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ID PMID Title PublicationDate abstract
10321962 Association of HLA shared epitope with joint damage progression in rheumatoid arthritis. 1999 Mar A nine years prospective study was performed on 82 Spanish rheumatoid arthritis patients with a disease duration of less than two years at the study entry, in order to evaluate the role of HLA markers in the susceptibility and progression of rheumatoid arthritis. Radiological evaluation of disease severity was performed at the time of diagnosis and 9 years later. High resolution HLA-DR typing demonstrated that the presence of the shared epitope (SE) was more frequent among patients (61% vs. 31% in controls; p = 0.00003; OR = 3.48). Fourteen patients carried two SE+ HLA-DRB1 alleles (SE+/+); 36, one single allele (SE+/-) and 32 were SE negative (SE-/-). HLA-DR4 (particularly DRB1*0401 and DRB 1*0405) and HLA-DR10 were increased among patients. At study entry, the frequencies of locally severe (hands and feet) RA were more frequent among SE+/+ patients (79%) than among SE+/- (47%) and SE-/-(44%) patients (p = 0.05; RR = 1.80). After 9 years of disease these differences disappeared, whereas differences in the extent of the disease arise: 79%, 50% and 32% of SE+/+, SE+/- and SE-/- patients respectively showed large joints involvement (shoulders, elbows, hips and knees) (p = 0.01; RR = 2.44 for SE+/+ vs. SE-/-; and p = 0.04; RR = 1.81 for SE+ vs. SE-). These results suggest that the presence of the shared epitope is associated with the extent and progression of radiological joint damage in rheumatoid arthritis.
9858425 The performance of the 1987 ARA classification criteria for rheumatoid arthritis in a popu 1998 Dec OBJECTIVE: The 1987 American Rheumatism Association (ARA) criteria for rheumatoid arthritis (RA) were developed to discriminate between patients with established RA and those with another rheumatological disorder. Their ability to determine which patients presenting with early synovitis have "true" RA is not known. We evaluated whether the 1987 ARA classification criteria for RA in patients newly presenting with inflammatory polyarthritis (IP) predict persistent, disabling, or erosive arthritis. METHODS: We studied 486 patients with early IP referred to the Norfolk Arthritis Register. The 1987 ARA criteria were applied at baseline, and assessed for their ability to identify (1) patients referred to hospital for whom the diagnosis of RA was recorded by the hospital physician; (2) patients at 3 years with (a) persistent synovitis; (b) moderate or greater disability; and (c) erosions. RESULTS: At baseline, 323 (67%) patients satisfied the ARA criteria in the classification tree format. Exactly 50% of those referred to hospital were given a diagnosis of RA. By 3 years, 76% of the 486 patients had persistent disease, 36% had a Health Assessment Questionnaire score > or = 1, and 40% had erosions. The sensitivity of the criteria was good, ranging from 77 to 87% depending on the outcome. The specificities were poor, and thus the overall discriminatory ability showed little improvement over random probability. CONCLUSION: . Among patients newly presenting with IP, the 1987 ARA criteria for RA had a low ability to discriminate between patients who developed persistent, disabling, or erosive disease and those who did not. Alternative criteria are required for studies investigating early RA.
11777140 The supratrochlear lymph nodes: their diagnostic significance in a swollen elbow joint. 2001 Nov In the differential diagnosis of a swollen elbow, the palpation of the supratrochlear glands is useful. They are not enlarged in a traumatic elbow joint. They are enlarged, discrete and shotty in rheumatoid arthritis. In tuberculosis, they are enlarged, matted and they may caseate and form a cold abscess on the medial aspect of the supratrochlear region of the arm.
10665742 Bone mineral density of the lumbar spine in patients with advanced rheumatoid arthritis. I 1999 We investigated factors that are related to generalized osteoporosis in advanced rheumatoid arthritis (RA). In this cross-sectional study we measured trabecular bone mineral density (BMD), by quantitative computerized tomography (QCT), in the lumbar spine of 57 patients with RA, most of whom were premenopausal women. In our material, 27 out of 57 patients (47%) had BMD <-1 SD expressed as Z-score and five patients had suffered from fractures. Our study shows that a cumulative corticosteroid dose (r = -0.41, p<0.010) and functional impairment (r = -0.37, p<0.050) were negatively related to spinal BMD, while daily intake of calcium correlated positively on BMD (r = 0.37, p<0.010). Our results indicate that low BMD is common in patients with advanced RA and it is associated with long-term corticosteroid use. Thus, in clinical practice we have to consider the benefits and harms of corticosteroid treatment and preventive therapy to osteoporosis.
