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ID PMID Title PublicationDate abstract
11454646 Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for 2001 Aug OBJECTIVE: Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functional status). These criteria are preliminary and not widely accepted but might be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed. METHODS: DXA (lumbar spine and femoral neck) was performed in 128 patients recruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population. RESULTS: The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13.7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnaire score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria. Their sensitivity for the diagnosis of osteoporosis (T score < or =-2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%. CONCLUSIONS: The proposed criteria seem a good screening method for the selection of those patients with RA whose bone mineral density should be assessed as the sensitivity and negative predictive value are acceptable.
11090241 Complex genetic control in a rat model for rheumatoid arthritis. 2000 Dec We have defined previously five quantitative trait loci controlling development of pristane-induced arthritis in a cross between E3 and DA rats. To define new loci controlling the disease we have mapped three recombinant inbred strains between DA and E3 and analysed an F2 cross between DA rats and one of these RI strains. Two novel loci affecting disease severity are identified on chromosome 1 (Pia8) and chromosome 4 (Pia7) respectively. We could also reproduce the earlier identified Pia3 locus on chromosome 6 associated with arthritis onset. In the original E3xDA F2 cross, neither of the loci Pia7, Pia8, or Pia1 showed any association with arthritis. To investigate the possibility of interacting loci preventing the phenotypic expression of other loci, the E3xDA F2 cross was re-analysed with a model for a two locus interaction, knowing the presence of these newly identified loci. We found suggestive evidence for an interaction where an effect of Pia7 and Pia1 on disease severity depends on DA homozygosity at specific loci, which themselves do not confer susceptibility. This shows that additional disease associated loci can be identified if other loci are neutralized. This will be of importance for understanding the complex genetics controlling rheumatoid arthritis.
9150113 Hematopoietic stem cell transplantation for autoimmune diseases. 1997 May Autoimmune diseases such as systemic lupus erythematosus, scleroderma, and rheumatoid arthritis cause significant morbidity and mortality. Although aggressive treatments may suppress disease activity in some cases, there are few if any complete cures. Since these conditions arise as a direct result of dysregulation of the immune system, modification of immune stem cells may be important in their control. Some slow acting antirheumatic drugs have significant effect on bone marrow, and more recently a number of case reports have appeared in which autoimmune diseases have gone into remission after bone marrow transplantation for other reasons. Data from animal models of autoimmune disease show significant abrogation of inflammation following bone marrow transplantation. Advances in the technology of stem cell transplantation coupled with increasing ability to identify at an early stage those patients likely to develop severe autoimmune disease require an indepth study of the role of stem cell transplantation for these conditions.
11126463 Stressful events and information processing dispositions moderate the relationship between 2000 Summer Relationships between positive affect, negative affect, and pain were analyzed as a prospective function of stressful events in a sample of rheumatoid arthritis patients and as a cross-sectional function of an information processing disposition in persons with fibromyalgia. Positive affect and negative affect were statistically separate factors overall in both samples. In addition, negative affect and pain were related across all conditions. However, positive affect and negative affect were more negatively correlated during stressful periods and more negatively correlated for patients who processed information in a more simplistic fashion. Also, positive affect predicted pain during stressful times and did so for patients who processed information more simplistically as well. These data suggest positive affect and negative affect are unique factors whose interrelation and external correlates are not static.
