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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
9253092 Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. 1997 Jul 15 STUDY DESIGN: This study analyzed the influence of atlantoaxial fusion in rheumatoid arthritis patients on inflammatory retrodental pannus. OBJECTIVES: To determine the value of fusion on the magnitude of pannus as a compressive structure on the spinal cord. SUMMARY OF BACKGROUND DATA: Transverse and vertical instability may lead to neurologic deficits from spinal cord compression. Increased size of the retrodental pannus can exacerbate the neurologic deterioration. Anterior removal of dens and pannus followed by posterior fusion has been proposed in such situations as a method to relieve spinal cord compression. METHODS: Twenty-two patients with atlantoaxial instability and verified pannus on magnetic resonance imaging underwent posterior fusion of the upper cervical spine. These patients were followed 12 to 75 months after surgery by clinical, radiologic, and magnetic resonance imaging evaluations. The size of the pannus was compared before and after surgery. RESULTS: In all patients, the retrodental pannus had significantly decreased or disappeared postoperatively. CONCLUSIONS: Pannus reduction occurred even in patients whose disease was active or progressing, supporting the hypothesis that the pannus is more a reactive fibrous tissue resulting from instability rather than a direct consequence of the inflammatory process itself.
9111403 Comparison of the results of bilateral total knee arthroplasty with and without patellar r 1997 Apr Simultaneous bilateral total knee arthroplasty was performed in twenty-six patients who had rheumatoid arthritis, and a patellar replacement was performed concurrently in one randomly selected knee in each patient. A lateral retinacular release was performed in all knees. The patients were followed for at least six years (mean, 6.6 years; range, 6.0 to 7.5 years), and the postoperative status of the patients was evaluated with the knee score of The Hospital for Special Surgery. Pain on standing and on ascending or descending stairs as well as tenderness of the patellofemoral joint also were assessed. The over-all score and the individual scores for pain, function, range of motion, muscle strength, flexion contracture, and instability were not significantly different between the knees that had had a patellar replacement and those that had not. However, pain on standing and on ascending or descending stairs as well as tenderness of the patellofemoral joint were only noted in knees that had not had a patellar replacement. These findings suggest that, in order to diminish pain on standing and on using stairs, replacement of the patella during total knee arthroplasty is preferable for patients who have rheumatoid arthritis.
9532653 [Hypothalamo-pituitary-thyroid system in patients with rheumatoid arthritis]. 1998 AIM: Study of the function of the hypothalamus-pituitary-thyroid system in rheumatoid arthritis (RA) MATERIALS AND METHODS: Three hundred and fifty patients with RA of different forms, stages, and intensity were examined. The blood and synovial fluid (SF) levels of thyroid-stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3) were measured by immunoradiometric assay. RESULTS: Patients with RA were found to have higher T4 levels (in articular rheumatism, there was its negative correlation with the intensity of the process and in the presence of systemic manifestations of RA, there was a positive correlation). Blood T5 levels with higher RA intensity tended to increase in patients untreated with glucocorticosteroids. Blood TST concentrations showed an upward tendency which correlated with the intensity and stage of RA. Changes were also revealed in SF TST, T4, T3 levels. CONCLUSION: The changes in the secretion of TSH, T4, T3 in patients with RA are caused by this pathological process and those in their SF levels affect the course of articular inflammation.
9621781 [Nutritional status of Danish patients with rheumatoid arthritis and effects of a diet adj 1998 May 18 This study deals with the nutritional status of Danish rheumatoid arthritis (RA) patients and addresses the question whether or not RA can be directly influenced by dietary manipulation. In a prospective, single-blinded study of six months' duration, 109 patients with active RA were randomly assigned to treatment with or without a specialized diet. The energy consumption was adjusted to normal standards for body-weight and the intake of fish and antioxidants was increased. A daily food diary was completed by the patients, and the total intake of 47 different food-elements was calculated. Nutritional status together with disease activity parameters were recorded. At baseline, the Danish RA-patients had neglected food habits with a significant reduction in intake of total energy, of D-vitamin and of E-vitamin. A very low intake of n-3 fatty acids was also found. During the study, 28 of the 109 patients dropped out, introducing a confounding effect on the overall result. In the remaining 81, those following the diet demonstrated a significant improvement in the duration of morning stiffness, the number of swollen joints, the pain status and reduced the cost of medicine, while doctors' global assessment, laboratory data, X-ray and the daily activities were unaltered. In conclusion, dietary analysis and appropriate, corrective advice should be offered to Danish RA patients.
