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ID PMID Title PublicationDate abstract
11501717 Biopsychosocial mediators and moderators of stress-health relationships in patients with r 2001 Aug OBJECTIVE: To investigate the mediating and moderating roles of social support, coping, and physiological variables in the relationship between life events and health status. METHODS: Psychological and biological measurements were taken in 54 patients (38 women, 16 men, mean age +/- SD 56 +/-14.4 years) with recently diagnosed rheumatoid arthritis (RA). RESULTS: Life events were correlated with psychological distress, but not with disease activity. No mediators for the relationship of life events with psychological well-being and disease activity were observed. In 40 tests, 4 moderators were found: Problem-focused coping, perceived support, diastolic blood pressure, and total number of lymphocytes were moderators of the relationship between daily hassles and health status (P < or = 0.05). CONCLUSION: Our study provides limited support for the notion that the interactions of life stress with biopsychosocial variables have an impact on health. None of these variables were found to be crucial mediators of stress-health associations in recently diagnosed patients with RA, but some provocative evidence was given that biopsychosocial variables may have a minor impact on stress-health relationships.
9585928 [Combined arthroscopic and radiation synovectomy in rheumatoid arthritis]. 1998 Mar In rheumatoid arthritis of the knee joint good results are obtained using arthroscopic synovectomy or radiation synovectomy. Aim of our study was to investigate, whether the combination of these two minimal invasive interventions achieves better results. First we performed arthroscopic synovectomy of the knee joint followed by radiation synovectomy with application of 111-222 MBq Yttrium-90 6 weeks later. In a prospective randomised clinical trial between 1987 and 1991 we performed radiation synovectomy on 22 knee joints and combined arthroscopic and radiation synovectomy on 26 knee joints. We explored the patients preoperatively, 6 weeks and 6 months postoperatively. In 1996 we evaluated 141 knee joints in a retrospective clinical trial. 90 Knee joints had been treated with the combined therapy, 39 only with radiation synovectomy and 12 only with arthroscopic synovectomy. Depending on the three different therapeutic interventions, the patients were classified into midterm (3-5 years) and long-term (6-8 years) observation groups. The trials are based on the standardized ARO-Questionnaire of the knee joint, the modified ARO Knee-Score and the radiological grading according to Larsen, Dale and Eek. In the prospective clinical trial we found significant better results for patients treated with the combined therapy than for patients treated with radiation synovectomy only regarding the parameter swelling, effusion, range of motion, pain and Knee-Score. In the long-term results of the retrospective clinical trial the patients treated with the combined therapy showed a significant better outcome for the parameters pain, swelling and Knee-Score, than the patients treated with radiation synovectomy. Although no statistically significant difference was found comparing the results of the combined therapy with arthroscopic synovectomy, an improvement of the clinical outcome can be observed performing arthroscopic synovectomy followed by radiation synovectomy. In the treatment of rheumatoid arthritis of the knee joint a better outcome is achieved performing combined arthroscopic and radiation synovectomy than performing only one of the methods.
11890653 Radiographic progression in rheumatoid arthritis: does it reflect outcome? Does it reflect 2001 Nov Although there is clear face validity that structural damage is related to outcome, it is difficult to prove this. Recently, more evidence became available that structural damage, as assessed on plain films, is indeed related to disease activity in clinical trials and therefore can be used to assess the effect of treatment. Also, a relationship between structural damage and outcome, mainly defined as physical disability, was established. Several examples of findings in recent publications are presented which lead to the following conclusions. There is a relation between the response to treatment measured as clinical disease activity and measured as radiographic progression in most clinical therapeutic trials. A strong relation between local inflammation and progression of damage in the individual joint is present. This is robust evidence for the hypothesis that inflammation leads to structural damage. There is a good relation between the damage in small and large joints as assessed on plain films. Damage measured in small joints is a good substitute for overall damage. Disease activity is always strongly correlated with functional disability throughout the disease course. There is an increasing relation between disability and structural damage with increasing disease duration.
