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ID PMID Title PublicationDate abstract
9061845 Clinical and histological assessment of collagen-induced arthritis progression in the diab 1997 Jan Collagen-induced arthritis in the diabetes-resistant BB (DR BB)/Wor rat is a severe, aggressive disease initiated by immunization with heterologous native Type II collagen. Onset of clinical symptoms reproducibly occurs in 100% of animals between days 10 and 12 following collagen immunization. Hypertrophy of the synovial lining is the first histological manifestation of the early inflammatory arthritis. A mild inflammatory infiltrate in the synovium rapidly becomes a fibrovascular pannus eroding articular cartilage and subchondral bone. Beginning at the joint margins, an active synovitis is present. Light microscopy and immunohistochemical staining show the infiltrate to be comprised of mononuclear (lymphocytes, macrophages) and polymorphonuclear inflammatory cells. In addition, there is histological evidence for chronic inflammatory nodules and necrotizing vasculitis in connective tissue from diseased joints, both morphologic features associated with rheumatoid arthritis in humans. Subchondral bone erosion appears to be mediated largely by the resorptive action of activated osteoclasts. These histological parameters of disease progression in the DR BB/Wor rat are similar to human rheumatoid arthritis. The extensive degree of similarity in the pathology of DR BB/Wor rat collagen-induced arthritis and human rheumatoid arthritis supports the role of this model as an in vivo disease model for human rheumatoid arthritis.
11072593 Intercellular adhesion molecule 1 (ICAM-1) gene polymorphisms in Italian patients with rhe 2000 Sep AIMS: Rheumatoid arthritis (RA) has a wide range of clinical expressions which probably reflects different genetic backgrounds. Intercellular adhesion molecule-1 (ICAM-1) plays an important role in the inflammatory synovial activity in RA. The aim of this study was to examine the potential associations of ICAM-1 gene polymorphisms with RA and its severity. METHODS: Seventy-eight seropositive Italian RA patients with erosive disease entered the study. Radiographs of hands and feet 5 years after the diagnosis were available for 68 patients and were evaluated for the number of eroded joints. We obtained an erosive score for each patient by counting the number of joints with at least one erosion. Patients in the upper part of the distribution over the median were considered as fast eroders (FE) and the others as slow eroders (SE). Patients' records were also evaluated for the presence of extra-articular features. 228 healthy subjects of the same ethnic origin were selected as a control group. All of the RA patients and controls were genotyped by polymerase chain reaction and allele-specific oligonucleotide techniques for ICAM-1 polymorphisms G/R at codon 241 (exon 4) and E/K at codon 469 (exon 6). RESULTS: The carriage rate of allele R241 was significantly higher in RA patients than in healthy controls (12.8% versus 5.7%, p = 0.039; odds ratio: 2.4 [95% CI 1.02 to 5.79]). The allele frequencies and carriage rate of the E 469 gene did not differ significantly between RA patients and the control group. When we compared the control group with the patients with more or less severe disease (presence or absence of extra-articular features, SE and FE) we found that only the group of patients with the more favourable course maintained a significant difference in the carriage rate of R241 (16.7 vs 5.7%, p = 0.009 for patients without extra-articular features and 18.9 vs 5.7%, p = 0.004 for SE patients). CONCLUSION: Our preliminary findings show that G/R 241 polymorphism of ICAM-1 is associated with RA, and that this confers a reduced risk of extra-articular manifestations and is associated with a slow rate of joint destruction.