10924587 Early-stage rheumatoid arthritis: prospective study of the effectiveness of MR imaging for 2000 Aug PURPOSE: To assess the effectiveness of magnetic resonance (MR) imaging for the diagnosis of early-stage rheumatoid arthritis (RA). MATERIALS AND METHODS: Fifty subjects (nine men and 41 women) with polyarthralgia who were suspected of having early-stage RA on the basis of clinical and radiographic findings were selected to undergo gadolinium-enhanced MR imaging of the hands. The MR imaging criterion for the diagnosis of early RA was bilateral enhancement in both wrists and/or the metacarpophalangeal and/or proximal interphalangeal joints. Follow-up continued until a final diagnosis was determined. Two patients left the study before the end of follow-up. RESULTS: Final diagnoses were established after a mean follow-up of 776 days: rheumatoid arthritis in 26 patients and nonrheumatoid disease in 22. Use of the MR imaging criterion yielded the correct diagnosis in 25 patients with RA and three false-positive results in three patients without RA. As compared with the traditional format and classification tree criteria of the American Rheumatism Association, the MR imaging criterion allowed detection of seven and six additional patients with true RA, respectively. CONCLUSION: The introduction of MR imaging into the diagnostic criteria for early RA may contribute to more accurate diagnosis in patients suspected of having RA and thus allow an earlier decision to start proper medication.
11087700 Responsiveness of the core set, response criteria, and utilities in early rheumatoid arthr 2000 Dec OBJECTIVE: Validation of responsiveness and discriminative power of the World Health Organisation/International League of Associations for Rheumatology (WHO/ILAR) core set, the American College of Rheumatology (ACR), and European League for Rheumatology (EULAR) criteria for improvement/response, and other single and combined measures (indices) in a trial in patients with early rheumatoid arthritis (RA). METHODS: Ranking of measures by response (standardised response means and effect sizes) and between-group discrimination (unpaired t test and chi(2) values) at two time points in the COBRA study. This study included 155 patients with early RA randomly allocated to two treatment groups with distinct levels of expected response: combined treatment, high response; sulfasalazine treatment, moderate response. RESULTS: At week 16, standardised response means of core set measures ranged between 0.8 and 3.5 for combined treatment and between 0.4 and 1.2 for sulfasalazine treatment (95% confidence interval +/-0.25). Performance of patient oriented measures (for example, pain, global assessment) was best when the questions were focused on the disease. The most responsive single measure was the patient's assessment of change in disease activity, at 3.5. Patient utility, a generic health status measure, was moderately (rating scale) to poorly (standard gamble) responsive. Response means of most indices (combined measures) exceeded 2.0, the simple count of core set measures improved by 20% was most responsive at 4.1. Discrimination performance yielded similar but not identical results: best discrimination between treatment groups was achieved by the EULAR response and ACR improvement criteria (at 20% and other percentage levels), the pooled index, and the disease activity score (DAS), but also by the Health Assessment Questionnaire (HAQ) and grip strength. CONCLUSIONS: Responsiveness and discrimination between levels of response are not identical concepts, and need separate study. The WHO/ILAR core set comprises responsive measures that discriminate well between different levels of response in early RA. However, the performance of patient oriented measures is highly dependent on their format. The excellent performance of indices such as the ACR improvement and EULAR response criteria confirms that they are the preferred primary end point in RA clinical trials.
