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ID PMID Title PublicationDate abstract
10331125 Tibiotalar joint arthrodesis for the treatment of severe ankle joint degeneration secondar 1999 Apr The technical aspects of fusion of the rheumatoid ankle do not deviate from those in the post-traumatic or osteoarthritic ankle. Screw fixation can usually be achieved, and rarely is fixation failure a problem in rheumatoid ankle arthrodesis. If fixation is difficult because of deformity or bone quality, external fixation or locking intramedullary nails should be used. The placement of cannulated screws and adequacy of screw fixation has not been a problem (Fig. 13). Screw fixation provides compression and prevents rotation. The surgeon, however, needs to be assured that no screws invade the subtalar joint and that all threads are beyond the arthrodesis site. A washer may be necessary for further stability if this screw is not inserted at too great an angle. The authors have found that troughing out of the cortical surface of the tibia with a power bur aids in screw insertion. Not only does the trough act as a countersink, but it also provides a path for screw insertion and prevents palpable screw irritation. Malalignment is unforgiving. The foot must be placed neutral to dorsiflexion and plantarflexion. Equinus positioning places added stress on the tibia and a back-knee gait occurs. Approximately 5 degrees of valgus is recommended, and varus positioning is unforgiving. Internal and external rotation is determined by the position of the contralateral extremity. Nonunion does not seem to be a problem with rigid internal fixation to any greater degree in patients with RA. Despite this, patients may continue to have pain despite solid fusion, which can be caused by incomplete correction of deformity, painful internal fixation, or adjacent joint pathology. Additionally, patients may experience supramalleolar pain above the fusion site consistent with tibial stress fracture, which is more common if the subtalar or midtarsal joint is rigid or if the patient is obese. A rocker sole shoe with impact-absorbing soles used after brief periods of guarded mobilization in a removable walking cast alleviates this stress on the tibia. Neurovascular insult can be avoided with careful dissection direct to bone, incisions placed in nerve-free zones, and avoidance of plunging deep posteriorly-medially and anteriorly when dissecting and resecting surfaces. Arthrodesis of the tibiotalar joint in the patient with RA should be performed to relieve severe pain caused by advanced arthrosis. Achieving a solid arthrodesis does not seem to be a problem and provides the patient with pain relief; however, marked improvement in patient function and level of activity remains limited by the nature of RA and adjacent joint involvement.
10895369 Vertebral bone mineral density changes in female rheumatoid arthritis patients treated wit 2000 May OBJECTIVE: To assess vertebral bone mineral density (BMD) changes in rheumatoid arthritis (RA) patients taking low-dose methotrexate (MTX). METHODS: We evaluated in a 2-year, longitudinal study female RA patients, who had recently started a disease-modifying antirheumatic drug (DMARD), divided into two groups: group A, receiving MTX, and group B, receiving other DMARDs. Lumbar spine BMD was assessed at baseline and every year; RA activity was assessed every 3 months. RESULTS: Sixty-two patients were enrolled in the study; 40 completed the follow-up period: 22 of group A, and 18 of group B. The results after 2 years showed that both groups lost bone significantly vs baseline (p < 0.001) in a comparable fashion: group A (mean +/- SD) -3.9 +/- 4.9% vs group B -3.0 +/- 3.7% (p = NS). The patients who showed active disease lost significantly (p < 0.05) more bone (-5.5 +/- 3.8%) than those with less active disease (-1.1 +/- 3.6%), independently of their DMARD. CONCLUSION: Low-dose MTX in RA does not seem to exert relevant effects on trabecular bone.
11346227 Pachymeningitis and optic neuritis in rheumatoid arthritis: successful treatment with cycl 2001 Pachymeningitis is a rare complication of rheumatoid arthritis. The case of a 52-year-old male rheumatoid arthritis patient with pachymeningitis and optic neuritis who was successfully treated with intravenous cyclophosphamide is described.