10606985 Soluble complement receptor one (sCR1) inhibits the development and progression of rat col 2000 Jan We set out to determine whether inhibition of complement using sCR1 could influence the development and progression of collagen arthritis in the Lewis rat. Collagen arthritis was successfully established in the Lewis rat, using a novel immunization schedule. In separate experiments, cobra venom factor (CVF) and sCR1 were used to achieve systemic complement inhibition. Their respective effects on disease onset and on the progression of established disease compared with saline-treated control animals was explored. Arthritis was assessed by measurement of clinical score, paw diameter and paw volume. Complement inhibition using either CVF or sCR1, prior to the onset of clinical signs of inflammation, delayed the development of disease. CVF was ineffective in the treatment of established disease, whereas sCR1 delayed the progression of disease in affected joints and prevented the recruitment of further joints while the animals were complement-depleted. In the control saline-treated groups the disease continued to progress relentlessly. We conclude that complement activation is important in the initiation and maintenance of inflammation in collagen arthritis. The potent disease-modulating effect of sCR1 provides persuasive evidence that specific complement inhibiting agents may be an effective approach to the treatment of inflammatory joint diseases
11708410 Factors associated with continued employment among patients with rheumatoid arthritis: a s 2001 Nov OBJECTIVE: To evaluate the association of demographic, disease, workplace, social, and household factors with the ability of patients with rheumatoid arthritis (RA) to remain employed over time. METHODS: Four hundred seventy-two employed patients with RA recruited from a national sample of rheumatology practices were followed. Patients were interviewed once a year by telephone for 9 years and patients' physicians provided data on clinical aspects such as disease stage, joint deformity, and flares. A proportional hazards survival model based on stepwise variable selection was developed to investigate the association between continuance of work over a 9 year period and demographic, work, attitudinal, disease, and social support variables. RESULTS: In the univariate analysis, the significant factors associated with longer work survival were being younger, being self-employed, having a higher prestige occupation, working more hours per week, having higher education level, and missing fewer days of work during the baseline year. The final multivariate model included age, type of occupation and number of days missed from work as a time varying co-variate. CONCLUSION: Ability to remain employed over the 9 year study was more strongly associated with age, work characteristics, and time lost from work than with disease factors. The underlying mechanisms related to occupational prestige as a predictor of work survival should be investigated in order to develop interventions to reduce the risk of work disability.
11588677 [MR-morphological changes of the metacarpophalangeal joints in patients with rheumatoid ar 2001 Oct MR-morphological changes of the metacarpophalangeal joints in patients with rheumatoid arthritis: Comparison of early and chronical stages. PURPOSE: Evaluation of MRI findings in the metacarpophalangeal (MCP) joints in patients with early (eRA) and chronical rheumatoid arthritis (cRA). MATERIAL AND METHODS: In 22 RA patients (9 with disease duration
10209661 Cardiovascular autonomic nervous system dysfunction in patients with rheumatoid arthritis 1999 Feb Although peripheral and central nervous system involvement have been well recognized in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), autonomic nervous system (ANS) involvement has rarely been studied, and has shown conflicting results. We performed cardiovascular ANS assessment in 34 RA and 37 SLE patients, using standard cardiovascular reflex tests. The results in each patient were compared with age- and sex-matched healthy controls. Forty-seven percent of the RA patients and 19% of the SLE patients had symptoms suggesting ANS dysfunction. The heart rate variation in response to deep breathing was significantly decreased in both the RA and SLE patients (p = 0.001). This diminished heart rate response showed no correlation with the disease duration, the number of swollen joints, the Ritchie articular index, ESR, or rheumatoid factor in the RA group, or the disease duration, the SLEDAI score or ESR in the SLE group. The clinical significance of the diminished cardiovascular ANS response needs to be investigated.
9830879 Predictors of functional disability in patients with rheumatoid arthritis. 1998 Oct OBJECTIVE: Using the World Health Organization's classification system of the consequences of disease, this study sought to examine the impact of physical and psychological impairment variables, beyond that contributed by social, demographic, and disease variables, on the functional disability of a rheumatoid arthritis (RA) sample. Data collected during an acute episode were used to predict concurrent and future disability status. METHOD: A secondary data analysis of 85 adults hospitalized for exacerbations in arthritis was undertaken. Disability was assessed with the Health Assessment Questionnaire. Physical impairment was measured with the Keitel Function Test and Pain Analog Scales, and psychological impairment was measured with the Center for Epidemiologic Studies Depression Scale and the Perceived Self-Efficacy Scale for People with Arthritis. RESULTS: Our findings indicated that physical impairment, demographic, and disease variables accounted for 64% of the explained variance in disability during the concurrent episode. Psychological impairment as well as demographic and disease variables accounted for 49% of the explained variance in future disability status. CONCLUSION: The combined influence of demographic characteristics and the consequences of the pathology of RA experienced as physical and psychological impairments contributed differentially to disability during concurrent and future time periods.