11780560 gamma delta-Lymphocytes in the peripheral blood of patients with rheumatoid arthritis--cor 2001 Rheumatoid arthritis (RA) is a chronic, autoimmune disease in the pathogenesis of which T-lymphocytes are believed to play a crucial role. The aim of this work was to investigate a subpopulation of gamma delta-lymphocytes in the peripheral blood of patients with RA in the context of chosen parameters of the disease. Moreover, we studied the influence of disease modifying antirheumatic drugs (DMARDs) on the number of gamma delta-lymphocytes in the peripheral blood of patients with RA. The gamma delta-lymphocytes were studied using monoclonal anti-delta 1 antibodies labelled with fluorescein (Becton Dickinson) then counted under a fluorescence microscope (Olympus). We found a significant increase in the number of gamma delta-lymphocytes in the peripheral blood of patients with RA as compared with normal controls. The highest numbers were observed in patients with RA and extraarticular manifestation of the disease. Treatment with DMARDs led to a gradual normalisation of the elevated values of gamma delta-lymphocytes.
9479312 Corticosteroids in rheumatic disease. Understanding their effects is key to their use. 1998 Feb Corticosteroids can have tremendous therapeutic benefits but can also cause severe side effects and toxicities. Judicious use of these agents plays an important role in many rheumatic diseases. Careful selection of the initial dose, aggressive attempts to taper doses, prescription of supplemental calcium and vitamin D, and consideration of steroid-sparing agents in patients who remain dependent on corticosteroids for disease control are the foundation of proper use. The roles of corticosteroids in treatment of rheumatoid arthritis are complex and remain, to some extent, controversial.
9061552 The palmaris longus tendon. Another variation in its anatomy. 1997 Feb The palmaris longus is one of the most variable muscles of the human body. An understanding of its variations is useful as it is often used as a tendon graft and for tendon transfer. We report another interesting variation in its anatomy.
11303311 [Bone tissue metabolism in patients with rheumatoid arthritis treated with glucocorticoste 2000 Aug The present study has been undertaken to evaluate bone turn-over in rheumatoid arthritis (RA) patients as well as the influence of low dose glucocorticosteroids (gcs) on bone mass loss. Ninety patients with establish RA has been investigated. The patients have been divided into two groups: 44 patients treated with gcs (age 52.5 +/- 12.4 years, disease duration 122 +/- 102 months, total dose of GCS, equivalent to prednisone -7.4 +/- 8.3 g) and 46 patients who were not treated with gcs (age 54.3 +/- 9.7 years, disease duration 134 +/- 120 month). Fifty patients have been assessed twice (after 12 month). Bone mineral content and bone mineral density have been determined in all patients in distal forearm. Additionally, some biochemical markers of osteoporosis: osteocalcin, alkaline phosphatase-bone formation, carboxyterminal telopeptides of type I collagen (CTx), procollagen type I carboxyterminal propeptide (PICP), deoxypyridynoline and some proinflammatory cytokine: IL-1 alpha, IL-6, TNF-alpha, GM-CSF has been determined. No difference in bone metabolism between RA patients receiving gcs treatment and those treated without gcs was shown. It is concluded that anti-inflammatory effect of gcs may balance the direct effect of gcs on bone mineral content in RA patients, particularly those with short term treatment.
9873839 Urinary N-acetyl-beta-D-glucosaminidase in rheumatoid arthritis. 1998 Sep 30 Excretion of urinary N-acetyl beta-D-glucosaminidase (NAG) and its isoenzyme patterns were studied in two groups of patients with rheumatoid arthritis (RA) and in normal control subjects. Urine samples were collected from 30 seropositive RA patients, 19 seronegative RA patients, and 15 normal healthy subjects. All the patients and normal subjects were assessed to have normal liver and kidney functions. A small portion of the urine sample was dialyzed against 0.01 M phosphate buffer, pH 7.0 and NAG activity was monitored. Mean +/- SD values of urinary NAG in seropositive RA patients, in seronegative RA patients and in normal healthy subjects were found to be 4.20 +/- 3.73 U/g creatinine, 2.96 +/- 2.11 U/gm creatinine, and 1.71 +/- 0.6 U/g creatinine, respectively. The mean urinary, NAG value in RA patients was found to be significantly higher (P < 0.05) in seropositive RA compared to the mean NAG value in normal healthy subjects and patients with seronegative RA when analyzed by one way ANOVA and Tukey-HSD test. The mean proportion of isoenzyme form B to isoenzyme form A in seropositive RA patients was also found to be significantly different (P < 0.05) from the mean proportion of these forms in normal healthy subjects and seronegative RA patients. There also appears to be a correlation between the concentration of urinary NAG and severity of the disease in seropositive RA.
