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ID PMID Title PublicationDate abstract
9494988 Surgical treatment of the rheumatoid elbow. An overview. 1998 Feb Surgical treatment of the patient with rheumatoid arthritis continues to evolve. Synovectomy continues to be an effective palliative procedure, preferred in the early stages of disease. Further investigation into the use of arthroscopic techniques may result in decreased morbidity and a quicker recovery. Total elbow replacement by experienced surgeons employing contemporary designs and surgical techniques is associated with a high degree of success approaching that for total hip and knee replacement.
9224236 Extraosseous manifestations of rheumatoid arthritis in the foot and ankle. 1997 Jul The immune mediated pathologic effects of rheumatoid arthritis on osteoarticular tissues are well delineated in the orthopaedic and medical literature. Less well explored are the extraosseous manifestations of rheumatoid arthritis. The rheumatoid disease process can affect virtually any organ system or tissue in the human body; from scleritis, arteritis, and splenomegaly to neuropathy, bursitis, and tendinopathy. The scope of this treatise is to define better for the clinician the extraosseous presentation of rheumatoid arthritis in the foot and ankle.
9659755 [Education of patients with rheumatoid arthritis. Assessment of a survey of interests]. 1998 Feb BACKGROUND: The congruence of interests between health care providers and clients is essential if subjects with chronic diseases will be educated. AIM: To assess, in patients with rheumatoid arthritis, those fields in which they would like to receive education. PATIENTS AND METHODS: Eighty eight patients with rheumatoid arthritis were surveyed about the topics in which they would like to be educated. The inquiry included medical aspects, handicap overcoming, social issues and labor aspects. RESULTS: Eighty two percent of patients were interested in medical aspects, 77% in social issues and 71% in handicap overcoming. Eighty three percent of patients with greater handicaps preferred handicap overcoming, 75% social aspects and 74% medical aspects. Younger patients had a greater interest in labor aspects, those with a recently diagnosed disease were interested in their legal rights and those with a prolonged disease wanted information about self help groups. CONCLUSIONS: The greater educational interests of patients with rheumatoid arthritis were on medical aspects. However, those impaired by the disease were interested in handicap overcoming. Age and duration of the disease also influenced the educational interests of patients. Thus, education in these patients must be individualized.
11001927 Genetic dissection of a rat model for rheumatoid arthritis: significant gender influences 2000 Sep 22 Rheumatoid arthritis (RA) is a common, chronic, autoimmune, inflammatory disease that is influenced by genetic factors including gender. Many studies suggest that the genetic risk for RA is determined by the MHC, in particular class II alleles with a 'shared epitope' (SE), and multiple non-MHC loci. Other studies indicate that RA and other autoimmune diseases, in particular insulin-dependent diabetes mellitus (IDDM) and autoimmune thyroid disease (ATD), share genetic risk factors. Rat collagen-induced arthritis (CIA) is an experimental model with many features that resemble RA. The spontaneous diabetes-resistant bio-breeding rat, BB(DR), is of interest because it is susceptible to experimentally induced CIA, IDDM and ATD, and it has an SE in its MHC class II allele. To explore the genetics of CIA, including potential gender influences and the genetic relationships between CIA and other autoimmune diseases, we conducted a genome-wide scan for CIA regulatory loci in the F(2) progeny of BB(DR) and CIA-resistant BN rats. We identified 10 quantitative trait loci (QTLs), including 5 new ones (Cia15, Cia16*, Cia17, Cia18* and Cia19 on chromosomes 9, 10, 18 and two on the X chromosome, respectively), that regulated CIA severity. We also identified four QTLs, including two new ones (Ciaa4* and Ciaa5* on chromosomes 4 and 5, respectively), that regulated autoantibody titer to rat type II collagen. Many of these loci appeared to be gender influenced, and most co-localized with several other autoimmune trait loci. Our data support the view that multiple autoimmune diseases may share genetic risk factors, and suggest that many of these loci are gender influenced.
