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ID PMID Title PublicationDate abstract
10446872 How much disability in rheumatoid arthritis is explained by rheumatoid arthritis? 1999 Aug OBJECTIVE: To measure the proportion of disability explained by disease manifestations compared with nondisease factors in rheumatoid arthritis (RA). METHODS: A hypothetical model of the disablement process specific for RA was constructed using the demographic, sociocultural, and clinical characteristics of a consecutive cohort of RA patients. Disability was measured with the modified Health Assessment Questionnaire (M-HAQ) and the physical function scale of the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. Independent variables, grouped according to their position in the RA disablement process model, were sequentially entered in a series of hierarchical regression models. The proportion of variance in disability explained by each group of variables was measured by the group's incremental R2. RESULTS: The overall proportion of disability explained by the full model was 59%. Factors in the main disease-disability pathway explained 33%, of which 3% was explained by disease duration, 5% by the Westergren erythrocyte sedimentation rate, 14% by articular signs and symptoms, and 11% by performance-based functional limitations. External modifiers and contextual variables explained 26% of the variance in disability, of which age and sex accounted for 2%, formal education 4%, psychological status 17%, and symptoms of depression 3%. CONCLUSION: Both the main disease-disability pathway and factors external to this pathway contribute significantly to disability in RA. These findings provide evidence of the relative influence of psychosocial factors, compared with disease manifestations, on the disability of patients with RA.
11642506 Autologous hematopoietic stem cell transplantation for severe autoimmune disease with spec 2001 Oct In 1996 an international collaboration began to explore the use of immunoablation and stem cell rescue in the treatment of severe autoimmune disease. Around 500 patients have been so treated according to consensus guidelines, the majority being registered in the combined European League Against Rheumatism and European Group for Blood and Marrow Transplantation (EULAR/EBMT) data registry. Results in terms of toxicity and benefit are different in the different autoimmune diseases, e.g., for rheumatoid arthritis (RA) a low transplant related mortality (TRM) of one patient out of 43 but high relapse rate (around two-thirds), whereas for systemic sclerosis (SSc) a higher TRM (12%) but less relapse. More aggressive immunoablative regimes were associated with more procedure related toxicity, but so far a clear therapeutic advantage has not been demonstrated. An overall actuarial TRM of 9% was observed. Randomized, prospective controlled phase III trials have begun in SSc and will soon commence in RA and multiple sclerosis. More phase I and II data are required for systemic lupus erythematosus and juvenile idiopathic arthritis.
9355209 Efficacy of multidisciplinary team care programs in rheumatoid arthritis. 1997 Oct OBJECTIVE: To assess the efficacy of multidisciplinary team care programs in rheumatoid arthritis (RA). METHODS: Data were obtained by a Medline and a manual search of the literature through January 1997. Both the design and analysis aspects of controlled trials were evaluated. RESULTS: Forty-two papers reporting on 35 clinical trials of multidisciplinary team care were initially identified. Fifteen trials had a controlled design, nine of which were randomized. Patient characteristics, interventions, end point measures, and presentation of the data varied widely among the controlled studies. In 12 trials, inpatient (n = 6) or outpatient (n = 6) multidisciplinary programs were compared with regular outpatient care. Inpatient programs (average duration, 10 to 28 days) had a direct favorable effect on disease activity, lasting up to 1 year. The effect of outpatient programs (average duration, 1 to 2 years) was less marked, with greater improvement of functional status at the end of the treatment program shown in one study. In three trials, inpatient multidisciplinary programs were compared with similar outpatient programs. One study showed that inpatient care was more effective, whereas in two studies similar results were obtained in both groups. CONCLUSION: Favorable effects on disease activity were seen in most trials comparing short inpatient team care with regular outpatient care. Proof of efficacy of prolonged outpatient team care is scanty. Results of trials comparing inpatient with outpatient team care remain inconclusive.
