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ID PMID Title PublicationDate abstract
11055831 Pulmonary nodule and aggressive tibialis posterior tenosynovitis in early rheumatoid arthr 2000 We report the case of a 34-year-old man with a rheumatoid pulmonary nodule preceding the development of articular symptoms of rheumatoid arthritis. Pulmonary nodules are a well known feature of rheumatoid arthritis and are mostly seen in severe established rheumatoid factor-positive cases. To differentiate between benign and malign pulmonary nodules we discuss the use of positron emission tomography (PET). Despite intensive therapy with steroids and methotrexate in our patient, within months he developed a severe tibialis posterior tendinitis, with partial rupture and evolution to a planovalgus deformity requiring surgery. Both these symptoms are rare but demonstrate the need for close follow-up in early rheumatoid arthritis.
10047717 [The levels of FDP, FDP-E and D-dimer in patients with rheumatoid arthritis]. 1998 Dec We studied the relationship of FDP and D-dimer levels of rheumatoid arthritis (RA) patients with their activities of RA. We evaluated FDP/D-dimer levels of thirty-six RA patients. And we also evaluated FDP/D-dimer levels of 14 patients with systemic lupus erythematosus (SLE) and 12 patients with other rheumatic diseases as control. RA patients were divided into two groups according to their activities. Nineteen patients, who fulfilled at least three of four activities criteria, were classified as active group [RA (A) group], and other 17 patients were classified as not-active group [RA (B) group]. FDP and D-dimer levels of RA patients were higher than those of SLE or other patients group significantly (P < 0.01). Furthermore, in RA patients, high levels of FDP and D-dimer were observed in RA (A) group compared to RA (B) group. In some RA patients, decrease of FDP and D-dimer levels were observed according to their RA activities. FDP and D-dimer levels were not correlated with the level of rheumatoid factor (RF). These results show that the FDP and D-dimer levels were elevated according to RA activity in RA patients.
10493669 Temporomandibular disorders in rheumatoid arthritis. 1999 Sep OBJECTIVE: To determine the frequency and character of temporomandibular disorders (TMD) in Oriental patients with rheumatoid arthritis (RA) and to investigate the relationship between TMD and RA in a tertiary referral center. METHODS: Symptoms and signs related to TMD were investigated in 80 patients (67 female, 13 male) who fulfilled the American College of Rheumatology 1987 revised criteria for RA. Diagnoses of TMD including muscle, disk displacement, or temporomandibular joint (TMJ) disorders were made based on clinical assessment. TMJ disorder was then correlated with the clinical, laboratory, and radiological features of RA. RESULTS: The mean age of the study population was 49.7 years and the mean duration of RA was 86.9 months. Eleven patients (13.8%) had active RA at the time of TMD assessment. About 76% of the study population had seropositive disease and 62% had peripheral joint erosions. Osteoarthrosis of the TMJ was the most common TMD in this Oriental population. Joint sounds on opening (35%), joint sounds on moving sideways or forward (27.5%), and pain in jaw joints (23.7%) were common TMD symptoms. Deviated mouth opening (45%) and coarse crepitus (15-21.3%) were most prevalent on examination. CONCLUSION: Patients with RA who had prolonged disease duration of RA and active peripheral joints tended to have osteoarthrosis of the TMJ. Presence of rheumatoid factor or peripheral joint erosions was not associated with TMJ osteoarthrosis.
11712756 Intracellular signaling pathways as a target for the treatment of rheumatoid arthritis. 2001 Jun Recent advances in our understanding of cellular and molecular mechanisms of rheumatoid arthritis have highlighted a critical role for interleukin-1 and tumor necrosis factor alpha. The quest for chemically amenable targets has recently led to the identification and characterization of the intracellular signaling pathways associated with these inflammatory cytokines. In particular the mitogen-activated protein kinase pathway, the nuclear factor kappaB pathway and the cross-talk between these offer several potential therapeutic opportunities for rheumatoid arthritis.
10651079 Clinical utility of the flow cytometric technique for shared rheumatoid epitope. 1999 The shared rheumatoid epitope (SRE) on the MHC class II antigen-presenting molecule constitutes a probable genetic risk factor for the occurrence of rheumatoid arthritis (RA) and may also determine disease severity. We have used a novel flow cytometric technique to determine the SRE in over 500 predominantly Caucasian patients attending a general rheumatology clinic. This technique has been validated against a polymerase chain reaction (PCR)/SSO molecular method. The SRE was observed in 90% of patients with Felty's syndrome (n = 10) and 75% of patients with RA (n = 178) as compared with 39% of patients with osteoarthritis or non-inflammatory rheumatic disorders (n = 73). Thus, the SRE determined by this method has a sensitivity for RA of 0.75, a specificity of 0.62 and an estimated positive predictive value of 0.02. In our RA cohort, there was no correlation between the functional outcome (health assessment questionnaire score) and SRE status. In conclusion, the determination of the SRE status by a flow cytometric method was found to have only modest sensitivity and specificity for RA; furthermore, the SRE did not correlate with functional outcomes. The clinical utility of the SRE assay is yet to be defined.
