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ID PMID Title PublicationDate abstract
10621072 Managed care issues and rheumatoid arthritis treatment. Based on a presentation by Michael 1999 Sep System of payment (whether managed care or fee-for-service) can impact long-term health outcomes and treatment options. Two studies focussing specifically on rheumatoid arthritis found little or no difference in outcomes for patients covered by these payment systems. However, it was found that unrestricted access to treatment from rheumatologists and the continuity of care provided by these specialists did have a strong positive influence on improving function and reducing disability overall.
11383295 Surgical treatment for rheumatoid neck arthritis bilateral occipitospinal fusion with plat 2001 Apr The results of surgical treatment of 12 patients with rheumatoid cervical spine arthritis were reviewed. The Ranawat classification was as follows: 5 with Ranawat IIIB, 1 Ranawat IIIA and 6 Ranawat II. Decompression and fusion using autogenous iliac bone graft and double occipitospinal plate fixation was carried out on 11 of these patients; the remaining patient underwent upper cervical spine fusion using screw and wire fixation. The main indication for surgery was neurological deterioration. In three cases previous surgery had been carried out on the cervical spine. The results were assessed at a mean follow-up of 26.1 months. According to Frankel's grading the neurological recovery in patients with neurological compression was one grade. There was clinical and radiological evidence of fusion in all these patients. The following complications required further surgery: acute postoperative epidural hematoma (one patient) screw loosening (one patient) CONCLUSION: Fusion of the occiput and lateral mass of the involved cervical spine using a plate on each side provides a relatively stable fixation in patients with rheumatoid arthritis of the cervical spine. Laminectomy and adequate decompression of the neural elements can be carried out without compromising spinal stability. There is a relatively high complication rate associated with surgery for rheumatoid neck and the patient needs to be informed.
9844773 The role of somatostatin in the pathophysiology of rheumatoid arthritis. 1998 Nov Involvement of neuro-endocrineimmune interactions in the development of pathologic responses has been suggested in patients with rheumatoid arthritis (RA). Recently we studied the production of an inhibitory neuropeptide-somatostatin (SOM)--and somatostatin receptor (SOMR) expression in RA synovium and its function in patients with RA. We found that physiologic concentrations of SOM inhibited the proliferation of RA synovial cells. Proinflammatory cytokine and matrix metalloproteinase (MMP) production by RA synovial cells were also inhibited by SOM. Subtype 1 and subtype 2 SOMR were expressed on fibroblast-like synovial cells, and the expression of subtype 2 SOMR was up-regulated with the proinflammatory cytokine treatment of the synovial cells in RA patients. RA fibroblast-like cells synthesized SOM by themselves, suggesting that SOM may act as an autocrine regulator of synovial cell functions in RA patients. SOM and SOM analogues have also been reported to be effective in the treatment of patients with RA. In summary, SOM inhibited aberrant synovial cell functions in patients with RA, suggesting a possible clinical application of this neuropeptide.
10622681 Clinical experience with soluble TNF p75 receptor in rheumatoid arthritis. 1999 Dec OBJECTIVES: Managing rheumatoid arthritis (RA) can be difficult: the disease may follow an unpredictable course, and therapies are often ineffective or toxic. Etanercept, a bioengineered fusion protein derived from the human soluble tumor necrosis factor p75 receptor, recently has been approved for use in patients with refractory RA. METHODS: Published data on clinical experience with etanercept in conjunction with case illustrations are presented. RESULTS: Reports from clinical trials of patients with refractory RA indicate that etanercept significantly improves measures of disease activity, including swollen and tender joint counts, morning stiffness, pain, and erythrocyte sedimentation rate, compared with placebo. In the phase 3 trial, swollen joint counts improved by 47% in patients receiving etanercept 25 mg compared with a 7% worsening in patients receiving placebo. The drug is well tolerated; injection site reaction, the most frequent adverse event, was minor and manageable. In long-term studies, etanercept remains well tolerated and effective. Our clinical experience indicates that patients with refractory RA experience dramatic symptomatic relief, along with reduced fatigue and improved quality of life. One of 18 patients discontinued treatment; the rest have remained on therapy for up to 18 months. CONCLUSIONS: Etanercept diminishes disease activity in patients with refractory RA. Its favorable safety profile provides symptom control without major toxicity. Etanercept is an important addition to RA therapeutic agents.