9825741 Fatigue in rheumatoid arthritis: the role of self-efficacy and problematic social support. 1998 Oct OBJECTIVE: To examine the relationship of fatigue in people with rheumatoid arthritis (RA) with self-efficacy, positive and problematic aspects of social support, and demographic and disease-related variables. METHOD: Out-patients with at least 5 yr RA were studied. Fatigue was measured with a visual analogue scale. Other variables included were: positive social support [Social Support List-Interactions (SSL12-I)] and problematic social support; self-efficacy towards coping with RA and towards mobilizing support; health status (Dutch-AIMS2); and laboratory tests: erythrocyte sedimentation rate (ESR), haemoglobin (Hb) and rheumatoid factor (RF); and disease duration. RESULTS: A total of 229 out-patients were included. Fatigue correlated with all scales of the Dutch-AIMS2: with pain, physical function and affect (P < 0.001). There was no significant correlation with social support, but there was a highly significant correlation of fatigue with problematic social support (P < 0.001). Both forms of self-efficacy correlated strongly with fatigue: patients with high self-efficacy expectations towards coping with RA, and towards mobilizing the social network (P < 0.001), had less fatigue. In the regression analysis to explain the variation in fatigue, only pain, self-efficacy expectations towards coping with RA, and towards asking for help and problematic social support remained significant. CONCLUSIONS: Fatigue can to a large extent (37%) be explained by pain, self-efficacy towards coping with RA, and towards asking for help and problematic social support. It is known that self-efficacy can be enhanced by self-management courses and it may thus be possible to improve fatigue.
10229137 Pain threshold in patients with rheumatoid arthritis and effect of manual oscillations. 1999 Using a pressure algometer pain threshold (PT) measurements were carried out in the paraspinal area as well as at the knee and ankle joints in 30 adults with active rheumatoid arthritis (RA) and in 30 healthy adults. The group of RA patients was then randomly divided in two. In 15 RA patients a manual oscillation technique was applied at T12 and L4 for 12 minutes. The 15 other patients were resting. Immediately after the experimental procedure the PT was measured again at the same points in all patients. The RA patients showed a significantly (p < 0.05) lower PT than the healthy adults at all investigated points, which suggests that in RA certain changes arise in the peripheral and central nociceptive processing system, as mentioned in the literature. In the second measurement session for the RA patients the PT was significantly higher (p<0.05) after manual oscillations than after rest, at the paraspinal area of T6, L1 and L3. Further research into the long-term effect of repeated manual oscillation sessions is warranted.
11641938 [Effects of alfacalcidol on mineral density of bone tissue in patients with rheumatoid art 2001 The analysis of antiosteoporotic efficacy of alphacalcidol was made in 50 patients with rheumatoid arthritis (RA). 30 RA patients received alphacalcidol in a dose 0.75-1.0 mcg/day for 12 months. 20 control RA patients did not receive the drug. Mineral density of the bone tissue (MD) of the proximal femur and low back spine was studied using double x-ray absorptiometry at the start of the treatment and 12 months after it. It was established that alphacalcidol stabilizes MD of the neck of the femur and low spine. A significant MD increase was observed in those areas of the proximal femur where cortical bone tissue prevails.
10709304 The costs of treating rheumatoid arthritis patients with complementary medicine: exploring 1999 Dec OBJECTIVES: To measure the marginal costs of providing complementary medicine services (mostly homoeopathy) in outpatient clinics for patients with rheumatoid arthritis (RA) and to illustrate how parameters to which the cost of complementary medicine may be sensitive can be identified. DESIGN: Retrospective, observational costing study. SETTING: The outpatient clinic of the Royal London Homoeopathic Hospital. SUBJECTS: Random sample of 89 patients from the 427 (RA) patients attending outpatient clinics from April 1995 to March 1996. MAIN OUTCOME MEASURES: The marginal costs incurred by the hospital of treating 89 patients attending outpatient clinics and the relative contribution of the different resources to the total costs. RESULTS: The total costs of treating 89 patients were 7,124 Pounds of which 543 Pounds was assumed to be fixed and the remainder variable. The marginal costs of treating additional patients, starting from zero patients treated, are presented. Consultation time (doctors and dietician) contributed to 29% of the total costs, non-conventional drugs contributed to 22% of the total costs. CONCLUSIONS: Understanding the marginal costs of providing complementary care to RA patients will inform the debate over whether these therapies are likely to be cost-effective. In addition, those who would like to explore the practicalities of establishing a service involving complementary medicine will gain an understanding of the likely provider costs. The cost of complementary medicine appears to be most sensitive to the time spent with the patient by the doctor.