9666414 Mechanism of action of leflunomide in rheumatoid arthritis. 1998 Jul Leflunomide, a novel drug with proven efficacy in rheumatoid arthritis, is an isoxazol derivative structurally unrelated to other immunomodulatory drugs. Leflunomide is rapidly metabolized to its active form, A77 1726. Two mechanisms of action have been identified for A77 1726: inhibition of dihydroorotate dehydrogenase (DHODH) and inhibition of tyrosine kinases. DHODH inhibition occurs at lower concentrations of A77 1726 than that of tyrosine kinases and is currently considered the major mode of action. Stimulated lymphocytes must increase ribonucleotide levels from 8 to 16-fold before proceeding from the G1 into the S phase. Increased levels of ribonucleotides can only be met by de novo ribonucleotide synthesis. At low levels of ribonucleotides, p53, a "sensor" molecule, gets activated and prevents progression through the cell cycle. Therefore, an inhibitor of de novo uridine monophosphate synthesis would predictably arrest stimulated cells at the G1 phase. In support of this mechanism of action, in vitro mitogen stimulated human peripheral blood lymphocytes treated with A77 1726 undergo arrest at the G1 phase; this inhibition is reversed by uridine.
15359511 Immune profile and thyroid function in patients with rheumatoid arthritis. 2000 Thyroid autoantibodies and thyroid function were studied in 175 patients with rheumatoid arthritis (ARA criteria, 1987). The study included 149 women and 26 men aged (54.7 +/- 13.1) all treated in the Clinic of Rheumatology, Higher Medical Institute, Plovdiv. A control group comprising 72 healthy subjects (aged 51.2 +/- 3.2) was used. Rheumatoid factor (RF) (latex agglutination test and Waaler-Rose test), antithyroglobulin (TAT) and antimicrosomal antibodies (MAT), thyroid stimulating hormone (TSH) and the free fraction of thyroxine (FT4) were measured. 69.7% of all patients tested positive for RF by the latex test and 64.5% by the Waaler-Rose test. TAT was found in 55 (31.4%), MAT in 26 (14.8%) from all the examined, which is significantly greater in comparison with the controls (p < 0.05). The thyroid gland was in a euthyroid state in most of the RA patients although MAT and/or TAT were detected in them. The results suggest existence of two autoimmune diseases - rheumatoid arthritis and Hashimoto's thyroiditis and raise the question of whether they are not manifestations of a single autoimmune disease with different body organ localisation.
11296456 [A multicenter cross-sectional study on the Health Related Quality of Life of patients wit 2001 Feb OBJECTIVE: A multicenter cross-sectional survey was conducted to study the current status of Health Related Quality of Life (HRQL) of Japanese patients with rheumatoid arthritis using a revised Japanese version of the AIMS 2, to investigate the association among the self-report physical disability scores and demographic, socioeconomic, and clinical variables in these patients. METHODS: A Japanese version of the AIMS 2 was administered to the randomly chosen 1614 patients with classical and definite rheumatoid arthritis attending arthritis clinics at eleven hospitals across the country. Self-report functional disability scores (FDSs) were calculated, by which patients were classified into five groups with graded levels of disability. Univariate correlations were examined between FDSs and the scores of the other four components of AIMS-HRQL, disease duration, age, medical costs, and physical and laboratory measures. Analysis of variance was performed to test for among level differences of these variables in each group of patients. Mean values and standard deviations of FDSs were calculated and analysis of variance was used to test for among level differences of the following factors: demographic, socio-economic, clinical measures, and treatment status. RESULTS: Among four scales composing the AIMS 2-HRQL, work disability scores were most strongly correlated with FDSs, followed by the scores of pain, affection and social interaction. The more severely disabled group proved to have weaker grip strength, higher joint count, longer disease duration, higher ESR and blood level of CRP, and lower level of Hb. Patients with more disabilities proved to be older, pay more medical costs, have longer duration of morning stiffness, and higher level of RF. Patients with more advanced Steinbrocker's functional class, doctor's global assessment, Steinbrocker's anatomical stage, higher daily dose of prednisolone intake, lower level of annual income and formal education, and patients taking more kinds of NSAIDs proved to be more severely disabled. Separate, single (never married, widowed), and divorced patients proved to be more severely disabled compared with married ones. Overall, females were more disabled than males. CONCLUSION: Physical disability is associated with the other important aspects of QOL, clinical signs and symptoms, and socio-economic conditions in RA patients. Prevention and management of physical disability should be seriously planned in consideration of the changes in these conditions in RA patients.