11138333 High serum and synovial fluid granulocyte colony stimulating factor (G-CSF) concentrations 2000 Nov OBJECTIVE: To determine the relationship between serum G-CSF, RA disease activity and the levels of inflammatory cytokines. METHODS: Sixty-one patients (5 men and 56 women; mean age; 56.1 +/- 11.4 [+/- SD] years, range, 22-70 years) who were selected at random and met the American College of Rheumatology criteria for RA were examined. Granulocyte-colony stimulating factor (G-CSF) levels in sera and synovial fluid were measured by solid-phase radioimmunoassay (RIA). We also measured various indices of RA disease activity and serum levels of IL-1 beta, IL-6 and TNF-alpha by ELISA. RESULTS: The morning stiffness, number of tender or swollen joints, ESR, Lansbury index and serum G-CSF levels in patients with active RA were significantly higher than the corresponding levels in patients with inactive RA. Serum G-CSF levels correlated significantly with morning stiffness, the number of tender or swollen joints and the Lansbury index. However, there was no correlation between serum G-CSF and ESR. High levels of IL-1 beta, IL-6 and TNF-alpha were detected in RA patients. The number of tender or swollen joints, ESR, Lansbury index, and IL-1 beta were significantly higher in G-CSF-positive RA patients than in G-CSF-negative RA patients. CONCLUSION: Our results suggest that G-CSF produced by synovial cells stimulated by inflammatory cytokines might contribute to inflammatory arthritis in RA patients.
11933345 The assessment and management of leg ulcers in rheumatoid arthritis. 2000 Jun Patients with rheumatoid arthritis appear to be at increased risk of developing chronic leg ulcers. This review identifies the factors that predispose these patients to leg ulceration and highlights how this problem can be managed and the risk of recurrence reduced.
9453739 [Development of surgical indications in the treatment of rheumatoid wrist. Report on exper 1997 The author relates his experience in surgical treatment of the rheumatoid wrist based on a consecutive series of 603 cases operated from 1968 to 1994. His therapeutic indications have changed over the years after a retrospective study of the long-term results. He distinguishes conservative surgery, which combines dorsal synovectomy and relaxation stabilisation of the wrist (also called surgery of the dorsal wrist) from total arthrodesis and arthroplasty of the wrist. The results of conservative surgery after a follow-up of more than five years confirm that the disease continues in spite of synovectomy. Furthermore, relaxation stabilisation using soft tissue (extensor retinaculum and tendon transfer) is not sufficient to stabilise the wrist. Most of the time, this has to be completed by a partial radiocarpal arthrodesis. This is indicated when the carpus shows a medial translation or early in potentially progressive forms (Larsen Stage 1). In advanced forms conservative surgery consisting of partial radiocarpal arthrodesis is only indicated when the midcarpal joint appears functional after dynamic radiological examination. The author used the Swanson implant to perform 70 arthroplasties from 1973 to 1988. Long-term results show a large number of complications, which increased progressively with time. The Swanson implant was therefore abandoned in 1988. In 12 cases operated from 1979 to 1984 wrist arthroplasty was performed using Jackson's technique which consists of resection-interposition of a silastic sheath. This technique was also abandoned in 1984 due to the variable and unpredictable results obtained. At the present time, the author:-does not perform arthroplasties; increasingly completes surgery of the dorsal wrist by radiolunate arthrodesis;-has noted an increase in indications for total wrist arthrodesis. He emphasizes the importance of long-term evaluation of surgical results in rheumatoid arthritis.
15311704 [Roentgenologic assessment of articular lesions in rheumatoid arthritis]. 2001 Jan The article presents a comparative analysis of methods for quantitative assessment of roengenologic changes in the joints in rheumatoid arthritis that have come to be widely used in USA and Europe. It is noted that the Steinbroker's method widely employed by clinicians fails to give an integral assessment of the articular affection. Expediency is documented of employment of the Sharp's method in roentgenologic monitoring in clinical trials of new antirheumatic drug preparations. In a routine clinical setting the Larsen's method or its modifications are to be preferred since in spite of its low sensitivity investigation time is cut down 2.3-fold by comparison with the Sharp's method.
