Browse

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

ID PMID Title PublicationDate abstract
10355058 [Treatment of rheumatoid arthritis with cytokine antagonists]. 1999 Mar The blockade of proinflammatory cytokines is an interesting experimental approach for the therapy of rheumatoid arthritis. Various biological inhibitors are currently being tested in a number of large clinical studies with encouraging results. This review summarizes the existing data and discusses potential future developments.
10685827 A review of controlled clinical trials examining the effects of antimalarial compounds and 2000 Feb At least 8 randomized controlled clinical trials have examined the effects of chloroquine or hydroxychloroquine on radiographic progression in rheumatoid arthritis (RA). At least 12 randomized controlled trials have examined the effects of either intramuscular or oral gold on radiographic progression. A review of these studies shows that hydroxychloroquine and chloroquine have minimal, if any, inhibitory effects on radiographically documented progression of bone erosions and joint destruction when used to treat RA. Intramuscular gold (with most of the data from studies of sodium aurothiomalate) appears to be better than placebo, about equal to intramuscular methotrexate (MTX), but probably not as effective as cyclophosphamide or azathioprine in its effects on radiographic progression. Auranofin appears to be better than placebo, comparable to or perhaps moderately less effective than intramuscular gold, comparable to lower dose oral MTX (7.5 mg/week), and not as effective as higher dose oral MTX (7.5-15 mg/wk) in inhibiting radiographic progression in RA. The inhibitory effects of gold compounds on proinflammatory cytokine synthesis (especially interleukin 1) offer a plausible mechanism for their inhibitory effects on bone erosion and joint destruction in RA.
11879532 Ex vivo gene transfer in the years to come. 2002 Synovial fibroblasts (SFs) have become a major target for ex vivo gene transfer in rheumatoid arthritis (RA), but efficient transduction of RA-SFs still is a major problem. The low proliferation rate and heterogeneity of RA-SFs, together with their lack of highly specific surface receptors, have hampered a more extensive application of this technique. Improving transduction protocols with conventional viral vectors, therefore, as well as developing novel strategies, such as alternative target cells, and novel delivery systems constitute a major challenge. Recent progress in this field will lead to the achievement of high transgene expression, and will facilitate the use of gene transfer in human trials.
9751469 Effects of static and dynamic shoulder rotator exercises in women with rheumatoid arthriti 1998 The aim was to compare static and dynamic shoulder rotator endurance training in a group of women with mild rheumatoid arthritis and to see whether such training could influence impairment, disability, and handicap. The effects on general health were also studied. Patients were randomly assigned to a static (n = 17) (average age 59, median disease duration 7) or a dynamic training group (n = 20) (average age 56, median disease duration 10.5). Measurements were taken at the start, 10 weeks later when the training period was finished, and after a further 10 weeks. After the training both groups had fewer swollen joints in the upper extremity and less shoulder-arm pain. The dynamic group patients also improved according to the physical and overall dimensions of the Sickness Impact Profile. As impairment and aspects of disability and handicap were influenced by training but not by the patients' opinions regarding perceived disease activity and health, these relationships must be studied further.
10627723 Natural history of rheumatoid arthritis of the cervical spine. 1999 Sep This article reviews the natural history of rheumatoid arthritis involving the cervical spine with special attention given to predictors of paralysis. Understanding the natural history of rheumatoid arthritis of the cervical spine is necessary to determine the benefit of various interventions. The primary treatment goal for cervical instability is prevention of irreversible neurologic injury. The natural history of rheumatoid arthritis for a period of 10 years or more is one of significant disease progression. The natural history of cervical instability in patients with rheumatoid arthritis is more variable, with only some patients having a neurologic deficit develop. Recent studies support prophylactic stabilization of the rheumatoid cervical spine to prevent paralysis in high risk patients. However, proponents for prophylactic arthrodesis must acknowledge that not all cervical instability in rheumatoid arthritis progresses to neurologic deficit, and surgical intervention in patients with rheumatoid arthritis incurs added morbidity and mortality. Identifying the risk factors for progression of cervical instability is the first step in eliminating morbidity and mortality from spinal cord and brain stem compression. Surgical stabilization is indicated not only for those patients with paralysis, but for the subgroups of patients with cervical rheumatoid disease who are at risk for spinal cord and brain stem compression. The posterior atlantodental interval is the most reliable screening tool and predictor of progressive neurologic deficit.