9613024 Psychosocial predictors of functional change in recently diagnosed rheumatoid arthritis pa 1998 Feb In order to examine the influence of active and passive pain-coping strategies and social support characteristics on the change in functional status in the first stage of the disease in rheumatoid arthritis patients, self-report data and clinical and laboratory measures were collected from 91 patients (70% female, mean age 57 yr) shortly after diagnosis and 1 yr later. Multiple regression analyses indicated that, after taking the influence of demographic variables, disease activity and pain into account, a decrease in functional status (mobility, self-care, grip strength) after 1 yr could be predicted by an initially more frequent use of the passive pain-coping strategies of worrying and resting. A decrease in mobility could be additionally predicted by an initially smaller social network. Results indicate the impact of passive pain-coping strategies and social network characteristics for the prognosis of functional outcome in the first stage of the disease and suggest the early manifestation of avoidance mechanisms, including behavioral, cognitive-emotional and social components, in face of a chronic stressor.
10662873 Hepatic fibrosis in rheumatoid arthritis patients treated with methotrexate: application o 2000 Jan OBJECTIVE: Evaluation of hepatic lesions in patients treated with methotrexate (MTX) generally used the Roenigk histological score. However, the sensitivity of the method for hepatic fibrosis assessment has been discussed. The semi-quantitative histological scoring system (SSS) offers a sensitive and specific evaluation of liver fibrosis. Both scores have been evaluated in liver biopsies of patients with rheumatoid arthritis. METHODS: Seventy-four liver biopsies were obtained in 57 rheumatoid arthritis patients before initiation of MTX (group 1, 38 cases), in cases of a persistently high level of transaminases during 1 yr of treatment (group 2, 10 cases) and after a MTX total dose of 2 g (group 3, 26 cases). Eleven biopsies of groups 1 and 3 originated from the same patient in 11 cases. Specimens were examined blindly by two anatomopathologists. The three groups were compared with an ANOVA. Sequential biopsies performed in 11 patients were compared with the Wilcoxon paired test. RESULTS: The Roenigk score and the SSS were significantly correlated (P<0.0001). Only a mild fibrosis was found in 33.8% (25/74) of the biopsies with the Roenigk score. Liver fibrosis, graded as mild (48.6%), moderate (41.8%) or severe (4%), was demonstrated in 94.6% (70/74) of the biopsies with the SSS. The Roenigk score and the SSS of the three patient groups were not statistically significantly different. The scores did not progress in the 11 patients who had serial biopsies. CONCLUSION: SSS is much more sensitive than the Roenigk score for the evaluation of hepatic fibrosis. However, SSS did not show progression of hepatic fibrosis in patients with rheumatoid arthritis treated with MTX.
10541009 A population-based register study of the association between schizophrenia and rheumatoid 1999 Nov 9 The authors investigated the association between schizophrenia and rheumatoid arthritis. The design is a population-based case-control and follow-up study. The cases were 20495 patients admitted for schizophrenia and registered in the Danish Psychiatric Case Register. A total of 204912 persons matched on age and gender and chosen from the general population served as controls. Admissions for rheumatoid arthritis and other non-autoimmune, musculoskeletal disorders were checked in the Danish National Patient Register. Odds ratios and relative risks were estimated by the Mantel-Haenszel estimator and Poisson regression. The same analyses were carried out for 10242 patients with bipolar affective disorder and 102420 controls for comparison. Individuals with schizophrenia had a reduced risk for being admitted with rheumatoid arthritis [odds ratio 0.44 (CI 0.24-0.81)] in the case-control study. A similar result was found in the follow-up study, but the incidence of the degenerative disorders in the musculoskeletal system was equally significantly lower in both studies. The incidence of rheumatoid arthritis among the bipolar patients was the same as in the control population. The negative association between schizophrenia and rheumatoid arthritis may thus be the result of ascertainment bias and selection due to under reporting and treatment of the medical illness. Clinicians are reminded of the difficulties in detecting medical illness among individuals with schizophrenia.
