Browse

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

ID PMID Title PublicationDate abstract
10461475 Extrapyramidal type rigidity in rheumatoid arthritis. 1999 Jul OBJECTIVES: We had noted cogwheel rigidity in a number of patients with rheumatoid arthritis (RA). Based on this finding, we aimed to investigate formally the presence of rigidity and cogwheeling in RA patients. Our secondary aim was to survey the co-existence of RA and Parkinson's disease (PD). METHODS: A total of 87 consecutive patients with a diagnosis of RA, 78 patients with PD and 67 otherwise healthy patients attending a dedicated headache clinic participated in the study. RESULTS: Rigidity was observed in 24% of RA, 60% of PD and 2% of headache patients. The frequency among the RA patients was significantly higher compared to that of patients with headache (chi 2 = 15.2; P = 0.00009). The frequency of PD among the RA patients was 2/87 (2.3%), while the frequency of RA among the PD patients was 6/78 (7.7%). CONCLUSION: Rigidity can be observed in approximately a quarter of patients with RA.
9252806 Plantar pressure distribution after resection of the metatarsal heads in rheumatoid arthri 1997 Jul Surgical correction of the forefoot in rheumatoid arthritis by resection of all metatarsal heads in combination with a resection arthroplasty of the first metatarsophalangeal joint showed excellent and good results in 20 (77%) of 26 cases and satisfactory and fair results in 6 (23%) of 26 cases. Twenty-six feet in 16 patients were operated on by a plantar approach and examined after a mean follow-up period of 50 months (range, 24-90 months). Seventy-three percent of the patients were free of pain. In 75 (58%) of all 130 investigated toes, complete absence of load distribution was noted. In the remaining 55 (42%) toes, we observed a variable extent of function, depending on the length of resection. Although toe function is better in minimal metatarsal resection, single excessive length or plantar spike formation revealed pressure peaks in the metatarsal area. Metatarsal head resection provided reduction of pain and correction of severe deformities, and permitted the patients to wear ordinary shoes in 24 (93%) of 26 cases.
11246682 Minocycline induced autoimmune disease in rheumatoid arthritis: a missed diagnosis? 2001 Feb Minocycline is one of the major drugs for acne and is effective in rheumatoid arthritis (RA). We describe the first case of drug induced lupus secondary to the use of minocycline in a patient with RA. The dificulties of making this diagnosis as well as the implications for its pathogenesis are discussed.
11312375 Self-efficacy and health status in rheumatoid arthritis: a two-year longitudinal observati 2001 Apr OBJECTIVE: To investigate the relationship between baseline level of self-efficacy for pain and other symptoms and changes in measures for similar dimensions of health status over a period of 2 yr in patients with rheumatoid arthritis (RA). METHODS: Data collected from patients with RA enrolled in a county-based disease register in Oslo, Norway were analysed: 815 patients were examined by mail questionnaire in 1994 and again in 1996. Relationships of the baseline level of self-efficacy and demographic variables with 2-yr changes in health status measures were examined by bivariate and multiple regression analysis. The following health status measures were included: pain and fatigue on a visual analogue scale; the patient's global assessment of disease activity; the symptom and affect scales of the Arthritis Impact Measurement Scales (AIMS2); and the bodily pain, mental health, general health and vitality scales of the Short Form-36 (SF-36). RESULTS: For all health status measures, there was a significant correlation between the change over a 2-yr span and baseline self-efficacy, even after adjustment for demographic variables and for the baseline level of the health status measure. Favourable changes were associated with high self-efficacy scores. CONCLUSIONS: In patients with RA, the baseline levels of self-efficacy for pain and other symptoms seem to influence 2-yr changes in health status measures regarding these aspects.
9339261 [Heart valve diseases specific in rheumatoid polyarthritis. Apropos of 2 cases]. 1997 Jul Rheumatoid nodules represent a rare cardiac valvular involvement in rheumatoid arthritis. Patients are usually asymptomatic. We report two cases of such involvement: one presented as a tumour implanted on the mitral valve, with systemic embolisation; the other presented as aortic regurgitation with acute heart failure. Surgical treatment was performed in both cases. Histological examination revealed typical rheumatoid nodules. The authors discuss valvular involvement in rheumatoid arthritis.