9153544 Treatment of early rheumatoid arthritis with minocycline or placebo: results of a randomiz 1997 May OBJECTIVE: To determine if minocycline is an effective therapy for seropositive rheumatoid arthritis (RA) when used within the first year of disease. METHODS: The Rheumatoid Arthritis Investigational Network enrolled 46 patients with RA of <1 year duration into a 6-month study of minocycline (100 mg twice daily) versus placebo. All patients were rheumatoid factor positive. The primary end point of the study was successful completion of 6 months of treatment with no drug toxicity while maintaining 50% improvement in composite symptoms of arthritis. RESULTS: Eighteen of the 46 patients who were enrolled met 50% improvement criteria at 3 months, and maintained at least a 50% improvement for 6 months with no significant drug toxicity. Among them were 15 of the 23 patients (65%) treated with minocycline and 3 of 23 patients (13%) treated with placebo (P < 0.001). CONCLUSION: In patients with early seropositive RA, therapy with minocycline is superior to placebo.
9836373 Role of pro-inflammatory cytokines in rheumatoid arthritis. 1998 Rheumatoid arthritis (RA) is well known to be a chronic autoimmune/inflammatory disease which leads to progressive joint damage and destruction. Less well known is the fact that in severe cases of RA, with extra-articular manifestations and multiple joint involvement, there is also a significant reduction in life expectancy [28]. Hence the need for new therapeutic agents. With the cloning of cDNAs encoding cytokines in the early to mid 1980s, it became possible to use new assays to evaluate cytokine expression in the local site of autoimmunity, the rheumatoid synovium. There were two goals. First would understanding cytokine expression help us understand the pathogenesis of RA? Secondly, would it be possible to learn enough about the cytokine network to establish possible therapeutic targets? While a complete understanding of either of these questions remains elusive, here we review the state of knowledge in early 1998, which shows that much progress has been made and that these goals have been partly reached. The clinical benefits of this knowledge are documented elsewhere in this compilation, as is the role of chemokines, anti-inflammatory cytokines and the cytokines involved in neovascularisation.
11354293 Cost-effectiveness of Prosorba column therapy for rheumatoid arthritis: a framework for an 2001 Apr Apheresis with the Prosorba column is safe and effective for treating refractory rheumatoid arthritis. It also is resource intensive. Economic evaluation of Prosorba column therapy could help promote efficient use of this technology. This article describes a framework and the data requirements for analyzing the cost-effectiveness of Prosorba column therapy. Several factors are considered in developing the framework including the target patient population, treatment alternatives, and clinical, economic, and quality of life outcomes of alternative treatments. We propose decision modeling as the appropriate study design because it provides a flexible framework for combining and analyzing data from different sources including experimental and nonexperimental studies. The cost-effectiveness of Prosorba column therapy will depend on the patient population in which it is used and the other treatment options still available to these patients. Offsets to the costs of providing Prosorba column therapy are likely to be largest in treatment-refractory patients and when this therapy is compared to other expensive new agents such as etanercept.