9598878 Diagnostic value of antibodies to filaggrin in rheumatoid arthritis. 1998 May OBJECTIVE: To determine the prevalence of antibodies to filaggrin in a cross sectional sample of patients with rheumatoid arthritis (RA). METHODS: Filaggrin from human skin was either extracted with 0.05% Nonidet P-40 and then partially purified by precipitating in ethanol and resuspending in water (Nonidet preparation) or extracted with 9 M urea and then purified by sequential fractionation on a DEAE Sephadex column and on a strong cation exchange column (purified preparation). Antibodies to filaggrin were detected using immunoblotting techniques with sera diluted 1:50. Antikeratin antibodies (AKA) were detected using indirect immunofluorescence microscopy on sections of rat esophagus. RESULTS: Antibodies to filaggrin were detected in 5 of 30 sera of patients with RA using filaggrin from the Nonidet preparation and 6 of 49 sera using filaggrin from the purified preparation. AKA were detected in 13 of 40 sera. A positive correlation existed between the presence of AKA and the presence of antibodies to filaggrin using the purified preparation (p=0.017). CONCLUSION: These data indicate that the reactivity of RA sera with filaggrin is not identical to the presence of AKA and is variable depending upon the preparation of filaggrin used. The diagnostic value of antibodies to filaggrin remains to be proven.
10225725 The efficacy of plasmapheresis or leukocytapheresis for articular and extraarticular manif 1997 Nov The authors investigated the clinical effectiveness of plasmapheresis (PP) or leukocytapheresis (LP) in 21 patients with articular or extraarticular manifestations of rheumatoid arthritis (RA). Salt-amino acid coprecipitation (SAC) or double membrane filtration plasmapheresis (DFPP) were used as PP regimens, and a centrifugation method (CS-3000) and leukocyte removal filter (Cellsorba) were used as LP regimens. The results were as follows. The removal rate of plasma globulin was higher with SAC than with DFPP, and the removal rate of leukocyte was higher with Cellsorba than with CS-3000. Based on a comparison of the present apheresis methods for short-term therapy, the leukocyte removal regimen proved more effective than the PP regimen by DFPP. In patients with extraarticular manifestations of malignant rheumatoid arthritis (MRA), there were rapid and dramatic intractable skin ulcers, rheumatoid nodules, low serum levels of complements, and high levels of immune complex. Cellsorba was the more useful regimen in short-term apheresis therapy as compared with DFPP. In RA or MRA patients receiving the long-term PP or LP regimen obvious improvements in grasping power and C reactive protein (CRP) levels were observed. The PP or LP regimen continuation rate was 88, 79, and 54% at 3, 12, and 20 months, respectively.
10868022 [Clinical day care treatment of patients with rheumatoid arthritis: concept of a new outco 2000 Apr Patients with rheumatic diseases are commonly treated as an outpatient in their local environment or are referred to specialized centers. Two recently founded day-patient clinics in Berlin and Frankfurt/Rhein-Main (Germany) for patients suffering from rheumatic diseases will be evaluated for their medical outcome and cost-effectiveness of comprehensive treatment of RA patients in stages of high inflammatory activity and progressive disability. The study design will be prospective, controlled, and randomized to compare outpatient and day-patient treatment. The case-control study design with matched pairs within the network of collaborative arthritis centers will be used to compare day-patient and inpatient treatment. The paper contains a review of studies published in English or German language dealing with day-patient treatment of RA patients.
11578015 Selenium supplementation in rheumatoid arthritis investigated in a double blind, placebo-c 2001 INTRODUCTION: Selenium is an essential trace element with antioxidant properties. Trials with selenium have been conducted in rheumatoid arthritis (RA) to correct impaired selenium status and increase defences against deleterious oxidant species. AIM OF THE STUDY: To investigate in a double blind multi-centric placebo-controlled study the effects of selenium supplementation in RA. METHODS: Fifty five patients with moderate RA received during 90 days either capsules containing selenium-enriched yeast (200 microg/d) or a placebo. RESULTS: The visual analog scale, the Ritchie index, the number of swollen and painful joints, and morning stiffness significantly decreased with time in both groups (p<0.001), but no difference between groups could be identified. When examining the quality of life a significant (p<0.01) improvement in arm movements and health feeling was evidenced in selenium-treated patients. CONCLUSION: Selenium treatment did not show clinical benefit on RA. Interestingly, the improval in both groups demonstrated a placebo effect of the intervention trial.
11172375 An alternative technique for revision arthrodesis of the rheumatoid wrist: a case report. 2001 Jan Few studies address the problem of failed rheumatoid wrist arthrodesis. We report a case of this difficult complication that was treated with a new technique of arthrodesis, which includes both the ulnocarpal and radiocarpal sites with 2 intramedullary nails and an ulnar ostectomy.