10587561 Soluble CD30 in early rheumatoid arthritis as a predictor of good response to second-line 1999 Dec OBJECTIVE: To evaluate whether serum levels of the soluble form of CD30 (sCD30) correlate with disease activity in early rheumatoid arthritis (RA) and may have prognostic value in predicting the response to disease-modifying anti-rheumatic drugs (DMARDs). METHODS: The levels of sCD30 and C-reactive protein (CRP) were measured in the serum of 14 untreated subjects with early RA, before and during treatment with hydroxychloroquine, for a follow-up period of 8 months. At the end of the study, patients were also evaluated for their response to DMARDs. RESULTS: An inverse correlation between sCD30 and CRP serum values was demonstrated at baseline, but not during the follow-up. Patients who responded to DMARD therapy had higher sCD30 basal levels than non-responders. CONCLUSIONS: The evaluation of sCD30 serum levels in early RA may reflect the attempt by CD30+ T cells to downmodulate inflammation and may be a useful marker to predict a good response to DMARDs.
11196513 Seronegative rheumatoid arthritis in elderly and polymyalgia rheumatica have similar patte 2001 Jan OBJECTIVE: To examine whether polymyalgia rheumatica (PMR) and late onset rheumatoid arthritis have identical or similar HLA-DRB1 genetic associations. METHODS: Seventy five PMR cases without evidence of giant cell arteritis were available for study. One hundred seven RA cases were investigated, of which 62 had disease onset after age 60 years. All cases were compared with 145 ethnically matched controls. All cases and controls originated from Lugo, NW Spain. HLA-DRB1 typing was performed on DNA samples using PCR based molecular methods. RESULTS: Early onset RA (< or =40 yrs) was strongly associated with DRB1*04 (DRB1*0401 and *0404). In contrast late onset RA (> or = 60 yrs) was not associated with DRB1*04 but was associated with DRB1*01. Stratification of late onset RA cases by rheumatoid factor status revealed that DRB1*01 was only increased in seropositive RA cases. Late onset seronegative RA cases exhibited increased frequency of DRB1*13/*14; this was also observed in PMR cases where coexistence of GCA had been excluded. CONCLUSION: These data indicate that (1) HLA associations with RA differ with respect to age at disease onset; and (2) seronegative late onset RA and "isolated" PMR have a similar HLA-DRB1 association and may have an identical etiological basis.
11508423 Prognostic factors for radiographic damage in early rheumatoid arthritis: a multiparameter 2001 Aug OBJECTIVE: To determine prognostic factors of radiologic damage and radiologic progression in early rheumatoid arthritis (RA). METHODS: A cohort of 191 patients with RA whose disease duration was shorter than 1 year were prospectively followed up for 3 years. Radiologic scores (as determined by Sharp's method, modified by van der Heijde) and radiologic progression were used as outcome measures. Numerous baseline clinical, laboratory, genetic, and radiographic data were obtained. RESULTS: The change in the total radiologic score for the patients followed up over 3 years was a mean +/- SD increase of 6.1 +/- 6.2. Radiologic progression was observed in 71 of the 172 patients for whom there were data at the end of the study. By univariate analysis with Fisher's exact test, radiologic scores and progression at followup were closely correlated with the baseline values of the erythrocyte sedimentation rate (ESR), C-reactive protein level, IgM and IgA rheumatoid factor positivity, antiperinuclear antibody positivity, radiologic scores, duration of morning stiffness, and RA-associated HLA-DRB1*04 genes. No correlation was demonstrated with sex, age, Disease Activity Score, swollen or tender joint counts, extraarticular manifestations, Health Assessment Questionnaire score, Ritchie Articular Index, patient's assessment of pain, positivity for anti-heat-shock protein 90-kd antibodies, anticalpastatin antibodies, anti-RA33 antibodies, antinuclear antibodies, YKL-40, or antikeratin antibodies, and HLA-DRB1*01 genes. The logistic regression analysis revealed that the only baseline values that were predictive of the 3-year radiologic scores were IgM rheumatoid factor positivity, DRB1*04 genes, pain score, and total radiologic score. Progression of joint damage was predicted by the ESR, IgM rheumatoid factor positivity, DRB1*04 genes, and erosions score at baseline. CONCLUSION: Prognostic factors for radiographic damage in early RA were identified. A combination of these baseline values allowed us to draw up a predictive arithmetic score that could be used to predict radiologic damage at 3 years and radiologic progression in individual patients.