10570514 [Treatment with chlorambucil of renal amyloidosis secondary to rheumatoid arthritis. Study 1999 Oct 16 BACKGROUND: Amyloidosis is a common complication of rheumatoid arthritis. Renal disease is the main manifestation and its usual outcome is the lost of renal function. Some clinical evidences suggest that low-dose treatment with chlorambucil may be effective as therapy of this complication. PATIENTS AND METHODS: The effect of chlorambucil treatment in a group of six patients diagnosed by renal biopsy of renal amyloidosis secondary to rheumatoid arthritis was evaluated. Patients were treated with 0.1 mg/kg body weight/day for a time above a year until reduction of proteinuria. RESULTS: 3 out of 6 patients showed decrease of proteinuria below 500 mg/day, two patients have started renal replacement therapy and one died without response to treatment. It was detected non reversible azoospermia in one patient. Mean follow-up time has been sixty months. CONCLUSIONS: Chlorambucil may be effective in the treatment of renal amyloidosis secondary to rheumatoid arthritis when treatment starts before renal function is impaired. Long term remissions can be obtained even after suspending treatment.
9385689 Prevalence of symptomatic bronchiectasis in patients with rheumatoid arthritis. 1997 Oct OBJECTIVE: To evaluate the prevalence of symptomatic bronchiectasis in patients with rheumatoid arthritis. METHODS: Cross-sectional retrospective study of 453 rheumatoid arthritis patients. All patients completed a questionnaire designed to detect manifestations of bronchiectasis and had a chest film taken. Computed tomography of the chest was performed in those patients whose chest film was normal. RESULTS: Thirteen patients (2.9%), all female, had symptoms that met Walker's criteria for definite (n = 7) or probable (n = 6) bronchiectasis. Symptom onset was during childhood or adolescence in 69% of cases and antedated the first symptoms of rheumatoid arthritis in all patients but one. Six of the 13 patients (46%) had chest film abnormalities suggestive of bronchiectasis, and three of the remaining seven patients had abnormal computed tomography findings, yielding a total of nine cases of bronchiectasis confirmed by imaging studies among the 13 patients with suggestive symptoms (69%). This proportion rose to 90% when the three patients who failed to come to their computed tomography appointment were excluded. CONCLUSION: Using a methodological approach similar to that previously used by pneumologists, we found a 2.9% prevalence of symptomatic bronchiectasis in a population of hospitalized rheumatoid arthritis patients, which is higher than the 0.03% prevalence previously reported in the population at large.
10984866 The negative effect of decreasing the level of activity in coping with pain in rheumatoid 2000 Aug The objective of this study was to analyze the effect of coping with pain in rheumatoid arthritis (RA) on subsequent changes in psychological distress and disease impact. A sample of 109 randomly selected RA patients was asked to participate in a longitudinal study. Patients were measured at baseline and after 3 years. Both measurements were completed in 80 patients. At each assessment the following variables were assessed: disease activity, pain, physical and psychological distress, disease impact, and coping. The relation between coping with pain at baseline and subsequent changes in psychological distress and disease impact was analyzed using stepwise regression. Disease status variables assessed at baseline and after 3 years were entered in the regression analysis as control variables. Results show that cognitive coping with pain at baseline was not related to subsequent changes in psychological distress or disease impact. On the other hand, behavioral pain coping assessed at baseline was related to subsequent changes in psychological distress and disease impact. "Decreasing activity" was related to an increase in self-reported psychological distress and disease impact after controlling for disease status at both assessments. It was concluded that cognitive pain coping did not predict any subsequent changes in psychological distress or disease impact. "Decreasing activity" as a behavioral pain coping style has a negative effect on subsequent changes in psychological distress and disease impact.
