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ID PMID Title PublicationDate abstract
9195427 Synovectomy, radial head excision, and anterior capsular release in stage III inflammatory 1997 Mar A retrospective study was performed to analyze the results of elbow synovectomy, radial head excision, and anterior capsular release in 12 elbows in 11 patients with radiographic stage III inflammatory arthritis. The follow-up period averaged 6.1 years. Average flexion arc improved from 93 degrees (range, 80 degrees-110 degrees) to 116 degrees (range, 65 degrees-140 degrees), with flexion contracture improving 13 degrees. Total arc of forearm rotation increased from 95 degrees to 145 degrees. Ewald scores improved from an average of 37 to 84 points. Pain was eliminated or improved in all cases; functional improvement was noted in all patients. Serial postoperative radiographs showed no significant disease progression over time. These results suggest that combined synovectomy, radial head excision, and anterior capsular release effectively relieves pain and improves function in stage III inflammatory arthritis of the elbow.
11550963 Power Doppler ultrasound assessment of rheumatoid hand synovitis. 2001 Sep OBJECTIVE: To evaluate power Doppler ultrasound (PD) as a technique in assessing response to treatment with steroids in rheumatoid hand synovitis. METHODS: Twelve patients with rheumatoid hand synovitis were assessed before and after treatment with steroids. Variables used to assess synovitis activity in each patient included patient visual analog scale (VAS) score for pain, physician assessment score (PAS), erythrocyte sedimentation rate (ESR), and PD of the metacarpophalangeal joints. RESULTS: Nine female and 3 male patients were studied; mean age was 53.3+/-6.5 yrs and mean disease duration 6.5+/-4.5 yrs. All patients had a good clinical response to steroid treatment and there was a significant improvement in the synovitis activity assessments. Wilcoxon signed-rank test using the exact method was applied to the change in disease activity variables. For PD signal, p < 0.002; VAS, p < 0.0016; ESR, p < 0.031; PAS, p < 0.008. CONCLUSION: PD quantifies synovitis and may be a useful adjunct to disease assessment and the response to treatment in RA.
10190599 Long-term functional results of wrist arthrodesis in rheumatoid arthritis. 1999 Feb The purpose of this study was to evaluate the long-term effectiveness of wrist fusion on the relief of pain and also the functional capacities of the upper limbs in patients with rheumatoid arthritis (RA). Eighteen patients were assessed at a mean of 7 years after wrist arthrodesis and a mean of 17 years after the onset of RA. Radiological measurements, pain assessment and impairment rating of the upper limbs were made of the fused and non-fused sides. The average position of arthrodesis was 8 degrees of extension and 9 degrees of ulnar deviation. All patients were pleased with the procedure and had satisfactory pain relief. Impairment ratings did not detect any significant difference in the sensory and motor function of the hand when the fused and non-fused groups were compared. We conclude that in patients with rheumatoid arthritis, wrist arthrodesis is a reliable procedure that provides predictable pain relief and a high degree of satisfaction without additional functional loss in the upper limb.
9232436 Effect of a CC chemokine receptor antagonist on collagen induced arthritis in DBA/1 mice. 1997 Jun 1 Chemokines are small proteins that selectively activate and recruit leukocytes to sites of inflammation. Several of them, including the CC chemokines RANTES, MIP-1 alpha, MIP-1 beta, MCP-1, and the CXC chemokines IL-8, GRO-alpha, ENA-78 have been identified in rheumatoid synovium, implicating a potential role for these molecules in rheumatoid arthritis. We have investigated the expression patterns of CC chemokine receptors in the joints of mice with collagen-induced arthritis, a model for human rheumatoid arthritis. In addition, we have investigated the incidence and severity of arthritis in mice receiving administration of MetRANTES, a modified chemokine which is a nanomolar antagonist of certain CC chemokine receptors. The mRNA expression pattern of the chemokines and their receptors in the joints of arthritic mice was investigated using reverse transcriptase-PCR and in situ hybridization. An upregulation of the CC chemokine receptors mCCR1, mCCR2; mCCR3 and mCCR5 was found in the joints from arthritic mice, compared to control animals. In addition, injections of MetRANTES reduced the incidence of disease in a dose dependent manner. Furthermore, in MetRANTES-treated mice that did develop arthritis a significantly lower severity of disease was observed compared with control animals. Our data clearly demonstrate a role for CC chemokines and their receptors in inflammatory joint destruction and support the use of chemokine receptor antagonists as potential tools to control inflammatory diseases such as rheumatoid arthritis.