9139753 Autoimmune disorders, physical activity, and training, with particular reference to rheuma 1997 Rheumatoid arthritis arises from a reaction of the immune system to normal body components, sometimes triggered by bacterial or viral infection. The synovia of affected joints are infiltrated by CD4+, CD19-, and plasma cells. The synovial fluid shows a sterile inflammation, with high neutrophil counts and increased concentrations of proinflammatory cytokines (particularly IL-1, IL-8, TNF-alpha and JFN-gamma). The plasma shows increased CD4+ counts and a pro-inflammatory shift in T cell populations with high titers of rheumatoid factors. Traditional treatment has included rest of the affected part, which can cause a reduction of physical condition. However, exercise induces changes in circulating immune function (including a decrease of CD4+ count) that would appear helpful in regulating inflammation. Further, there is evidence that patients can tolerate a program of regular moderate aerobic exercise. Moreover, empirical data suggest that such a prescription substantially enhances physical performance, without exacerbating either clinical or immunological markers of the disease process.
10874546 Serum selenium, serum alpha-tocopherol, and the risk of rheumatoid arthritis. 2000 Jul Antioxidant micronutrients have been hypothesized to provide protection against rheumatoid arthritis. We investigated serum selenium and serum alpha-tocopherol for their prediction of subsequent development of rheumatoid arthritis in a case-control study nested within a Finnish cohort of 18,709 adult men and women who had neither arthritis nor a history of it at the baseline examination in 1973-1978; by late 1989, 122 had developed rheumatoid arthritis. Of the incident cases, 34 were rheumatoid factor-negative. Three controls per each incident case were individually matched for sex, age, and municipality. Serum selenium and alpha-tocopherol concentrations were measured from stored serum samples collected at baseline. Serum selenium was inversely related to subsequent occurrence of rheumatoid factor-negative but not rheumatoid factor-positive rheumatoid arthritis. The relative risks, adjusted for smoking and serum total cholesterol, for the highest relative to the lowest tertile of serum selenium, were 0.16 [95% confidence interval (CI) = 0.04-0.69] for rheumatoid factor-negative and 0.96 (CI = 0.49-1.90) for rheumatoid factor-positive rheumatoid arthritis. During the first 10 years of follow-up, the relative risk for rheumatoid arthritis for the highest compared with the lowest tertile of serum alpha-tocopherol was 0.44 (CI = 0.19-0.99). No association was found for longer follow-up periods. Low selenium status may be a risk factor for rheumatoid factor-negative rheumatoid arthritis, and low alpha-tocopherol status may be a risk factor for rheumatoid arthritis independently of rheumatoid factor status.
10871913 Osteolysis of the pelvis presenting as insufficiency fracture in a patient with rheumatoid 2000 Summer Physician awareness of the risk of osteoporosis and subsequent fractures in a patient with a history of long-term steroid treatment is high. The tendency to assume that a fracture is owing to steroid-induced osteoporosis may result in an unnecessarily intense antiresorptive treatment regimen for a patient who may not have osteoporosis. I report here about a patient with rheumatoid arthritis who presented with bone fracture despite antiresorptive therapy and without evidence of osteoporosis by bone mineral density testing.
10524552 Urinary thrombomodulin in patients with rheumatoid arthritis: relationship to disease subs 1999 In 110 patients with rheumatoid arthritis (RA), the mean (+/- SD) urinary thrombomodulin (TM) concentration was 74.4+/-19.5 ng/mg creatinine (Cre), which was significantly higher than the mean in age-matched healthy controls (49.9+/-10.8 ng/mg Cre; p<0.0001). The mean urinary TM concentration in the RA subset with least erosive disease (LES) was 65.2+/-12.4 ng/mg Cre (n = 41), with more erosive disease (MES) was 77.4+/-20.4 ng/mg Cre (n = 58) and with mutilating disease (MUD) was 92.6+/-20.2 ng/mg Cre (n = 11). TM in the MUD group was the highest of the three subsets (ANOVA, p<0.0001). By contrast, the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the MES and MUD groups were not significantly different. Urinary TM levels may allow differentiation of RA subsets, unlike markers of inflammation such as ESR and CRP.
