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ID PMID Title PublicationDate abstract
10090191 Methodological issues in radiographic scoring methods in rheumatoid arthritis. 1999 Mar Radiographs are important endpoints in clinical trials in rheumatoid arthritis (RA). Several scoring methods exist. However, many methodological issues are unsolved and require more attention. The following issues will be addressed: the abnormalities that should be scored; joints that should be included in a scoring method; whether both right and left hands and feet should be scored; views that should be used; the order in which radiographs should be scored; how data should be evaluated; how intra/interobserver variation and sensitivity to change should be assessed; the optimum number of readers to assess radiographs; the score to be used if there are multiple readers; quality assurance, international training, a validation set of radiographs, and automated scoring of radiographs.
9457570 Arthroscopic synovectomy of the rheumatoid wrist. A 3.8 year follow-up. 1997 Dec Twenty-four wrists in 19 patients with rheumatoid arthritis affecting the wrist were treated by arthroscopic synovectomy. Range of motion, subjective pain, wrist function and X-ray changes were recorded preoperatively and at an average of 3.8 years after operation. Arthroscopic synovectomy of the rheumatoid wrist reduced pain and improved wrist function in the majority of patients. Progress of arthritic degeneration was significantly less common in patients with no, or very early changes at the time of surgery.
10788543 Feasibility and validity of the RADAI, a self-administered rheumatoid arthritis disease ac 2000 Mar OBJECTIVE: The goal of the Rheumatoid Arthritis Disease Activity Index (RADAI) is to provide an easy to use assessment of disease activity. It is a self-administered questionnaire that combines five items into a single index: current and past global disease activity, pain, morning stiffness and a joint count. METHODS: A sample of 484 rheumatoid arthritis (RA) patients was used to assess the internal consistency and the convergent validity of the RADAI. This was achieved by calculating Cronbach's alpha and RADAI item and total score correlations with core set measures and DAS28. RESULTS: Cronbach's alpha was 0.87, supporting the summation of the items into a single index. The index correlated best with physicians' global assessment (r = 0.59; P < 0.0001), the Health Assessment Questionnaire (r = 0.55; P < 0.0001) and the number of tender joints (r = 0.55; P < 0.0001). Correlation with the erythrocyte sedimentation rate was low (r = 0.27; P < 0.0001). The RADAI and the DAS28 were correlated (r = 0.53; P < 0.0001), but there was low agreement. CONCLUSIONS: The RADAI is valid to assess disease activity in RA patients. However, the RADAI may not automatically replace other measures of disease activity, such as the DAS28.
10090194 How to read radiographs according to the Sharp/van der Heijde method. 1999 Mar This article is a short overview of the development of the Sharp/van der Heijde method for scoring radiographs of hands and feet in rheumatoid arthritis, in addition to a detailed description on how to use the scoring method.
9572641 IL-10 gene promoter polymorphisms in rheumatoid arthritis. 1998 IL-10 is an anti-inflammatory cytokine which may modulate disease expression in RA. Three dimorphic polymorphisms within the IL-10 gene promoter have recently been identified and appear to influence regulation of its expression. The 1082*A allele has been associated with low and the 1082*G allele with high in vitro IL-10 production. We have analysed 117 unrelated Caucasoid RA patients and 119 ethnically matched controls. No significant differences in the allele frequencies of the three polymorphisms were found between controls and RA patients. In contrast, a significant association between the 1082*A allele and the (-1082*A/-819*C/-592*C) haplotype and IgA RF+ve/IgG RF-ve patients was observed. The association of genotypes encoding low IL-10 production with IgA RF in RA is incompatible with its suggested role in antibody isotype switching. IgA RF has been associated with severe RA and may thus be indirectly correlated with a genotype encoding low IL-10 production.
10451065 Lipid profiles in untreated patients with rheumatoid arthritis. 1999 Aug OBJECTIVE: To investigate lipid profiles in patients with untreated active rheumatoid arthritis (RA) and to assess the relationship of the inflammatory condition of RA with lipid profiles. METHODS: Forty-two patients with RA and 42 age and sex matched healthy controls were studied. Patients with RA had not been treated with corticosteroid or disease modifying antirheumatic drugs prior to the study. Total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, apolipoprotein A1 (apo A1), apolipoprotein B (apo B), lipoprotein(a) [Lp(a)], and C-reactive protein (CRP) were measured in both groups. RESULTS: The levels of apo A1 and HDL-cholesterol were significantly lower in patients than in controls (128.5 vs. 151.8 mg/dl, 41.2 vs. 54.9 mg/dl, respectively). The level of Lp(a) was significantly higher in patients than in controls (27.1 vs. 18.0 mg/dl). The ratios of apo B/apo A1, total cholesterol/HDL-cholesterol, and LDL-cholesterol/HDL-cholesterol were significantly higher in patients than in controls (0.82 vs. 0.67, 4.4 vs. 3.4, 2.8 vs. 1.9, respectively). CRP showed a significant correlation with apo A1 (r = -0.44, p<0.01) and HDL-cholesterol (r = -0.35, p<0.05). CONCLUSION: Our study suggests that patients with untreated active RA have altered lipoprotein and apolipoprotein patterns that may possibly expose them to higher risk of atherosclerosis. The inflammatory condition of RA may affect the metabolism of HDL-cholesterol and apo A1.