9228125 Progression of cervical spine changes in patients with early rheumatoid arthritis. 1997 Jul OBJECTIVE: To evaluate the development and progression of radiological changes of cervical spine in early rheumatoid arthritis (RA). METHODS: Sixty-seven patients with early RA treated actively with disease modifying antirheumatic drugs were followed prospectively for a mean of 6.5 years. Conventional clinical and laboratory variables were used for measuring disease activity and radiographs of the cervical spine, hands, and feet were taken serially during the followup. RESULTS: Thirty percent (20/67) of the patients showed radiological evidence of the cervical spine involvement characteristic of RA. Atlantoaxial subluxation was the first type of cervical change to occur, followed by vertical and subaxial subluxations and erosions. Patients with cervical involvement were initially more often rheumatoid factor positive and had higher initial C-reactive protein level than patients without cervical changes. Also, radiological progression of peripheral joints was associated with cervical involvement. HLA-DR4 or B27 positivity did not seem to influence early involvement of cervical spine. CONCLUSION: Involvement of the cervical spine begins early in RA. Therefore, cervical radiographs should be included in the clinical evaluation during the first years of disease onset, especially in patients with rapid radiological progression in peripheral joints. Aggressive therapy is emphasized in these patients, including the conservative treatment of cervical spine.
10540208 Dendritic cells: the driving force behind autoimmunity in rheumatoid arthritis? 1999 Oct Dendritic cells (DC) are likely to play a significant role in immune-mediated diseases such as autoimmunity and allergy. To date there are few treatments capable of inducing permanent remission in rheumatoid arthritis (RA) and elucidation of the role of DC may provide specific strategies for disease intervention. Dendritic cells have proven to be powerful tools for immunotherapy and investigations are under way to determine their clinical efficacy in transplantation and viral and tumour immunotherapy. The present review will focus on the current view of DC and their role in autoimmunity, in particular RA. Two possible roles for DC in the pathogenesis of RA will be proposed, based on recent advances in the field.
10399222 [The characteristics of the distribution of painfulness and erosive lesions of the small j 1999 AIM: Identification of all small joints the affection of which is interrelated and the study of such joints grouping in polyarthritis clinical picture variants. MATERIALS AND METHODS: Upon examination of 102 patients with rheumatoid arthritis (RA) we assessed articular pain, erosion of bones in small joints by x-ray picture of the feet and hands, estimated correlations between the pain and erosion in each joint and compared distribution of small joint erosions with distribution of pain in these joints. RESULTS: The groups of small joints of the bones and feet have been compiled in which RA pain or erosions were independent of the condition of the joints from the other groups. CONCLUSION: RA patients' distribution by joint lesions reflects latent mechanisms of RA development operating separately within various groups of small joints.
9236679 Detection of joint pathology by magnetic resonance imaging in patients with early rheumato 1997 Jun Magnetic resonance imaging (MRI) permits the visualization of anatomical structures not appreciated by conventional radiographic imaging, and may assess inflammatory disease and its progression with greater sensitivity than conventional radiography. In this study of 30 patients with early rheumatoid arthritis (RA), which could be considered as a pilot study because of the relatively small number of patients, we compare MRI of the knee and the fifth metatarsophalangeal joint with clinical and radiographic findings. A parallel study of 10 healthy individuals served as a reference group. In all but one of the 30 patients, MRI revealed some kind of joint abnormality, whereas conventional radiography was normal in 14 patients. The present study thus suggests that MRI may detect inflammatory and/or destructive joint changes in patients with early RA, and that these changes may occur in the absence of clinical symptoms or signs and/or radiographic signs in the examined joint. If these data prove to be confirmed in further controlled studies, MRI may be of importance both for the assessment of prognosis and for the decision to treat in the early critical stages of RA.