9215148 Differential expression of the urokinase receptor (CD87) in arthritic and normal synovial 1997 Apr AIM: To determine whether the urokinase plasminogen activator receptor (u-PAR; CD87) exhibits a possible pathogenic role in rheumatoid and osteoarthritis. METHODS: A semiquantitative, indirect immunoperoxidase histochemical analysis was performed on frozen synovial tissue sections. The recently characterised monoclonal antibody 10G7 recognising transfectants bearing u-PAR was used. Synovial tissue was obtained from 10 patients with rheumatoid arthritis, 10 patients with osteoarthritis, and four normal subjects. RESULTS: u-PAR was expressed on 70-90% of synovial tissue lining cells and subsynovial, interstitial macrophages from the arthritis patients, but only on a few myeloid cells from the normal subjects. It was also present on more endothelial cells from the rheumatoid and osteoarthritis patients, than from normal synovial tissue. CONCLUSIONS: Plasminogen activators are important in joint destruction underlying arthritis. The up-regulated expression of u-PAR in diseased versus normal synovial tissue suggests a role for this antigen in the inflammatory and angiogenic mechanisms underlying rheumatoid and osteoarthritis.
11361206 Magnetic resonance imaging in rheumatoid arthritis: summary of OMERACT activities, current 2001 May Complementing the 3 papers that precede it, this paper explains the rationale for the activities of an OMERACT working party on magnetic resonance imaging (MRI) evaluation of rheumatoid arthritis (RA), sets out provisional recommendations for the acquisition and scoring of MRI of the hand and wrist in RA, and delineates some of the many residual problems that need to be addressed.
9710883 Minocycline for the treatment of rheumatoid arthritis. 1998 Aug The scientific basis for the use of antibiotics (with special emphasis on tetracycline and its derivatives) in the treatment of RA is discussed. The data on efficacy and toxicity are presented. The possible place of tetracycline derivatives within the overall strategy of RA treatment is also presented.
11354303 A randomized double-blind sham-controlled trial of the Prosorba column for treatment of re 2001 Apr The Prosorba column has been studied as a novel therapy for rheumatoid arthritis in several clinical settings over the last 5 years. In this article, we summarize the pivotal clinical trial study supporting the safety and efficacy of the Prosorba column as it is applied to treatment of rheumatoid arthritis. The Prosorba column is a medical device that contains purified staphylococcal protein A covalently bound to a silica matrix. This device is used to treat patient plasma in conjunction with a plasmapheresis machine. In this ex vivo treatment, blood is withdrawn from the patient, cells are separated from plasma in the machine, and the plasma is passed through the Prosorba column. The plasma then is recombined with the cells and returned to the patient. The Prosorba column was approved for the treatment of idiopathic thrombocytopenic purpura in 1987 and, in 2 open-label trials (1,2), showed promising evidence of efficacy in rheumatoid arthritis. A subsequent Phase 3 pivotal trial demonstrated statistical superiority of Prosorba treatments to sham column apheresis (3). Analysis of the pivotal trial of patients who completed all treatments indicated that 41.7% of the Prosorba treated patients met American College of Rheumatology defined response criteria as compared to 15.6% of the sham treated patients. This difference was significant at a level of p < or = 0.02.
11208503 Repeated cyclosporine therapy of peripheral arthritis associated with ankylosing spondylit 2001 Jan BACKGROUND: A case history of a patient with ankylosing spondylitis and peripheral arthritis unresponsive to the conventional drug therapy, but successfully controlled by the use of cyclosporin. MATERIAL AND METHODS: In a 68 years old female patient with a 36 years history of typical ankylosing spondylitis a peripheral polyarthritis (hands, feet, wrists, and knees) developed. The patient did not suffer any other disease known to cause secondary spondylitis (psoriasis, inflammatory, bowel, disease). After the unsuccessful use of non-steroidal antiinflammatory drugs a combination therapy with cyclosporin (4 mg/kg/day) and azapropazone (300 mg t.i.d.) was introduced. RESULTS: Clinical improvement was achieved after 6 months of combined therapy, the polyarthritis completely resolved after one year. Therefore cyclosporin was discontinued. After one year the polyarthritis reappeared therefore the cyclosporin therapy was reinstituted with success. CONCLUSION: Cyclosporin has proved consistently effective in our case to control the peripheral arthritis associated with ankylosing spondylitis.
