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ID PMID Title PublicationDate abstract
14635299 The ability of the Cochin rheumatoid arthritis hand functional scale to detect change duri 2000 Oct OBJECTIVE: To assess changes measured with the Cochin rheumatoid arthritis (RA) hand functional disability scale during the course of the disease. METHODS: A cohort study evaluating outcome measure responsiveness in RA was conducted in a referral center. Ambulatory or hospitalized patients with RA according to the 1987 American College of Rheumatology (formerly the American Rheumatism Association) criteria were evaluated twice. Clinical measures included Cochin's scale, Revel's functional index, hand functional index, visual analog scale of patient-perceived handicap, visual analog scale of pain in hands and wrists, total score of swelling, total score of tenderness, and morning stiffness duration. Responsiveness was assessed by the effect size (ES) and the standardized response mean (SRM). The nonparametric Spearman rank correlation coefficient (r) was used to assess the correlation between two quantitative variable changes. RESULTS: Fifty-five patients (44 women) were evaluated twice at an interval of 15.4 +/- 1.4 months (mean +/- SD) (range 13-18 months). The Cochin scale total score had worsened at the second visit (95% confidence interval for mean differences -5.16, 0.73). Its SRM and ES values were -0.20 and -0.15, respectively. Changes in the score had the highest correlation (r = 0.58) with changes in the patient-perceived handicap, while it had only fair or little correlation with changes in the disease activity measures. The factor 2 scale subscore significantly worsened and had the highest values of SRM and ES (SRM = -0.40 and ES = -0.31). CONCLUSION: The Cochin scale can detect small but meaningful changes in RA hand disability.
10836523 TNF-alpha gene polymorphism does not affect the clinical and radiological outcome of rheum 2000 The present study was undertaken in order to investigate the relationship between tumor necrosis factor-alpha (TNF-alpha) gene polymorphism and the radiological progression of rheumatoid arthritis (RA) within the first 3-years of the disease. Sixty-eight RA patients (59 women and nine men) were observed for 3-years. TNF-alpha polymorphism analysis was performed in all patients. Radiographs of the hands were taken at the onset of study and after 3-years of follow-up. Radiographs were assessed according to the Larsen index (damage score and progression of damage score). We did not observe any correlation between TNF gene polymorphism and damage score or progression of damage score. The obtained data suggests that TNF-308 polymorphism cannot serve as an indicator of the disease course in RA patients.
11333342 Leflunomide and methotrexate. 2001 May Methotrexate and leflunomide are both effective drugs in the treatment of patients with rheumatoid arthritis. Methotrexate has been available for many years, whereas leflunomide is a relatively new drug. Several large trials describing its efficacy and safety in comparison with both sulfasalazine and methotrexate and with placebo have been published recently. It appears that leflunomide is approximately equally effective as sulfasalazine and methotrexate. New data are also available on the mechanism of action of leflunomide especially. This drug probably acts as an immunomodulatory agent by interfering with the de novo synthesis of pyrimidines.
9791327 What do self-administered joint counts tell us about patients with rheumatoid arthritis? 1998 Aug OBJECTIVE: This report presents data from two sources showing that a self-administered joint count (SAJC) suitable for use in clinical settings provides information comparable with that of observer-assessed joint counts. METHODS: Patients were tested with a 1-page form containing a 40-joint mannequin on which they could mark their painful or swollen joints. The first sample of 110 patients was used to compare the SAJC with the tender or swollen joint counts (TJC or SJC) performed by a rheumatologist and to a battery of clinical and laboratory measurements. The second sample consisted of 240 rheumatoid arthritis (RA) patients enrolled in a cohort study of RA outcomes, in whom the relationship between the SAJC and health-related quality of life measures was examined. RESULTS: Test-retest reliability of the SAJC was excellent (ri = 0.89), as was its agreement with the observer-assessed TJC (ri = 0.78). The SAJC was significantly correlated (P < or = 0.01) to pain on a 10-point scale (r = 0.33), the McGill Pain Questionnaire (r = 0.27), the pain subscale of the Arthritis Impact Measurement Scales (AIMS) (r = 0.32), the duration of morning stiffness (r = 0.27), and to the AIMS subscales of physical function (r = 0.20), impact (r = 0.31), and global health (r = 0.29). The SAJC was inversely related to formal education (r = -0.32), but did not correlate significantly with the modified Health Assessment Questionnaire, walking velocity, grip strength, or erythrocyte sedimentation rate. The responsiveness of the SAJC was comparable with that of other measures commonly employed to assess RA outcomes. Either the SAJC or the TJC could be included alternatively in multivariate models to explain 7 of the 8 subscales of the Medical Outcomes Study Short Form-36 (SF-36) questionnaire. CONCLUSION: The SAJC is a reliable and responsive measure that agrees highly with the observer-assessed TJC and is significantly associated to the health-related quality of life of patients with RA. Given its low cost and ease of administration, it is suggested that SAJC be included in future studies of RA outcome in routine clinical practice.