11508323 Fatal pancreatitis associated with systemic amyloidosis in a rheumatoid arthritis patient. 2000 We report here a case of severe acute pancreatitis associated with systemic AA amyloidosis in a 69-year-old rheumatoid arthritis (RA) patient. AA amyloid deposition was detected on the walls of small pancreatic arteries and arterioles. The acute pancreatitis was resistant to various interventions, and acute necrotizing pancreatitis and multiple organ failure developed. Although AA amyloidosis in RA patients is rarely complicated with acute pancreatitis, acute pancreatitis in such cases could be severe and intractable and might result in a fatal outcome.
11138614 Progress in the use of biochemical and biological markers for evaluation of rheumatoid art 2000 Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disorder which is predominant in females. The exact etiology remains undefined. Recently, a large number of biochemical and biologic markers, which are useful in the diagnosis, prognosis, and monitoring therapy of RA, have been reported. The new markers include genetic markers, filaggrin, citrulline containing peptides, A2/RA33, cytokines, joint and collagen breakdown products, and bone turnover markers. No laboratory tests in and of themselves are diagnostic of RA. The new markers have been employed in monitoring RA patients during treatment and following the course of the disease. With the development of innovative therapies for RA, many of the biochemical and biologic markers will be useful.
10418067 Multiple rheumatoid bursitis with migrating chylous cysts. Report of a case in a European 1999 Jun We report a case of recurrent multiple bursitis (19 episodes at nine sites) requiring seven surgical procedures in a European women with a 38-year history of severe, nodular, destructive seropositive rheumatoid arthritis unresponsive to second-line drugs. The episodes of bursitis were not correlated with activity of the joint disease. Some cysts migrated over a considerable distance. At least two cysts contained chylous fluid. The histologic study of one cyst demonstrated a cholesterol crystal granuloma. Potential relationships linking cholesterol crystals, chylous cysts, and migrating multiple bursitis are discussed. The relevant literature is reviewed.
9163649 Airway obstruction and rheumatoid arthritis. 1997 May The aim of this study was to assess the percentage of respiratory disorders and airway obstruction in patients with rheumatoid arthritis by comparing lung function test results between patients with rheumatoid arthritis and control subjects with other rheumatological conditions. A prospective case-control study of respiratory symptoms and lung function abnormalities was performed in a series of 100 patients with rheumatoid arthritis. Eighty eight patients with other rheumatological diseases served as controls. Diagnosis of respiratory disorders was based on clinical, radiological and spirometric findings. Airway obstruction was determined from predicted values. The results were compared using Student's t-test and Chi-squared tests. An explanatory analysis was carried out by linear regression. The number of symptoms, respiratory disorders (including bronchiectasis) and lung function abnormalities was higher in patients with rheumatoid arthritis than in controls. After exclusion of smokers, the proportion of airway obstruction in patients with rheumatoid arthritis was 16% (versus 0% in controls), although the patients with rheumatoid arthritis still had more symptoms and respiratory disorders. The Chi-squared test did not identify any relationship between airway obstruction, duration of rheumatoid arthritis and type of treatment and occurrence of Sjögren's syndrome. In the nonsmokers, different explanatory models for the patients with and without a history of cardiac and respiratory disease emerged from multivariate analysis of indices of obstruction. These models included variables characterizing the severity and course of the rheumatoid arthritis. Respiratory disorders (including bronchiectasis) and airway obstruction are more frequent among patients with rheumatoid arthritis than in rheumatological controls. Although the exact pathophysiology of the link between bronchial obstruction and rheumatoid arthritis is still a matter of debate, explanatory factors for obstruction included variables characterizing the rheumatoid arthritis.