10556819 A recurrent valpha17/vbeta10 TCR-expressing T cell clone is involved in the pathogenicity 1999 Nov Collagen-induced arthritis (CIA) is an experimental model that mimics clinical and histological features of rheumatoid arthritis. In this disease, a crucial role in initiating the pathological changes has been assigned to T lymphocytes expressing the Th1 phenotype. Aiming at identifying type II collagen (CII)-specific T cells involved in CIA, T cell clones were generated in vitro from the lymph nodes (LN) of CII-immunized DBA / 1 mice. In three independent experiments, we repeatedly isolated CD4(+) Th1 clones recognizing the immunodominant epitope in the CB11 fragment of bovine CII and expressing a unique alpha betaTCR produced by the rearrangement of Valpha17/Jalpha20 and Vbeta10/Dbeta1.1/Jbeta2.5 gene segments. By reverse transcriptase-PCR, we demonstrated the presence of mRNA transcripts specific for the beta complementary-determining region 3 of this clonotype in the LN of the majority (73%) of mice with CIA whereas it was never detected in control animals. When transferred to CII-immunized DBA/1 mice, this recurrent Th1 clone augmented the incidence, aggravated significantly the clinical signs of CIA and greatly enhanced the anti-CII antibody response. Altogether, these results provide evidence that a CD4(+) Th1 clone belonging to the public arm of the response toward the immunodominant epitope of CII is involved in the cascade of events leading to CIA.
11374260 Primary total hip arthroplasty in patients with rheumatoid arthritis. 2001 Twenty-eight (11 cemented and 17 noncemented) total hip arthroplasties (THA) were performed in 20 patients with rheumatoid arthritis (RA). The average age at operation was 42.1 years and the average follow-up was 10.8 years. There were two deep infections requiring removal of the prosthesis. Three cemented acetabular cups and one cemented femoral component were revised due to aseptic loosening. One cemented cup was loosened radiologically. One PCA polyethylene liner was revised because of significant wear. Both cemented and noncemented femoral components are capable of providing respectable results in RA patients. The relatively inferior results of THA among RA patients is due not only to the fixation method, but also to the poorer bone quality.
9193731 Middle ear mechanics in subjects with rheumatoid arthritis. 1997 May The incudo-malleolar and incudo-stapedial joints are true diarthroses and therefore may be subject to the same rheumatic lesions as any other articulation in the body. The existence of this involvement in rheumatoid arthritis (RA), however, is highly controversial. The present study investigates modifications of the mechanical properties of the middle ear in a group of subjects with RA by evaluating the resonance frequency obtained with multiple-frequency tympanometry (MFT). Thirty patients with RA, aged 20 to 68 years (mean age: 45.8 +/- 12.4 years), participated in the investigation. Their data were compared with those obtained in a control group of 48 age-matched subjects. Results obtained in both ears were examined in all subjects. The two groups displayed almost equal hearing levels with mean air conduction thresholds ranging from 10 to 22 dB HL. None of the subjects displayed an air-bone gap greater than 5 dB. Normal resonance frequency, calculated at the 95th percentile from the control group, ranged from 900 to 1250 Hz. Twelve rheumatoid arthritis patients (40 per cent) displayed abnormal resonance values. These findings were monolateral in 9 patients and bilateral in 3. Eleven out of 15 ears with abnormal multiple-frequency tympanometry data were characterized by an increase in resonance and 4 by a decrease. A correlation between abnormal resonance values and more aggressive RA was established. The results of this study suggest that rheumatoid arthritis may involve the incudo-malleolar and incudo-stapedial joints, altering the ossicular mechanics in response to static air pressure modifications. This does not impair sound conduction through the middle ear, but might reduce the protective mechanisms of the middle ear towards high static pressures.