9683880 Rheumatoid neutrophilic dermatitis. 1998 Jul Rheumatoid neutrophilic dermatitis (RND) is a rare disorder seen in patients with severe rheumatoid arthritis. We present a 63-year-old Japanese with seropositive rheumatoid arthritis and rheumatoid lung who showed erythematous plaques and papules with pustules on his extremities and buttocks. Histological examination revealed a dense neutrophilic infiltration the upper dermis and neutrophilic abscesses in the dermal papillae. obvious vasculitis was seen. We suggest that RND could be included within the concept of a neutrophilic vascular reaction and that this condition develops through immune complex-mediated and neutrophil-induced vascular damage.
9608321 The genetic contribution to the pathogenesis of rheumatoid arthritis. 1998 May The association of HLA-DR4 or other HLA-DRB1 alleles excoding the shared (or rheumatoid) epitope has now been established in nearly every population. Similarly, the fact that the presence and gene dosage of HLA-DRB1 alleles affect the course and outcome of rheumatoid arthritis has likewise been seen in most (although not all) studies. Family studies are making it increasingly clear that other genes are involved in the pathogenesis of rheumatoid arthritis, both within and outside of the major histocompatibility complex, and much work is ongoing to help identify them and their impact on the disease. This article reviews where we stand in the knowledge of HLA and other genes and their associations with predisposition to and outcome in rheumatoid arthritis.
9825751 Can collagen type II sustain a methotrexate-induced therapeutic effect in patients with lo 1998 Oct OBJECTIVE: Based on the results of two recently published, randomized, double-blind and placebo-controlled studies, a possible improvement in rheumatoid arthritis disease activity after oral tolerization with triple helical collagen type II has been suggested. The goal of this study was to go one step further and ask the question whether collagen type II can sustain the therapeutic effect induced by methotrexate, the most widely accepted disease-modifying anti-rheumatic drug in patients with long-standing rheumatoid arthritis. METHODS: Ninety-two patients with rheumatoid arthritis on stable therapy with methotrexate were enrolled in a 3 month double-blind, randomized and comparative study to examine the efficacy of oral triple helical collagen type II as compared to continuing methotrexate. The dose of methotrexate (or the respective placebo drug) and of concomitant corticosteroids was not changed and intra-articular corticosteroids were not allowed during the 3 months. The primary study endpoint was disease activity as measured by physician and patients. RESULTS: While patients under ongoing therapy with methotrexate had, as expected, no change in disease activity, almost all parameters of disease activity and outcome in patients under a daily oral dose of 0.5 mg triple helical collagen type II worsened significantly (highly significant difference in swollen joints, between the two groups, P < 0.0001). No significant differences in side-effects between the two groups during the study period could be demonstrated. CONCLUSIONS: Substitution of methotrexate with daily 0.5 mg of triple helical collagen type II in patients with rheumatoid arthritis leads to a significant increase in disease activity, suggesting that oral collagen type II at the given dose is not capable of sustaining the methotrexate-induced anti-inflammatory effect in patients with long-standing rheumatoid arthritis.
10081128 [Characteristics of mental disorders in patients with rheumatoid arthritis]. 1999 Peculiarities of mental disorders in patients with rheumatic arthritis were studied in 70 patients aged 20-60 years. The most typical mental disorders were: asthenic symptomatology, depressive phenomena with anxiety, fears, ideas of self-accusation, a peculiar variation of the syndrome of dysmorphophobia due to defects of appearance, stable disorders of sleep, psychopathic-like disorders and, quite frequently, manifestations of psycho-organic syndrome.
10083962 The contribution of functional imaging techniques to our understanding of rheumatic pain. 1999 Feb The main cerebral components of the human pain matrix have been defined using functional imaging techniques. The experience of pain is likely to be elaborated as a result of parallel processing within this matrix. There is not, therefore, a single pain center. The determinants of pain are as likely to be determined by top-down as by bottom-up processes. The precise function of the different components of the matrix are just beginning to be defined. There appear to be important adaptive responses in the forebrain components of the matrix during arthritic pain. Endogenous opioid peptides are strong candidates for the modulation of some of these responses. More extensive and sequential behavioral and functional imaging studies are required to establish the contribution these adaptive responses make to the perception of pain.