9751465 Chronic arthritis and gamma heavy chain disease: coincidence or pathogenic link? 1998 In 1991, gamma heavy chain disease was diagnosed in a 43-year-old female, who 3 years earlier had contracted an erosive seronegative chronic arthropathy. Her gamma heavy chain disease had a benign course, requiring no specific therapy for 5 years. In 1996, however, her lymphoproliferative disorder underwent a more malignant course, with renal and cardiac failure and increasing articular problems, requiring treatment with melphalan and prednisolone, following the protocol for myelomatosis. Laboratory studies revealed a monoclonal component in serum and urine. consistent with dimers of gamma-chains of the gamma3 subclass, but with a smaller molecular mass than normal gamma3-chains, suggesting molecular aberrations as consistently observed in this disorder. Massive localization of plasma cells and blasts with cytoplasmic or cell membrane staining for gamma3-chains, but no staining for kappa or lambda light chains, was observed by immunohistochemical studies of tissue specimens from bone marrow as well as affected synovial tissue. Large amounts of extracellular gamma3-chains were deposited in the synovial membrane. In addition, marked inflammatory changes with synovial cell hyperplasia were seen. Whether the present case represents primarily a gamma heavy chain deposition disease with reactive inflammatory changes in the joints, or another example of gamma heavy chain disease preceded by seronegative rheumatoid arthritis, remains elusive. Regardless, a possible pathogenic link between the two disease processes is an intriguing possibility.
10743791 The predictive value of the HLA shared epitope for severity of radiological joint damage i 2000 Mar OBJECTIVE: To evaluate the clinical importance of the RA "shared epitope" (SE) as a prognostic marker of radiological severity and extension of the disease to large joints in patients with rheumatoid arthritis (RA). METHODS: Eighty-two patients who met the American College of Rheumatology criteria for RA with a disease duration < 2 years at presentation were included in the study. Radiographs of hands, wrists, feet, shoulders, elbows, hips, and knees were taken at study entry and 8-10 years later. HLA-DRB1 genotypes were determined by polymerase chain reaction-sequence-specific oligonucleotide probes. Radiological severity was assessed in small joints of hands, wrists, and feet. Extension of the disease to large joints was evaluated in radiographs of shoulders, elbows, hips, and knees. RESULTS: At the end of the study, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) titer, and percentage of maximum radiological score at baseline were significantly associated with RA severity (p < 0.01, p < 0.01, p < 0.05, respectively). Extension of RA to large joints was related to a higher ESR (p < 0.001) and a lower hemoglobin level (p < 0.01) at baseline. Neither at entry nor at the end of the study was the RA shared epitope predictive for radiologic severity or extension of disease to large joints (p = 0.8, p = 0.3, respectively). CONCLUSION: Presence of the SE in patients with RA is not a good prognostic marker of radiological severity after a mean followup period of 9 years.
9454312 [Treatment of chronic polyarthritis]. 1997 Nov 15 Rheumatoid arthritis (RA) is a chronic autoimmune disease involving progressive destruction of multiple joints and, in the later stages, significant mortality. Worldwide, 1% of the population is afflicted. Despite new insights into the autoimmune mechanisms during the last decade a cure has not been found, although pain, disability and general suffering can be alleviated via several therapeutic approaches when carefully coordinated. Early use of immunosuppressive therapy with DMARDs (disease modifying antirheumatic drugs), while avoiding their side effects, is critical for disease control. Counselling within a good doctor-patient relationship, with the additional help of physiotherapy and ergotherapy, increases the patient's capacity to cope with the disease. Hand and joint surgery, skillfully performed, decreases pain and disability. Newer strategies of immunosuppression, while encouragingly effective, are only short term. These experimental agents are more expensive, they are associated with side effects and their future place in RA therapy has yet to be defined.
10803748 Pathogenesis of bone erosions in rheumatoid arthritis. 2000 May Patients with rheumatoid arthritis are at risk for the development of a generalized form of bone loss affecting the axial and appendicular skeleton. In addition, juxta-articular osteopenia and focal erosion of marginal and subchondral bone are commonly seen. The pathogenesis of focal bone erosions is an area of active investigation. Studies of tissue sections from sites of bone erosion in rheumatoid arthritis and in animal models of inflammatory arthritis have identified multinucleated cells with the phenotype of osteoclasts in bone resorption lacunae in these sites, suggesting that osteoclasts mediate a component of this pathologic bone loss. Numerous soluble and cell-membrane factors produced by rheumatoid synovial tissues are likely to play a role in the initiation and progression of bone erosions. In addition, recent studies suggest a role for T lymphocytes and their products in osteoclast-mediated bone loss. This paper reviews the cellular mechanisms and factors implicated in bone erosions in rheumatoid arthritis, and discusses the possible therapeutic strategies suggested by these findings.