11518039 Increased level of YKL-40 in sera from patients with early rheumatoid arthritis: a new mar 2001 Jul YKL-40 is a newly discovered major secretory protein of human chondrocytes and synoviocytes. We measured serum levels of YKL-40 in 52 patients with early onset rheumatoid arthritis (RA) by enzyme-linked immunosorbent assay (ELISA) during a 2-year prospective follow-up, correlating values with laboratory and clinical variables and radiographic progression. Levels at baseline before antirheumatic therapy were significantly higher in patients than in healthy controls. The levels of YKL-40 correlated with laboratory and clinical markers of disease activity both at baseline and during follow-up. Baseline YKL-40 values correlated with baseline Larsen scores but did not predict radiographic progression. Baseline and mean YKL-40 values did not differ between fast and slow radiological progressions. Mean YKL-40 levels correlated with the number of swollen joints but were not predictors of radiographic progression. These results suggest that in early RA, serum YKL-40 is an inflammatory marker correlating with disease activity. However, its levels do not predict clinical course or radiographic progression.
10907352 [Incidence of osteoporosis in patients with rheumatoid arthritis]. 2000 Juxta-articular osteoporosis in rheumatoid arthritis (RA) is an early and specific pathology in this disease, however in RA patients there are also factors predisposing for the development of the generalised bone atrophy. 103 female patients with the diagnosis of RA established according to ACR criteria were included in the study. Its aim was to evaluate the generalised osteoporosis incidence in women suffering from RA as well as to find out how osteoporosis was related to certain clinical symptoms and laboratory findings, the disease process activity, and the treatment used. The mean age of the patients was 57.6 +/- 12 years, and the disease duration was 11.4 +/- 9 years. The bone mineral density (BMD) was measured by DEXA method with a LUNAR device and included: the radial bone in its 1/3 of the shaft's distal part; L1-L4 vertebral region; and the proximal part of the femoral bone. The division into subgroups was done basing on the 1994 WHO criteria. In RA female patients generalised osteoporosis was observed more frequently than in the control group. The study discovered a negative, statistically significant, correlation between BMD values and: the disease duration, the time of joint involvement acc. to Steinbrocker, the degree of functional impairment, the presence of extra-articular lesions, periods of immobilisation. There was also a dependence found upon the presence of positive Waaler-Rose reaction, and upon the therapy with Methotrexate and D-penicillamine, and when the patients were treated with glicocorticosteroids--upon the cumulative dose.
9278910 Natural history of upper cervical lesions in rheumatoid arthritis. 1997 Aug The natural history of the upper cervical lesions in rheumatoid arthritis (RA) was investigated, based on a follow-up study of 79 patients. At the beginning of this study, anterior atlantoaxial subluxation (AAS) was found in 35 patients, AAS combined with vertical subluxation (VS) in 34, and VS alone in 10. During the follow-up period (mean, 6.4 years), these lesions deteriorated in 30 of the 79 patients. To evaluate the occipitoatlantoaxial relation, the angles between occiput and atlas (C0/C1 angle) and between atlas and axis (C1/C2 angle) were measured, and the correlation between these angles and deterioration of the lesions was investigated. The severity of RA was classified according to the "disease subset" advocated by one of us (T.O.): the least erosive subset (LES), the more erosive subset (MES), and the mutilating subset (MUD). There was a significant positive correlation between the C1/C2 angle and atlantodental interval (ADI) and a significant negative correlation between the C0/C1 angle and the ADI. This indicates that the atlas not only shifts forward but also slips down and forward at an incline from the axis. With an increase of the atlantal inclination, the anterior arch of atlas displaces in an anteroinferior direction, and VS combines with AAS. The development of associated VS lessens the amount of the ADI. At the advanced stage of the natural course, AAS is concealed, and VS alone is demonstrated. We concluded that the upper cervical lesion deteriorated in the order of AAS, AAS + VS, and VS alone. In patients classified as the LES subset, only AAS was found, and VS was never combined with AAS at the terminal stage. In patients in the MES, VS frequently combined with AAS. All patients who deteriorated to VS alone were ranked as MUD.