9291854 Radiographic damage in large joints in early rheumatoid arthritis: relationship with radio 1997 Aug An assessment of the onset of radiographic damage in the large joints (hip, knees, shoulders, elbows, ankles and tarsus) in patients with early rheumatoid arthritis, and the relationship of the progression of large joint damage with joint damage in hands and feet, with physical disability, and with cumulative disease activity, was performed in a prospective 6 yr follow-up study. Large joint damage appeared to be an early phenomenon with 20% of the patients having some damage in at least one large joint within 1 yr, and 50% of the patients within 6 yr after disease onset. Radiographic damage in large joints was significantly related to the damage in hands and feet, the physical disability index, and the cumulative disease activity. The initial disease activity at study entry was the only prognostic factor that reached significance.
11561117 One-year outcomes of a randomized controlled trial of an educational-behavioural joint pro 2001 Sep OBJECTIVE: Joint protection aims to reduce pain and local inflammation, preserve the integrity of joint structures and improve function. There is evidence that it can improve pain and function in the short term, but the long-term effects are uncertain. This study evaluated the effects of joint protection in early rheumatoid arthritis (RA). METHODS: A randomized, controlled, assessor-blinded trial of duration 1 yr was conducted. Two interventions (both 8 h) were compared: standard arthritis education, including 2.5 h of joint protection education based on typical UK practice; and a joint protection arthritis education programme, using educational-behavioural teaching methods. Assessments were made at entry and 6 and 12 months. RESULTS: Sixty-five people with RA attended the joint protection programme and 62 the standard programme. The groups were matched for age (51 and 49 yr), disease duration (21 and 17.5 months) and use of non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs. In comparison with the standard group, the joint protection group significantly improved with respect to adherence to the joint protection programme (P=0.001), hand pain (P=0.02), general pain (P=0.05), early morning stiffness (P=0.01), self-reported number of disease flare-ups (P=0.004), visits to the doctor for arthritis (P<0.01), and the AIMS2 (Arthritis Impact Measurement Scales) activities of daily living scale (P=0.04). A trend to improved swollen joint counts was identified (P=0.07). Within-group analyses also showed improvements in arthritis self-efficacy and perceived control. Hand deformity scores continued to increase in both groups. CONCLUSION: We found significant improvements in adherence, pain, disease status and functional ability amongst those attending the joint protection programme. Benefits became more apparent with time, suggesting that joint protection can help slow the progression of the effects of RA over and above the effects of drug therapy.
9852809 Range of motion of the temporomandibular joint in rheumatoid arthritis: relationship to th 1998 Jul The purpose of this study was to determine the frequency and nature of temporomandibular joint (TMJ) involvement in rheumatoid arthritis (RA) patients with symptoms in this joint, and to investigate the relationship of symptoms to the C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Steinbrocker stage. Clinical examination of the range of motion of the TMJ was performed in 218 RA patients. In addition, correlations between the maximal mouth opening and the severity of RA were studied. Restriction in opening the mouth (defined as < or = 30 mm movement in the central incisor region from the fully occluded to maximally open positions) was observed in 12.8% of the RA patients (28/218). The CRP, ESR and Steinbrocker stage were all correlated with maximal opening (p < 0.05). There was a positive correlation between the severity of RA and the range of motion of the jaw.
9415632 Relationship between duration of rheumatoid arthritis before knee joint surgery and HLA-DR 1997 Dec OBJECTIVE: To examine whether genetically determined factors can be used as predictors of requirement for knee joint surgery in the early phase of rheumatoid arthritis (RA). METHODS: We determined HLA-DRB1 alleles in 322 patients with seropositive RA by polymerase chain reaction and allele specific oligonucleotide probe techniques. Patients were classified into 3 groups (S/S, S/N, and N/N) based on their possession of two, one or no susceptibility alleles of RA, respectively. The stage of radiographic change in the knee joint determined using Larsen's standard film was compared to results of genotyping. Duration of RA before joint surgery in the 3 groups was also compared retrospectively. RESULTS: The median number of years to develop to stages I, II, III, and IV and the number of years of disease duration before total knee arthroplasty (TKA) were significantly shorter in the S/S group than in the S/N and N/N groups (p < 0.05). CONCLUSION: TKA was required earlier in the S/S group than in the S/N and N/N groups. This finding will affect planning of surgical management for RA based on anticipated courses.