11083353 Postural control in rheumatoid arthritis patients scheduled for total knee arthroplasty. 2000 Nov OBJECTIVE: To investigate the use of compensatory visual and attentional control strategies for standing balance in patients with rheumatoid arthritis (RA) with severe knee joint impairment. DESIGN: Experimental 2-group design. SETTING: Specialized clinic for orthopedics, rheumatology, and rehabilitation in The Netherlands. PARTICIPANTS: Eighteen patients without comorbidity (age range, 65 +/- 7.7 yr; 16 women, 2 men) from a consecutive sample of patients with RA scheduled for total knee arthroplasty; 23 controls of the same age group also were tested (13 women, 10 men). MAIN OUTCOME MEASURES: By means of a dual-plate force platform, the velocity of center of pressure (COP) fluctuations were analyzed in the anteroposterior and lateral sway directions during quiet standing with eyes open, eyes closed, and while performing a secondary attention-demanding arithmetic task. RESULTS: Patients showed an average 80% greater COP velocity in both directions of sway compared with controls. In addition, stability deteriorated substantially more in patients than controls when deprived of visual information, which was associated with the degree of knee destruction. The effect of the arithmetic task was small and similar in patients and controls. CONCLUSION: RA patients with severe knee joint impairment can have a substantial basic postural instability; their relatively high reliance on visual information suggests impaired sensory feedback from the lower limbs. Current research is aimed at determining whether these postural deficits can be improved by total knee replacement.
9619889 Depression and depressive symptoms in rheumatoid arthritis patients: an analysis of their 1998 Apr The objectives were to determine the differences in depressive symptoms and depression between rheumatoid arthritis (RA) and osteoarthritis (OA) patients, and to analyse the contribution of sociodemographic and clinical variables to depression in RA patients. The responses of 60 Egyptian RA patients and 40 patients with OA of the knees to the Symptom Checklist-90-R Depression subscale were compared. The proportions of patients from both groups confirmed by a psychiatric interview to be clinically depressed according to the DSM-III-R criteria were also compared. The contributions of sociodemographic and disease variables to depressive symptoms and clinical depression in RA patients were explored by multiple linear and logistic regression, respectively. RA patients showed significantly higher depression scores than OA patients (P = 0.001). The difference was unaffected by controlling for the effects of age, sex, disease duration and the sociodemographic covariates. A depressive disorder was clinically confirmed in 23% of RA patients and 10% of OA patients. The erythrocyte sedimentation rate (ESR), being unmarried and an urban residence were significant predictors of depressive symptoms (P < 0.05), while being unmarried (P < 0.05, OR = 2.1) and HAQ disability (P < 0.01, OR = 3.8) were significant predictors of clinical depression in RA patients. RA patients have significantly more depressive symptoms and tend to be more clinically depressed than OA patients. The contribution of some sociodemographic and clinical variables to depression in RA patients was modest, albeit significant.
10771570 [Hypersensitivity peumonitis in a patient with rheumatoid arthritis]. 2000 Feb We report a case with rheumatoid arthritis and hypersensitivity pneumonitis. A 66-year-old female was admitted to our hospital because of fever, cough, and progressive dyspnea on October 10, 1997. She had a history of rheumatoid arthritis from 1987 and was treated with cyclophosphamide when she developed pulmonary symptoms in September 1997. On admission arthritis was subsided. Fine crackles on ausculation of lung, hypoxia, ground-glass appearance on chest X-ray were detected. The computed tomography of the chest disclosed diffuse interstitial shadow with patchy destruction of alveolar structures. Bronchoalveolar lavage demonstrated an increase in lymphocytes with predominance of suppressor-cytotoxic T cell subset (CD 8+). The histopathological examination of transbronchial lung biopsy showed interstitial inflammation with marked predominance of lymphocyte with intraalveolar exudate. Her condition got better and she discharged without definitive diagnosis and treatment for her respiratory symptoms. Eight hours after she went back home, she suddenly presented high fever and cough and gradually developed dyspnea. She was readmitted 5 days after the previous discharge. Although no specific precipitin antibody against various microorganisms was detected in her sera, the diagnosis of hypersensitivity pneumonitis was made. Thirty mg per day of prednisolone was resolved her symptoms promptly. There was no reported case with hypersensitivity pneumonitis and rheumatoid arthritis of other collagen diseases. The clinical course that arthritis and pulmonary symptoms appeared alternatively is of considerable interest to investigate for the pathogenesis of these two immune disorders.