10652644 Evaluation of established rheumatoid arthritis. 1999 Dec There are two major aspects to evaluate in patients with established RA, namely (i) the state or progress of the disease, and (ii) the effects of specific interventions. The evaluation should include reliable, valid and sensitive measures of disease activity, tissue damage and health status. It is important to recognise that measures of disease activity can be influenced by tissue damage as well. Also, in established RA, health status is likely to be influenced by both disease activity and tissue damage. Whether current rules concerning improvement or remission, which were developed in the context of early RA, can be applied to established disease has to be investigated. While use of radiographs is the current standard method of assessing damage in established RA, range-of-motion measures and muscle strength indices may be a more practical and an equally valid alternative. When selecting health status instruments one should carefully explore and pretest possible health status measures for specific clinical or study settings.
9446010 [Inflammation and bone metabolism in rheumatoid arthritis. Pathogenetic viewpoints and the 1997 Oct 15 BACKGROUND: Systemic osteoporosis is a common and pathogenetically heterogenous complication in rheumatoid arthritis. Various factors such as disease activity, dosage and duration of glucocorticoid treatment and immobilization are involved in pathogenesis of osteoporosis in rheumatoid arthritis. INFLAMMATION AND BONE METABOLISM: Proinflammatory cytokines secreted by immunocompetent cells have a role in the regulation of the activity of osteoblasts and osteoclasts. The effects of these proinflammatory cytokines include the inhibition of bone formation and an increase in bone resorption. Interleukin-6 and nitric oxide induced in osteoblasts by proinflammatory cytokines are likely to be important mediators between these cytokines and the function of osteoblasts and osteoclasts. Furthermore, disease activity dependent changes in the secretion of glucocorticoids and in vitamin D metabolism may be involved in the pathogenesis of osteoporosis in this disease. Alteration of bone remodeling associated with immobilization is an important factor of systemic bone loss in rheumatoid arthritis. CONCLUSION: The inflammatory process in rheumatoid arthritis may cause penarticular and systemic bone loss by various cytokine and hormone mediated mechanisms. Concluding from these pathogenetic mechanisms, bisphosphonates and active vitamin D metabolites are likely to be effective therapeutic options in osteoporosis associated with rheumatoid arthritis.
10852259 The accuracy of self-report of physician diagnosed rheumatoid arthritis in moderately to s 2000 Jun OBJECTIVE: To determine the accuracy of self-report of physician diagnosed rheumatoid arthritis (RA) in moderately to severely disabled older women. METHODS: A total of 1002 participants in the Women's Health and Aging Study were included. These women were > or =65 years old, had an average of 4 chronic illnesses, and represented the one-third most disabled women living in the community. Self-report of a physician's diagnosis of RA was compared to cases of "definite" RA that were adjudicated using an algorithm modeled on the American College of Rheumatology criteria for RA. RESULTS: The sensitivity of self-report of physician diagnosed RA was 77%, with 90.6% specificity and 99% negative predictive value, kappa = 0.46. The positive predictive value was 34% and likely reflected the low prevalence of RA in this sample (3.1%). Five of the 6 women who did not correctly report RA were under the care of a rheumatologist. CONCLUSION: The accuracy of self-report of a physician's diagnosis of RA in this sample of disabled women with multiple chronic illnesses matched that observed in the general adult population of previous studies. Accuracy was enhanced by including report of receiving care by a rheumatologist.