11740796 Cigarette smoking and rheumatoid arthritis. 2001 Dec OBJECTIVES: To examine and explore the potential relationships among the following: the incidence/severity of rheumatoid arthritis (RA), the extra-articular manifestations of RA, vascular disease, certain specific malignancies, the p53 tumor suppressor gene, and cigarette smoking. METHODS: The medical literature was reviewed from 1985 to 2001 with the assistance of a MEDLINE search using the key words vascular disease, smoking, protein p53, RA, rheumatoid vasculitis, cancer, and malignancies. A qualitative review was performed after all articles were abstracted and new information summarized. RESULTS: Cigarette smoking has been increasingly shown in epidemiologic and case-control studies to be an important risk factor for both the incidence and severity of RA, especially in seropositive men. Further, there is evidence of a downward trend in incidence of extra-articular manifestations of RA, especially RA vasculitis, observed with a decrease in worldwide tobacco use and overall improved mortality in RA. The association of cigarette smoking with lung and other cancers and its link to vascular disease (including Buerger's disease) and atherosclerosis appears secure. Mutations or alterations in p53, a suppressor gene that regulates cell growth, have been found in certain cancers, cigarette smokers, and in patients with RA. CONCLUSIONS: Cigarette smoking appears to have an undeniable link to the pathogenesis of vascular disease of many types, including the possibility of a strong causal connection to rheumatoid vasculitis. The observations worldwide of decreasing tobacco use along with secular trends of diminished RA vasculitis and extra-articular manifestations, and with improved survival, points to a better outcome for our patients. The example of p53 may be a first step in the discovery of additional links between environmental triggers and phenotypic expression of chronic illness.
11178128 The development of clinical signs of rheumatoid synovial inflammation is associated with i 2001 Paired synovial tissue samples were obtained from both clinically uninvolved (CU) and clinically involved (CI) knee joints of eight rheumatoid arthritis (RA) patients. In addition, biopsies were taken from five control subjects. We observed the expression of the chemokines CXCL8, CXCL9, CXCL10, CCL2 and CCL4 in CI and CU joints of RA patients. In particular, CXCL8 protein levels were specifically increased in CI joints compared with CU joints, which was confirmed by immunohistochemistry and in situ hybridization.
11757214 [The assessment of the value of ultrasound and magnetic resonance imaging in diagnosing ha 2001 Aug The main imaging investigation used in diagnosing rheumatoid arthritis is radiography of the hands and feet. It allows visualisation of bone erosions--typical of the disease. However, bone erosions occur during the later stages of the rheumatoid arthritis and are preceded by synovitis. The aims of the study were to use ultrasound (US) and magnetic resonance imaging (MRI) in examining joints in patients suffering from chronic arthritis, and also to assess the value of these methods in diagnostics. In 61 patients with chronic arthritis (39 with rheumatoid arthritis--RA, and 22 with another etiology arthritis), plain radiography, US and MRI of the hands was performed. MRI and US were more sensitivity in visualisation of bone erosions than plain radiography. Both methods showed synovitis in all patients with RA. In detecting bone erosions in the hand joints MRI and US are more sensitive methods than plain radiography. Both methods detect synovitis and tenosynovitis. Inflammatory changes shown using the MRI and US are more intensive in RA than in patients suffering from another etiology arthritis.
11285372 A case-control study examining the role of physical trauma in the onset of rheumatoid arth 2001 Mar OBJECTIVE: To investigate whether physical trauma may precipitate the onset of rheumatoid arthritis (RA). METHOD: In a case-control study comparing RA out-patients with controls attending non-rheumatology out-patient clinics, 262 patients and 262 age- and sex-matched controls completed a postal questionnaire or were interviewed about any physical trauma in the 6 months before the onset of their symptoms. RESULTS: Fifty-five (21%) of the RA patients reported significant physical trauma in the 6 months before the onset of their disease, compared with only 17 (6.5%) of the controls (P<0.00001). A preceding history of physical trauma was significantly more common in RA patients who were seronegative for rheumatoid factor (P=0.03), but was not significantly associated with sex (P=0.78), age (P=0.64), a family history of RA (P=0.07) or type of occupation, defined as manual or sedentary (P=0.6). CONCLUSION: Physical trauma in the preceding 6 months is significantly associated with the onset of RA.