9101492 Association of HLA-DRB1*0405 with extraarticular manifestations and erosions in Singaporea 1997 Apr OBJECTIVE: To determine the association of disease related HLA-DRB1 locus with disease severity and extraarticular features in Singaporean Chinese patients with rheumatoid arthritis (RA). METHODS: 70 patients with RA and 80 controls were typed for HLA class II alleles by the polymerase chain reaction-sequence specific oligonucleotide probe method. RESULTS: 56 patients (80%) had erosive disease; 51 were seropositive (73%), and 16 had extraarticular features (23%). Patients with HLA-DRB1*0405 had significantly higher prevalence of extraarticular features (43 vs 10%; p = 0.001) and erosions (93 vs 71%; p = 0.022) compared to those without the allele. There was also a greater frequency of seropositivity and joint surgery, and a higher number of second line agents used by patients with HLA-DRB1*0405 in comparison to those without, although the difference was not statistically significant. CONCLUSION: HLA-DRB1*0405 is associated with the presence of extraarticular features and erosions in Singaporean Chinese patients with RA.
11178114 The stressed synovium. 2001 This review focuses on the mechanisms of stress response in the synovial tissue of rheumatoid arthritis. The major stress factors, such as heat stress, shear stress, proinflammatory cytokines and oxidative stress, are discussed and reviewed, focusing on their potential to induce a stress response in the synovial tissue. Several pathways of stress signalling molecules are found to be activated in the synovial membrane of rheumatoid arthritis; of these the most important examples are heat shock proteins, mitogen-activated protein kinases, stress-activated protein kinases and molecules involved in the oxidative stress pathways. The expression of these pathways in vitro and in vivo as well as the consequences of stress signalling in the rheumatoid synovium are discussed. Stress signalling is part of a cellular response to potentially harmful stimuli and thus is essentially involved in the process of synovitis. Stress signalling pathways are therefore new and promising targets of future anti-rheumatic therapies.
9870779 Methotrexate-induced hepatic necrosis requiring liver transplantation in a patient with rh 1998 Jul MTX-induced hepatic injury and liver enzyme elevations have been demonstrated after treatment of leukemia, gestational disease and during treatment of psoriasis and rheumatoid arthritis. A 40-year-old man with a long standing history of rheumatoid arthritis was treated with MTX over a 6 month period and developed an overwhelming hepatic necrosis. He was successfully transplanted.
9569070 A comparison of two recently developed health status instruments for patients with arthrit 1998 Feb Two multidimensional health status instruments of rheumatic diseases, the Dutch-AIMS2 and the IRGL (Impact of Rheumatic diseases on General health and Lifestyle), were compared in a sample of 284 rheumatoid arthritis patients with regard to their measurement properties and usefulness for research purposes. Both questionnaires showed an excellent reliability (Cronbach's alpha), and were highly comparable with regard to their construct and convergent validity. Second-order factor analysis confirmed the physical, psychological and social health dimensions for both questionnaires. The comparability between the instruments was established by high intercorrelations between the physical and psychological health dimensions. Sufficient convergent validity was indicated by the strong correlations between the physical functioning scales and clinical and laboratory measures. The main differences between both questionnaires relate to their length and emphasis on health aspects. The Dutch-AIMS2 is characterized by a more extensive assessment of the physical dimension and the additional measurement of general health aspects. The shorter IRGL exclusively assesses the main health dimensions with a more comprehensive measurement of the psychological and social dimensions. The instrument that reflects the subject in question most adequately should be chosen.
9269399 Clinics in diagnostic imaging (24). Cervical spine instability in seronegative rheumatoid 1997 Apr A 59-year-old man presented with neck pain and limb numbness. He also had bilateral symmetrical joint deformities of his hands and wrists. Cervical spine radiographs showed C 1/2 instability and features of rheumatoid arthritis. Magnetic resonance imaging demonstrated erosion ofthe odontoid peg by pannus. C 1/2 surgical fusion was performed. The role of imaging in cervical spine involvement by rheumatoid arthritis is reviewed.
10468176 Idiopathic hypoparathyroidism associated with adult rheumatoid arthritis. 1999 A 48-year-old female patient with adult onset idiopathic hypoparathyroidism diagnosed at the age of 28 years developed a typical seropositive rheumatoid arthritis (RA) at 46 years of age after several years of evolution of a palindromic rheumatism. Only one case of an association between idiopathic hypoparathyroidism and RA has been described in the medical literature. Autoimmunity seems to play a pivotal role in the aetiopathogenesis of both diseases, and could explain the nature of this association; nevertheless, a chance association could not be excluded.
10646483 Future trends in the treatment of rheumatoid arthritis: cytokine targets. 1999 Nov Recently, anti-inflammatory cytokines and cytokine-blocking agents such as monoclonal antibodies, soluble receptors and receptor antagonists have been explored as therapeutic agents for patients with rheumatoid arthritis. The anti-inflammatory cytokines interleukin 10 (IL-10), which reverses the cartilage degradation induced by antigen-stimulated mononuclear cells, and IL-4, which reduces prostaglandin production by synoviocytes, are currently being tested for their clinical efficacy. Trials with the tumour necrosis factor alpha blocking agents infliximab (monoclonal antibody) and etanercept (the fusion protein of soluble tumour necrosis factor receptors linked to human immunoglobulin) have produced improvements in clinical and laboratory measures of inflammation with mild side-effects. Trials of IL-1 blockade with recombinant human IL-1 receptor antagonist produced significant improvement of clinical parameters with mild side-effects. Blockade of IL-6, the cytokine that induces biosynthesis of acute-phase proteins, has been attempted with i.v. injections of anti-IL-6 monoclonal antibodies with improvement in clinical variables as well as reduced acute-phase proteins.