9228129 Magnetic resonance imaging of the wrist in defining remission of rheumatoid arthritis. 1997 Jul OBJECTIVE: To assess the efficacy of magnetic resonance imaging (MRI) in objectively defining a state of remission in rheumatoid arthritis (RA) after treatment. METHODS: Ten patients with RA involving the wrist were evaluated before treatment with methotrexate and hydroxychloroquine, and then mean 14 mo later with a followup evaluation. Clinical variables, laboratory measurements, and MRI using various techniques (T1 weighted image, T2 weighted image, fat suppression T2 weighted image, postcontrast T1 weighted image, postcontrast dynamic image, postcontrast 3 dimensional image) were observed. Remission was defined by ACR criteria. MRI changes were observed using 3 variables: extent of synovial proliferation; extent of bone marrow edema; and development of new erosion. In 6 of 10 patients, synovial signal intensity time curve changes at 30 s (E30 ratio) were determined for quantitative assessment of synovitis. RESULTS: Four patients achieved remission and 6 did not. All patients in remission showed decrease in extent of synovial proliferation and bone marrow edema with no newly developed erosion after treatment, compared to baseline. Five of 6 patients in nonremission showed newly developed erosions with variable changes in extent of synovial proliferation and bone marrow edema. E30 ratio was determined in 3 patients in the remission group and 3 in the nonremission group, with 48% reduction in the former compared to 9% reduction in the latter. CONCLUSION: MRI is feasible for objectively defining remission and assessing the therapeutic effect of antirheumatic drugs; utility of MRI measures in clinical remission criteria remains to be verified.
11210773 [Radiological evaluation of foot deformities in rheumatoid arthritis]. 2000 Dec Deformities of the feet are common in patients with rheumatoid arthritis (RA). We investigated whether there was any correlation among forefoot deformities, flat foot or articular destruction of the midfoot and hindfoot, in 146 feet of 73 RA patients whose age varied from 26 to 81 years (mean 58.5 years). In all patients, anteroposterior (AP) and lateral radiographs of the feet with weight bearing were obtained. The hallux valgus angle (HVA), the intermetatarsal angle between the 1st and 2nd metatarsals (M 1 M 2), and the intermetatarsal angle between the 1st and 5th metatarsals (M 1 M 5) were measured on AP radiographs. On slateral radiographs, the height of the arch was measured and articular destruction of the talocalcaneal, talocrural, talonavicular, cuneonavicular and cuneometatarsal joints was measured and classified using Steinbrocker's classification. The average HVA was 23.4 degrees, the average M 1 M 2 was 11.1 degrees, and the average M 1 M 5 was 28.4 degrees. There was no correlation between forefoot deformities and flat foot. There were significant correlations between arthritic destruction of the cuneometatarsal joint and HVA, M 1 M 2 and M 1 M 5. The correlations between arthritic destruction of the cuneonavicular joint and HVA or M 1 M 2 were also significant, although weaker. Thas, we found some relationships between forefoot deformity and arthritics destruction of midfoot joints. Especially, the correlations between arthritic destruction of the cuneonavicular and cuneometatarsal joints and forefoot deformities were significant. Many radiographic methods for the assessment of RA have been reported, however, it is difficult to assess sarthritic destruction of rheumatoid feet with the existing methods. Accordingly, a new method should be established.
11354305 Patterns of disease-modifying antirheumatic drug use, medical resource consumption, and co 2001 Apr We compared medical resource use and costs among rheumatoid arthritis (RA) patients receiving alternative disease-modifying antirheumatic drugs (DMARDs). The cohort study used data from a managed care organization. Health plan members who were prescribed DMARD therapy for at least 2 consecutive months, were age 18 years or older, had at least 6 months of DMARD-free enrollment prior to the first DMARD, and had a diagnosis of RA before or during the first month of DMARD were eligible. Median duration of initial DMARD therapy was 10 months overall: 11 months for hydroxychloroquine (n = 252), 15 months for methotrexate (n = 185), 5 months for sulfasalazine (n = 49), and 5 months for other mono/combination therapy (n = 85) (p < 0.0001). The average monthly cost of care was $853, of which $294 (34%) was for RA-coded medical services. In multivariate analyses, monthly RA-coded costs varied significantly by initial DMARD. RA costs and duration of initial therapy varied significantly by initial DMARD.