10088940 High frequency of hysterectomies and appendectomies in fibromyalgia compared with rheumato 1999 We investigated, in retrospect, if there were differences in the frequency and types of abdominal surgery between newly diagnosed female fibromyalgia (n = 80) and rheumatoid arthritis (n = 47) patients performed before the formal diagnosis. There was no difference in the total number of abdominal operations between both groups. In the rheumatoid arthritis group more cholecystectomies (p = 0.01) were performed, probably due to the older age of these patients (58.5 vs 48.5 years). However, in the fibromyalgia group there were more hysterectomies (p = 0.04) and appendectomies (p = 0.05) than in the rheumatoid arthritis group.
11093437 A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Itali 2000 Nov OBJECTIVE: To determine the frequency of osteoporosis in a large cohort of women with rheumatoid arthritis (RA) and to investigate the main determinants of bone mineral density (BMD) and risk factors for vertebral fractures in this population. METHODS: We recruited 925 consecutive female patients with RA at 21 Rheumatology Centers in Italy. For each patient pre-registered demographic, disease, and treatment-related variables were collected. BMD was measured at lumbar spine and proximal femur by dual x-ray absorptiometry technique. Collected variables underwent a univariate and multivariate statistical procedure. Osteoporosis was defined as BMD > -2.5 T score. RESULTS: The frequency of osteoporosis in the whole sample was 28.8% at lumbar spine and 36.2% at femoral neck and increased linearly from Steinbrocker's functional stage I to IV (p = 0.0001). Patients with spinal or femoral osteoporosis were significantly older (p = 0.0001), had a lower body mass index (BMI) (p < 0.02), a significantly longer disease duration (p < 0.02) and a significantly higher Health Assessment Questionnaire (HAQ) score (p = 0.0001). These differences were significant, even after adjusting for age. Steroid use was associated with significantly lower lumbar and femoral BMD (p = 0.0001) even after adjusting for the main confounding covariates. Analysis of lateral spine radiographs revealed 74 women with at least one vertebral fracture. These women had a significantly lower lumbar and femoral BMD (p = 0.0001). The generalized linear model showed that steroid use, menopause, BMI, age, and HAQ were all significant independent predictors of lumbar and femoral BMD. The logistic procedure showed that age (OR 1.05, 95% CI 1.03-1.07), HAQ (OR 1.3, 95% CI 1.07-1.7), menopause (OR 1.9, 95% CI 1.1-3.2), use of steroids (OR 1.5, 95% CI 1.07-2.1), and BMI (OR 0.8, 95% CI 0.8-0.9) were significantly associated with the risk for osteoporosis. The only variables associated with an increased risk for vertebral fracture were age (OR 1.04, 95% CI 1.01-1.08), HAQ (OR 1.7, 95% CI 1.08-2.09), and cumulative steroid intake (OR for 1 g of prednisone 1.03, 95% CI 1.006-1.07). CONCLUSION: To prevent osteoporosis and its dramatic complications in RA the therapeutic challenge is to preserve functional capacity using the lowest possible dosage of corticosteroids.
10780156 [Do patients with rheumatoid arthritis suppress anger and aggression?]. 2000 Mar Given the contradictory findings on aggression in patients with rheumatoid arthritis (RA), this topic was examined again in two studies. In both studies RA patients and patients with arthrosis were compared (in-patients in study I, n = 28 in each sample; out-patients in study II, each sample comprising 22 subjects). Two aggression/anger inventories (Fragebogen zur Erfassung von Aggressivitätsfaktoren = FAF and State-Trait-Anger-Expression Inventory = STAXI) with a total of 10 scales were used for comparison. Samples were matched for gender and age; duration and severity of illness were used as covariates. No replicable differences between groups were found in any variable. Our results do not support aggression theories of rheumatoid arthritis.
