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ID PMID Title PublicationDate abstract
9785391 Prospective study of the prevalence of bronchiectasis in rheumatoid arthritis using high-r 1998 Jul A prospective study of the prevalence of bronchiectasis in rheumatoid arthritis was conducted over an 18-month period in 46 patients (34 women and 12 men with a mean age of 60.1 years) meeting 1987 American College of Rheumatology criteria for rheumatoid arthritis. All patients underwent high-resolution computed tomography of the chest, whose results were confronted with a number of clinical, laboratory test and lung function testing parameters. Bronchiectasis or bronchiolectasis was found in 23 patients (50%) and was the most common abnormality detected by high-resolution computed tomography. When the four patients with isolated bronchiolectasis were excluded, the prevalence was 41%. Eighteen of the 23 patients had not been diagnosed with bronchiectasis before the study and 13 were free of respiratory symptoms. No significant differences were found between the 23 patients with and the 23 patients without bronchiectasis for age at onset or duration of the rheumatoid arthritis, extraarticular involvement, positive rheumatoid factors, bony erosions, use of corticosteroids or immunosuppressives, respiratory manifestations, smoking, or spirometry parameters. Patients without bronchiectasis were more likely to have impaired diffusion of carbon monoxide across the alveolar-capillary membrane. Among the patients with bronchiectasis, those with respiratory symptoms (n = 10) were more likely to have a history of lung disease and those without respiratory symptoms (n = 13) were more likely to have a diagnosis of bronchiectasis secondary to rheumatoid arthritis; no other differences were found between these two subgroups. Routine use of high-resolution computed tomography, a technique capable of demonstrating silent bronchiectasis, showed that bronchiectasis was the most common lung change in rheumatoid arthritis in our study. At the time of the study, there was no evidence that presence of bronchiectasis was associated with more severe joint or lung symptoms.
10646488 Management of refractory rheumatoid arthritis. 1999 Nov Based on the results of a MEDLINE search (1992-1997), the term 'refractory rheumatoid arthritis' (refractory RA) is ill-defined, in terms of both patient characterization and description of previous treatments. Current strategies of management of refractory RA include increasing disease-modifying anti-rheumatic drug dosage above standard dosage regimens, using combination therapy, and adding or increasing the dosage of corticosteroids. Options for further strategies include target-oriented biological agents (e.g. anti-tumour necrosis factor), gene therapy, stem-cell treatment and oral tolerance induction.
9196870 The impact of life events on patients with rheumatoid arthritis: a psychological myth? 1997 Mar OBJECTIVE AND METHODS: A large number of studies from the field of "psychorheumatology" have investigated the relationship between critical life events and disease parameters with varying results. In the present study 48 patients with rheumatoid arthritis (RA) (mean age 57.8; range 32-78 years) were questioned about life events within the past two years using an "inventory for assessing life change events"-ILE (1). In contrast to previous studies, this inventory not only assesses the number of life events, but also captures the extent of subjectively experienced stress caused by these events. Since psychosocial factors such as social support and coping strategies influence subjectively experienced stress, these factors were taken into consideration for the definition of "life event". Furthermore, a series of objective medical parameters as well as the patient's and the physician's subjective impression of disease activity were assessed. RESULTS: The results show that patients with RA in the earlier stages of the disease cannot be differentiated from severely affected patients in later stages on the basis of life event parameters. In addition, no differences in the life event data could be observed between patients with and those without subjectively experienced episodes of illness in the two years immediately preceding the study. CONCLUSION: Our results suggest that the course of RA is influenced neither by the number of life events nor by the extent of stress caused by these life events. Therefore, the role of life events should not be overemphasized, at least as far as the disease parameters in RA is concerned.