10442484 Increases in mast cells and chymase in fibroproliferative paws of collagen-induced arthrit 1999 Jun OBJECTIVE AND DESIGN: To investigate whether mast cells (MCs) and chymase, the major protease of murine MCs, were involved in a chronic fibroproliferative disorder of the paws associated with type II collagen (CII)-induced arthritis. MATERIALS: Eighteen DBA/1J mice were divided into 3 groups and were used to study fibroproliferative changes in paws elicited by immunization. TREATMENT: Arthritis was induced by immunization with CII, which was intradermally injected as an emulsion made with adjuvant. A booster shot was done 3 weeks after the initial shot. A group with no treatment and that received adjuvant alone served as control. METHODS: Twelve weeks after the booster shot, inflammation of the paws was evaluated for pathological and biochemical indices. Chymase activity was determined with a chromogenic peptide substrate. RESULTS: In CII-immunized group, collagen bundles accumulated around the destructed joints. In accordance with the pathological findings, MC density in the affected paws was increased (154.8+/-13.3/mm2; p<0.05 vs. control) and chymase activity was also increased (29.5+/-2.8 mU/mg protein; p<0.01 vs. control). CONCLUSIONS: The present results demonstrate increases in MCs and chymase in fibroproliferative paws of collagen-induced arthritic mice.
10648023 Prevalence of radiological changes in the cervical spine--a cross sectional study after 20 2000 Jan OBJECTIVE: To evaluate the prevalence of cervical spine changes in patients with rheumatoid factor (RF) positive rheumatoid arthritis (RA) followed prospectively for 20 years. METHODS: An inception cohort of 103 patients with RF positive RA have been followed at the Rheumatism Foundation Hospital, Heinola. A total of 68 patients attended for the 20 year followup. An additional 28 patients died and 7 were not able to attend due to severe disease or old age. The plain cervical spine radiographs of 69 patients (68 and one received from another hospital) taken after 20 years of RA were evaluated. RESULTS: Anterior atlantoaxial subluxation was found in 16 cases (23%), while 18 patients (26%) had atlantoaxial impaction as judged by the Sakaguchi-Kauppi method. Subaxial subluxations and lateral atlantoaxial subluxations were found in 13 cases (19%) and 3/52 cases (6%), respectively, while 45 patients (65%) had subaxial disc space narrowing. CONCLUSION: Cervical spine changes are common in patients with long lasting RA. They should be diagnosed and treated early to avoid complications. In our patient group no cervical spine surgery was performed, but at least 7 patients (10%) required further evaluation for possible surgery.
10381055 Amelioration of type II collagen induced arthritis in rats by treatment with sodium diethy 1999 Jun OBJECTIVE: Sodium diethyldithiocarbamate (Ditiocarb, DDTC), which is used in the treatment of heavy metal poisoning, effectively inhibits NF-kappaB activation and cytokine secretion in vitro. To investigate the antiinflammatory and immunosuppressive potency of DDTC, we examined its influence on the course of collagen induced arthritis in rats. METHODS: Arthritis was induced in female DA rats by injection of rat collagen type II emulsified in incomplete Freund's adjuvant into the tail base. After onset of arthritis, the animals received DDTC or vehicle by intraperitoneal injections or subcutaneous infusion using osmotic pumps. Disulfiram, which is cleaved into DDTC within the gastrointestinal tract, was administered orally via gastric gavage. The course of arthritis was followed by clinical scoring and measurement of joint swelling. RESULTS: Collagen induced arthritis was significantly ameliorated by intraperitoneal injection (2 x 300 mg/kg/day) and subcutaneous infusion (120 mg/kg/day) of DDTC and by enteral administration of disulfiram (200 and 300 mg/kg/day). CONCLUSION: Dithiocarbamates may provide an effective new approach for the treatment of arthritis and other inflammatory diseases.