11681094 [Development of rheumatoid arthritis orthopedics in German-speaking countries]. 2001 Oct In the realization that the cause of and thus an appropriate curative systemic therapy for rheumatoid arthritis did not and does not exist, surgical treatment of this usually destructive disease emerged as a major field in orthopedics in collaboration with internists specialized in rheumatology. The establishment of working groups within the scientific society initiated by the German Association for Orthopedics and Traumatology (DGOT) in 1971 to improve efficiency was a decisive factor for the further development in the German-speaking countries. A significant role was played by the fact that the Swiss N. Gschwend from Zurich was entrusted with the formation of the working group. This ensured that other German-speaking colleagues in Austria as well as Scandinavia also had the opportunity to add their input and influence rheumatoid orthopedics to a large extent. The DGOT also supported the creation of the ARO, which was founded as an independent association within the DGOT in 1992. The growth of rheumatoid orthopedics received considerable impetus from the fact that it was recognized in 1981 as the only subspecialty of orthopedics granted equal footing, as was the case for rheumatology in internal medicine. At the start of the 1970s, interest was focused on synovectomy for joint preservation, also with regard to its techniques and the possibility for preventive indications. Influenced by the experience gained from the development of endoprosthetic replacements, arthrodeses for rheumatic patients, e.g., in the region of the shoulder and knee joints, were almost completely ignored. The special field of reconstructive surgery on the hand and wrist employing implantation of finger joints and limited arthrodeses yielded impressive subjective and partially functional improvement for the patients. New impulses in the surgical treatment of foot deformities with joint-saving techniques for toe joints and endoprosthetic reconstruction of the ankle have brought about new trends in rheumatoid orthopedics in the past 10 years. Operative stabilization of cervical instabilities represents a special aspect in the development of rheumatoid orthopedics. Both the differential indication and the surgical technique have changed. The development of magnet resonance tomography and new implants for the cervical spine has played a significant role. Rheumatoid arthritis surgery has shown preference to integrating physical measures including in particular ergotherapy and special hand therapy into local surgical interventions. Functional treatment measures, care of braces and aids, and training in joint protection have become a firm part of the therapeutic concept. It is significant that in the German-speaking countries a treatment plan focused solely on the joints has thus far not gained general acceptance as is the case in Anglo-American countries. Preference is given to working as a team with subspecialties for upper and lower extremities and the spinal column. This guarantees that the priorities of the patients who usually present with multiple joint alterations can be dealt with by one group.
9476267 An open study of the anti-TNF alpha agent pentoxifylline in the treatment of rheumatoid ar 1997 Dec OBJECTIVE: Monoclonal antibodies to TNF alpha have a rapid therapeutic effect in rheumatoid arthritis. Pentoxifylline is an anti-TNF alpha agent that is easier to handle than antibodies. METHODS: An open prospective trial was conducted in 21 patients with active rheumatoid arthritis. Pentoxifylline was given in a daily dosage of 1,200 mg for at least one month. Five patients received the drug as a continuous intravenous infusion during the first seven days. RESULTS: After one month, a significant decrease in the pain severity score was noted, but all other clinical and laboratory efficacy parameters were unchanged. A limited response was seen in four patients. TNF alpha levels did not decrease under therapy. CONCLUSION: Under the conditions of our trial, the therapeutic benefits provided by pentoxifylline were too small to warrant use of this drug in severe refractory rheumatoid arthritis.
11078898 Morphological and mechanical analysis of the glenoid by 3D geometric reconstruction using 2000 OBJECTIVE: To provide a morphological and mechanical analysis of the glenoid by 3D geometric reconstruction using computed tomography. DESIGN: For patients with different pathologies (Group A=control group, Group B=primary osteoarthritis, Group C=rheumatoid arthritis), the variation in shape of the scapula was characterized by measuring the glenoid version (beta). METHODS: Mapping the computed tomography number and its 3D variation in the bone as a finite element structure. RESULTS: In Group A, the mean value of version was 17 degrees (range 12-22 degrees ). In Groups B and C the mean value of version were 27 degrees (range 4-48 degrees ) and 31 degrees (range 25-31 degrees ) of retroversion. At the center of the glenoid there was a homogeneous area of bony tissue with low computed tomography values and the subchondral bone could be clearly identified. For Group B patients, the computed tomography values were increased at the posterior margin of the glenoid, with a thickening of the posterior area acting as a strengthening column. For the Group C patients, the anatomical modifications were not reproducible between two cases examined. CONCLUSION: Results reveal a great difference between a healthy and a pathological glenoid. RelevanceThe method will be the basis for future study of the pathological characteristics of the joint. Results should provide a new pre-operative insight to help guide the surgeon.