9694068 Quantitative analysis of hyaluronan in the synovial tissues of patients with joint disorde 1998 Quantitative analysis of hyaluronan (hyaluronic acid; HA) in the synovial tissues of patients with joint disorders were performed. HA was found not only in the synovial intimal cells and matrices, but also especially in the alveolar lymphoid follicles and connective tissues surrounding blood vessels in the inflammatory granular synovium which formed the pannus. HA levels in the synovium of patients with rheumatoid arthritis (RA) (459.0+/-66.2 microg/g) where shown to be higher than those in patients with osteoarthritis (246.9+/-34.8 microg/g) and traumatic injury (227.7+/-35.4 microg/g). It follows from the present findings, HA in the synovium might contribute to the high amounts of serum levels of HA in patients with rheumatoid arthritis.
9783765 Interleukin-10 promoter polymorphisms in rheumatoid arthritis and Felty's syndrome. 1998 Sep OBJECTIVE: To examine whether promoter polymorphisms associated with variation in interleukin-10 (IL-10) production are relevant to the development of rheumatoid arthritis (RA) or Felty's syndrome (FS). METHODS: DNA was obtained from 44 FS patients, 117 RA patients and 295 controls. The promoter region between -533 and - 1120 was amplified by polymerase chain reaction, and polymorphisms detected by restriction enzyme digest or sequence-specific oligonucleotide probing. RESULTS: We found no significant difference in allele or haplotype frequencies between the groups. CONCLUSION: There is no association between FS or RA and these recently identified IL-10 promoter polymorphisms. Other genetic or environmental factors could explain the alterations in IL-10 levels seen in these conditions.
11358413 What is the natural history of rheumatoid arthritis? 2001 Mar Inflammatory polyarthritis can be a self-limiting disease, develop into rheumatoid arthritis (RA) or differentiate into another form of chronic arthritis. It remains a clinical and scientific challenge to understand the relationship between these phenotypes, determine their aetiologies and predict the course and outcome for individual patients. Even patients labelled as having RA show a wide spectrum of clinical phenotypes. Disease definition is a major problem in studying the aetiology of RA as currently used classification criteria were derived using patients with established disease. RA is thought to result from the combination of genetic susceptibility and exposure to an appropriate environmental trigger. The genetic component is probably oligogenic. The association with HLA has been known for over 25 years. RA is now thought to be associated with a conserved sequence of amino acids in a number of HLA-DRB1 alleles, called the RA shared epitope. However, the shared epitope appears to be associated with RA chronicity and severity more than with susceptibility. Other potential RA susceptibility genes include IL-1, aromatase, corticotropin-releasing hormone and a region on the X chromosome. Hormonal and reproductive factors also influence RA susceptibility and severity. RA is more common in women than men, especially before the menopause. Men may be protected by hormonal factors and require a stronger genetic component to develop disease. Although infectious triggers of RA have long been suspected, no definitive evidence has been obtained. Previous blood transfusion, smoking and obesity are also possible risk factors. Chronicity and remission are important aspects of the natural history of early RA. Although we can identify patients at risk of adverse prognosis with some accuracy, we remain unable to predict remission. Functional disability and radiological damage are the most studied outcomes in RA. Radiological damage often occurs early in the course of RA, but patients may show erosion for the first time several years after symptom onset. Many studies have demonstrated a relationship between HLA and features of severe RA in established patients. This appears to be related to gene dosage.
11503123 The influence of technique on fixation of primary total hip arthroplasty in patients with 2001 Aug This is a prospective, consecutive study of 98 total hip arthroplasties implanted by 1 surgeon in 66 patients with rheumatoid arthritis. The mean follow-up time was 7.4 years (range, 2-13 years). All 98 acetabular components were uncemented titanium fiber metal-coated components fixed with multiple screws. Sixty-five hips had bulk or cancellous allograft for protrusio acetabuli. Following a prospective protocol based on patient age, 51 hips had an uncemented femoral component, and 47 hips had a cemented femoral component. Using the Harris Hip Score, 30 hips were rated as excellent; 44, good; 15, fair; and 9, poor. There were no early deep infections. One hybrid hip was removed for late metastatic infection at 7 years. Radiographic evaluation of 98 acetabular components showed 1 case of septic loosening, 2 cases of aseptic loosening (1 patient asymptomatic), and 1 case with severe wear and ischial osteolysis. None of the 47 cemented femoral components subsided, and osteolysis was seen in only 3 femora (7%). Of the 51 uncemented femoral components, subsidence occurred in 7 hips (14%), and osteolysis occurred in 15 hips (30%). Uncemented acetabular components have a high rate of success in patients with rheumatoid arthritis who have a total hip arthroplasty. There is a high rate of subsidence and osteolysis, however, with first-generation cementless femoral components.