11143904 Oral immunomodulation therapy in rheumatoid arthritis. 2000 Because the gastrointestinal mucosa is a vast interface between the body and the environment, it is the main entry site for many environmental antigens. Enterocytes can cleave environmental antigens into peptides, bind these peptides to their CD1 receptor, and present them to T cells. Intact antigens can penetrate through specialized Peyer's patch enterocytes called 'M cells'; they are then degraded and presented by dendritic cells to Peyer's patch T cells. The influx of multiple antigens through the gastrointestinal mucosa usually results in tolerance. High-dose tolerance is due to T cell deletion or anergy, whereas low-dose tolerance involves activation of TGFbeta-producing Th2 or Th3 cells. TGFbeta inhibits lymphocyte proliferation and the production of antibodies to ingested antigens; in addition, it blocks the proliferation of lymphocytes in organs to which gastrointestinal Th3 lymphocytes migrate. This 'innocent bystander' effect has been used to try to induce oral tolerance. For instance, pretreatment with oral bovine type II collagen has proved capable of modulating several models of experimental polyarthritis. Arthritis severity was considerably reduced. Preliminary attempts in humans with rheumatoid arthritis have yielded promising results.
10943857 Mannose-binding lectin and rheumatoid arthritis in southern Chinese. 2000 Aug OBJECTIVE: Insufficiency of mannose-binding lectin (MBL) is associated with recurrent infections. Rheumatoid arthritis (RA) may represent an aberrant immune response to infections. This study examined the phenotypic expression and variant alleles of the MBL gene and its etiologic role in Chinese with RA. METHODS: We studied 211 RA patients and 196 healthy subjects. Serum MBL concentrations and codon-54 mutation of the MBL gene and its promoter polymorphisms were analyzed. Clinical characteristics and disease activity were also examined. RESULTS: Patients with RA had significantly lower serum MBL levels and higher frequency of codon-54 mutation of the MBL gene compared with controls. Additionally, there was a significant difference in the distribution of promoter polymorphisms, H/L, between RA patients and controls, although the frequencies of Y/X and those of nonstructural polymorphisms, P/Q, did not differ between the 2 groups. Furthermore, patients with RA had a lower incidence of the highest-producing haplotype HY and a higher incidence of the lowest-producing haplotype LX compared with controls. Serum MBL levels did not correlate with drug treatment or with disease activity. However, patients with erosive and serious extraarticular disease had significantly lower serum MBL levels than those without these disease manifestations at the time of study. Also, significantly more patients with erosive disease had a codon-54 mutation of the MBL gene compared with those with nonerosive disease. CONCLUSION: The codon-54 mutation and low-producing promoter polymorphisms of the MBL gene are associated with RA. A low serum level of MBL predisposes to the development of RA and is a risk factor for severe disease in southern Chinese.
9606615 Cytokines in rheumatoid arthritis. Potential targets for pharmacological intervention. 1998 May The ingress of inflammatory leucocytes into the synovium is a crucial step in the pathogenesis of rheumatoid arthritis (RA). Cytokines are mediators involved in the inflammatory events, adhesive mechanisms, angiogenesis and osteopenia associated with RA. Pro- and anti-inflammatory cytokines, growth factors and chemokines all have an important role in these processes. Because the efficacy of currently used antirheumatic therapy is often limited, there is a need for more specific intervention strategies. Anticytokine therapy may include the use of monoclonal antibodies, antagonistic cytokines, soluble cytokine receptors, cytokine receptor antagonists, somatic gene transfer or other approaches. Hopefully, the study of cytokines and their interactions will lead to the development of new immunomodulatory strategies that will benefit patients with RA.