9918237 Matrix metalloproteinases, tissue inhibitors of metalloproteinases, and glycosaminoglycans 1999 Jan OBJECTIVE: To investigate the correlation between synovial fluid (SF) concentrations of metalloproteinase (MMP) -2, -3, and -9, tissue inhibitors of metalloproteinases (TIMP)-1 and -2, chondroitin 4-, 6-sulfate (deltadi-C4S, deltadi-C6S), hyaluronic acid (deltadi-HA), antigenic keratan sulfate (KS), and radiologic grade in patients with rheumatoid arthritis (RA) and to assess the clinical value of these factors as disease markers. METHODS: Enzyme linked immunoassays and high performance liquid chromatography were used. SF samples were collected from 52 patients with RA. Radiographic (Larsen grade) and clinical evaluations were also done. RESULTS: There was no significant correlation between the concentrations of MMP, TIMP, and deltadi-C4S, deltadi-C6S, deltadi-HA, and antigenic KS. No significant correlations were found between the radiologic grade and the concentrations of MMP or TIMP in SF. There was a significant increase in the concentration of antigenic KS and deltadi-C6S/deltadi-C4S ratio in SF from patients with Larsen grade 2 compared to grade 5. A significant correlation between deltadi-C6S and antigenic KS concentrations in SF was observed. CONCLUSION: Although there were large variances between the samples in this study, proteoglycan metabolism in the cartilage matrix of the patients with RA might have been increased in the early phases of tissue destruction and decreased in advanced stages because of scanty cartilage tissue. The concentrations of MMP-2, -3, -9 and TIMP-1, -2 in SF did not seem to be influenced by the amount of residual cartilage.
10782810 High serum levels of pro-matrix metalloproteinase-3 are associated with greater radiograph 2000 Apr OBJECTIVE: To determine if there is a relationship between serum pro-matrix metalloproteinase-3 (proMMP-3) levels and radiographic damage in rheumatoid arthritis (RA), and to investigate whether high levels are associated with presence of the HLA-DRB1 shared epitope (SE). METHODS: Serum proMMP-3 levels were measured by ELISA on 45 RA patients with early disease and 292 with established disease. Early RA was arbitrarily defined as disease duration <3 years. Clinical and laboratory measures of disease activity and severity were obtained. Radiographic damage was assessed by scoring radiographs of the hands and feet using the method of Larsen. HLA-DRB1 typing was performed by sequence-specific oligonucleotide probing. Data were analyzed by multiple regression analysis. RESULTS: In all patients, there was a correlation (r = 0.318, p<0.0001) between serum proMMP-3 levels and Larsen scores. Other correlations were found with Health Assessment Questionnaire score (r = 0.261, p<0.0001) and C-reactive protein (CRP) (r = 0.357, p<0.0001) levels. ProMMP-3 levels were significantly higher in SE+/+ patients than in those completely lacking the SE, with the highest levels in patients carrying an HLA-DRI+/DR4+ phenotype. The greatest difference in proMMP-3 levels between SE+/+ and SE-/- patients was in those with a disease duration <3 years (381.6 vs. 71.7 ng/ml; p = 0.02). CONCLUSION: Our data indicate that there is a significant relationship between radiographic damage and serum levels of proMMP-3. As well, higher circulating levels of proMMP-3 are found in patients positive for the SE, particularly in early RA, and this may partly explain the association between the SE and more erosive disease.
