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ID PMID Title PublicationDate abstract
9553427 [Difficulties in diagnosing pulmonary visceral forms of rheumatoid arthritis in tuberculou 1998 The articulovisceral form of rheumatoid arthritis is severe, which creates difficulties in its diagnosis as it is characterized by polymorphism and atypical features. This type concurrent with pulmonary manifestations should be differentiated from inflammatory lung diseases, including tuberculosis.
10472828 Heterotopic ossification complicating total elbow replacement in a patient with rheumatoid 1999 Summer Heterotopic ossification after total elbow replacement is a new complication. In this particular case, it resulted in severe limitation of motion. Excision of the heterotopic bone resulted in an excellent functional outcome for the patient.
11072600 Psychological well-being in patients with primary Sjögren's syndrome. 2000 Sep OBJECTIVES: To evaluate quality of life and psychological symptoms in patients with primary Sjögren's syndrome and to compare this with patients with rheumatoid arthritis. METHODS: A standardised questionnaire, the Psychological General Well-Being Index (PGWB), was used to examine the quality of life and psychological symptoms in patients with primary Sjögren's syndrome (pSS; n = 34). Patients with rheumatoid arthritis (RA; n = 32) were used as patient controls. RESULTS: The total mean score +/- SD for PGWB was 84.9 +/- 16.2 in pSS patients and significantly lower (p = 0.001) than in RA patients (97.7 +/- 17.5). Patients with pSS had an increased propensity for depressed mood (p = 0.0009), and suffered from reduced well-being (p = 0.002) and impaired vitality (p = 0.003). CONCLUSION: The results suggest that patients with pSS have a reduced quality of life, a higher degree of distress and a lower sense of well-being than patients with RA.
10405933 Anterior arthroscopic synovectomy plus capsuloplasty with a pedicle graft for the treatmen 1999 Jul OBJECTIVE: To assess the value of arthroscopic synovectomy plus capsuloplasty with a pedicle graft in patients with rheumatoid cysts of the knee. METHODS: We examined 31 rheumatoid knees in 9 men and 22 women with an average age of 52.5 years at time of operation. Postoperative clinical symptoms were investigated in comparison with each factor examined before the operation. RESULTS: Postoperative results showed that 74% of the patients were grade 0 (no swelling or pain), 23% were grade 1 (swelling and slight discomfort after strenuous work or sports), and 3% were grade 2 (swelling and tenderness after normal activities). The improvement rate of the patients with arthroscopic synovectomy plus pedicle graft capsuloplasty was significantly higher than that of the untreated controls or patients with arthroscopic synovectomy or pedicle graft capsuloplasty. The preoperative degree of joint effusion, acceleration in the erythrocyte sedimentation rate, radiographic grades, and histological activity in the knee joint at the time of operation were correlated with the final clinical symptoms. CONCLUSION: Our method may be useful for preventing recurrence of rheumatoid popliteal cysts.
9501617 [Articular and tendon manifestations indicating the stage of rheumatoid polyarthritis]. 1997 Nov 15 Synovial inflammation and the destruction which results from recurrent and chronic inflammation lead to arthritis and tenosynovitis. Clinical manifestations are bilateral and symmetrical, affecting virtually all joints. The hands and the feet are the main targets. Cervical involvement should be routinely investigated. X-rays demonstrate the erosion and deformation caused by rheumatoid arthritis. Altogether, the manifestations of the disease constitute a distinct and painful handicap. Treatment should be undertaken as early as possible in the course of rheumatoid arthritis in an attempt to avoid evolution toward irreversible destruction.
9173748 [Work disability work in the first year of chronic polyarthritis. A comparison with member 1997 Jan Even though sick-leave (SL) is a direct consequence of the reduction of work capacity due to the disease, this has not gained much attention in early rheumatoid arthritis (RA). Therefore, the occurrence and duration of SL (defined as the history of SL as certified by a physician) was determined in a cross-sectional multicenter study of early RA (< or = 12 months duration) and compared to the members of the compulsory health insurance. One hundred and thirty four gainfully employed consecutive outpatients fulfilled > or = 4 of 7 ACR 1987 criteria of RA: 85 females (63% of 134 patients), age 50 years (median), disease duration 7 months (median). SL due to RA occurred in 102 of 134 patients (76%). The duration of SL because of RA was 11 days per month (about one-third of the disease duration) in males and 8 days per months (one-quarter of the time since the onset of RA) in females. SL due to RA was five times longer than expected from controls. In addition to SL because of RA, SL due to other causes occurred with a similar duration as in controls. Already in the first year of RA the large proportion of patients with SL due to RA and the long SL duration indicate the extent of substantial handicap concerning gainful employment.
