demand for appointments are encouraging. Further work is needed on the methodology of multidisciplinary care evaluation. Coping strategy evaluation tools may allow to identify some of the specific benefits provided by the multidisciplinary approach.
11727840 Intra-articular glucocorticoid treatment of the rheumatoid wrist. An ultrasonographic stud 2001 Fifty consecutive patients with RA and clinical wrist synovitis were randomly allocated to either receive an injection of glucocorticoid into the radiocarpal joint or have the same amount of drug divided into the radiocarpal and midcarpal joints. Inferior radioulnar joint synovitis was treated with extra steroid injection only in the latter group. Patient's and doctor's assessments as well as ultrasonography improved significantly at month 3 in both groups. A statistical difference between the groups was found in the midcarpal joint measurement favouring the extra midcarpal injection. Ten wrists (20%) were normal when assessed with ultrasound at month 3 while 34 wrists (68%) were normal on clinical assessment.
11771778 Increased demand for steroid therapy in hyperprolactinemic patients with rheumatoid arthri 2001 The role of increased plasma prolactin (PRL) in rheumatoid arthritis (RA) is not fully explained. The aim of this study was to compare the clinical features and the treatment administered in RA patients with normal and elevated plasma PRL concentrations. Forty-nine patients with rheumatoid arthritis and 16 healthy subjects were included in this study In healthy controls, PRL concentrations were 7.6 micro/l (median), in 34 patients plasma PRL was less than 20 micro/l (9.9 micro/l) and in 15 patients it was elevated, with a median of 26.7 micro/l. No differences in clinical features were found compared with normal or increased plasma PRL. The introduction of corticoid therapy produced a significant difference. Steroid therapy was administered to 93% of the patients with hyperprolactinemia, compared with 59% of those with normal PRL concentrations. Daily prednisone doses higher than 5 mg were administered to 43% of the patients with elevated PRL, compared with 25% of patients with normal prolactin concentrations. In conclusion, the clinical feature of patients with rheumatoid arthritis did not differ in subjects with elevated PRL concentrations and in those with normal concentrations. The difference between these two groups was in the higher demand for steroid therapy in patients with hyperprolactinemia.
10332969 Self-administered joint counts and standard joint counts in the assessment of rheumatoid a 1999 May OBJECTIVE: To determine the comparability of a text to a mannequin format for the assessment of joint counts (JC) among patients with rheumatoid arthritis (RA) participating in a randomized clinical trial (RCT). METHODS: A subgroup of patients participating in the MIRA (Minocycline in RA) RCT completed self-administered JC and joint scores (JS), which were compared to those of a trained assessor. RESULTS: JC and JS data were consistently higher for the patient than for the assessor. Higher correlations were obtained for JC than for JS. CONCLUSION: Our data suggest JC can be used in the context of clinical trials or in the clinical setting, but are not interchangeable with trained assessor JC.
11476306 Total hip arthroplasty using porous-coated femoral components in patients with rheumatoid 2001 Jul We studied the results of total hip arthroplasty (THA) using AML porous-coated femoral components at a mean follow-up of 11 years in a non-selected, consecutive series of patients with rheumatoid arthritis. We reviewed 64 patients with 82 primary THAs using these components. There were seven men (8 hips) and 57 women (74 hips) with a mean age of 55.1 years (24 to 80) at the time of surgery. Nine patients (11 hips) died before the two-year follow-up. Of the remaining 71 hips, only one stem was revised for aseptic loosening. Survivorship for the stems was 98.1% (95% confidence interval (CI) 94.5 to 100.0) at ten years, using a life-table analysis, with revision for any reason as an endpoint. Of the 70 unrevised stems, 66 (94%) had bony ingrowth, while four (6%) were radiologically loose at the most recent follow-up (mean 11.4 years). Our study shows the excellent long-term results which can be achieved with porous-coated femoral components in patients with rheumatoid arthritis.
10434574 [Effects of a 5-day fast on clinical laboratory data from patients with rheumatoid arthrit 1999 Jun There have been few studies on the effects of a fast on clinical laboratory data in Japanese. We studied twelve women with rheumatoid arthritis who were not taking any medicine and stayed in the Koda hospital for a diet which lasted 55 days. They basically took a 1200 kcal vegan diet and undertook a 3-5-day fast three times. The clinical laboratory data obtained before and after the second fast (day 27-day 31) were compared. Average body weight decreased by 1.5 kg. There were no changes in CRP. Rapid turnover proteins such as alpha 1 and beta 2-microglobulin decreased, whereas albumin, IgG, IgA and IgM increased. HDL-C increased without a change in LDL-C or triglycerides. Free T3 decreased and free T4 increased, while TSH did not change. The increases in albumin, Ig, HDL-C and free T4 were not consistent with the results of previous studies. This difference may have been due to the low calorie vegan diet before the fast.
9498142 Painful snapping in rheumatoid knees. 1997 Painful snapping caused by a solitary intra-articular nodular mass was found in 11 knee joints of 8 patients with rheumatoid arthritis. The masses were characteristically situated in the anterolateral aspect of the lateral femoral condyle of each joint, and appeared to jump and slip in and out of the patellofemoral articulation during flexion and extension. The snapping caused by the solitary mass was noticed as the joint flexed from 15 degrees to 30 degrees in 9 knees and from 50 degrees to 60 degrees in 3. Histopathological examination of the masses revealed typical findings of a rheumatoid nodule in 4 knee joints and myxomatous degeneration and collagen necrosis in 7.