10646481 The role of cytokines in the pathogenesis of rheumatoid arthritis. 1999 Nov Recombinant DNA technology has made it possible to identify the cytokines expressed in the joints of people with active rheumatoid arthritis (RA). Because a large number of cytokines are expressed in the rheumatoid synovium and many of these cytokines may have redundant biological functions, it was necessary to study cytokine regulation to identify potential therapeutic targets. The regulation of interleukin 1, a proven inducer of bone and cartilage destruction in the rheumatoid synovium, was thus studied and anti-tumour necrosis factor alpha (anti-TNF-alpha) antibody was found to reduce its synthesis markedly, as well as that of other cytokines, leading to our proposal of TNF-alpha as a therapeutic target. The further study of clinical trials in RA verified that the mechanism of action of anti-TNF-alpha includes the down-regulation of several pro-inflammatory agents, diminished leucocyte recruitment and possibly regulation of angiogenesis.
11247858 Immunohistological study of entheses in spondyloarthropathies: comparison in rheumatoid ar 2001 Apr OBJECTIVE: To determine which inflammatory cell types are present in entheses from patients with spondyloarthropathy (SpA) compared with patients with rheumatoid arthritis (RA) or osteoarthritis (OA). METHODS: Enthesis specimens were obtained during orthopaedic procedures in eight patients with SpA, four with RA, and three with OA. After decalcification, the lymphocyte subsets (CD3, CD4, CD8, CD20) in the bone marrow component of each enthesis were measured by an immunohistochemical technique. RESULTS: Oedema and an inflammatory infiltrate were present in all the SpA specimens, being clearly predominant in the bone marrow component of the entheses. The density of all cell types in the bone marrow was significantly higher in the SpA group than in the two other groups. The cell type CD3+ showed the greatest difference between the SpA and RA groups, being increased fivefold in the SpA group. Within the SpA group, CD3+ cells were considerably more numerous than CD20+ cells-a difference from the RA group-and the predominant T cells were CD8+. CONCLUSION: Persistent oedema with an inflammatory infiltrate composed predominantly of CD8+ cells was noted in the entheses of patients with SpA, being predominant in the bone marrow. These results suggest that CD8+ cells may have a key role in local inflammation in SpAs.
11039609 Rhabdomyolysis and aggravation of arthritis in a rheumatoid arthritis patient as a result 1999 Dec A 63-year-old man with rheumatoid arthritis presented with rhabdomyolysis and intractable arthritis of acute onset. He was diagnosed to have sepsis due to Staphylococcus aureus infection through of an ulcerated rheumatoid nodule. Staphylococcus aureus isolated from pus in the ulcerated rheumatoid nodule and a blood sample obtained from the heart post-mortem produced the toxic shock syndrome toxin-1 (TSST-1). The TSST-1 and/or unmethylated CpG motifs in the oligonucleotides present in a bacterium, Staphylococcus aureus in this case, might be implicated in the induction of rhabdomyolysis and intractable arthritis.
12552728 [Neural network approach to medical grading of rheumatoid arthritis]. 1999 Dec A grading system based on neural network has been developed and used int he medical grading diagnosis of a case group of Rheumatoid Arthritis presenting Cold syndrome intermingled with Heat syndrome. The possibility of using neural network in TCM diagnosis is preliminarily explored in this paper.