9266135 The treatment of rheumatoid arthritis in this century: from spas to monoclonal antibodies. 1997 May In this paper I review the advances in the treatment of rheumatoid arthritis that have taken place in this century. From spas to monoclonal antibodies for the manipulation of the immune system, we have come a long way in just one hundred years. However, although research is being pursued in many promising directions, the discovery of a truly effective treatment for rheumatoid arthritis is still being awaited.
10672699 [The medical rehabilitation characteristics of patients after therapeutic prophylactic ope 1999 Oct Overall 119 treatment and prophylactic operations were performed on those patients in early phases of rheumatoid arthritis who derived no benefit from a combined conservative treatment. With preliminary medial instability of the joint in 19 patients the surgical intervention involved some elements making for reinforcement of the capsular ligamentous apparatus. Good results of the above operations occurred in 78% of cases. Relapses of synovitis were encountered in eight percent of cases, which fact is related to the generalized advancing disease. Satisfactory results were obtained in those patients (14%) who were free from the origination of synovitis, which fact can be explained by lack of an efficient system of complex medical rehabilitation in the outpatient stage. A scheme is suggested of medical rehabilitation after treatment and prophylactic interventions for patients with early stages of rheumatoid lesions of the knee joint, that permits improving results of treatment in the above category of patients.
9617876 Rheumatoid arthritis associated with diffuse panbronchiolitis. 1998 Mar Diffuse panbronchiolitis (DPB) is a distinct clinicopathologic entity, which is characterized by chronic recurrent sinopulmonary infection and inflammation. We describe 3 patients with rheumatoid arthritis (RA) associated with DPB and consider that DPB is one of the bronchopulmonary manifestations associated with RA.
11001377 Current treatment paradigms in rheumatoid arthritis. 2000 Jun Rheumatoid arthritis (RA) has traditionally been treated using the pyramid approach, in which non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment and disease-modifying anti-rheumatic drugs (DMARDs) are introduced relatively late in the disease. This approach is no longer valid. Previously regarded as a benign disease, RA is now recognized as causing substantial morbidity and mortality, as do the NSAIDs used in treatment. DMARDs are more effective in controlling the pain and disability of RA than NSAIDs, and are often no more toxic. The current treatment paradigm emphasizes early, consistent use of DMARDs. A 'sawtooth' strategy of DMARD use has been proposed, in which a rising but low level of disability triggers a change in therapy. Determining the most clinically useful DMARD combinations and the optimal sequence of DMARD use requires effectiveness studies, Bayesian approaches and analyses of long-term outcomes. Such approaches will allow optimization of multiple drug therapies in RA, and should substantially improve the long-term outcome for many patients.
10415608 Endocrine end-points in rheumatoid arthritis. 1999 Jun 22 Our previous studies are reviewed and at the same time preliminary experimental observation to the topic of endocrine end-points in autoimmune disease is introduced. To this end, we have used rheumatoid arthritis (RA), including synovial fluids and primary cultures of synovial macrophages, as a model system in order to investigate (a) expression and subcellular localization of high-affinity sites of steroid binding in immune effector cells; (b) steroid metabolic profiles in both male and female RA patients, as compared to healthy subjects; and (c) activities of key steroid enzymes that govern intratissue accumulation of sex hormones. In RA tissues and cells, the concurrent evidence for (1) androgen and/or estrogen receptors, (2) high concentrations of biologically active steroids, (3) key enzymes of steroid metabolism, and (4) significant changes of estrogen to androgen ratio, all strongly suggests that individual immune cells, including synovial macrophages, may behave as steroid-sensitive cells, namely, they may represent a target for sex steroids, supporting the hypothesis of a potential endocrine regulation of the immune response also in RA disease. In this respect, definition of several endocrine end-points may have important implications for the treatment of rheumatic disease and other immunological disorders.
10852987 Clinical quality management in rheumatoid arthritis: putting theory into practice. Swiss C 2000 May Clinical quality management (CQM) in rheumatoid arthritis (RA) aims to reduce inflammatory activity and pain in the short term, and damage, and consequently disability, in the long term. Within CQM as used in Switzerland rheumatologists are provided with a measurement feedback system with which they can regularly follow their patients. Inflammatory activity is measured with the Disease Activity Score (DAS28) and the Rheumatoid Arthritis Disease Activity Index questionnaire (RADAI), damage with an X-ray score and disability with the Stanford Health Assessment Questionnaire (HAQ). Feedback is used to optimize therapy, which in the short term allows the activity of the inflammatory process to be adjusted or 'titrated'. In the long term, the therapy result for the individual patient is monitored by the course of disability and damage. In this paper we present a series of cases to illustrate the usefulness of the CQM system in the management of individual RA patients. CQM in RA may be helpful when making decisions about adjustment of treatment, and to document and communicate these decisions based on quantitative data.