11766499 [Diagnostic imaging of inflammatory rheumatic joint diseases. Part I: peripheral joints]. 2001 Dec 3 The options for peripheral joint imaging in inflammatory joint diseases have increased markedly over the last few years. High-frequency ultrasonography and magnetic resonance imaging in particular appear to have a large potential in the diagnosis, monitoring, and prognostication of these diseases. However, the new methods have still to be fully validated. In clinical practice, it is essential to use a validated method, generally conventional radiography, as the first "basic" imaging modality. As newer methods may provide significant additional information, it is also very important that the value of these is evaluated in scientific studies. This article reviews current knowledge of conventional radiography, computer tomography, ultrasonography, and magnetic resonance imaging in the assessment of peripheral joints in inflammatory joint diseases.
11642499 Intensive immunosuppression and autologous stem cell transplantation for patients with sev 2001 Oct Ten patients with active, destructive rheumatoid arthritis refractory to antirheumatic therapy enrolled in a study to evaluate the effects of intensive immunosuppression followed by autologous stem cell transplantation. Intensive immunosuppression was achieved with high dose cyclophosphamide as part of the mobilization (4 g/m2) and conditioning (200 mg/kg) regimen. The autologous stem cell products were enriched for CD34+ cells to minimize the chance of reinfusing autoreactive lymphocytes. Eight patients completed all consecutive treatment steps, one patient withdrew after mobilization because of improvement, one patient was taken off study because of pulmonary embolism. The treatment appeared feasible and safe, and marked sustained clinical improvement was observed in 6 patients, 2 of whom were previously unresponsive to tumor necrosis factor blocking therapy. In 5 patients disease modifying antirheumatic drugs were successfully withdrawn after transplantation. The treatment induced significant lymphopenia, with low levels of naive CD4+ T cells in particular, without clinical sequelae. Titers of rheumatoid factor dropped but did not normalize.
9335631 Measurement of depression in Mexican patients with rheumatoid arthritis: validity of the B 1997 Jun OBJECTIVE: To validate a Spanish version of the Beck Depression Inventory (BDI) in Mexican patients with rheumatoid arthritis (RA). METHODS: Thirty-five patients with RA seen in our outpatient clinic were included. A semistructured psychiatric interview was applied, and the following instruments were administered: the BDI, the Hospital Anxiety and Depression Scale (HAD), and the Health Assessment Questionnaire Disability Index. Diagnostic properties of the BDI for both full-length and smaller versions taking out somatic items were compared against a gold standard. The gold standard for comparison was the diagnosis of depression according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised Criteria. RESULTS: Thirty-seven percent of RA patients had a diagnosis related to depression, most of which were major depression or dysthymia. The original BDI showed a high sensitivity (92%) and a high correlation with the HAD (r = 0.83). Exclusion of somatic items in modified versions of the BDI had a similar performance. CONCLUSIONS: The original BDI is a suitable instrument to detect depression in Mexican RA patients. Nevertheless, shorter versions without some of the somatic items also show an adequate performance.
10953742 Leflunomide: a new DMARD for rheumatoid arthritis. 2000 May Early diagnosis and referral of rheumatoid arthritis may significantly improve patient outcomes. Arava (leflunomide) is the first new disease modifying antirheumatic drug (DMARD) to be introduced in the UK for over a decade. Arava has a rapid onset of action and has been shown to retard radiographic disease progression and significantly improve patients' functional ability.
10538856 Pharmacoeconomics of emerging therapies for rheumatoid arthritis. Based on a presentation 1999 Jun Rheumatoid arthritis is a costly disease. Patients with this condition not only utilize substantial medical resources, but also incur high indirect costs in the form of work disability. These indirect costs are generally much greater than the direct costs. Therefore, a new therapy that is able to control this disease more effectively may be cost effective, even if the direct costs of the therapy itself are high. From a cost-analysis point of view, patients with refractory disease may be good candidates for a new therapy. All costs, direct and indirect, should be considered, and a global, long-term perspective on patient care should be taken. One way to estimate the worth of a therapy based on its ability to improve how patients feel would involve a utility or quality-of-life analysis.
10406343 A positioning device to allow rotation for cine-MRI of the distal radioulnar joint. 1999 Jun 'Cine-mode' magnetic resonance imaging (MRI) is useful in the diagnosis and treatment of patients with disorders of joint motion. We have designed a device for imaging of the distal radioulnar joint by cine-MRI. Five normal wrists and eight patients with rheumatoid arthritis were investigated prior to surgery for subluxation of the distal radioulnar joint. Normally, the radius moves in a constant arc around the ulna, whereas in rheumatoid wrists the centre of rotation varies continuously with increase in rotation. The device should prove helpful in imaging disorders of the distal radioulnar joint.
10331122 Reconstruction of the rheumatoid forefoot. 1999 Apr The authors discuss the forefoot manifestations of RA and their effects on the biomechanics of the foot. Surgical intervention should be performed to alleviate the patient's pain and to restore and maintain stability of the forefoot. Each patient should be considered individually, and the best procedure for him or her should be selected as opposed to one procedure that is applied to all. Furthermore, each patient should be counseled about the progressive nature of his or her disease. Surgery should not be viewed as a cure. Reconstructive surgery can restore function and relieve pain, which is very rewarding for the surgeon and the patient.