10817553 Breast-feeding and postpartum relapse in women with rheumatoid and inflammatory arthritis. 2000 May OBJECTIVE: To test the hypothesis that breast-feeding increases the risk of postpartum flare in inflammatory polyarthritis. METHODS: We compared disease activity during pregnancy and at 6 months postpartum among 49 non-breast-feeders, 38 first-time breast-feeders, and 50 repeat breast-feeders. RESULTS: After we adjusted for possible confounders, including treatment, first-time breast-feeders had increased disease activity 6 months postpartum, based on self-reported symptoms, joint counts, and C-reactive protein levels. CONCLUSION: Postpartum flare may be induced by breast-feeding.
9589972 [The use of acupuncture reflexotherapy in treating patients with rheumatoid arthritis]. 1997 Nov Efficiency was studied of multi-modality treatment of rheumatoid arthritis (RA) involving acupuncture (A). Indices were assessed for the number of the inflamed joints, the joint index, duration of the morning rigidity and visual scale of pain. Combined treatment of RA using A was found to more effectively lower the values for the joint index and visual scale of pain. A conclusion was reached to the effect that A may improve results of drug treatment.
11310945 Preference for fractures and other glucocorticoid-associated adverse effects among rheumat 2001 Mar OBJECTIVE: The objective of this study was to determine rheumatoid arthritis (RA) patients' preferences for validated health state scenarios depicting glucocorticoid adverse events, predictors of these preferences, and psychometric properties of different preference techniques in this population. METHODS: Preferences were elicited by rating scale and time trade-off methods. Time trade-offs included trading current health for either time spent alive in an adverse health state for chronic conditions (time trade-off) or time spent in a sleeplike state for acute conditions (sleep trade-off). RESULTS: A total of 107 subjects with long-standing RA participated in the preference interviews. Mean preference values (rating scale/trade-off) were lowest for serious fracture adverse events, including hip fracture requiring a nursing home stay (0.55+/-0.22/0.76+/-0.36) and vertebral fracture with chronic pain (0.59+/-0.23/0.67+/-0.35), and highest for cataracts (0.84 + 0.17/0.96 0.09) and wrist fracture (0.82+/-0.18/0.81+/-0.29). Rating scales had a stronger correlation (r= 0.88) with physician ranking of scenarios than trade-off methods (r = 0.31). All methods were feasible and demonstrated good reliability, while rating scale method showed better construct validity than trade-off techniques. CONCLUSION: Relative to their current health, RA patients assigned low preference values to many glucocorticoid adverse events, particularly those associated with chronic fracture outcomes. Results varied with the preference measure used, indicating that methodological attributes of preference determinations must be considered in clinical decision making.
11357169 Interleukin-1 receptor antagonist treatment of rheumatoid arthritis patients: radiologic p 2001 Apr OBJECTIVE: The Genant/Sharp scoring method is a validated radiologic scoring system useful for diagnosing, classifying, and defining specific clinical problems associated with rheumatoid arthritis (RA). The Genant/Sharp scoring method is described, and its level of correlation with the Larsen scoring method is discussed. METHOD: The Genant/Sharp scoring system evaluates erosion, joint space narrowing (JSN), and a combination of erosion and JSN referred to as the total score. This method was used to determine change in radiographic progression during 2 consecutive 6-month intervals within a multicenter, double-blind, placebo-controlled study of recombinant human interleukin-1 receptor antagonist (IL-1ra) in patients with RA. These results were compared with the results obtained through the Larsen scoring method to determine their correlation. RESULTS: The Genant/Sharp scoring method showed a moderate correlation with the Larsen scoring method, particularly at baseline, and showed similar treatment trends in a study of IL-1ra in patients with RA. CONCLUSION: The Genant/Sharp scoring method provides an alternative to the Sharp and Larsen approaches for radiographic assessment in RA.