9767983 [Inflammation and joint destruction during rheumatoid polyarthritis: what relation?]. 1998 Mar 14 A QUESTION REVISITED: It is generally accepted that acute then chronic joint inflammation leads to the development of a synovial pannus and secondarily to characteristic degenerative joint disease en rheumatoid arthritis. However accumulating clinical and biological evidence would question the real relationship between inflammation and joint destruction, and suggest therapeutic strategies might need to be revisited. THE CAUSAL EVENTS: Synovial proliferation is the fundamental event in joint lesions. The contact between the synovial pannus and the cartilage leads to characteristic joint damage mediated by pro-inflammatory cytokines (TNF alpha and IL 1) and enzyme secretion, particularly metalloproteases. ROLE OF T CELLS: The role of T-lymphocytes is a question of much debate. Although it is generally accepted that T cells are crucial in the initial phases of rheumatoid arthritis, several arguments suggest that the process of synovial proliferation and joint destruction in advanced stage disease would be independent of T cell activity. Synovial macrophages and fibroblasts, and perhaps chondrocytes, play a central role at this phase. THERAPEUTIC IMPLICATIONS: A direct mandatory relationship between inflammation and joint destruction appears to be excluded, although complex and poorly understood links exist between these events in rheumatoid arthritis. A better understanding of the mechanisms involved would be very useful for the development of more adapted therapeutic strategies in rheumatoid arthritis.
9207007 An antagonist of monocyte chemoattractant protein 1 (MCP-1) inhibits arthritis in the MRL- 1997 Jul 7 An antagonist of human monocyte chemoattractant protein (MCP)-1, which consists of MCP-1(9-76), had previously been characterized and shown to inhibit MCP-1 activity in vitro. To test the hypothesis that, by inhibiting endogenous MCP-1, the antagonist has antiinflammatory activity in vivo, we examined its effect in the MRL-lpr mouse model of arthritis. This strain spontaneously develops a chronic inflammatory arthritis that is similar to human rheumatoid arthritis. Daily injection of the antagonist, MCP-1(9-76), prevented the onset of arthritis as monitored by measuring joint swelling and by histopathological evaluation of the joints. In contrast, controls treated with native MCP-1 had enhanced arthritis symptoms, indicating that the inhibitory effect is specific to the antagonist. In experiments where the antagonist was given only after the disease had already developed, there was a marked reduction in symptoms and histopathology, although individuals varied in the magnitude of the response. The mechanism of inhibition of disease is not known, although the results suggest that it could be more complex than the competitive inhibition of ligand binding that is observed in vitro. The demonstration of the beneficial effects of an MCP-1 antagonist in arthritis suggests that chemokine receptor antagonists could have therapeutic application in inflammatory diseases.
9572714 Epidemiology of rheumatoid arthritis in Finland. 1998 Apr OBJECTIVES: To review the work pertaining to rheumatoid arthritis (RA) morbidity in Finland and to compare the data with that available from other countries. METHODS: Extensive investigations in Finland of the epidemiology of RA, based on nationwide registers designed primarily for administrative purposes and on extensive population studies, frequently in combination. RESULTS: According to several surveys with somewhat different study designs, the prevalence of clinically significant RA is about 0.8% of the adult Finnish population. Five national health interviews from a 30-year period have revealed figures about 50% higher, but with no clear change in prevalence. The incidence of clinically significant RA is about 40 per 100,000 of the adult population, which is in accordance with the prevalence figures. The mean age at diagnosis increased by 7.6 years from 1975 to 1990. Between 1978 and 1980, 5.8% of the severe disability in the adult Finnish population was attributable to RA. Some evidence suggests that severe disability resulting from RA diminished during the 1980s, possibly because of joint replacement surgery. CONCLUSIONS: Monitoring sickness insurance statistics is a useful means of following the epidemiology of RA.
10406710 Repair of supracondylar femur fracture and unilateral knee replacement at the same surgery 1999 Jun In patients who are candidates for a total knee arthroplasty and suffer a periarticular fracture of the femur, the arthroplasty may be performed after bony union of the fracture or immediately, in conjunction with the fracture repair. Herein we present the case of a sixty-year-old female with rheumatoid arthritis and a supracondylar fracture of the right femur in whom total knee arthroplasty and retrograde nail insertion were addressed at one surgery; the outcome was favorable. The transverse extraarticular fracture pattern in this patient was advantageous for simultaneous procedures; had the fracture been more comminuted or intraarticular, it might not have been possible to perform both procedures at the same time.