10518455 [Lymphedema of the leg associated with rheumatoid arthritis]. 1999 May Only a few cases of the occurrence of chronic lymphoedema as a non-systemic, regional colagenosis associated with a real systemic disease of connective tissue, such as rheumatoid arthritis, have been reported so far. The aim of this article is to review an obridus case of chronic primary lymphoedema in a female patient suffering from rheumatoid arthritis. Reported lymphoedema appeared after many years of remission of rheumatoid arthritis and was not in correlation with its relapse. The doppler ultrasonography, lymphoscintigraphy and histopathological examination confirmed the diagnosis of primary chronic lymphoedema. The operation that consists of omentopexy (with vascularized omental flap) was the treatment of choice for this patient with favorable result. More than a year after the operation, the decreased difference in the circumference of lower limb for more than a 50% is maintained without any occurrence of new episodes of complications of lymphoedema.
9428052 Daily activities in women with rheumatoid arthritis. Aspects of patient education, assisti 1997 The major aims of the study were to identify the difficulties in daily activities (ADL) of women with rheumatoid arthritis (RA) and to demonstrate the effect of interventions. Methods were developed for measuring grip force, the Grippit instrument, and assessing ADL without and with assistive devices. Effects of interventions were explored, and the need for new solutions concerning daily activities was identified. Seventy-three women with RA participated in the study, 14 women with fibromyalgia were included in the grip force measurements, and 187 healthy women and 65 healthy men acted as a reference group. In describing the consequences of the disease with regard to daily activities, the patient's perspective was taken into account. RESULTS: Grip force (peak value and average value over 10 seconds) was reduced in women with RA compared to the reference values. With an elastic wrist orthosis, pain decreased and grip force increased significantly in defined ADL situations. After a patient education programme in joint protection, designed to influence knowledge, inspiration and action, on average 91% of the assistive devices provided were in use, most frequently for kitchen work and personal care. Pain also decreased significantly with the use of specially designed assistive devices like breadsaws, potato peelers, and scissors compared to using standard tools. The cost of these interventions could be judged to be low in relation to its effectiveness. Using an alternative model of the Health Assessment Questionnaire (HAQ) where the use of assistive devices did not influence the ratings, grip force was correlated to more ADL activities than disclosed by the ordinary HAQ ratings. The difference between these two models for rating HAQ items was demonstrated. The Evaluation of Daily Activity Questionnaire (EDAQ) was developed and can be used to evaluate both intrinsic (without assistive devices) and actual (with such assistance) disability. The EDAQ consists of 102 items arranged in 11 dimensions. The number of activities with perceived difficulty without assistive devices/altered working methods in RA women ranged between 13 and 99 and after interventions between 6 and 57. Assistive devices appeared most effective in the dimensions Eating, Cooking and Toileting. Only a few useful devices were identified in the dimensions Dressing, Washing/Clothes care and Cleaning. The ordinal score from EDAQ was transformed by the Rasch analysis to obtain linear measures. This allowed the construction of an acceptable model with items ranging from "hard" to "easy". The hardest items were found to be shopping and cleaning the kitchen floor, the easiest were walking indoors and using telephone. CONCLUSIONS: Women with RA have reduced grip force and pain, which affect their performance of daily activities. Usage of assistive devices and altered working methods reduced the perceived difficulty in various activities. The ADL items assessed with the EDAQ questionnaire, which also considers the individuals' own solutions to their problems, could be arranged hierarchically from "hard" to "easy".