11062604 Acute-phase serum amyloid A production by rheumatoid arthritis synovial tissue. 2000 Acute-phase serum amyloid A (A-SAA) is a major component of the acute-phase response. A sustained acute-phase response in rheumatoid arthritis (RA) is associated with increased joint damage. A-SAA mRNA expression was confirmed in all samples obtained from patients with RA, but not in normal synovium. A-SAA mRNA expression was also demonstrated in cultured RA synoviocytes. A-SAA protein was identified in the supernatants of primary synoviocyte cultures, and its expression colocalized with sites of macrophage accumulation and with some vascular endothelial cells. It is concluded that A-SAA is produced by inflamed RA synovial tissue. The known association between the acute-phase response and progressive joint damage may be the direct result of synovial A-SAA-induced effects on cartilage degradation.
9578104 Arthrodesis of the ankle secondary to replacement. 1998 Apr One hundred total ankle arthroplasties were performed in our department between 1974 and 1994, and of these, 21 have been reoperated on with arthrodesis due to septic or nonseptic failures after 6 months to 15 years (median 40 months). Immobilization using a Hoffman external fixator was the dominating method. The total ankles were of six different designs. Sixteen of the 21 patients suffered from rheumatoid arthritis. Four of the 21 ankles did not fuse whereas 17 did: 13 at the first attempt and 4 after repeat arthrodesis. At the time of the review, two patients had died. Of the remaining 15 patients whose ankles had fused, all but one were satisfied or somewhat satisfied with the result. Twelve of these 15 ankles rated excellent or good according to the Mazur and Kofoed scoring systems. We conclude that arthrodesis can be performed successfully after a failed ankle arthroplasty.
10990222 The role of life events and childhood experiences in the development of rheumatoid arthrit 2000 Sep OBJECTIVE: To evaluate the role of stressful life events, including negative childhood experiences on the development of rheumatoid arthritis (RA). METHODS: Retrospective, community based, case-control study founded upon 116 cases, aged 45 to 74 years, registered with the Norfolk Arthritis Register (NOAR), who were also participants in the Norfolk European Prospective Investigation of Cancer study (EPIC). Three controls, matched for age and sex, were selected for each of the cases from among EPIC participants not suffering from arthritis. Data on adverse experiences during childhood and adulthood were available from a self-report questionnaire. The 1987 American Rheumatism Association (ARA) criteria for RA were met by 55 NOAR cases and this subset provided the primary focus for analysis. RESULTS: The number and timing of occurrence of stressful life events, as well as their subjective immediate impact, did not differ between participants who developed RA and their matched controls. Termination of pregnancy was the only specific event individually associated with a higher risk of developing RA (OR 3.74; 95% CI 1.4-9.9). Negative childhood experiences were not associated with the risk of RA. However, RA cases reported significantly slower adaptation to the effects of adverse events than controls. CONCLUSION: The results of this study do not support the hypothesis that the rate of exposure or reported impact of stressful life events and of adverse childhood experiences play an etiologic role in the development of RA.
11552603 [Combination therapy in rheumatoid arthritis]. 1999 Rheumatoid arthritis is progressive systemic disorder with poor outcomes. Better recognizing of the disease patophysiology resulted in changing therapeutic approaches in DMARDs treatment and creating new drugs. Combined therapy is accepted worldwide in the last 10 years. The rationale for combined treatment is that different drugs with different mechanisms of action can affect different disease pathways to achieve better outcomes.