9662757 Rheumatoid hyperviscosity: analysis of a patient with intermediate complexes that block ot 1998 Jun OBJECTIVES: To report a patient who rheumatoid arthritis presented with hyperviscosity syndrome, analyze this patient's rheumatoid factor, and review the previously reported patients. METHODS: Immunofluorescence for antinuclear antibodies, double immunodiffusion, enzyme-linked immunosorbent assay, and size exclusion chromatography were used before and after plasmapheresis to study the patient's rheumatoid hyperviscosity, and polyclonal gammopathy and references in identified papers was used to identify previously reported patients. RESULTS: Similar to several previous patients, this patient's sera contained both IgG and IgM rheumatoid factor and abundant intermediate complexes. Other autoantibodies, either from the patient or from other patients, were masked by rheumatoid factor or intermediate complexes from the reported patients sera. Rheumatic hyperviscosity is seen uncommonly, being reported in only 18 patients with rheumatoid arthritis and nine with other rheumatic illnesses. CONCLUSIONS: There are two mechanisms by which rheumatoid factor can lead to hyperviscosity, both of which require large amounts of rheumatoid factor. Rheumatoid hyperviscosity must be recognized because this life-threatening syndrome usually can be successfully treated with plasmapheresis acutely and immunosuppressives for long-term control.
11324685 An approach to identify new genes in autoimmune diseases: lessons from rheumatoid arthriti 2000 We have searched the human genome for genes that predispose to rheumatoid arthritis using fluorescence-based microsatellite marker analysis and affected sib-pair linkage studies. A panel of 41 Japanese families, each with at least two affected siblings, was typed for genome-wide 358 polymorphic microsatellite marker loci. Three principal chromosome regions of linkage, D1S253/214, D8S556 and DX1232, have been assigned, which we call RA1, RA2 and RA3 for rheumatoid arthritis disease loci. We are now assigning the death receptor 3 as a candidate gene for RA1, and the truncated form of Dbl proto-oncogene, which does not contain the 23rd and 24th exons, as disease gene for RA3. Microsatellite marker analyses seem to be promising and new genes are now being identified by reference to sequence tag sites.
9058646 HLA-DMA and DMB genotyping in patients with rheumatoid arthritis. 1997 Mar OBJECTIVE: To investigate the relation of HLA-DMA and DMB alleles to the development of rheumatoid arthritis (RA). METHODS: We studied HLA-DMA and DMB alleles in 153 patients with RA and 138 healthy controls using the amplification created restriction site method and digestion with restriction enzymes. RESULTS: There was no significant difference in frequencies of HLA-DMA and DMB alleles between patients with RA and controls. The HLA-DMA and DMB alleles were not related to extraarticular involvement, seropositivity for rheumatoid factor, or bone erosion. There was also no significant difference in frequencies of HLA-DMA and DMB alleles among DR4-positive and DR4-negative patients and controls. CONCLUSION: HLA-DMA and DMB do not appear to be associated with the pathogenesis of RA.
10888940 Results of a longer than 10-year follow-Up of patients with rheumatoid arthritis treated b 2000 Jul 15 STUDY DESIGN: Evaluation of results a longer than 10-year follow-up of patients with upper cervical lesions due to rheumatoid arthritis who underwent occipitocervical fusion. OBJECTIVE: To determine the final outcome of patients with upper cervical lesions due to rheumatoid arthritis treated by occipitocervical fusion. SUMMARY OF BACKGROUND DATA: There are few studies reporting the final outcome of patients with rheumatoid arthritis treated by occipitocervical fusion and observed for longer than 10 years. METHODS: The subjects were 16 patients with rheumatoid arthritis with myelopathy who underwent occipitocervical fusion with a rectangular rod more than 10 years ago. All 16 patients had irreducible atlantoaxial dislocation, and 11 also had vertical dislocation of the axis. All patients had preoperative nuchal pain, and were classified into Class II (two patients), Class IIIA (nine patients), and class IIIB (five patients) according to Ranawat's preoperative neurologic classification. RESULTS: The atlas-dens interval remained the same as immediately after surgery. Vertical dislocation returned to the preoperative condition, despite successful surgical correction. Preoperative occipital pain disappeared or was reduced in all cases. Myelopathy improved in 12 of the 16 patients (75%) by more than one class in the Ranawat preoperative neurologic classification. Survival rate at 10 years after surgery was 38%; mean age at death was 70.7 years. The postoperative periods during which patients could walk by themselves ranged from 6 months to 13 years (mean, 7.5 years). CONCLUSIONS: Occipitocervical fusion for patients with rheumatoid arthritis is useful for decreasing nuchal pain, reducing myelopathy, and improving prognosis.