9676177 [Silicone breast prosthesis and rheumatoid arthritis: a new systemic disease: siliconosis. 1998 Apr Today the number of women receiving breast implants of silicone gel, for augmentation or reconstruction of the breast, is increasing. Silicon implants may cause local complications (such as capsular contracture, rupture, closed capsulotomy, gel "bleed", nodular foreign body granulomas in the capsular tissue and lymph nodes) or general symptoms. An adverse immune reaction with signs and symptoms of rheumatoid disorders is also possible, although an increased frequency of true autoimmune systemic connective tissue diseases is controversial. The US Food and Drug Administration advised that these silicone implants should be used only in reconstructive surgery and as part of clinical trials. Silicone is not an inert substance and silicone compounds were found in the blood and liver of women with silicone breast implants. The development of disease related to silicone implants would depend on genetic factors, so that only a very few women are potentially at risk. HLA-DR53 may be a marker of predisposed subjects. Breast-feeding by women with silicone implants should not be recommended for possible autoimmune disorders in the children. We report the case of an adult female patient with silicone breast implantation for bilateral mastectomy (performed 12 months before) and a unique syndrome characterized by low-grade fever, chronic fatigue, arthralgias of the hands, dysphagia, dry eye, increased level of rheumatoid factor and decreased value of complement C3 and C4. No increased erythrocyte sedimentation rate occurred, and no ANA, nDNA, ENA and AAT autoantibodies were evidence. A critical review of literature (source: MEDLINE 1980-1997) was performed and our case seems to be the first one reported in Italy. The internist should become familiar with the immunological disorders related to silicone breast implants, often so marked to require the explantation of the prostheses to improve symptomatology. However, perhaps due to the leak and spreading of silicone, the progression to a severe systemic involvement may remain despite the implant removal.
9397494 99mTc-labelled immunoglobulin scintigraphy in arthritis: an analysis of synovial fluid act 1997 Nov The distribution of 99mTc-labelled human polyclonal non-specific immunoglobulin G (HIG) in the synovial fluid was studied in 14 patients with rheumatoid and non-rheumatoid arthritides. Analysis included the determination of the total activity per ml synovial fluid 6 h post-injection (p.i.) of the tracer as well as of the protein- and cell-bound fractions. At 6 h p.i., > 60% of the injected dose remained in plasma as protein-bound radioactivity. Values in the synovial fluid ranged between 0.001 and 0.009% of the injected dose per ml. Importantly, the synovial fluid to plasma ratio was consistently < 1 (range: 0.09-0.43), which is in the range of ratios observed for endogenous proteins in vivo. Similar values were obtained in samples of synovial tissue obtained at surgery in two patients. These data are consistent with the hypothesis that labelled HIG accumulates in the extracellular fluid (both within the synovial tissue and fluid) by non-specific mechanisms (such as increased blood pool and capillary permeability) and does not equilibrate with circulating plasma proteins in accordance with basic knowledge of synovial physiology. In addition, it was found that most of the activity remained bound to the proteins in the fluid and that cell-binding occurred to a very low degree that cannot be considered an important mechanism of uptake of this radiolabelled agent in vivo. These results provide the first evidence in an in vivo human setting that radiolabelled HIG accumulates mainly by non-specific mechanisms in inflamed joints.