11511751 Responsiveness of the Cochin rheumatoid hand disability scale after surgery. 2001 Aug OBJECTIVE: To assess the responsiveness of the Cochin functional disability scale for the rheumatoid hand after surgery. METHOD: In a prospective study, patients with rheumatoid arthritis (RA) scheduled for surgery of the wrist and/or fingers were evaluated within 48 h before surgery and at least 6 months after surgery. Clinical outcome measures included duration of morning stiffness, total score for tenderness, total score for swelling, visual analogue scale score for pain in the hands and wrists, a score for overall mobility of the wrist and the fingers, grip and pinch strength, the Hand Functional Index (HFI), the Kapandji index and the Cochin scale. Responsiveness was assessed with the paired t-test, the effect size (ES), the standardized response mean (SRM) and the non-parametric Spearman rank correlation coefficient (r(S)). RESULTS: Fifty patients (42 women) were evaluated twice at an interval of 7.16 +/- 2.10 months (mean +/- s.d.) (range 6-15 months). Thirty-six patients (72%) were very satisfied or satisfied with the results of surgery, seven (14%) were not satisfied or dissatisfied and seven (14%) were dissatisfied or very dissatisfied. The Cochin scale score improved at the second visit (P < 0.0001), with SRM and ES values of 0.66 and 0.58 respectively. The correlation of the change in Cochin score with patient overall satisfaction was r(S) = 0.40. Among the impairment measures, grip strength showed the best responsiveness (SRM = - 0.43, ES = - 0.36, correlation with patient overall satisfaction r(S) = 0.46). The change in Kapandji index had the best correlation (r(S) = 0.51) with patient overall satisfaction but its SRM and ES values were low (- 0.19 and - 0.10 respectively). CONCLUSION: The Cochin scale is responsive and appropriate for the assessment of the effects of surgical treatments on disability in RA hands.
9291852 HLA DRB1* typing and cartilage oligomeric matrix protein (COMP) as predictors of joint des 1997 Aug The carriage of a characteristic sequence of amino acids at position 67-72 in the third hypervariable region of the HLA DRB1 chain has been linked to susceptibility to rheumatoid arthritis (RA). Whether this epitope is also a predictor of more severe disease remains controversial. Cartilage oligomeric matrix protein (COMP) is a protein, the serum levels of which have been found to correlate with large joint destructive disease in previous work. In this paper, we compare DRB1* typing and serum COMP levels in a prospectively observed group of RA patients with or without early hip joint destruction. The COMP levels at study inclusion, median 11 months from onset of symptoms, were significantly higher in the patients with early hip joint destruction compared to the patients in the more benign group. There was no difference in the number of disease susceptibility-related epitopes between the groups. DRB1*04, in contrast, was found among 8/8 patients with hip destruction, but also in 5/8 more benign cases. We conclude that in this type of RA patient, COMP serum levels are more informative predictors of aggressive disease than HLA DRB1* typing.
11109611 [Alpha-2 macroglobulin in serum and synovial fluid of patients with rheumatoid arthritis a 2000 AIM: To study concentrations of alpha-2-macroglobulin (A-2-MG) in blood serum and synovial fluid (SF) in patients with rheumatoid arthritis and formulation of basic clinical, laboratory and x-ray criteria of RA activity. MATERIALS AND METHODS: A-2-MG levels were measured in the serum and SF from 151 RA patients and in the serum of 20 patients with osteoarthrosis (OA) and 62 healthy donors. The serum concentration for RA patients was 166 +/- 65.3 mg%, for OA patients--175.26 +/- 36.99 mg% and for healthy donors--177.772 +/- 50 mg%. Mean concentration of SF A-2-MG in RA patients was 98.77 +/- 82.43 mg%. CONCLUSION: Changes in the concentration of A-2-MG are unrelated to inflammation activity in the joints of RA and OA patients. Serum and synovial concentration of this protein corresponds to changes in the concentration of IgM and rheumatoid factors in RA patients.