10208146 Effects of writing about stressful experiences on symptom reduction in patients with asthm 1999 Apr 14 CONTEXT: Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness. Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports, well-being, and health care use in healthy individuals. OBJECTIVE: To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using standardized quantitative outcome measures. DESIGN: Randomized controlled trial conducted between October 1996 and December 1997. SETTING: Outpatient community residents drawn from private and institutional practice. PATIENTS: Volunteer sample of 112 patients with asthma (n = 61) or rheumatoid arthritis (n = 51) received the intervention; 107 completed the study, 58 in the asthma group and 49 in the rheumatoid arthritis group. INTERVENTION: Patients were assigned to write either about the most stressful event of their lives (n = 71; 39 asthma, 32 rheumatoid arthritis) or about emotionally neutral topics (n = 41; 22 asthma, 19 rheumatoid arthritis) (the control intervention). MAIN OUTCOME MEASURES: Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinically examined by a rheumatologist. Assessments were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition. RESULTS: Of evaluable patients 4 months after treatment, asthma patients in the experimental group showed improvements in lung function (the mean percentage of predicted forced expiratory volume in 1 second [FEV1] improved from 63.9% at baseline to 76.3% at the 4-month follow-up; P<.001), whereas control group patients showed no change. Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity (a mean reduction in disease severity from 1.65 to 1.19 [28%] on a scale of 0 [asymptomatic] to 4 [very severe] at the 4-month follow-up; P=.001), whereas control group patients did not change. Combining all completing patients, 33 (47.1%) of 70 experimental patients had clinically relevant improvement, whereas 9 (24.3%) of 37 control patients had improvement (P=.001). CONCLUSION: Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group. These gains were beyond those attributable to the standard medical care that all participants were receiving. It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases.
10622679 The incidence of cancer associated with the treatment of rheumatoid arthritis. 1999 Dec OBJECTIVES: The treatment of rheumatoid arthritis (RA) targets inflammation either by inhibiting the activation of immune cells or their clonal expansion. We evaluated the available evidence concerning the risk of cancer associated with RA treatment. METHOD: Articles published between 1966 and 1998 reporting the incidence of cancer in RA patients were reviewed. RESULTS: Large follow-up studies suggest the relative risk (RR) of lymphomas associated with RA is about twofold higher than in the general population. A role for azathioprine in the development of lymphomas and a role for cyclophosphamide in cancers, particularly bladder cancer, has been suggested. However, no studies have shown that methotrexate increases the risk of cancer in RA patients. Studies that showed an increased risk of cancer associated with gold or cyclosporine therapy in RA patients are inconclusive as they have used cancer incidence in the general population as the reference. One study measured the RR of cancer in a group of cyclosporine-treated RA patients (1.6 year on average) using RA patients as a control and found no enhanced risk. CONCLUSIONS: Although evidence suggests an increased risk of specific cancers associated with the use of some treatments, this may be outweighed by the potential benefit of therapy, especially in patients with severe disease.
9973158 Clinical course and remission rate in patients with early rheumatoid arthritis: relationsh 1998 Dec OBJECTIVE: To investigate the clinical course in early rheumatoid arthritis (RA) patients followed prospectively, to relate course to outcome after 5 yr, and to try to identify prognostic features. METHODS: A total of 183 patients with definite RA and a mean disease duration of 11 months were included. Of these, 75% were rheumatoid factor (RF) positive; 85% carried the shared epitope, 32% on both alleles. Most patients were assessed every 6 months. Disability was evaluated with the Health Assessment Questionnaire (HAQ) and radiographic findings according to Larsen. Remission was defined in two ways: with the American Rheumatism Association (ARA) criteria and as 'no arthritis at least at one follow-up visit'. RESULTS: Twenty per cent achieved ARA-defined remission periods of at least 6 months duration; 21 were spontaneous and 18 drug induced. Average length of remission was 20.5 months. The remission periods constituted 7% of follow-up for all patients. Another 36% achieved remission according to the second definition. All 56% were considered to have a relapsing-remitting disease pattern, in contrast to the remaining 44% with a persistent disease pattern. More patients with persistent disease were treated with disease-modifying anti-rheumatic drugs (DMARDs) and had also received a larger number of different drugs. Outcome after 5 yr regarding disability, joint inflammation and joint damage was worse for patients with persistent disease. Neither ARA-defined remission nor disease pattern could be accurately predicted. CONCLUSIONS: Long-term ARA-defined remission was rare, constituting 7% of follow-up for the entire cohort. For those 20% achieving remission, this period represented 34% of their follow-up. A total of 56% had a relapsing-remitting disease pattern and 44% had a persistent disease pattern. This classification had prognostic implications with persistency being a bad prognostic sign.