10763130 [Resection of the head of the ulna in patients with rheumatoid arthritis]. 2000 Jan PURPOSE: The purpose of the study was to investigate value and effect of distal ulna resection (Darrach procedure) on the wrist in rheumatoid arthritis. CLINICAL MATERIAL: From 1985 to 1995, resection of the distal ulna was performed in 47 patients (54 hands) with rheumatoid arthritis. 38 patients (6 men, 32 women, 43 hands) had an average clinical and radiological follow up of 4.7 years (range 3 to 13 years). RESULTS: 15 of the cases with rheumatoid arthritis were pain-free, 19 complained about pain after severe stress, seven complained about pain after mild stress and two about continuous pain. 85% of the patients had a range of motion (pro- and supination) of more than 120 degrees. 75% of the patients had a good or very good wrist function. In 32 cases, the patients were absolutely satisfied with the operative outcome, in five cases, they had expected more improvement. Six reported, that there was no change due to the operation. CONCLUSION: The results demonstrate that the main indication for the resection of the distal ulna is rheumatoid arthritis. This operation does not influence the progress of rheumatoid arthritis. Preoperative radiological changes (Larsen's classification) have the main prognostic value. In Larsen's II and higher, a partial arthrodesis is recommended.
11771520 A method to reduce the number of measured parameters when using isokinetic muscle strength 2001 The aim of the study was to present a method enabling a reduction of the number of measurements when quantifying isokinetic muscle strength (IMS), and to describe an expression for IMS which is independent of measuring conditions. IMS is a measure of muscle strength used to categorise patients and to assess changes over time. IMS measurements involve one or several measures of peak torque at different chosen angular velocities. Comparisons between studies are difficult and an expression of IMS independent of measuring conditions is needed. Thirty-six women with rheumatoid arthritis were followed for 1 year. IMS was measured on five occasions on both knees at seven angular velocities, giving 10 sets of peak-torque data for each patient. The log[peak-torque]-angular-velocity diagram showed a linear relationship. From this, the peak-torque value at the chosen angular velocity of 30 degrees/s (IMS30) was estimated for each test and the uncertainties involved were quantified. IMS30 is a reliable parameter when comparing effort between knees, visits and patients, and may be based on three sets of data only. IMS may be expressed by a single value, IMS30, representing the fitted line in a log[peak-torque]-angular-velocity diagram. The regression line may be fitted by three or more angular velocities. In principle, IMS30 is independent of the chosen angular velocity, which makes it possible to use an estimated value as IMS30 to compare results, studies and centres in between.
11269531 Clinical significance of low titer anti-nuclear antibodies in early rheumatoid arthritis: 2001 Feb The objective of this study was to evaluate the clinical significance of anti-nuclear antibodies (ANA) detected in the early stages of rheumatoid arthritis (RA), by a retrospective comparison of the clinical, laboratory, and therapeutic characteristics of patients with or without ANA. The files of 99 longstanding seropositive RA patients were reviewed. Data relating to demographics, medical history, family history, physical findings, extra-articular complications, laboratory tests, drugs [dosage, duration. efficacy, combinations, adverse effects (AEs)], intra-articular injections, and surgery were recorded. Patients with or without ANA at presentation of their disease were compared using chi-square and t-tests. Fifty-two ANA positive (group 1) and 47 ANA negative (group 2) patients were enrolled in the study. All were comparable in terms of their mean age, age at diagnosis, follow-up duration (approximately 10.5 years), and male:female (M:F) ratio. On admission, pain complaints were more pronounced in group 1 (P = 0.004 in the feet), but the physical findings did not differ. Deformities and nodules developed in similar numbers. Extra-articular complications were evenly distributed; vasculitis, however, was significantly more prevalent in ANA positive (10/52) than in ANA negative (2/47) patients. Thyroid disease was more common in group 2 (10/47 vs 3/52). Laboratory tests (presentation and maximal values) were similar, with the exception of higher anti-DNA (but within normal ranges) and gamma-globulin% in group 1. Group 1 used more drugs prior to diagnosis. Corticosteroids and disease-modifying anti-rheumatic drugs (DMARDs) were evenly used. Combination therapy, joint injections, and surgery were more prevalent in group 2. AEs to various DMARDs were more common in group 1. Although similar in many aspects, RA patients with ANA tend to present with more pain complaints, a higher risk of vasculitis and AEs relating to use of DMARDs, while those without ANA needed more aggressive therapeutic modalities.