9987962 [Rheumoorthopedics as an integral part of complex therapy of rheumatic diseases with joint 1998 The paper gives the results of conservative and surgical rehabilitation of patients over 38 years after the foundation of an orthopedic service at the Institute of Rheumatology. Conservative treatments for rheumatic diseases (RD) such as position treatment, formation of a correct stereotype, treatment of the cervical portion of the spine in rheumatic arthritis (RA) and osteoarthrosis derformans (OAD) are evaluated. The author's own experience involving over 5000 operations on the locomotor apparatus in RD, which permits assessment of the most common and successful operations, such as sinovectomy, arthroplasty, arthrodesis, endoprosthesis. Rheumoorthopedics is a part of complex rehabilitative treatment for RD as it enables one to infer actively at different stages of RD and to achieve high results in patients, including those who unresponsive to medical treatment.
10425545 Detection of sarcolectin-specific receptors like the cytokine macrophage migration inhibit 1999 Jul The objective of this study was the evaluation of the relation between the N-acetyl-neuraminic acid-binding endogenous lectin sarcolectin and the cytokine macrophage migration inhibitory factor (MIF) during development of rheumatoid nodules (RN) in seropositive rheumatoid arthritis (RA). Sarcolectin was purified and biotinylated. The binding patterns of this probe were analyzed in RN from patients with RA (n = 23) and compared with the distribution of antibodies with specificity for MIF, fibrin, fibronectin. In early RN, all areas of the inflammatory tissue displayed presence of receptors for sarcolectin. Macrophages were especially positive. In mature rheumatoid nodules binding of sarcolectin was restricted to the periphery of necrotic areas, to endothelial cells and perivascular connective tissue of marginal zones. Distribution patterns of MIF were similar but not identical. The histological staining characteristics demonstrate sarcolectin-binding receptors in RN that are altered upon disease progression. The finding suggests that specific interactions between this endogenous lectin and MIF may be involved in the course of RA.
10562906 [Pericardial and myocardial adiastole in rheumatoid polyarthritis]. 1999 Oct The authors describe a case of clinical, echocardiographic and haemodynamic adiastole in a man with severe rheumatoid arthritis with a previous history of pericardial effusion. The adiastole was mixed, fibrous pericarditis, confirmed by ultra fast CT scan and at surgery; myocardial adiastole was suspected on finding thickening of the ventricular walls (in the absence of hypertension and coronary artery disease) and, unfortunately, confirmed by the persistence of adiastole despite very satisfactory pericardectomy. The authors underline the involvement of the three cardiac tunics in rheumatoid arthritis and the value of different diagnostic methods in the differentiation between constrictive pericarditis and restrictive cardiomyopathy.
9566109 [Concomitant manifestation of ochronosis and chronic polyarthritis in a patient]. 1998 Feb Ochronosis is rare disorder of tyrosin catabolism with an autosomal, recessive trait. Clinical signs predominantly affect the locomotor system. Inflammatory episodes in large joints can mimick Rheumatoid Arthritis (RA). Brownish discoloration of sclerae and cartilage is characteristic, diagnosis is confirmed by typical changes of spinal X-rays and the findings of homogentisic acid in urine samples. We describe a case of a 53 year old female patient with ochronosis and a second diagnosis of RA.
11094428 Macrophages in rheumatoid arthritis. 2000 The abundance and activation of macrophages in the inflamed synovial membrane/pannus significantly correlates with the severity of rheumatoid arthritis (RA). Although unlikely to be the 'initiators' of RA (if not as antigen-presenting cells in early disease), macrophages possess widespread pro-inflammatory, destructive, and remodeling capabilities that can critically contribute to acute and chronic disease. Also, activation of the monocytic lineage is not locally restricted, but extends to systemic parts of the mononuclear phagocyte system. Thus, selective counteraction of macrophage activation remains an efficacious approach to diminish local and systemic inflammation, as well as to prevent irreversible joint damage.