10090193 Introduction to reading radiographs by the Scott modification of the Larsen method. 1999 Mar To examine its ability to evaluate progressive radiological damage, the Scott modification of the Larsen score was used for the hands, wrists, and feet (metatarsophalangeal joints) at time zero and at 12 months in 52 patients with early rheumatoid arthritis taking part in a therapeutic intervention study. The major practical difficulty was the technical discrepancy between initial and followup films in some patients. The metrological problems are discussed in the analysis, which compares the score on the same films using the Sharp score.
11201830 [Anxiety disorders as psychological personality characteristics in patients with rheumatoi 2000 AIM: To study types of anxious disorders (AD) in patients with rheumatoid arthritis (RA) and AD correlations with clinicolaboratory indices. MATERIAL AND METHODS: 80 RA patients and 38 healthy subjects have undergone MMPI test. RESULTS: 95% of the examinees were found to have AD which seem to form in active participation of psychoemotional factors. Development of AD was characterised by internal strain, emotional stress, anxiodepressive conditions. Psychological profiles of AD patients were analysed. No correlations were found with clinicolaboratory indices: Additional correlations exist between the MMPI scales in AD. CONCLUSION: AD in RA patients may result in vegetative dysfunctions.
10078020 [Disease modifying anti-rheumatic drugs(DMARDs)]. 1999 Feb Several kinds of disease modifying anti-rheumatic drugs (DMARDs) can be utilized for the treatment of patients with rheumatoid arthritis (RA) to expect the prevention of joint damage progression and the improvement of quality of life. However, the methodology for the use of DMARDs is still controversial. On the basis of our prospective study, earlier introduction of DMARDs can be more efficient for the suppression of active disease. Thus, for the patients with more than three swollen joints, high ESR and CRP, immediate prescription of DMARD is recommended. And if these situation will not change even 6 months after starting the therapy, we should make all possible efforts to lead patients into remission using DMARD or corticosteroids, which would prevent patients from disability of joint function and thus would improve the quality of life of patients with early RA.
9093773 Outcome of radical multiple synovectomy as a novel surgical treatment for refractory rheum 1997 Jan OBJECTIVE: The authors developed a technique for radical multiple synovectomy (RaMS), a novel surgical treatment for refractory rheumatoid arthritis (RA) intended to control RA activity as much as possible. The purpose of this article is to describe the technique and its short-term results. METHODS: Eighteen RA patients were followed up for at least 3 years after RaMS. Post-operative results were determined and the significance of the HLA-DRB1 alleles was studied. RESULTS: Six patients met the ARA criteria for clinical remission persistently and were classified as "remission" cases. Thirteen patients in whom the limited Lansbury index remained improved were rated as "improvement". The cumulative success rates for "remission" and "improvement" were 33.3% and 57.8%, respectively, at the time point of the latest observation. Remission was not achieved in any of the DRB1*0405-positive patients. Nine out of 10 DRB1*0405-negative patients showed persistent improvement. CONCLUSION: RaMs provided good results in one-third of patients with refractory RA at a minimum of 3 years. HLA-DRB1*0405 may be a good marker to follow the effects of RaMS in RA patients.
10852325 Outcome after cup hemiarthroplasty in the rheumatoid shoulder: a retrospective evaluation 2000 Apr 33 rheumatoid patients, treated with hemispherical cup resurfacing hemiarthroplasty of the shoulder without medullary fixation (6 bilaterally), were reviewed after mean 4.4 (2-6) years. The median Constant score was 30 (15-79), mean proximal migration of the humerus 55 (SD 5.2) mm and mean glenoid erosion 2.6 (SD 1.7) mm. Proximal migration and glenoid erosion did not correlate with shoulder function or pain. Radiographic signs of loosening (changes in cup inclination combined with changes in cup distance above the greater tuberosity) occurred in one quarter of the shoulders. At follow-up, 26 patients were satisfied with the procedure, despite poor shoulder function and radiographic deterioration.
11109613 [Long-term drug therapy of rheumatoid arthritis and remission]. 2000 AIM: To evaluate the duration of rheumatoid arthritis (RA) remission with respect to different drug treatments. MATERIALS AND METHODS: Remission duration observed at 20-year follow-up of 442 RA patients living in the south of Estonia has been reviewed. Also, the data are provided on the disease onset, articular status, systemic lesions, RA activity and progression, the latest exacerbation and previous remission, standard laboratory indices, humoral immunity, examination of the biopsy of the articular tissues and subcutaneous fat for amyloid. RESULTS: According to the retrospective analysis, slow-progressive RA course occurs primarily in remissions longer than 5 years and less frequently in remissions lasting from 1 to 5 years. No matter what the drug was used, 14% of the patients have failed the treatment. 3% of the patients were in remission longer than 5 years. Short-term remissions (1-3 months) were induced in 13%, stable ones (3 months-1 year) in 39% of the cases. These remissions were observed in early RA, more frequently in patients with initial arthritis of the small joints. Remissions from 1 to 5 years were registered in 31% of the patients. CONCLUSION: RA remissions up to 1 year represent temporary clinical improvement and do not inhibit progression of the rheumatoid process. Consideration of association between RA clinical course and remission duration helps to recognize groups of RA risk and to timely change treatment policy.