10215479 MR imaging of the arthritic rabbit knee joint using albumin-(Gd-DTPA)30 with correlation t 1999 Feb The purpose of this study was to demonstrate a technique, in a pilot study, for measuring abnormal capillary permeability in synovial tissue of rabbit arthritic knees using dynamic MRI with a gadolinium-based blood pool agent. Arthritis, simulating rheumatoid arthritis, was induced in knees of 8 rabbits by intra-articular injection of carrageenan (n = 4) or ovalbumin (n = 4). Sequential fat presaturated T1-weighted Spoiled Grass images were obtained before and up to 30 min after intravenous administration of albumin-(Gd-DTPA)30. Estimates of synovial tissue plasma-volume (PV), fractional-leak-rate (FLR), and permeability-surface-area-product (PS) were computed. Histologic correlation was obtained in the corresponding regions. Dynamic MRI showed extravasation of albumin-(Gd-DTPA)30 into hypertrophic synovium in six of the eight arthritic knees. Histologic examination of these six knees showed markedly inflamed synovium. The two knees that did not show abnormal vascular permeability contained non-hypertrophic synovium. None of the rabbits showed abnormal permeability in muscle. MRI derived microvascular characteristics (PV, FLR and PS) correlated positively (r2 = 0.51, 0.97 and 0.86) with the histology. Factors involving the structural and functional microvascular characteristics of synovial tissue can be estimated non-invasively using albumin-(Gd-DTPA)30. This technique may be useful for monitoring disease progression and treatment response in rheumatoid arthritis.
9333881 [Evaluation of mineral density in the distal radius during the course of rheumatoid arthri 1997 Rheumatoid arthritis (RA) of progressive systemic disease predisposing for osteoporosis. Inflammatory process, applied treatment as well as considerably impared efficiency of motor organ create conditions for osteoporosis. The changes of bone mineral density in RA were assessed in 50 patients treated for various form of RA, at the Rheumatological and Rehabilitation Hospital in Cracow. The age of patients ranged from 21-79 yrs: the mean age was 50 years. The group consisted of 46 (92%) females and 4 (8%) males. Apart from standard clinical examinations there was assessed in all cases mineral density in distal radius using Osteometer DTX 100. Mineral density BMD was estimated in distal and ultradistal region of radius. All patients were qualified into 4 groups depending on the stage of radiological changes according to Steinbrocker. Group I included 16%, group II-30%, group III-30%, and IV-24% of patients. Steroid therapy was applied in 20 (40%) cases. The results showed progressive decrease of mineral density BMD in distal radius in patients with advanced RA. It was also observed that in RA patients mineral density defect occurs earlier in trabecular than in cortical bone.
10814639 A case of rheumatoid pericarditis with high concentrations of interleukin-6 in pericardial 2000 Jun A case of rheumatoid pericarditis that developed into cardiac tamponade without deterioration of rheumatoid arthritis is described. The concentration of interleukin-6 (IL-6) in pericardial fluid was notably increased compared with serum. IL-6 may be associated with progression or maintenance of rheumatoid pericarditis.
10516834 [Follow-up and prognosis in chronic polyarthritis]. 1999 Sep 1 The spectrum of rheumatoid arthritis (RA) ranges from benign remitting manifestations to rapidly progressive forms with increased mortality. About 10% of the patients show an intractable rapidly progressive course associated with severe extraarticular manifestations. Within the first three years, 70% of the patients develop radiological erosions of the joints and 31% deformities of the hands. Life expectancy is shortened by 3-18 years. Particularly, infections are more frequent causes of death in RA compared with controls. Work disability occurs in about a quarter of the patients within the first three years of RA and in 43-85% after eight to ten years. The ratio of direct to indirect costs is 1:3 in RA. Preliminary data show that regular rheumatological treatment leads to a marked reduction in indirect costs caused by production loss. The most important early indicators of an unfavourable disease course are the large number of swollen joints, early severe functional impairment, highly elevated laboratory markers of inflammation and rheumatoid factor. Knowledge of the current data regarding the course and prognosis of RA are helpful for assessment of the disease for insurance purposes.
9751464 Correlation of serum IgA rheumatoid factor levels with disease severity in rheumatoid arth 1998 In the present study, the IgA rheumatoid factor (IgA RF) was assayed by ELISA in 114 sera of patients with active RA. IgA RF was found in the sera of 38 (33.3%) patients. A total of 56 disease variables were studied, differences in variables between IgA RF positive and negative patients were analyzed. The presence of IgA RF was found to be associated with a rapid progressive course, RA activity, onset of extra-articular manifestations (especially systemic rheumatoid vasculitis), high IgM RF titres, circulating immune complexes, cryoglobulins, and C-reactive protein levels. There was no statistically significant difference in serum IgA levels between IgA RF seropositive and seronegative patients. The presence of IgA RF showed a positive correlation with the level of IgM RF. The results of this study showed that the determination of IgA RF has a practical use in the establishment of the severe course of RA with systemic damages.