11396100 Rheumatoid arthritis. Treatment of early disease. 2001 May Treatment of rheumatoid arthritis (RA) is changing with the rapid increase of information on the efficacy of old and new antirheumatic agents. This article provides an opinionated review of the data currently available and makes a case for rapid and aggressive treatment of all patients with RA as early as possible. In the future, corticosteroids will be an important component of such treatment strategies.
9584365 Tibiotalar arthrodesis in the rheumatoid foot. 1998 Apr The results of 14 open ankle arthrodeses in 13 patients with rheumatoid arthritis are reviewed. Ten arthrodeses were treated with Charnley compression clamps (six of these were combined with a fibular strut graft). Three had cannulated screws and one had a fibular strut graft and a short leg walking cast. The mean followup time was 41.2 months. There were five nonunions and one delayed wound healing. The results of the patients treated with fibular strut grafts are far better than the results in patients treated with open ankle arthrodesis without grafting procedure. This seems a promising technique in a patient population with rheumatoid arthritis.
11252691 Cancer polyarthritis resembling rheumatoid arthritis as a first sign of hidden neoplasms. 2001 Recent onset arthritis reminiscent of rheumatoid arthritis (RA) may be an early manifestation of an occult malignancy. In this report, we present two patients with cancer-associated polyarthritis. Both suffered from symmetric polyarthritis when initially visiting their physicians and did not achieve relief when treated with non-steroidal anti-rheumatic drugs (NSAIDs). In both patients, subsequent work-up led to the diagnosis of an underlying malignancy. One patient suffered from small cell lung cancer (SCLC), while the other was diagnosed with adenocarcinoma of the colon. In both, the arthritis spontaneously disappeared after successful treatment of the malignancy, i.e. chemotherapy and tumor resection, respectively. We discuss these cases in view of the existing literature, since awareness of the entity of cancer polyarthritis is necessary for its timely treatment and may potentially be life-saving.
9287391 An historical review of rheumatoid arthritis treatment: 1948 to 1952. 1997 Aug OBJECTIVES: The early responses by practicing physicians to the discovery of the effect of cortisone (compound E) and adrenocorticotropic hormone (ACTH) on acute rheumatoid arthritis in 1948 and their reactions to the drugs' scarcity have been reviewed. METHODS: Review of the relevant literature in American, British, and European medical journals and some newspapers. RESULTS: Whereas the effect of the compound E and ACTH was stunning, their scarcity made them unavailable to most physicians. Nevertheless, practicing physicians took a lively interest in the new therapy, as witnessed by the large number of letters with comments and questions to professional journals from all over the world. As expected, most of these were about attempts to find a substitute for cortisone or a way to release it endogenously to a sufficient degree. A few alternative therapies were suggested too, some quite unorthodox. A lively interest was shown by the general public. CONCLUSIONS: No alternative therapy recommended to treat acute rheumatoid arthritis in lieu of cortisone proved to be effective. The era of scarcity was ended by the discovery of a more efficient method to manufacture cortisone.
11465705 Expression of hypoxia-inducible factor 1alpha by macrophages in the rheumatoid synovium: i 2001 Jul OBJECTIVE: To determine if the rheumatoid synovium is a suitable target for hypoxia-regulated gene therapy. METHODS: Sequential sections of wax-embedded synovial membrane samples were obtained from 10 patients with rheumatoid arthritis (RA), 10 with primary osteoarthritis (OA), and from 6 healthy controls. Membrane sections from each patient were immunostained for hypoxia-inducible factor 1alpha (HIF-1alpha) and CD68 (a pan-macrophage marker). RESULTS: HIF-1alpha was expressed abundantly by macrophages in most rheumatoid synovia, predominantly close to the intimal layer but also in the subintimal zone. There was markedly lower expression of HIF-1alpha in OA synovia, and it was absent from all of the healthy synovia. CONCLUSION: These observations indicate that macrophages transduced with a therapeutic gene under the control of a hypoxia-inducible promoter could be administered to RA patients systemically. Migration of these cells to synovial tissue would result in the transgene being switched on in diseased joints but not in healthy tissues.