9791324 Using focus groups to understand arthritis patients' perceptions about unconventional ther 1998 Aug OBJECTIVE: To understand arthritis patients' use of unconventional therapies (UT). METHODS: Thirty-three rheumatoid arthritis and osteoarthritis patients followed in university clinics participated in 5 focus groups to discuss: their beliefs about arthritis and UT; UT they have used; reasons for using UT; effectiveness of UT; sources of information on UT; and communication about UT with the physician. Two investigators analyzed focus group transcripts to identify common themes. RESULTS: All patients believed arthritis to be incurable by conventional regimens or UT. Over one-half had used UT to relieve pain; cost was unimportant. Patients trusted information about UT from family, friends, and others with arthritis, but not supermarket tabloids or television commercials. Most discussed UT use with their physician, primarily to prevent interactions with prescribed treatments. Physicians' reactions ranged from ridicule to giving permission to continue using UT. CONCLUSIONS: These results provide an understanding of arthritis patients' motives for using UT and for discussing this behavior with their physician.
9632090 Pancytopenia secondary to hemophagocytic syndrome in rheumatoid arthritis treated with met 1998 Jun Hemophagocytic syndrome is an exceptional cause of pancytopenia. Its etiologies are most commonly viral or bacterial infections, lymphoproliferative syndromes, acquired or congenital immunodeficiencies, systemic diseases, or immunomodulatory treatment. We describe a patient with rheumatoid arthritis (RA) treated with methotrexate (MTX), sulfasalazine, and low dose corticosteroids, whose case was seriously complicated by the occurrence of acute febrile pancytopenia. The pancytopenia appeared secondary to hemophagocytic syndrome triggered by Escherichia coli septicemia. The evolution was marked by severe aggravation of RA, probably due to release of cytokines from macrophages (tumor necrosis factor-alpha, interleukin 6). Reintroduction of MTX (without sulfasalazine) resulted in partial remission and there was no reappearance of new hematological anomalies after 16 month followup. A knowledge of this syndrome is particularly important, since it mimics drug toxicity and other complications such as lymphoproliferative diseases.
9236671 The relationship between HLA-DRB1 alleles and disease subsets of rheumatoid arthritis in J 1997 Jun To assess the association between HLA-DRB1 and the pathogenesis of rheumatoid arthritis (RA) in the Japanese population, we typed for HLA-DRB1 alleles in 852 Japanese patients. An analysis of HLA-DRB1 allele associations was performed on the overall group and in three disease subsets of adult-onset RA, classified according to the extent of joint destruction evident on plain radiograms, i.e. least erosive subset (LES), more erosive subset (MES) and most erosive subset with mutilating disease (MUD). The Japanese RA patients with positively associated with DRB1*0101 and *0405, and negatively associated with DRB1*0701, *0802, *1302 and *1405. DRB1*0101 was associated more strongly with a milder disease subset and the relative risk (RR) was 1.9, 1.5 and 1.2 for LES, MES and MUD, respectively. On the other hand, DRB1*0405 was associated more strongly with a more severe disease subset, the RR being 1.8, 4.0 and 4.3 for LES, MES and MUD, respectively. These findings suggest that RA is a heterogeneous disease, not only clinically, but also in terms of its immunogenetic background, and that HLA-DRB1 can be a useful prognostic factor for RA.
11642500 Treatment of relapse after autologous blood stem cell transplantation for severe rheumatoi 2001 Oct There is little information about the clinical course of patients with rheumatoid arthritis (RA) who relapse after autologous blood stem cell transplantation (ASCT). We describe 6 patients with severe RA who received ASCT in 3 US centers. Duration of followup was between 24 and 42 months posttransplant. Five patients achieved major responses but relapsed 3-22 months posttransplant. Two patients with relapse improved remarkably after restarting disease modifying antirheumatic drugs (DMARD). Two patients developed a mild RA flare at 3 and 5 months posttransplant and improved spontaneously. All 4 patients who improved after an initial disease flare remained highly functional at 14-22 months posttransplant. All patients in this study were anti-tumor necrosis factor (TNF) drug naive; all received a TNF blocker as a second line posttransplant salvage therapy, but only 3 responded. Future ASCT strategies need to focus on improving the durability of the early posttransplant responses.