10606359 Risk factors for radiographic articular destruction of hands and wrists in rheumatoid arth 1999 Dec OBJECTIVE: To carry out a cross sectional case-control study of the risk factors for articular destruction in a large sample of patients with a long history of rheumatoid arthritis (RA), presupposing that the variables we measured were unrelated to the duration of disease. METHODS: Each inpatient with RA admitted to our department from January 1, 1985, to December 31, 1995, underwent standard examination, laboratory tests, and hand roentgenograms. We carried out a radiographic cross sectional study on 287 of them. Radiographic evaluation was performed by the same observer (correlation coefficient 0.97) using the modified Sharp method. To investigate an association between articular destruction and prognostic variables, a matched analysis of the case-control data and calculation of the odds ratio (OR) with 95% confidence intervals (CI) were carried out. For each patient with severe articular destruction, patients hospitalized during the study period with the same disease duration but without severe articular destruction were included as controls. The sample size was chosen to show an OR > 2 (1-alpha = 95%; 1-beta = 80%). RESULTS: The risk of articular joint destruction was higher in women than in men (OR 2.72, CI 1.17-7.9, p<0.023), whereas age at onset or the presence of HLA-DR4, antiperinuclear factor, or antikeratin antibodies was not sufficiently strongly associated with the process of articular destruction to be considered relevant prognostic markers. CONCLUSION: We conclude that female sex is significantly associated with a higher risk of articular destruction.
9263145 Family history as a risk factor for rheumatoid arthritis: a case-control study. 1997 Aug OBJECTIVE: To investigate the risk of rheumatoid arthritis (RA) in the first degree relatives and to investigate whether the sex of the parent influences the pattern of inheritance. METHODS: An interview based case-control study, with subjects serially matched for age and sex. We analyzed 126 cases (hospital cases) and 94 controls (derived from the same hospitals), who gave information for family history of RA. Data concerning RA history among siblings and parents were computerized and analyzed univariately and multivariately. RESULTS: The odds ratio (OR) for developing RA is 4.4 (p < 0.001) if a first degree relative reported having the disease and 5.4 (p < 0.01) if a female first degree relative reported having the disease. For females the OR is 7.0 (p < 0.01) if the first degree relative is female. When the analysis was restricted to parents only, it was found that mothers with RA predispose their daughters and sons to develop RA more (OR = 8.6, p < 0.01, for daughters and 4.8, p < 0.05, for both sexes) than fathers (OR = 1.1 and 1.9, respectively). CONCLUSION: This case-control study confirms the familial clustering of RA and suggests that mothers confer susceptibility to RA on their offspring more often than fathers.
11944245 [Application of the apparatus autohemotransfusion in endoprosthesis of big joints]. 2001 Nov We observed 16 patients in whom the method of camera intraoperation reinfusion of washed erythrocytes was used during endoprosthetics of joints. For reinfusion we used the system Elmd-500 (Electromedics Inc., USA). The concentration of hemoglobin in peripheral blood remained stable in early and late post-operation period. No complications after transfusion of washed erythrocytes were observed.
10803747 Activation of synoviocytes. 2000 May The evaluation of molecular pathways has revealed various novel insights into rheumatoid arthritis pathophysiology during the past year. In addition, there is an increasing tendency toward analysis not merely of a single mechanism but rather of data addressing a substantial part of the cascade of events leading to cellular activation. Because synovial fibroblasts are key cells involved in joint destruction, this review outlines the events that trigger or inhibit the crucial pathways leading to their aggressive behavior. Major topics include cellular and humoral interactions (frequently modulated by cytokines), intracellular signaling and upregulation of gene transcription, and the deleterious effects on articular homeostasis.
10461482 Gait variables: appropriate objective outcome measures in rheumatoid arthritis. 1999 Jul OBJECTIVE: To assess the reliability and responsiveness of gait speed, cadence and stride length at two self-selected speeds (SSS) in subjects with rheumatoid arthritis (RA). METHODS: Thirty-one subjects with RA were assessed on three occasions. At each assessment session, subjects were asked to self-report walk pain on visual analogue scales, rate physical function using the Health Assessment Questionnaire, and walk five times at both a normal SSS and a fast SSS along an 8 m electric footswitch walkway. RESULTS: Despite stability of pain and physical function, there were significant gait changes from the first to the second assessment session at the normal SSS, although this 'learning' effect was not evident at either SSS between the second and the third assessment session. CONCLUSION: If the recommended protocol is followed, quantitative gait variables can provide reliable and responsive outcome measures in this population for use in evaluating therapeutic interventions.