11084945 Hormonal alterations in rheumatoid arthritis, including the effects of pregnancy. 2000 Nov A number of hormonal abnormalities are present in RA patients. A major theme of these abnormalities seems to be that deficiencies in the production or action of gonadal (estrogens and androgens) and adrenal (corticosteroids and DHEA) hormones may be involved in regulating the onset, severity, and progression of RA. Differences in RA incidence and activity in the pregnant and postpartum periods provide the strongest support for this view. Hormonal changes during these periods clearly have the potential to exert profound effects on RA incidence and activity. The effect of pregnancy on RA activity is actually greater than the effect of some of the newer therapeutic agents. The striking increase in corticosteroids, estrogen, and progesterone during pregnancy may suppress RA onset or activity through the regulation of production or action of cytokines such as TNF alpha, IL-1, IL-6, IL-12, and IL-10. The relative adrenal- and gonadal-deficient environment of the postpartum period further supports the view that hormonal deficiencies predispose to the development or increased activity of RA. These observations justify the search for hormonal abnormalities in RA patients outside the pregnancy and postpartum periods. In particular, further studies on the period before the onset of disease are needed. Additional evidence does exist that a functional abnormality in the adrenal glands in RA patients results in dysregulation of corticosteroid and DHEA production. These abnormalities seem to be linked to aging and disease activity. It is still not established whether these abnormalities are primary or secondary, although data indicating adrenal hypofunction before the development of RA or within the first year of disease activity suggest a primary abnormality. Several hormonal abnormalities seem to be restricted by gender and age, particularly around perimenopause and menopause. These age- and gender-influenced effects may be the cause of some of the contradictory data reviewed here. Studies in the future should make greater efforts to segregate study populations by age, gender, and reproductive status. The identification of the specific hormonal abnormalities and patient populations that are at risk is important, because these factors may allow new therapeutic approaches that are less toxic than current regimens.
10474282 Quality of life of women with systemic lupus erythematosus or rheumatoid arthritis: domain 1999 Aug The aim of this study was to increase understanding of the domains of life that are important to Swedish women with chronic rheumatic disease and to describe their dissatisfaction with these domains. Fifty women with Systemic Lupus Erythematosus (SLE) and 50 with Rheumatoid Arthritis (RA) were interviewed by telephone regarding their quality of life using five open-ended questions. Content analysis of their responses revealed nine categories: Health/wellness, Family/friends, Work, House/home/living environment, Social support/functional services, Hobbies/cultural activities, Sufficient income, Independence, Integrity/identity. Areas of importance correspond closely to those areas with which they were most dissatisfied. Although the domains identified in both groups were the same, SLE patients expressed more dissatisfaction with their perceived control over their bodies and understanding about their condition on the part of physicians and people in general. RA patients were more dissatisfied with areas of their lives that threatened their independence. Health care providers should be aware of these areas of dissatisfaction so that they can plan strategies to maximize patient quality of life.
9734676 Assessment of disease activity in rheumatoid arthritis using magnetic resonance imaging: q 1998 Aug We attempted to assess whether pannus volume measured by magnetic resonance imaging (MRI) can be used as an indicator of disease activity in rheumatoid arthritis (RA). Eleven women (mean age 46 yr) with uncontrolled RA were studied for 1 yr. Pannus formation in both hands was quantified using MRI at the start of the study, and at 6 and 12 months thereafter. The volume of enhancing pannus (VEP) was compared with changes in the radiological scores, grip strength, joint tenderness counts, joint swelling counts, erythrocyte sedimentation rate (ESR), and serum C-reactive protein (CRP). Patients were classified into three groups based on VEP changes between 0 and 12 months: unchanged (n = 2), decreased (n = 6) and increased (n = 3). VEP at 6 months and at 12 months differed significantly between the three groups. No statistically significant differences were found between the groups in radiographic scores, physical parameters or laboratory parameters despite the fact that some of these parameters changed in the direction indicated by the changes in VEP. VEP can be used as a new indicator to assess disease activity in individual RA patients and, using this parameter, treatment outcome can be assessed in fewer subjects than with traditional measures.