11552614 [Effect of combination therapy and nonsteroidal antirheumatic agents on acute phase reacta 1999 The purpose of the study was the evaluation of the effects of the combined therapy and non steroidal anti-inflammatory drugs on the acute phase reactants and clinical symptoms in patients with rheumatoid arthritis. The acute phase reactants that were observed were sedimentation of erythrocytes, C-reactive protein, haptoglobin and fibrinogen, while the clinical parameters that were observed were the number of swollen joints and the number of joints sensitive to the pressure. All the parameters were evaluated before the therapy initiation, there and six months after the therapy was finished. The treatment involved 80 patients with rheumatoid arthritis separated into three groups depending on the therapy applied: Group A (n = 29) received gold salts, sulphasalazine and tenoxicam, Group B (n = 25) received gold salts, sulphasalazine and indometacin, and Group C (n = 26) received gold salts, chloroquine and piroxicam. The results of our examination showed statistically significant descrease in value of acute phase reactants and of clinical indicators after the therapy carried out in each of the patient groups, while the values between the groups were of no statistical significance.
9881411 [Combined tibio-talar and subtalar arthrodesis by retrograde nail in hindfoot rheumatoid a 1998 Nov PURPOSE OF THE STUDY: Many techniques for ankle arthrodesis have been described. Some are not applicable to patients with severe rheumatoid arthritis (RA) because of osteopenia and deformities. This study describes a new surgical technique for arthrodesis in painful valgus deformity of the hind-foot in advanced rheumatoid arthritis (RA) with severe osteopenia. MATERIALS: The present series included 9 patients. Eleven talocrural and talocalcaneal arthrodeses were performed for degenerative changes secondary to RA involving hind-foot joints. All patients were reviewed after an average follow-up of 6 years. Mean duration of RA was 34 years. All patients had severe osteopenia, including major deformations of the hind-foot in 5 cases. METHODS: After removal of talocrural and talocalcaneal articular surfaces using an anterolateral approach, deformities were corrected by removal of an appropriate bone wedge. A Küntscher nail was then positioned in the calcaneal plantar cortical through the plantar surface of the foot and driven proximally into the medullary canal of the tibia through the talus. This nail allowed both deformity correction and fixation. Aftercare required immobilization in a short leg cast. Weight bearing was allowed with the cast approximately 5 weeks after surgery. The ankle was immobilized for 7.5 weeks. DISCUSSION: Results showed a 80 per cent fusion rate. Two non-unions occurred (one recurrence of valgus deformity after early nail migration requiring removal of the nail; and the other asymptomatic). A complication occurred in one foot (delayed healing). At follow-up, all patients but one were satisfied with respect to pain relief and residual deformities. Our results are comparable with those of other series and should be considered in the context of severe RA. CONCLUSION: This technique of vertical retrograde transarticular nailing allows an easy control of hind-foot deformities correction. Other techniques are preferable in case of solid bone. This technique is an acceptable alternative in advanced RA.
9619900 The risk of treatment. A study of rheumatoid arthritis patients' attitudes. 1998 Apr Despite its importance, there is no well-validated method of measuring patients' concept of 'acceptable' risk of medical treatment. Numerical methods give widely varying results depending on the methodology. We have attempted to assess 'acceptable' risk using relative comparisons. We administered a questionnaire to 67 patients with rheumatoid arthritis (RA). In general, patients' estimate of acceptable risk was less than the actual risk of treatment. Some illogical choices were made, showing poor understanding by patients of the concepts of risk and risk:benefit ratio. Patients appeared willing to accept higher levels of risk from procedures than from drug treatment. Willingness to accept risk in exchange for successful treatment of their RA did not correlate with disease severity, age, willingness to take non-medical risks or family responsibilities.
9331033 Arthroscopic synovectomy of the elbow for rheumatoid arthritis. A prospective study. 1997 Sep The short-term assessment of 14 arthroscopic synovectomies of the elbow in 11 patients with rheumatoid arthritis showed that 93% achieved a short-term rating of excellent or good on the Mayo Elbow Performance Score. At the most recent assessment at an average of 42 months, however, only 57% maintained excellent or good results; four had required total elbow replacement. Although rehabilitation is facilitated by an arthroscopic procedure the results deteriorate more rapidly than after open synovectomy. This may be due to the limitations of the arthroscopic technique and is consistent with experience of the similar procedure in the knee. Recognition of the short-term gain and the potential for serious nerve injury should be considered when offering arthroscopic synovectomy.