9608322 Are autoantibodies active players or epiphenomena? 1998 May Autoantibodies have the potential of pathogenicity in several diseases. In rheumatoid arthritis (RA), however, this has not been ultimately proven. RA is characterized by a variety of autoantibodies. Newer insights into characteristics of rheumatoid factors indirectly suggest their pathogenetic involvement. In contrast, antibodies to collagen, despite the availability of an experimental model, do not appear to be pathogenetic in man. Anti-hnRNP antibodies, particularly anti-A2/RA33, are present in RA and experimental models of RA, and therefore, aside from their diagnostic value in established and early RA, could also be involved in the disease process. The nature of Sa, another target antigen in RA, has not yet been elucidated. Filaggrin is the antigen recognized by antikeratin antibodies and antiperinuclear factor; however, citrullin is the target amino acid in filaggrin, and anticitrullin antibodies have a high predictive value. Among a series of cartilage proteins, most have not yet been characterized sufficiently; one, gp39, appears to be of particular interest. Whether or not these antibodies are involved in RA pathogenesis is not yet known. It can be speculated that autoimmunity to some, if not all, of these autoantigens mirrors events important in the development of RA, but further studies on T-cell reactivities and in experimental models are needed to fully understand the involvement.
10198988 [RS3PE-syndrome]. 1999 Feb The RS3PE syndrome (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) is a manifestation of rheumatoid arthritis in the elderly with a good prognosis. It usually presents as an acute, symmetric polysynovitis with edema of the dorsum of the hands and feet. Anti-inflammatory treatment with corticosteroids leads to prompt improvement. We describe the case of an 81 year old man with a primarily unilateral manifestation involving the right hand. A thrombosis of the axillary vein was suspected. Within a few days he developed a pitting edema of the dorsum of the other hand. Movement of both shoulders and wrists was painful. Low-dose corticosteroid therapy resulted in a rapid improvement of the edema and the inflammatory symptoms.
11762934 Long-term morbidity, mortality, and economics of rheumatoid arthritis. 2001 Dec OBJECTIVE: To estimate the morbidity, mortality, and lifetime costs of care for rheumatoid arthritis (RA). METHODS: We developed a Markov model based on the Arthritis, Rheumatism, and Aging Medical Information System Post-Marketing Surveillance Program cohort, involving 4,258 consecutively enrolled RA patients who were followed up for 17,085 patient-years. Markov states of health were based on drug treatment and Health Assessment Questionnaire scores. Costs were based on resource utilization, and utilities were based on visual analog scale-based general health scores. RESULTS: The cohort had a mean age of 57 years, 76.4% were women, and the mean duration of disease was 11.8 years. Compared with a life expectancy of 22.0 years for the general population, this cohort had a life expectancy of 18.6 years and 11.3 quality-adjusted life years. Lifetime direct medical care costs were estimated to be $93,296. Higher costs were associated with higher disability scores. CONCLUSION: A Markov model can be used to estimate lifelong morbidity, mortality, and costs associated with RA, providing a context in which to consider the potential value of new therapies for the disease.
11265568 [Blockade of TNFalpha--new therapeutic principle in severe rheumatoid arthritis]. 2001 Feb 21 TNF-alpha is a proinflammatory cytokine. It has a key function in the inflammatory cascade both systemically and locally in the inflamed joints of patients affected by rheumatoid arthritis (RA). Treatment with two different "biological" drugs that block the proinflammatory capacity of TNF-alpha has recently been approved by the European drug authorities. This paper discusses experience gained in clinical trials and during the first year of treatment in Sweden using infliximab (anti-TNF-alpha monoclonal antibodies) and etanercept (recombinant TNF-alpha receptor fusion protein).
10047718 [An evaluation of efficacy of minocycline as an anti-rheumatic drug in patients with activ 1998 Dec The efficacy and safety of minocycline was investigated in Japanese patients with rheumatoid arthritis (RA) who had already received more than three disease modifying anti-rheumatic drugs (DMARDs). Minocycline was administered at 100 mg twice a day to fifteen patients with active RA. The drug efficacy was evaluated by the clinical variables including the number of painful and/or swollen joints, the duration of morning stiffness, grip strength, the erythrocyte sedimentation rate, serum concentrations of C-reactive protein, and the titer of rheumatoid factor. Three patients experienced adverse effects such as dizziness and abdominal pain or discomfort, but only one patient with abdominal pain and dizziness was discontinued. Fourteen RA patients, who had taken minocycline for at least 6 months, were subjected to the clinical evaluation. Among them, 8 patients (54%) showed a significant improvement of clinical valuables for disease activity, beginning even at 4 weeks of the therapy. The continued effects were observed in 8 patients with over 1 year-minocycline therapy. Intriguingly, an active patient with a history of multiple DMARDs-resistancy showed a marked favorable response to this drug. The present study indicates that minocycline may be an effective DMARD with highly safe performance for patients with active and refractory RA. This is the first demonstration of the benefit of minocycline in the Japanese patients.