9086696 Stressful life events' effects on rheumatoid arthritis disease activity. 1997 Apr A 53-year-old female rheumatoid arthritis (RA) patient endured 2 unexpected family deaths during a 12-week study investigating the prospective relationships between stressful small life events, negative affect, and disease activity. Her disease went into temporary remission the same week as the deaths. She was identified as a case study participant, and weekly data collection was extended to 1 year. Clinical exams verified a large decrease in disease status immediately after the major losses. In addition to major events, negative affect and small events were found to serve as independent arthritis symptom predictors within this patient. Major events were associated with decreased symptoms. Negative affect and small events related to symptom increases. Subsequent between-subjects analyses conducted on 25 participants from the parent project probed for generalizability. The substantive findings from the case study were supported: Major life events and small life events functioned as opposing predictors of RA disease states.
9564772 [Clinical relapse of rheumatoid arthritis (escape phenomenon) during low-dose methotrexate 1998 Feb OBJECTIVE: To clarify the incidence and background of clinical relapse (escape phenomenon) during low-dose methotrexate therapy for rheumatoid arthritis. METHODS: Seventy one patients with rheumatoid arthritis (RA) were analyzed. They were started on therapy with methotrexate (MTX) between April 1, 1991 and May 30, 1995. Among them, 60 patients showed clinical improvement within 6 months after the start of the therapy and were subjected to the analysis for clinical relapse (escape phenomenon). RESULTS: Twelve patients showed an initial improvement followed by a relapse with increased serum CRP and number of painful joints despite the MTX therapy was continued. Two types of the relapses were seen; (1) early, escape (relapse after an initial brief improvement) in 7 patients, and (2) late escape (relapse after a long-term improvement with MTX therapy) in 5 patients. The early escape was seen at 9.0 +/- 0.7 months after the start of therapy while the late escape was seen at 23.3 +/- 4.8 months. Patients with both types of escape phenomenon had the longer duration of the disease and more advanced stage. There was no relationship between clinical relapse and age, baseline RA activity, MTX dose, or concurrent use of corticosteroids and other disease modifying anti-rheumatic drugs. The efficacy of MTX for RA was restored by increasing dose of MTX in 11 patients. CONCLUSION: These results suggest that clinical relapse is not rare in RA patients during low-dose methotrexate therapy, but could be improved by increasing dose.
10584494 [Endoprosthesis of the knee joint]. 1999 The experience of primary total endoprosthesis of a knee joint for restoration of its motility and stability was presented. Prostheses "Zimmer MG II", "Zimmer I B II", "Richards-Genesis", "Richards-Trigon-C", "Aesculap Mul. II", "Howmedica-kinematics" were implanted in 16 patients with gonarthrosis and rheumatoid arthritis stage III. One to four-year follow-up result after the operation was excellent in 68.75% patients, good--in 25%, fair--in 6.25%.
9385344 Antibody to stratum corneum (antikeratin antibody) and antiperinuclear factor: markers for 1997 The purpose of this study was to examine the relationship between circulating antibodies to stratum corneum (AKA) and antiperinuclear factors (APF) on one hand, and the x-ray progression of joint damage in chronic poly/oligoarthritis on the other hand. The analysis involved 133 patients with either rheumatoid or nonspecific arthritis derived from a cohort of 442 patients with recent onset arthritis. The patients were followed up for eight years with regular clinical, laboratory, and radiological evaluations. Radiographic evidence of joint destruction was quantitated by a radiographic index based on the Larsen grading. AKA and APF were detected, either at entry or at follow-up, in 26 and 54 patients, respectively. Seventy-six of the 133 patients had developed erosions. All AKA-positive patients had a rheumatoid factor-positive erosive poly-arthritis. The presence of APF was also associated with a progressive arthritis although four APF-positive patients had a non-erosive disease. Neither AKA nor APF were able to distinguish a particularly severe form of progressive RA.