11642509 Peripheral blood stem cell transplantation for rheumatoid arthritis--Australian experience 2001 Oct Trials of high dose immunosuppression and peripheral blood stem cell transplantation (PBSCT) in patients with severe rheumatoid arthritis (RA) have now commenced based on encouraging data from case reports of patients with coexistent malignancy and animal transplant models. Early case reports in Australia documented the potential for cure of RA in most patients receiving allogeneic or syngeneic transplants. However, the relatively high morbidity and mortality of these procedures has necessitated the use of autologous PBSCT. in accordance with international guidelines released by the EBMT/EULAR working party. Phase I trials in autologous PBSCT have seen substantial remissions of RA in the majority of patients who had previously failed all available therapies. Recurrence of disease occurs in most patients usually within 2 years; however, the use of disease modifying agents after recurrence results in substantial amelioration of the disease, again suggesting a form of "immunomodulation." This observation raises the possibility of maintenance therapy associated with procedure to prolong responses. Other modifications of the procedure are discussed, including T cell depletion of the graft, currently the subject of a randomized trial.
11324786 Adaptation into Danish of the Stanford Health Assessment Questionnaire (HAQ) and the Rheum 2001 OBJECTIVES: The study was designed to adapt the Stanford Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) for use in Denmark. METHOD: The instruments were translated into Danish and then field-tested with 10 RA patients for relevance, and face and content validity. Reliability and validity were assessed by administering the new measures and a comparator instrument (the Danish Nottingham Health Profile) to 80 RA patients on two occasions. RESULTS: Patients found both measures acceptable and easy to complete. They had good test-retest reliability (>0.90) and internal consistency and were both able to discriminate between groups with different levels of functional status and self-perceived severity. When compared with the NHP sections, both measures showed expected convergence and divergence. CONCLUSION: Given the excellent psychometric properties of the Danish versions of the RAQoL and HAQ, both are recommended for inclusion in clinical trials and studies.
11211795 Colchicine treatment in a patient with neutrophilic dermatosis associated with rheumatoid 2000 Dec Neutrophilic dermatoses (ND) are characterized by epidermal and dermal infiltrates of polymorphonuclear leukocytes (PMN), without any infectious or other detectable agents as a cause. We describe a case of ND, which very rapidly improved upon colchicine treatment. The patient was a 67-year-old female with an 8-month history of dusky-red, tender, swollen plaques and nodules with superimposed vesicles and bullae on the buttocks, hands, and ankles associated with rheumatoid arthritis. The diagnosis of ND was made on the basis of the clinical and histopathological features of the skin lesions. She was treated with 0.6 mg of oral colchicine twice daily. Within one week, the erythematous plaques and arthralgia began to recede and disappeared within four weeks. In our case, colchicine seemed to improve the signs and symptoms of ND and appeared to be more effective than the other drugs we had used.
9619885 Knowledge in patients with rheumatoid arthritis: a longer term follow-up of a randomized c 1998 Apr Despite the wide availability of disease-related leaflets, their impact on patients' knowledge and well-being has rarely been evaluated. A randomized controlled study of a 'Rheumatoid Arthritis' leaflet revealed increased knowledge among the intervention group after 3 weeks. In addition, the leaflet was viewed as a source of reassurance. The purpose of the follow-up study was to determine whether the increase in knowledge was maintained in the longer term and to examine psychological well-being. Eighty-four patients (42 intervention and 42 control) completed the 6 month follow-up. There were no significant changes (P > 0.01) in mean outcome measures over the period 3 weeks-6 months for either the intervention or control groups. Patients in the intervention group retained the increase in knowledge observed at 3 weeks. Moreover, there was no evidence of adverse reactions to the leaflet in terms of psychological distress. Leaflets can be effective in promoting longer term increases in knowledge.