11333351 Have the new drugs relieved the burden of the orthopedic surgeon? 2001 May Rheumatoid arthritis (RA) represents a chronic joint inflammation that leads to destructive lesions of joint cartilage and periarticular bone. Increased understanding of the molecular and cellular mechanisms of RA and recent advantages in molecular technology have resulted in new antirheumatic drugs such as tumor necrosis factor-alpha blockers, inhibitors of interleukin-1, and novel disease-modifying antirheumatic drugs such as leflunomide. This review summarizes the important effects of the novel antirheumatic drugs and their potential impact on the work of orthopedic surgeons. The ability of these agents not only to improve the clinical signs and symptoms of RA but also to prevent progressive joint damage promises support to the work of orthopedic surgeons and to the interdisciplinary treatment of RA patients. The challenge, however, will be to conduct studies that show the concrete way in which the single drugs may best relieve the burden of the orthopedic surgeon.
9598882 Sense of coherence--a protective factor for depression in rheumatoid arthritis. 1998 May OBJECTIVE: A stress-vulnerability model of depression was investigated in patients with rheumatoid arthritis (RA). Antonovsky's Sense of Coherence (SOC) was examined as a factor protecting against depression. METHOD: Relationships between sociodemographic factors, disease activity, functional impairment, pain, depression, and SOC were assessed using multivariate methods in a cross sectional sample of 89 consecutive outpatients with RA. RESULTS: Increased prevalence of depression was associated with low SOC and high self-rated pain levels, but not with other factors assessed. By multiple regression analysis, independent contributions to depression were observed for SOC (23% of variance) and for pain (24% of variance), but not functional impairment or disease activity. CONCLUSION: Comprehensive models of adjustment in RA need to include protective factors such as SOC, in addition to pain and other pathological variables. SOC may be helpful in identifying individuals with RA who are particularly vulnerable to depression, who may be helped by focused psychological interventions such as cognitive therapy.
10834860 Improved medical and surgical management of cervical spine disease in patients with rheuma 2000 Jun OBJECTIVES: (1) To compare clinical outcome and symptomatology of rheumatoid cervical myelopathy between patients managed conservatively and surgically. (2) To determine if surgical outcome has improved since the series published from this unit in 1987. (3) To examine the role of magnetic resonance imaging (MRI) in the diagnosis of cervical myelopathy. METHODS: Patients undergoing MRI of the cervical spine between 1991 and 1996 were identified. Case records were reviewed retrospectively. RESULTS: 111 patients with RA underwent 124 MRI scans. The median age at onset of cervical spine symptoms was 58 years (range 16-87) with median disease duration of 16 years (range 1-59). 18 (16%) required surgery immediately after MRI. 93 (84%) were managed conservatively, 9 of whom (10%) later required surgery. 2/7 deaths in the conservative group were directly related to cervical myelopathy. Patients requiring surgery were more likely to report paraesthesia, weakness, unsteadiness and to exhibit extensor plantar reflexes, gait disturbance, and reduced power. MRI findings did not correlate with clinical features. When compared with the 1974-82 cohort, fewer patients had severe myelopathy (Ranawat grade IIIB) before surgery (34% versus 7%). Early postoperative mortality improved from 9% to 0% and surgical complication rate fell from 50% to 22%. 89% of patients in the 1991-96 cohort reported subjective improvement in overall function. CONCLUSION: In this series surgical outcome has improved. The major factor in this more favourable outcome is probably that patients presenting with rheumatoid cervical myelopathy are now referred for surgery at an earlier stage of disease. Clinical findings correlate poorly with MRI findings, therefore clinical history should remain the key to determining the need for MRI.
9536336 Osteoporosis in rheumatoid arthritis. 1997 Periarticular osteopenia of appendicular bones occurs early in the course of RA. Loss of the balance between bone resorption and formation contributes to the development of periarticular osteopenia and might be mediated through increased production of cytokines and prostaglandins by the synovium and bone marrow. Generalized osteopenia is also common and leads to an increased risk of fracture. Although the pathogenesis of this osteopenia is considered to be multifactorial, disease activity, immobility, corticosteroids and menopausal status are the important determinants.