11145036 Reduced bone mineral density in male rheumatoid arthritis patients: frequencies and associ 2000 Dec OBJECTIVE: To examine reductions in bone mineral density (BMD) and factors associated with reduced BMD in 94 male rheumatoid arthritis (RA) registry patients ages 20-70 years. METHODS: Dual-energy x-ray absorptiometry was used to measure BMD in the anteroposterior lumbar spine at L2-LA, the femoral neck, and the total hip, and clinical data were collected. The patients were recruited from a validated county RA registry (completeness 85%) comprising 192 men ages 20-70 years. Age-specific BMD values were compared with a pooled healthy European/United States population. Bivariate and multivariate analyses were performed to determine demographic and disease-related associations with BMD and reduced bone mass (Z score of < or =1 SD below the mean value in controls). RESULTS: A statistically significant BMD reduction was found only for the oldest age group (60-70 years): 5.2% reduction in the femoral neck and 6.9% in the total hip. No BMD reduction was found at L2-L4. The proportions (95% confidence intervals) of RA patients with Z scores of < or =1 SD below control (16% expected) were 30.9% (21.6-40.2) for L2-L4, 30.8% (95% CI 21.3-40.3) for the femoral neck, and 33.0% (95% CI 23.3-42.7) for the total hip. Disease activity and severity measures were, in general, not associated with BMD or reduced bone mass. CONCLUSION: A 2-fold statistically significant increased frequency of patients with reduced bone mass (Z score of < or =1 SD below control; 16% expected) was found for both the spine and the hip. The only significant reduction in BMD by age group was for the hip in patients who were ages 60-70 years, with no reduction in L2-LA BMD. Multivariate analyses did not reveal consistent associations between reduced BMD and demographic or disease variables.
9417408 [Vitamin E in active arthroses and chronic polyarthritis. What is the value of alpha-tocop 1997 Sep 20 Known and recognized mechanisms of action of alpha-tocopherols are the grounds for the use of vitamin E in activated arthrosis or rheumatoid arthritis. This is also supported by the positive clinical results obtained in double-blind studies. On this basis, a change in the evaluation of these substances has taken place in recent years. Initially characterised as "unorthodox", "unconventional" or "additive" therapy, the term now applied tends to be "adjuvant-accepted" therapy. The results of double-blind studies and clinical empiricism support the following hyperthesis: The pathogenetic substrate "free oxygen radicals" increases quantitatively from activated arthrosis to (bland, mild) chronic polyarthritis. This could explain the graded differentiated antioxidative (or hypothetically the "central-analgesic") effects of alpha-tocopherols. While there still is no causal treatment with the alpha-tocopherols-pain alleviation and anti-inflammatory effect-are similar to those achieved with non-steroidal antiinflammatory drugs, the potency of which, however, is superior.
9881816 The etiology of rheumatoid arthritis. 1998 Aug The etiology of rheumatoid arthritis has been elusive, but it finally seems to be explained by a combination of three factors: (i) a relatively mild deficiency of cortisol, the normal adrenocortical hormone that is essential for normal immunity but which has achieved a bad reputation because of the use of excessive dosages of it or its stronger derivatives, (ii) a deficiency of dehydro-epi-androsterone (DHEA), the chief androgen produced by the human adrenal cortex but which has been little studied, and (iii) infection by organisms such as mycoplasma, which have a relatively low virulence, are difficult to culture in the laboratory, and cause inflammation and destruction of tissue in periarticular and articular areas of immunocompromised hosts. The mild adrenocortical deficiency apparently is sufficient to impair immunity, especially after stress, and permit these organisms to cause inflammatory arthritis. Further studies are necessary to determine optimum therapy, but it will probably include safe physiologic dosages of cortisol and DHEA plus antibiotic treatment of infection by mycoplasma or other causative organisms.