9588732 The influence of sex on the phenotype of rheumatoid arthritis. 1998 May OBJECTIVE: To explore whether there are different disease patterns of rheumatoid arthritis (RA) in women and men. METHODS: We studied 55 male case patients and 110 female control patients who developed RA between 1970 and 1985 and who resided and received medical care in Olmsted County, Minnesota, for at least 10 years after the diagnosis of RA. Case and control patients were matched for the date of first diagnosis. The pattern and extent of joint involvement, the frequency of joint surgeries, and the presence and type of extraarticular manifestations were determined by retrospective chart review. RESULTS: Incidence rates in women were variable and age dependent, whereas the risk in men older than 36 years was constant over their lifetime. Erosive disease was more frequent in men than in women (72% versus 55%, respectively; P < 0.05) and tended to occur earlier (47% versus 31% for erosive disease within the first 4 years of RA). Although male sex was correlated with a higher risk of bony erosions and an accelerated course of RA, structural consequences of joint destruction were more pronounced in women. Joint surgery was performed more frequently in women (50%) than in men (27%) (P = 0.01). In particular, the frequencies of arthroplasties and arthrodeses of hand and foot joints were different (34 procedures in women versus 1 procedure in men; P < 0.001). Sex influenced the risk as well as the pattern of organ involvement in RA. Nodules and rheumatoid lung disease were typical manifestations in men (P = 0.001 and P < 0.001, respectively), whereas women typically developed sicca syndrome (P = 0.05). Despite differences in disease aggressiveness and disease pattern, there was little difference in the medical therapy in the men compared with the women. CONCLUSION: RA is a heterogeneous disease with variations in phenotype. Sex-associated factors influence disease severity as well as disease pattern. Because sex-related effects influence treatment goals, treatment responses, and side effects, they should be considered in clinical study design and analysis as well as in the treatment decisions for individual patients with RA.
9599518 [Reconstructive joint surgery and rheumatoid arthritis. Status over a developing field]. 1998 Apr 6 Rheumatoid arthritis has a prevalence of between 1% and 2%. The majority of patients face the prospect of surgical treatment of joints, that do not respond to medical treatment. With respect to the extensive development in joint surgery during the last decade, today's recommendations for surgical treatment of the individual joints are surveyed.
10774855 Cementless cup supporter for protrusio acetabuli in patients with rheumatoid arthritis. 2000 The MC cup supporter is an acetabular reinforcement ring for the Harris-Galante (HG) cementless porous-coated socket. This supporting ring has been used with autogenous bone graft since 1991 in the management of protrusio acetabuli in patients with rheumatoid arthritis (RA). We have reviewed 15 hips in 13 patients at an average of 53.6 months (range 24-84 months) after operation. The clinical results of total hip arthroplasty (THA) in protrusio acetabuli using this ring were satisfactory. All grafts appeared to have united radiologically with no radiolucent lines between graft and acetabulum.
11371665 Evaluation of functional ability of Thai patients with rheumatoid arthritis by the use of 2001 May METHODS: The Health Assessment Questionnaire (HAQ) was translated into Thai and its validity and applicability were assessed in 22 Thai patients with active rheumatoid arthritis (RA) before and after 6 months of treatment with disease-modifying anti-rheumatic drugs (DMARDs). The activities in three subcategories of the Thai HAQ were modified, including Eating, Hygiene and ACTIVITIES: Two common activities in Thai people were incorporated into the items in the Grip and Arising domains. RESULTS: Significant improvements in mean HAQ scores and other parameters were observed after DMARD therapy. Mean HAQ scores correlated significantly with tender joint count, patient global and physician global assessments, and grip strength. CONCLUSIONS: The Thai HAQ met validity requirements and can be used in the measurement of functional capacity of Thai RA patients.
9831320 Clinical and basic studies on the G-1 column, a new extracorporeal therapeutic device effe 1998 Oct The G-1 column, which is filled with cellulose acetate spherical beads of 2 mm diameter, is a new type of extracorporeal perfusion device originally designed to remove granulocytes from the venous circulation of patients with rheumatoid arthritis. A dramatic improvement in clinical symptoms was seen after treatment with the G-1 column in two successive clinical trials. Early effects include pain relief, reduction in the swollen joints, and a continued decrease in inflammation as a late effect. The results were further confirmed in the adjuvant arthritic rat model. G-1 beads adsorb some amounts of platelets at the beginning and then about a quarter of circulating neutrophils, monocytes, natural killer cells, and B cells, but not T cells. Various factors released from blood cells during transit through the column must have influenced the cells including lymphocytes which passed through the column. G-column actually eliminates some parts of aggressive leukocytes, but a more interesting story is the modification of blood components, which occurred in the G-1 column, and when returned to the patients, may have ameliorated the unbalanced homeostatic network and induced acceleration of healing.