9279235 Interstitial lung disease in recent onset rheumatoid arthritis. 1997 Aug Interstitial lung disease (ILD) is associated with rheumatoid arthritis (RA); however, the prevalence and natural history are undefined. Our aim was to determine the prevalence of ILD associated with RA using a number of sensitive techniques in patients with joint disease of less than 2-yr duration. Patients who met ARA criteria for RA were recruited from community-based and hospital rheumatologists and assessed using the following measures: clinical, lung physiology, radiology (chest X-ray, high resolution CT [HRCT]), bronchoalveolar lavage (BAL) and 99mTc-DTPA nuclear scan. Thirty-six patients (25 female and 11 male) of joint disease duration of (mean +/- SD) 13.2 +/- 8.6 mo were studied. Abnormalities consistent with ILD were found in one or more investigations in 21 of 36 (58%), which were in lung physiology in 22%, CXR in 6%, HRCT in 33%, BAL in 52%, and 99mTc-DTPA nuclear scan in 15%. Based on the results, they were categorized as having clinically significant ILD (Group 1), abnormalities compatible with ILD, but no clinically significant ILD (Group 2) and no abnormalities compatible with ILD (Group 3). Five of 36 (14%) were in Group 1, 16 of 36 (44%) in Group 2, and 15 of 36 (42%) in Group 3. The only risk factor for the presence of abnormalities compatible with ILD was male gender (p < 0.04, Student's t test). In conclusion, changes consistent with ILD in early RA are frequent. The significance of these changes is being determined in a longitudinal study.
10652465 Rheumatoid arthritis and p53: how oxidative stress might alter the course of inflammatory 2000 Feb Oxidative stress at sites of chronic inflammation can cause permanent genetic changes. The development of mutations in the p53 tumor suppressor gene and other key regulatory genes could help convert inflammation into chronic disease in rheumatoid arthritis and other inflammatory disorders.
11547230 [GUEPAR total elbow prosthesis in rheumatoid arthritis. A multicentric retrospective study 2001 Sep PURPOSE OF THE STUDY: We conducted a multicentric retrospective analysis of outcome after implantation of 38 GUEPAR elbow prostheses in 36 patients with rheumatoid polyarthritis. MATERIAL AND METHODS: The GUEPAR elbow prosthesis is an anatomic prosthesis developed in 1985 by the Groupe pour l'Utilisation et l'Etude des Prothèses Articulaires (GUEPAR). The recommended surgical technique is described. Patients included in this series had moderate to severe persistent elbow pain. Preoperative motion was 113 degrees flexion with a mean 41 degrees extension deficit. The mean global Mayo Clinic score was 32/100; clinically, the overall assessment was poor in 8 and mediocre in 30. Radiographically there were 16 grade III, 16 grade IV and 4 grade V elbows in the Larsen classification. Two cases were arthroplasty revisions. RESULTS: All patients were seen at a mean 47.6 months follow-up (12 to 97 months). There were two early failures (1 infection and 1 instability) leading to ablation of the prosthesis. Results were analyzed for the 36 remaining arthroplasties. Total pain relief was achieved in 18 cases with only occasional pain in 17 others. Postoperative motion was 132 degrees flexion with a 30 degrees extension deficit, giving a mean 30 degrees gain. The global Mayo Clinic score was 85/100 with 32 excellent, 3 good and 1 mediocre results. Radiography revealed 2 cases of loosening of the humeral component and 1 bipolar loosening that had not required revision at last follow-up. Prosthetic instability was the most frequent among the early and late complications. DISCUSSION: Total elbow arthroplasty is a useful therapeutic option among the treatments proposed (including chemical or isotopic synoviothesis, synovectomy, arthroplastic resection) for rheumatoid elbows. It is indicated for Larsen grades III, IV and V and provides good functional outcome and nearly constant pain relief with an amplitude greater than the 100 degrees, generally accepted as functionally useful. In light of our experience we propose certain modifications of the current GUEPAR implant: adjunction of a condylar extension to the humeral component in order to reduce rotation stress and thus avoid humeral loosening and a radial head element to limit the risk of instability.