10806902 [Arthrocentesis in rheumatology practice]. 2000 Mar 10 This study of Norwegian rheumatologists' use of intraarticular steroid injections is based on a survey among members of the Norwegian Society for Rheumatology. 79% of the members responded, i.e. 108 rheumatologists. 69 reported having used intraarticular steroid injections in any joint during the last week, a total of 637 times. There have been no previous studies on this subject in Norway. The results show that Norwegian rheumatologists consider intraarticular steroid injections a very effective treatment. Only 9% reported that they had seen side effects over the last 12 months (a total of 51 side effects), of which post-injection pain and subcutaneous atrophy were the most common. There were no reports of septic arthritis. Almost all side effects were considered not serious.
9844866 [3',5'-cAMP phosphodiesterase inhibitors in the combined treatment of patients with rheuma 1998 Aug A study was made of clinical effectiveness and mechanism of action of the inhibitor of the specific 3',5'-cAMP phosphodiesterase papaverine in a therapeutic complex of measures designed to treat RA patients involving an immunodepressive preparation free from any cytopenic effect prospidin as a basic mediator. It has been shown that the papaverine antiarthritic action is associated with its positive effects on the unspecific component of the immune-complex inflammation, viz. processes of lipid peroxidation, activity of the antioxidant system of defence as well as on the vascular tone and microcirculation. All this improves tissue metabolism, and in this way enhances efficiency of RA basic therapy.
9987961 [Early rheumatoid synovitis and its evolution]. 1998 The clinical and morphological evidence of rheumatoid synovitis of 3 months to 5 years duration was analyzed. Its early lesions were characterized by angiomatosis, vasculopathy, and proliferation of synoviocytes and fibroblasts. Protein infiltrates contained IgG and C3 complement. Herpes simplex was detected in the vessels and synoviocytes. Structural changes may be explained by immune mechanisms and by infectious agents as well. Chronic inflammation, vasculitis, and sclerosis were prevalent in late rheumatoid synovitis. Lymphoid follicles, macrophages, and endothelial proliferation can be markers for infectious persistence.
9918238 Evaluation of surgeries for rheumatoid shoulder based on the destruction pattern. 1999 Jan OBJECTIVE: To identify the optimal treatment of rheumatoid shoulder, we analyzed the clinical results of shoulder surgeries according to each type of shoulder destruction pattern. METHODS: Forty-seven shoulder surgeries for rheumatoid arthritis (18 arthroscopic synovectomies, 10 total shoulder replacements, 19 humeral head replacements) were assessed clinically and compared in regard to 5 different destruction patterns of rheumatoid shoulder (nonprogressive, arthrosis-like, erosive, collapse, and mutilating patterns). RESULTS: For nonprogressive-type shoulders, we were able to obtain both pain relief and range of motion (ROM) improvement with arthroscopic synovectomy. For erosive-type shoulders, we could obtain pain relief but no ROM improvement with synovectomy; and we obtained both pain relief and ROM improvement with prosthetic replacement. For the collapse-type shoulders, we could not obtain pain relief or ROM improvement with arthroscopic synovectomy, but did obtain pain relief with prosthetic replacement. For mutilating-type shoulders, we could obtain only pain relief with prosthetic replacement. The results of the various surgeries for rheumatoid shoulder were distinctly different depending on the shoulder destruction patterns. CONCLUSION: These findings could be of value for the selection of treatment, including a surgical procedure, for rheumatoid shoulders. For the nonprogressive-type and for erosive-type shoulders before bone destruction progresses, arthroscopic synovectomy should be selected. For erosive-type shoulders after bone destruction, for the collapse-type, and for mutilating-type shoulders, prosthetic replacement should be selected. In regard to the prosthetic replacement, the humeral component should be cemented because the incidence of migration in noncemented humeral component procedures was high.