10741496 Are magnetic resonance flexion views useful in evaluating the cervical spine of patients w 2000 Feb OBJECTIVE: To determine whether MR imaging in flexion adds value relative to imaging in the neutral position with respect to displaying involvement of the subarachnoid space, brainstem and spinal cord. DESIGN AND PATIENTS: T1-weighted MR images of the cervical spine in 42 rheumatoid arthritis patients with cervical spine involvement were obtained and analyzed prospectively. We assessed changes between images obtained in the neutral position and following active flexion, especially horizontal atlantoaxial and subaxial motion, presence or absence of brainstem compression, subarachnoid space involvement at the atlantoaxial and subaxial level and the cervicomedullary angle. Vertical atlantoaxial subluxation and the amount of pannus were correlated with motion and change in subarachnoid space. RESULTS: The flexion images showed horizontal atlantoaxial motion in 21 patients and subaxial motion in one patient. The flexion view displayed brainstem compression in only one patient. Involvement of the subarachnoid space increased at the atlantoaxial level in eight (19%) patients (P=0.004) and at the level below C2 in five (12%) patients (P=0.03). There were no patients with a normal subarachnoid space in neutral position and compression in the flexed position. The cervicomedullary angle changed significantly with flexion. Vertical atlantoaxial subluxation and the amount of pannus did not show a significant correlation with motion or subarachnoid space involvement. CONCLUSION: MR imaging in the flexed position shows a statistically significant narrowing of the subarachnoid space at the atlantoaxial level and below C2. Cord compression is only observed on flexion views if the subarachnoid space in neutral position is already decreased. MR imaging in the flexed position might be useful, since subarachnoid space involvement may be an indicator for the development of neurologic dysfunction.
10657501 Exercise and variations in neuropeptide concentrations in rheumatoid arthritis. 1999 Aug The aim of the present study was to investigate the influence of an exercise program on neuropeptide concentrations, disease activity, impairments and disabilities in rheumatoid arthritis (RA). Eleven females (median age 60 years, median disease duration 6.5 years, ARA functional classes I or II) exercised 30 min daily for 4 weeks. The urine concentrations of calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) and neuropeptide Y-like immunoreactivity (NPY-LI) were analyzed 1 week prior to exercise start, at exercise start, after 2 and 4 weeks of exercise, and after a 4-week follow-up period. Measurements of disease activity, aerobic capacity, grip force, limb muscle function, and activities of daily living (ADL) were also undertaken. The results indicate a decrease (md 5.64 pM to md 3.48 pM, P
10399224 [Changes in the acid-base status of the synovial fluid in rheumatoid arthritis patients]. 1999 AIM: The study of changes in joint fluid (JF) acid-base balance in RA patients to evaluate severity of joint lesions, efficacy of on-going therapy and to predict appearance and persistence of RA remission. MATERIALS AND METHODS: A routine examination and measurements of JF pH of the affected joints and venous blood before and during the treatment were performed in 65 RA patients with articular or articular-visceral forms (46 and 19 patients, respectively). 19 patients were seropositive and 20 seronegative by rheumatoid factor. A group of 17 patients suffering from osteoarthritis deformans with synovitis served control. RESULTS: Inflammation in RA is running with lowering of JF pH in the affected joints and with acidic shift in the acid-base balance manifesting as compensated metabolic acidosis in blood. JF pH of the affected joints inversely correlated with activity of the inflammation. Its changes were more pronounced in RA systemic lesions and in the seropositive variant. CONCLUSION: JF pH may be used for assessment of inflammation activity in RA.
11206342 Proteus IgG antibodies and C-reactive protein in English, Norwegian and Spanish patients w 1999 The distribution of Proteus antibody levels was compared in English, Norwegian and Spanish patients with rheumatoid arthritis (RA). Using an indirect immunofluorescence method, the IgG antibody titre against Proteus mirabilis was measured in the sera of 27 English, 53 Norwegian and 34 Spanish patients with RA and divided into active and inactive disease groups according to the serum C-reactive protein (CRP) level (> or = 10 mg/l). Serum samples were also collected from 25 English, 30 Norwegian and 14 Spanish healthy individuals who served as controls. The levels of Proteus IgG antibodies were significantly higher in the sera of active RA patients (p<0.001) when compared with the corresponding healthy controls, whether these groups belonged to the English, Norwegian or Spanish populations. Furthermore, active RA patients from each country showed significantly higher levels of Proteus antibodies when compared with inactive English (p<0.01), Norwegian (p<0.001) or Spanish (p<0.001) RA patients. Finally, a significant correlation was observed between Proteus IgG antibody levels and the CRP concentrations in RA patients whether each population was tested individually or all together (p<0.001). The increased levels of Proteus antibodies in RA patients from three different European countries support the concept of a possible aetiopathogenetic role for Proteus microorganisms in the development of RA.