11001374 Radiographic imaging: the 'gold standard' for assessment of disease progression in rheumat 2000 Jun Rheumatoid arthritis (RA) is characterized by a chronic inflammation of the joints, which leads to the destruction of articular cartilage and bone. The degree of joint damage assessed by radiographic imaging represents a key outcome in RA. There are several methods for scoring the joint damage associated with RA. The most widely used are the Sharp and Larsen systems, as well as more recent modifications of each method. Radiographic imaging has several advantages compared with other outcome measures in RA, specifically: X-rays reflect the history of joint pathology, provide a permanent record for serial evaluation, and can be randomized and blinded for objective scoring. Several modifications of these methods have been proposed and employed in the investigation of disease progression. A review of the radiographic progression of RA is presented, as well as a simplified scoring system useful for the evaluation of joint damage in RA in a clinical setting.
9102710 [Functional reserve of the exocrine pancreas in Sjögren's syndrome]. 1997 Jan Exocrine pancreatic function was studied in a homogeneous group of 33 female patients aged 42-67 years. Of these patients, 11 were classified as rheumatoid arthritis (RA), 11 as Sjögren's syndrome I (SSI) and 11 as Sjögren's syndrome associated with RA (SSII). Clinical features, laboratory tests and special instrumental techniques excluded gastroenteric-hepatobiliary causes of pancreatic diseases. These patients were subjected to direct pancreatic stimulation with secretin and caerulein (S. Cae test). Test results, compared to control-group (10 voluntary healthy females) showed, in the last 30 m of stimulation, a statistically significant decrease (p < 0.05) in duodenal juice volume, bicarbonates and trypsin in 6 cases (54.5%) of SSI and in 3 cases (27.2%) of RA. SSII S. Cae test showed a decrease of volume and bicarbonates in 6 patients (54.5%) and in only 4 of these (36.4%) it was associated with a concomitant decrease in trypsin levels. Authors discuss the subclinical exocrine pancreatic function in relationship to sicca-syndrome, possible immunological factors and primary disease of pancreatic ducts.
11358418 Bone changes in early rheumatoid arthritis. 2001 Mar Bone disease in rheumatoid arthritis affects the peri-articular and axial skeleton and is a major cause of disability. Recent studies have shown that pro-inflammatory cytokines stimulate the expression of osteoprotegerin ligand, a transmembrane protein of the tumour necrosis factor ligand superfamily, on synoviocytes and activated T cells. Osteoprotegerin ligand stimulates osteoclast formation and activation, membrane-bound and soluble osteoprotegerin ligand leading to osteoporosis as well as erosions. Bone densitometry using dual energy X-ray absorptiometry is an objective and precise method for monitoring this bone disease. Bone loss is more rapid in patients with early rheumatoid arthritis and correlates well with measures of inflammation and function. Data are emerging that monitoring bone loss of the hands in early rheumatoid arthritis could be an outcome measure and a prognostic indicator of future functional disability. Suppressing inflammation effectively and the use of bone active agents can reduce the rate of loss. In animal models, osteoprotegerin-a decoy receptor of osteoprotegerin ligand-blocks osteoporosis and erosions without affecting inflammation. The use of new biological agents could in future effectively prevent and treat rheumatoid bone disease.
10685828 Radiographic assessment of disease progression in rheumatoid arthritis patients treated wi 2000 Feb Radiographic studies of methotrexate (MTX) treated and minocycline treated patients with rheumatoid arthritis (RA) are reviewed. A formal metaanalysis of publications of RA treated with MTX was undertaken at the time when MTX was used for patients with established RA. Thus the conclusions of that metaanalysis may not be applicable to patients treated with MTX earlier in the course of their disease. On the other hand, there are no sufficient data to conduct a formal metaanalysis of patients with RA treated with minocycline.