10190854 A clinico-pathological study of cervical myelopathy in rheumatoid arthritis: post-mortem a 1999 Two patients who developed cervical myelopathy secondary to rheumatoid arthritis were analyzed post mortem. One patient had anterior atlanto-axial subluxation (AAS) combined with subaxial subluxation (SS), and the other had vertical subluxation (VS) combined with SS. In the patient with AAS, the posterior aspect of the spinal cord demonstrated severe constriction at the C2 segment, which arose from dynamic osseous compression by the C1 posterior arch. A histological cross-section of the spinal cord at the segment was characterized by distinct necrosis in the posterior white columns and the gray matter. In the patient with VS, the upper cervical cord and medulla oblongata showed angulation over the invaginated odontoid process, whereas no significant pathological changes were observed. At the level of SS, the spinal cord was pinched and compressed between the upper corner of the vertebral body and the lower edge of the lamina. Histologically, demyelination and gliosis were observed in the posterior and lateral white columns.
11215159 [Interrelationship between disease activity and nutrient intake or serum cytokine in patie 2000 Oct OBJECTIVE: This study was designed to investigate the possibility of nutrition guidance for patients with rheumatoid arthritis (RA). We studied interrelationship between disease activity and nutrient intake or serum cytokine concentration in patients with RA. METHODS: Dietary survey was performed to assess nutrient intake of RA patients. Disease activity parameters, such as weariness index, arthritically index and QOL index were evaluated by self-questionnaire. CRP and serum cytokine concentrations were measured. Interactions between these parameters and nutrient intake were analyzed. RESULTS: In comparison of nutrient intake between patients with RA and healthy controls, RA patients indicated lower ratio of polyunsaturated to saturated fatty acid (P/S) than controls. Preceding with the analysis between disease activity parameter and nutrient intake, RA patients were divided into two groups according to their activities. High weariness group indicated higher lipid intake and energy supplies from fat than low group, suggesting the relationship between disease activity and lipid intake in RA patients. From the comparative study of serum cytokine concentration between patients with RA and healthy controls, RA patients indicated higher concentration of IL-1 beta, IL-6 and IL-8. Serum concentrations of these proinflammatory cytokines correlated significantly with some nutrient intakes. CONCLUSION: These results imply the relationship between nutrient intake and disease activity in patients with RA. It is important to develop nutrition guidance to improve symptoms for patients with RA.
11196543 Becoming a disability pensioner with rheumatoid arthritis in Norway 1971-1990. 2001 Jan OBJECTIVE: Physically demanding occupations have been associated with becoming a disability pensioner with rheumatoid arthritis (DPRA), but not with the disease of RA. The association with becoming DPRA probably reflects that patients with RA have difficulties in maintaining employment in a physically demanding occupation. However, the attitudes of the employers concerning employment of persons with RA might vary. For example, the patient's age may influence the strength of the association between a physically demanding occupation and becoming DPRA. We assessed whether the association between the predictors and becoming DPRA was stronger for the youngest or the oldest age group. METHODS: The study was prospective with data on persons in Norway 30-56 years old either in the census of 1970 or 1980. All new cases of DPRA during the 2 followup periods 1971-80 and 1981-90 were identified and analyzed by logistic regression. RESULTS: For women the predictors employment, low level of education, and period ( 1981-90 compared to 1971-80) were more strongly associated with becoming DPRA for the youngest compared to the oldest persons, while manual work and part time work were not predictors of becoming DPRA. For men, all the predictors in the study were more strongly associated with becoming DPRA for the youngest compared to the oldest age group. CONCLUSION: The higher risk of becoming DPRA was associated with most predictors for persons aged 30-39 years than the group aged 50-56 years. Our results appear to indicate that the consequences of having RA in the labor market are greater for the youngest age group.