9494245 Our experience in the treatment of rheumatoid knee by arthroscopic synovectomy. 1997 Jul The authors present the results obtained in the treatment of rheumatoid knee by arthroscopic synovectomy. A total of 29 knees operated on in 25 patients after a mean follow-up of 38 months based on the Laurin evaluation scale were re-examined. There was significant improvement for pain, synovitis, and overall function (mean values pre- and postoperative 2.07 vs 0.98; 2.14 vs 0.84, 2.37 vs 1.26, respectively); there were no, substantial variations in joint movement (2.47 vs 2.58). By dividing the patients into the 4 Larsen radiographic classes, the worst results were observed in patients in classes 3 and 4. In this series of patients complications of significance were not observed. Thus, we consider arthroscopic synovectomy to be the treatment of choice for rheumatoid knee because of the intrinsic advantages of minimum disease rate, rapid functional recovery, with expectations of results inversely proportional to the stage of progression of the disease.
9204259 T-cell-dependent pathways in rheumatoid arthritis. 1997 May Two theories, not necessarily mutually exclusive, attempt to explain the pathogenesis of rheumatoid arthritis. The mesenchymal hypothesis proposes that, after an initial event triggered by T cells, synovitis is maintained by autocrine and paracrine pathways involving macrophages and synovial fibroblasts. The T-cell hypothesis proposes that T cells are continuously involved in the pathogenesis of rheumatoid arthritis from its initiation phase through to the chronic stage. This paper reviews recent work in this area and concludes that there is substantial evidence in support of the T-cell hypothesis.
9769722 [The effect of drugs on hand function in rheumatoid arthritis]. 1997 In 30 inpatients with diagnosis of rheumatoid arthritis according ACR criteria we evaluated efficacy of non steroid-antiinflammatory drugs (NSAIDs) and corticosteroids (CS) on pain, morning stiffness and grip strength. NSAIDs and combination of NSAIDs and CS showed statistically significant analgesic effect (P < 0.005). Combination of NSAIDs and CS statistically significant shortened morning stiffness comparing NSAIDs or CS as single drug. Grip strength didn't rise in any investigated group. This could be explained with long disease duration (11.69 years). Morning stiffness is symptom not related only to extracellular fluid cumulation in affected areas but also to other progressive and longlasting disease signs.
11157143 The effects of treatment with interleukin-1 receptor antagonist on the inflamed synovial m 2001 Jan OBJECTIVE: To evaluate the effects of treatment with interleukin-1 receptor antagonist (IL-1Ra) on synovial tissue in rheumatoid arthritis (RA). METHODS: Twelve patients with RA entering a randomized clinical trial of human recombinant IL-1Ra underwent synovial biopsies before and after treatment. Cellular infiltration and adhesion molecule expression were evaluated after immunohistochemical staining. RESULTS: There was a notable reduction in intimal layer macrophages and subintimal macrophages and lymphocytes after treatment with IL-1Ra at 150 mg/day (n=3). Increased cellular infiltration was observed in all patients receiving placebo (n=3); variable changes were observed after IL-1Ra 30 mg/day (n=6). In a limited study of adhesion molecule expression, down-regulation of E-selectin and vascular cell adhesion molecule-1 was observed after treatment with IL-1Ra 150 mg/day, but not after IL-1Ra 30 mg/day or placebo. The apparent arrest of progressive joint damage seen in four patients after treatment with IL-1Ra was associated with reduced intimal layer macrophage accumulation in all patients. CONCLUSION: Treatment of RA with IL-1Ra resulted in reduced mononuclear cell infiltration of synovial membrane, which may represent the in vivo inhibition of biologically relevant IL-1ss-mediated pathogenic effects.
10076939 Effects of glucocorticoids on bone mineral density in rheumatoid arthritis patients. A lon 1999 We carried out a comparative study in 78 post-menopausal women with rheumatoid arthritis (RA). Forty-four women with a mean disease duration of 17.5 years had been treated with low-dose glucocorticoid (prednisone at < 5 mg/day) for at least 12 months. They were studied for an average period of 3 years and 8 months. The remaining 34 women had been treated only with nonsteroidal anti-rheumatic drugs (NSAIDs) and served as the control group. Bone mineral density (BMD) in the lumbar spine (L2-4) and femoral neck was measured by dual-energy X-ray absorptiometry (DXA). Reduction of BMD in the lumbar spine was significant in both groups (P < 0.05 to approximately 0.01), but there was no statistically significant difference between the two groups. BMD of the femoral neck decreased significantly (P < 0.05) in the prednisone group, but again the difference was not significant between the two groups. Our data suggest that low-dose prednisone administration probably does not induce significant axial bone loss in female RA patients.