10986306 Nitric oxide is a mediator of apoptosis in the rheumatoid joint. 2000 Sep OBJECTIVE: To study the role of nitric oxide (NO) derived from the inducible nitric oxide synthase (iNOS) pathway in the induction of apoptosis in the rheumatoid joint. METHODS: Joint tissue was obtained from four rheumatoid arthritis (RA) patients, three osteoarthritis patients and two patients with a fractured neck of the femur (NOF#), and apoptotic cells were identified in cryosections using the TUNEL (terminal dUTP nick end labelling) assay. Expression of iNOS was determined using immunohistochemistry. NO synthesis and the effect of NOS inhibitors on apoptosis levels were studied in explant cultures of RA cartilage and synovium. RESULTS: Numbers of apoptotic cells were greatly increased in rheumatoid synovium and articular cartilage compared with NOF# and osteoarthritic synovium. Immunohistochemistry showed co-localization of iNOS staining and apoptosis in the synovial lining layer and articular cartilage. The NOS inhibitor L-NMMA (L-N(G)-monomethylarginine) strongly inhibited apoptosis in explant cultures of synovium and cartilage, and this was reversed by the NO donor S-nitroso-acetyl-penicillamine. CONCLUSION: This study indicates that NO acts as a mediator of apoptosis in RA and suggests that NOS inhibitors reverse this process.
11642507 High dose therapy and autologous hemopoietic stem cell transplantation in rheumatoid arthr 2001 Oct If a niche is to be established for autografting in the treatment of severe rheumatoid arthritis (RA), investigators should have the common goal of providing higher levels of evidence. Autografting in RA can be envisaged only for severe RA that has resisted all safer available treatments, and given the relatively large numbers necessary for statistical power in randomized studies, investigators will need to work together. This article summarizes the current literature and discusses practical issues relating to future trials.
11109610 [In vivo and vitro effects of interferon-alpha 2b on functional activity of T-lymphocytes 2000 AIM: To investigate the effect of recombinant alpha 2b-interferon (r alpha 2b-IFN) on functional capacity of peripheral blood (PB) T cells in rheumatoid arthritis (RA) patients and the relationship between functional characteristics of T lymphocytes and the disease activity. MATERIALS AND METHODS: PB mononuclear cells (PBMC) were separated by Ficoll-Verografine++ gradient centrifugation from 24 healthy donors (HD) and 75 RA patients 19 of which were treated with r alpha 2b-IFN (realdiron, Biofa, Lithuania) in the dosage 1 million IU i.m. each other day for 20 days, 10 injections a course. Cell surface markers (CD3, CD4, CD8) and adhesion molecules (CD18, CD54, CD2) were analyzed using specific monoclonal antibodies (MoAbs) and flow cytometry on the PBMC, freshly isolated and treated for 72 hours with medium alone, PHA, r alpha 2b-IFN and their combination. The proliferative response of PBMC to MoAbs for CD3, PHA and r alpha 2b-IFN were assessed by 3H-thymidine incorporation. The percentage of spontaneous and inducing apoptosis was quantified by flow cytometry using propidium iodide staining. RESULTS: The expression of CD18 was lower on RA PB lymphocytes compared to HD PB lymphocytes (p < 0.05). After stimulation of PBMC in both RA patients and HD with PHA, percentages of CD2+, CD3+, CD4+, CD18+ cells significantly diminished (p < 0.05), whereas the percentages of CD54+ and CD18+ (p < 0.05) cells increased. We have found three types of RA PB lymphocytes response to complex factors in vitro: 1) the presence of the proliferative response to T-mitogens but not to r alpha 2b-IFN (56% of the patients); 2) the presence of the increased proliferative response to T-mitogens and r alpha 2b-IFN (17% of the patients); 3) the absence of the proliferative response to T-mitogens and r alpha 2b-IFN (27% of the patients). PBMC of HD demonstrate only the first type of the response. R2 alpha b-IFN demonstrated own mitogenic effect and increased mitogen-induced proliferation in PBMC cultures with a high proliferative response to T-mitogens. The levels of spontaneous and inducing apoptosis were increased in RA PB lymphocytes compared to HD. After stimulation with PHA, RA PB lymphocytes preferentially underwent apoptosis whereas cells of HD proliferated. High disease activity correlated positively with an increase of a proliferative response to mitogens and apoptosis and a decrease in the percentage of lymphocytes, expressed adhesion molecules. The treatment with r alpha 2b-IFN induces changes in T-cell response to mitogens similarly to those after incubation with r alpha 2b-IFN in vitro before treatment. CONCLUSION: Functional capacity of RA PB lymphocytes relates to the disease activity. Inhibitory or stimulatory effects of r alpha 2b-IFN depend on functional activity of RA lymphocytes. Using the test with alpha 2b-IFN incubation, we may predict changes of apoptosis and proliferation levels caused by different agents in RA lymphocytes after treatment with r alpha 2b-IFN.