10725066 Evaluation of filtration leucocytapheresis for use in the treatment of patients with rheum 2000 Feb OBJECTIVES: To evaluate the efficacy of filtration leucocytapheresis (LCP) for rheumatoid arthritis (RA). METHODS: LCP was carried out three times, with 1 week separating each session, in 25 drug-resistant RA patients. RESULTS: During each session, 96, 98, 61, 84 and 8% of the granulocytes, monocytes, lymphocytes, platelets and erythrocytes, respectively, that entered the LCP filter were removed. The number of granulocytes, monocytes and lymphocytes in the peripheral blood significantly decreased during each session of LCP. However, there was no significant decrease in the number of circulating blood cells during the study period. On average, 110 x 10(8) granulocytes, 5.23 x 10(8) monocytes, and 20.5 x 10(8) lymphocytes were removed during LCP therapy. Assessment of RA before and after LCP showed a substantial and rapid improvement in the tender joints counts, swollen joint counts, and patient's and physician's assessments. No adverse reactions or complications were noted. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels decreased following LCP, although the change in the latter parameter was statistically insignificant. The concentrations of serum albumin, gamma-globulin, IgG, IgM, CH50 and rheumatoid factor titres did not change during or after LCP. Careful analysis indicated that 16 of 25 patients with RA showed > or =20% improvement following LCP therapy. CONCLUSIONS: Our results suggest that filtration LCP to remove leucocytes from the peripheral blood exerts an immunomodulatory effect in patients with RA.
10524798 Production of murine collagen-induced arthritis using Klebsiella pneumoniae O3 lipopolysac 1999 Collagen-induced arthritis (CIA) was produced in mice with non H-2q and H-2r haplotypes by repeated immunization of porcine type-II collagen (CII) together with Klebsiella O3 lipopolysaccharide (KO3 LPS) as an immunological adjuvant. Histological changes that appeared in joints of repeatedly immunized mice were characterized by destruction of normal joint structure, synovial hyperplasia with proliferation of synovial cells, and infiltration of inflammatory cells. No such lesions were produced in mice receiving repeated injections of CII alone or KO3 LPS alone. Development of the humoral antibody and the delayed-type hypersensitivity to CII was exclusively found in mice immunized with the mixture of CII and KO3 LPS. It was therefore suggested that arthritis lesions induced by repeated immunization with the mixture of CII and KO3 LPS might be caused by an autoimmune mechanism, and that the experimental model might be useful for characterization of human rheumatoid arthritis (RA).
9697142 [Analysis of acetabulum migration in rheumatoid arthritis compared with cementless acetabu 1998 Jun In a retrospective analysis the migration profile of 73 cementless total hip implants (Zweymüller Alloclassic) in 54 patients with rheumatoid arthritis were compared with the results of 58 implants of the same design in 50 patients undergoing cementless revision after loosening of an Endler cup. 258 conventional radiographs of the rheumatoid patients and 164 radiographs of the revision group were digitized. The migration analysis was performed using a modified Dickob's technique that allows for correction of different X-ray magnifications as well as horizontal and vertical tilting of the pelvis. The analysis of migration exceeded 2 mm in eight rheumatoid patients. In three of them clinical loosening of the acetabular cup was obvious. In the group of patients after cup revision a significantly higher amount of cranial migration was detected compared with the rheumatoid patients. This phenomenon could be explained by the destruction of the weight-bearing cranial acetabular sclerosis after reaming.
10589361 Etanercept and methotrexate combination therapy. 1999 Nov Tumor necrosis factor (TNF) is a major proinflammatory cytokine in the rheumatoid joint. TNF activity can be neutralized by administration of a recombinant version of its soluble p75 TNF receptor linked to the Fc portion of human immunoglobulin IgG1 (etanercept). The present study examined the combination of etanercept with methotrexate (MTX) in a group of patients with rheumatoid arthritis (RA) who had persistent activity despite monotherapy with MTX. The etanercept-MTX group had a significantly better outcome than the placebo-MTX group using American College of Rheumatology (ACR) criteria. At 6 months, 71% of the patients in the etanercept-MTX group had an ACR 20% response (versus 27% in the placebo-MTX group). In the etanercept-MTX group, 39% had an ACR 50% response (versus 3% in the placebo-MTX group), and 15% in the etanercept-MTX group versus 0% in the placebo-MTX group met the robust ACR 70% response. The present study indicates that etanercept is a novel and robust drug in combination with MTX for the treatment of RA.