11247859 Bone destruction, upward migration, and medialisation of rheumatoid shoulder: a 15 year fo 2001 Apr OBJECTIVE: To evaluate bone destruction, upward migration, and medialisation of the glenohumeral (GH) joint in a cohort of 74 patients with seropositive and erosive rheumatoid arthritis followed up prospectively. METHODS: At the 15 year follow up 148 shoulders were radiographed by a standard method. Bone destruction in the GH joint was examined from the radiographs by four methods, of which three measured the migration and one the remodelling of the humeral head. The distances from the greater tuberosity of the humeral head to the coracoid process (medialisation distance (MD)) and to the articular surface of the humeral head (GA) have been previously developed to evaluate the preoperative offsets of the arthritic GH joint. Medial displacement index (MI) and upward migration index (UI) have been recently developed to evaluate the destructive pattern of the rheumatoid GH joint. Destruction of the GH joints was assessed by the Larsen method on a scale of 0 to 5. The relation between the measurements and the grade of destruction of the GH joints was examined. UI was compared with our previous measurements of the subacromial space. RESULTS: Both the MI and the UI had a negative correlation with the GH joint destruction (Larsen grade), r=-0.49 (95% CI -0.36 to -0.60) and r=-0.58 (95% CI -0.46 to -0.68). The UI correlated significantly with the subacromial space, r=0.90 (95% CI 0.86 to 0.93). The mean MI and UI measurements of the non-affected joints were within the reported normal variation. The mean MD collapsed between Larsen grades 4 (83.0 mm) and 5 (65.5 mm). The morphology of the humeral head began to flatten and erode from the grade 3 onwards and medial head destruction was detected at grade 5. CONCLUSIONS: Medialisation seems to be preceded by upward migration of the humeral head, indicating rotator cuff damage. Symptomatic Larsen grade 3 shoulders should be intensively followed up by clinical and radiological means. If a total shoulder arthroplasty is considered, an orthopaedic consultation is worthwhile at a sufficiently early stage (Larsen 3 and 4), when soft tissue structures responsible for function are still in proper condition and timing of the operative procedure can be well planned.
11063291 Failure to detect Bartonella henselae infection in synovial fluid from sufferers of chroni 2000 Bartonella henselae causes granulomatous and indolent infection in the immune competent human, and angioproliferation in the context of persistent infection and impaired immunity. This bacterium is found in up to 40% of household cats, from which humans acquire it by either a cat scratch or a bite (hence the name, cat-scratch disease). Approximately 5% of Australian and US blood donors have serological evidence of past infection, but most associated illnesses are mild or subclinical. A number of lines of evidence prompted us to consider a relationship between rheumatoid arthritis (RA) and Bartonella infection. These include epidemiological associations with household pet exposure; apparent responsiveness of some RA cases to tetracycline therapy; the granulomatous and angioproliferative nature of Bartonella lesions; the insidiousness and high seroprevalence of this infection in the community; and even reported Bartonella infection mimicking juvenile RA. In a small group of patients with chronic arthritides, we found no direct evidence of humoral antibodies to, nor of persistent infection with, Bartonella henselae in synovial fluid. While larger and more invasive studies are likely to provide more confident exclusions of this hypothesis, this suggests that persistent Bartonella infection is unlikely to play a major role in RA.
10092163 Prevalence of mutilans-like hand deformities in patients with seropositive rheumatoid arth 1999 This study examined radiographically the prevalence of arthritis mutilans hand deformities in an inception cohort of 68 rheumatoid arthritis (RA) patients. Hand deformities of 103 RF-positive RA patients were evaluated after 8 years, 83 patients after 15 years and 68 patients 20 years after entry. The grade of destruction in the hand joints was assessed by the Larsen method and Larsen scores of 0-50 were determined for both PIP (+IP) and MCP joints. At the end point, 3 patients had Larsen scores > or =40 for both PIP and MCP joints. These three patients had severe resorption in most of the finger joints, but did not demonstrate classical opera-glass hand. The prevalence of mutilans-like hand deformities with RA was 3/68 (4.4%) in a prospective 20-year study.