10356413 Multiple rheumatoid papules characteristic of the early stage of rheumatoid vasculitis. 1999 Jun The rheumatoid papule has recently been described as the skin manifestation of rheumatoid arthritis (RA). The papules represent leukocytoclastic vasculitis and necrobiosis clinicopathologically. We report a 59-year-old Japanese woman with multiple recurrent rheumatoid papules located on the bilateral extensor forearms in correlation with the level of RA activity and as a cutaneous manifestation of rheumatoid vasculitis. These papules appeared prior to other cutaneous manifestations. It was suggested that rheumatoid papules represent the early stage of rheumatoid vasculitis and that they are a reliable early clinical marker of rheumatoid vasculitis.
10466583 Expression of FCepsilonII/CD23 on human neutrophils isolated from rheumatoid arthritis pat 1999 Oct CD23, the low affinity receptor for IgE, is a 45 kilodalton molecule belonging to the C-type lectin family, some members of which have been identified as adhesion molecules. Since it has been described upregulated in different cells in chronic inflammatory diseases and in rheumatoid arthritis in particular, where neutrophils are directly involved in tissue damage, our interest, in this work, has been focused on the expression and regulation of this antigen on neutrophil membrane. We studied 22 patients suffering from rheumatoid arthritis and 22 healthy control subjects. CD23 expression on neutrophil membrane was analyzed by immunofluorescence. Neutrophils of 9 out of 22 patients expressed CD23 molecules, neutrophils of 11 out of 22 patients expressed CD23 only after 24 h of incubation in RPMI; only 2 out of 22 patients did not express the CD23 antigen on neutrophil membrane either after isolation or after a 24 h incubation. On the contrary neutrophils isolated from healthy subjects did not express CD23 molecules upon isolation. Only in 7/22 control subjects neutrophils resulted positive after 24 h of incubation in RPMI. Moreover, we found that in our experimental conditions the presence of IFN-g or GM-CSF alone or in combination with IL-4 inhibited CD23 expression during the 24 h incubation. Our results show that there is a strong association between neutrophil ability to express CD23 and rheumatoid arthritis, and that such expression may be regulated by GM-CSF, IFN-gamma and IL-4.
10914845 Metatarsalgia and rheumatoid arthritis--a randomized, single blind, sequential trial compa 2000 Jul OBJECTIVE: To compare the effects of semi-rigid and soft orthoses worn in supportive shoes, and supportive shoes worn alone, on metatarsal phalangeal (MTP) joint pain. MTP joint synovitis, and lower extremity function in patients with rheumatoid arthritis. METHODS: Twenty-eight subjects referred to occupational therapy received in random order 3 interventions for 12 week trials, separated by 2 week washouts. A crossover design compared effectiveness of interventions. RESULTS: Twenty-four subjects completed the study. A reduction in mean pain scores from baseline to final visits showed that semi-rigid orthoses had a highly significant effect on pain. Soft orthoses did not show a significant effect on pain from baseline to final visit, nor did shoes worn alone. None of the interventions had a significant effect on synovitis or function. CONCLUSION: Semi-rigid orthoses worn in supportive shoes were an effective treatment for metatarsalgia. Supportive shoes worn alone or worn with soft orthoses did not provide pain relief for metatarsalgia.