11096165 A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. 2000 Nov 30 BACKGROUND: Etanercept, which blocks the action of tumor necrosis factor, reduces disease activity in patients with long-standing rheumatoid arthritis. Its efficacy in reducing disease activity and preventing joint damage in patients with active early rheumatoid arthritis is unknown. METHODS: We treated 632 patients with early rheumatoid arthritis with either twice-weekly subcutaneous etanercept (10 or 25 mg) or weekly oral methotrexate (mean, 19 mg per week) for 12 months. Clinical response was defined as the percent improvement in disease activity according to the criteria of the American College of Rheumatology. Bone erosion and joint-space narrowing were measured radiographically and scored with use of the Sharp scale. On this scale, an increase of 1 point represents one new erosion or minimal narrowing. RESULTS: As compared with patients who received methotrexate, patients who received the 25-mg dose of etanercept had a more rapid rate of improvement, with significantly more patients having 20 percent, 50 percent, and 70 percent improvement in disease activity during the first six months (P<0.05). The mean increase in the erosion score during the first 6 months was 0.30 in the group assigned to receive 25 mg of etanercept and 0.68 in the methotrexate group (P= 0.001), and the respective increases during the first 12 months were 0.47 and 1.03 (P=0.002). Among patients who received the 25-mg dose of etanercept, 72 percent had no increase in the erosion score, as compared with 60 percent of patients in the methotrexate group (P=0.007). This group of patients also had fewer adverse events (P=0.02) and fewer infections (P= 0.006) than the group that was treated with methotrexate. CONCLUSIONS: As compared with oral methotrexate, subcutaneous [corrected] etanercept acted more rapidly to decrease symptoms and slow joint damage in patients with early active rheumatoid arthritis.
9579757 Education and self-care activities among persons with rheumatoid arthritis. 1998 Apr Associations between low formal education and increased morbidity and mortality have been well established among persons with rheumatoid arthritis (RA) and other conditions. This study attempted to identify a partial explanation for the association between low education and poor outcomes among persons with RA by examining self-care activities performed by persons with different levels of education. Persons with 13+ yr of education were significantly more likely to perform specific self-care activities (e.g., using a heated pool, tub, shower, OR = 2.59; using relaxation methods, OR = 3.00; using stress control methods, OR = 2.41; avoiding certain foods, OR = 1.74). The association between education and performance of self-care activities was not linear. When significant differences were noted, 13 yr of education was usually the point at which performance was significantly different than among lower education groups; individuals with 12 yr of education often exhibited lower frequencies of particular behaviors than did individuals with 9-11 yr of education. The association between higher education and performance of more self-care activities may shed light on previously described associations between education and morbidity. However, low education should not be viewed as the cause of increased morbidity and mortality, but as a proxy for a constellation of factors responsible for poor health outcomes.
11197846 [Possible pathogenesis of rheumatoid arthritis]. 2001 Jan Rheumatoid fibroblast-like synoviocytes characteristically proliferate in an anchorage-independent manner, and are deeply implicated in cartilage destruction. Our previous results showed that rheumatoid synoviocytes expressed Fas ligand and were induced apoptosis by anti-Fas antibody treatment. In addition, several transcriptional factors, such as NF kappa B and AP-1 significantly activated in rheumatoid synoviocytes. We are now clarifying the pathogenesis of RA with the method, yeast two-hybrid system as 'post genome' strategy. We recently found that several factors that related with cell differentiation highly expressed in rheumatoid synoviocytes. In this report we discuss possible pathogenesis of RA based on our recent data and application to the therapy tool against RA.