10402072 Predicting 'normal' grip strength for rheumatoid arthritis patients. 1999 Jun OBJECTIVE: An ability to predict accurately 'normal' grip strength in rheumatoid arthritis (RA) patients would facilitate a more accurate assessment of the degree of their functional loss. This, in turn, would allow the setting of more meaningful treatment goals aimed at restoring hand function towards normal. This study carefully measures three modalities of hand grip strength and their correlation with multiple simple anthropometric parameters in normal subjects. We aim to determine which of these parameters are best correlated to grip strength, and whether this correlation is strong enough to allow the accurate prediction of what normal grip strength should be in RA patients. METHODS: In 81 normal subjects (67 female), power, pinch and tripod grip strength measurements were made using an MIE digital pinch grip analyser. These strength data were correlated with specific local forearm anthropometric measurements: forearm circumference, forearm length, forearm volume, hand circumference, hand length, hand volume, hand and forearm volume, and various general anthropometric parameters (weight, height and age). These normal subjects had been chosen so as to be age and sex matched with 83 RA patients (67 female) in whom the same strength and anthropometric parameters were assessed and correlated. In patients, the grip strength results were additionally correlated with two markers of disease activity: a modified Ritchie Articular Index local to the hand and forearm (mRAI) and a visual analogue scale (VAS) assessing subjective pain severity. RESULTS: In normal subjects, clear correlations were demonstrated between hand grip strengths and all specific anthropometric variables, the strongest correlation being with forearm and hand volume (r = 0.729 and 0.638 for dominant and non-dominant hands, respectively; P < 0.01 for both). The patients were considerably weaker than normal subjects. Markers of disease activity showed a negative correlation with grip strength. In normal subjects, the dominant hand was significantly stronger than the non-dominant hand, and on average by 8%, while the opposite was true in patients, who were 20% weaker on the dominant side. CONCLUSION: Simple anthropometric measurements, and forearm and hand volume in particular, would be useful at baseline for predicting 'normal' hand grip strength in RA patients, both in the clinical setting and in research trials aimed at improving grip strength and hand function.
11128661 Serum matrix metalloproteinase 3 in early rheumatoid arthritis is correlated with disease 2000 Dec OBJECTIVE: To analyze the clinical significance of serial measurements of serum matrix metalloproteinase 3 (MMP-3) levels in relation to markers of disease activity and radiological progression in early rheumatoid arthritis (RA). METHODS: In a 3 year prospective study of 33 patients with early RA (symptoms < 1 year at entry) monthly measurements of serum MMP-3 were transformed into time integrated values for 6 month periods for comparison with other markers of disease activity like swollen joint count (SJC), tender joint count (TJC), Ritchie articular index (RAI), the disease activity score (DAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and radiological progression, scored according to Sharp's method, in which erosions and joint space narrowing are scored separately and combined to a total Sharp score. RESULTS: Significant correlations were found between serum MMP-3 and SJC, ESR, and CRP during all periods and between 6 and 30 months with the DAS. There were no correlations between serum MMP-3 and TJC or the RAI. During the first 12 months serum MMP-3 was correlated only with the item joint space narrowing of the Sharp score. After 12 months of followup it was also correlated with the total Sharp score and after 18 months it was correlated with all 3 items of the Sharp score. There was a wide interindividual variation in the relation between serum MMP-3 and radiological progression but intraindividually this relation seemed to be rather constant. CONCLUSION: Time integrated values of serum MMP-3 are correlated with time integrated values of other markers of disease activity such as joint swelling, ESR, CRP, and the DAS. Of the radiological scores, as outcome measures, especially joint space narrowing correlated closely with cumulative serum MMP-3.