11708413 High mortality in patients with rheumatoid arthritis and atlantoaxial subluxation. 2001 Nov OBJECTIVE: To study relationships between atlantoaxial subluxation (AAS) and total mortality in patients with rheumatoid arthritis (RA). METHODS: Radiological reports and clinical files of patients with RA were reviewed for the presence of cervical spine involvement verified by cervical radiographs. RESULTS: Among 241 patients with cervical radiographs, anterior AAS > or = 4 mm was found in 5% [95% confidence interval (CI) 2-8] of patients. Vertical and posterior subluxations were found in 1.4 and 0.5%, respectively. The mean observation time from RA diagnosis to AAS was 3.9 years. Patients with AAS had 8 times higher mortality than patients without AAS (95% CI 3-25). According to the death certificate, the patients died from cancer, stroke, and myocardial infarction. Cervical spine disorder was not mentioned on the death certificate. However, an autopsy was not performed. CONCLUSION: We found high mortality in RA patients with AAS. AAS in the cervical spine developed relatively early in the course of the disease. Analyses adjusted for seropositivity, erosiveness, and glucocorticosteroids did not reduce the mortality rate ratio. Our results underline the need for careful evaluation of patients with RA with respect to development of AAS.
10064116 Carnitine homeostasis in patients with rheumatoid arthritis. 1999 Jan Myopathy is a frequent finding in patients with rheumatoid arthritis (RA). Since carnitine is important for skeletal muscle energy metabolism, carnitine metabolism was investigated in patients with RA and myopathy. Muscle strength was estimated by determination of a muscle strength index (MSI) which is derived from isometric measurements of muscle strength at knees and elbows. Carnitine was determined by a radioenzymatic method and 3-methylhistidine by high-performance liquid chromatography. In comparison to control subjects, patients had a reduced MSI. Both the 24-h creatinine and 3-methylhistidine excretions were reduced in patients. The plasma carnitine pool was not different between patients and control subjects, except for a higher long-chain acylcarnitine concentration in patients. Urinary excretion of carnitine was decreased in patients, also after normalization for body weight. Accordingly, renal carnitine clearance and excretion fraction were both decreased in patients. Skeletal muscle free- and total carnitine levels were increased in patients, whereas the long-chain acylcarnitine content was markedly decreased. The total skeletal muscle carnitine content showed a negative correlation with the MSI and no association with disease activity. Carnitine deficiency does not explain reduced skeletal muscle strength in patients with RA. Decreased renal carnitine excretion in patients is most likely due to reduced carnitine biosynthesis, leading to more efficient tubular carnitine reabsorption for maintaining the carnitine body stores.
10914850 A randomized controlled trial to evaluate the effectiveness of an exercise program in wome 2000 Jul OBJECTIVE: To evaluate the effects of a 12 month, weight bearing, aerobic exercise program on disease activity, physical function, and bone mineral density (BMD) in women with rheumatoid arthritis (RA) taking low dose prednisone. METHODS: A group of women with RA (n = 23) not receiving steroid therapy and in American College of Rheumatology functional class I or II was compared to 30 steroid treated patients with similar demographics. The latter group was randomized to usual care (n = 16) or an aerobic, weight bearing exercise program (n = 14) 3 times a week for 12 months. All subjects were recruited from an outpatient rheumatology clinic or physical therapy department and met the study inclusion criteria. Outcome measures included disease activity (erythrocyte sedimentation rate, active joint count), physical function (Health Assessment Questionnaire disability index, activity level) and BMD of the spine and femoral neck (by dual energy projection radiology). RESULTS: Subjects in the exercise group had a small but nonsignificant decrease in disease activity and statistically significant improvements in function (p = 0.05) and activity levels (p = 0.05). BMD remained unchanged in the exercise group, decreased significantly (p = 0.004) in the nonsteroid comparison group (hip), and changed nonsignificantly in the control group. However, between-group changes in spinal BMD of the steroid treated groups was not significant (p = 0.09). CONCLUSION: Women with RA taking low dose steroid therapy can safely participate in a dynamic, weight bearing exercise program with positive effects on their physical function, activity and fitness levels, and BMD with no exacerbation of disease activity.