10071506 [Measure of bone loss in rheumatoid arthritis]. 1999 Feb 7 The authors examined the degree of bone loss by single photon osteodensitometry in 72 patients with rheumatoid arthritis (RA). A control group was set up consisting of osteoarthritis patients of the same age and gender. As a result of the osteodensitometrical examination osteopenia was observed in 22-, osteoporosis in 37- and normal density in 14 rheumatoid arthritis patients. These results showed considerable difference compared to the density results of the control group (n = 72) (p < 0.001). They also analysed the role of risk factors affecting bone loss in three groups of rheumatoid arthritis patients, with osteoporosis, osteopenia and with normal density results. As risk factors the duration of the rheumatoid arthritis, the duration of the postmenopause, the age, the cumulative doses of steroid and the activity of rheumatoid arthritis were mentioned. Among risk factors the duration of the rheumatoid arthritis, the age, the duration of the postmenopause and the Steinbrocker phase classification correlated with the osteodensitometrical results. At the same time no correlation has been observed in relation to the cumulative doses of steroid and the Ritchie joint index.
10652651 Management of therapy-resistant rheumatoid arthritis. 1999 Dec During the last two decades, newly introduced therapeutic strategies have resulted in satisfactory modification of the disease course in the majority of the patients with rheumatoid arthritis (RA). Nevertheless, a definite number of RA patients remain therapy-resistant, and for this group more aggressive treatment may be required for preventing permanent disability and progressive joint damage necessitating surgical procedures. Therefore, management of therapy-resistant RA is one of the major challenges in modern rheumatology. RA patients who have not responded to conventional disease-modifying antirheumatic drug (DMARD) therapy are defined as refractory RA patients. However, a uniform description or definition for 'refractory' RA does not appear to be available. In this article we will deal with, and discuss, the term 'refractory RA' based on a MEDLINE database search using this term, currently available therapeutic options, data on therapy-resistant RA patients from an inception cohort of RA patients attending the Nijmegen University Hospital, management of extra-articular manifestations and future management strategies.
9777310 Disease-modifying antirheumatic drugs. Using their clinical pharmacological effects as a g 1998 Sep Rheumatoid arthritis is a disease of unknown aetiology characterised by persistent joint swelling, functional disability and increased mortality. No curative therapy exists at present but some therapeutic agents, commonly referred to as disease-modifying drugs, offer the potential for suppression of the inflammatory activity and attenuation of the disease process. Since the precise mechanism of action of most disease modifying drugs is uncertain, the selection of a particular therapy must at present be based on the pharmacologic properties of each available agent, appropriately individualised for each clinical setting. The toxicity of disease-modifying agents often limits the dose and/or duration of therapy and makes careful monitoring mandatory. No consensus exists as to the order in which disease-modifying agents should be employed. Less toxic disease-modifying drugs such as auranofin, hydroxychloroquine, minocycline, and sulfasalazine are usually used in early and mild disease. Azathioprine, penicillamine (D-penicillamine), methotrexate and parenteral gold are usually considered to be more toxic and are most often used in the setting of progressive disease while the most toxic agents, such as chlorambucil and cyclophosphamide, are reserved for life-threatening manifestations such as vasculitis. Newer therapeutic approaches presently under study include the use of existing drugs in combination and novel biologic agents which selectively inhibit lymphocyte and cytokine activity. These strategies offer the hope of more efficacious and less toxic therapy in the future.
9088527 Specialist management: needs and benefits. 1997 Feb In increasingly cost-conscious, accountable and integrated health-care systems, the appropriate role of speciality care is under scrutiny. The data on the impact of rheumatologist care on outcomes in patients with rheumatoid arthritis (RA) is limited and inconclusive. However, based on a review of processes of care known to be related to superior patient outcomes it is suggested that rheumatologists should be the lead physicians in patients with RA. Rheumatologists but usually not generalists have the experience necessary to make an early diagnosis and to initiate appropriate disease modifying anti-rheumatic drug (DMARD) treatment. Rheumatologists have an in-depth understanding of new assessment methods to optimize medical treatment and to make best use of and co-ordinate multi-disciplinary care. To avoid delay of diagnosis and initiation of treatment, patients with polyarthritis should be referred to rheumatologists as soon as possible. This requires that access to rheumatologist care is guaranteed.