10857798 Computer-based methods for measuring joint space and estimating erosion volume in the fing 2000 Jun OBJECTIVE: This study was conducted 1) to determine the feasibility of using computer programs to measure radiographic joint space width and estimate erosion volume in the hands of patients with rheumatoid arthritis (RA), and 2) to compare the new computer-based methods with established scoring methods. METHODS: To measure the joint space width in the finger and wrist joints of RA patients, hand and wrist radiographic films were scanned using a tabletop scanner and analyzed with programs written using the "macro" capabilities of NIH Image software. Estimation of erosion volume was determined by utilizing gray-scale intensity to calibrate bone density units per mm3, which made possible comparisons between the erosions and noneroded, anatomically similar sites. RESULTS: In 3 sets of duplicate measurements of joint space width on 79, 48, and 48 finger and wrist joints, the mean absolute deviation from the mean of the 2 measurements was 0.036 mm (SD 0.034), 0.032 mm (SD 0.049), and 0.021 mm (SD 0.016), respectively. Joint space measurements and scoring of joint space narrowing both demonstrated a difference between active treatment and placebo in an old trial set on gold therapy (P = 0.03 and P = 0.01, respectively). Two repeated measurements of bone density units in the bones of 3 different hands differed from the mean of the measurement by 2.29-4.04%. In 2 experiments, estimates of erosion volume showed a greater difference between gold therapy and placebo than did erosion scores in the trial set (P = 0.049 and P = 0.016 versus P = 0.27). CONCLUSION: Computer-based methods for measuring finger and wrist joint spaces and estimating erosion volume in patients with RA agree with the results of radiographic scoring of erosions and joint space narrowing.
11094450 Cell-cell interactions in synovitis. Endothelial cells and immune cell migration. 2000 Leukocyte ingress into the synovium is a key process in the pathogenesis of rheumatoid arthritis and other inflammatory conditions. In this review, the role of endothelial cells in leukocyte extravasation will be discussed, including the role of the most relevant cellular adhesion molecules. These molecules play an important role in mediating leukocyte--endothelial interactions. It is likely that different adhesive pathways are involved in different steps of leukocyte adhesion to and migration through endothelia. Targeting of pathological endothelial function, including leukocyte--endothelial adhesion, may be useful for the future management of inflammatory arthritis.
11219389 Clonal expansion is a characteristic feature of the B-cell repetoire of patients with rheu 2000 The present study was designed to analyze the level of B-cell clonal diversity in patients with rheumatoid arthritis by using HCDR3 (third complementarity determining region of the rearranged heavy chain variable region gene) length as a marker. A modified immunoglobulin VH gene fingerprinting method using either genomic DNA or complementary (c)DNA derived from B cells of the peripheral blood, synovial fluid, and tissues of several rheumatoid arthritis patients was employed. These assays permitted the detection and distinction of numerically expanded B-cell clones from activated but not numerically expanded B-cell clones. The present data suggest that B-cell clonal expansion is a common and characteristic feature of rheumatoid arthritis and that it occurs with increasing frequency from the blood to the synovial compartments, resulting in a narrowing of the clonal repertoire at the synovial level. These clonal expansions can involve resting, apparently memory B cells, as well as activated B cells. Furthermore, some of these individual expansions can persist over extended periods of time. These findings support the hypothesis that a chronic ongoing (auto)immune reaction is operative in rheumatoid arthritis and that this reaction, at least at the B-cell level, may be unique to each individual joint. A determination of the targets of these autoimmune reactions may provide valuable clues to help understand the immunopathogenesis of this disease
9168980 Identification of human semaphorin E gene expression in rheumatoid synovial cells by mRNA 1997 May 8 Rheumatoid arthritis (RA) is characterised by chronic inflammation of synovial tissue with aggressive proliferation of synovial cells causing destruction of cartilage and bone. Immunopathological mechanisms, infectious causes and genetic factors have been discussed, but the etiology of the disease has not been understood until now. Especially, the mechanisms driving tumourlike growth and invasive behaviour of fibroblastoid synovial cells have not been identified yet. Our aim is to find cellular factors which are mediators for such pathways. One possibility to approach this, is searching for disease-relevant genes. We applied the mRNA-differential display technique to compare mRNA expression patterns of normal and rheumatic synovial fibroblasts. We identified an upregulation of the human semaphorin E gene in rheumatoid synovial fibroblastoid cells. Interestingly semaphorin E is a member of a protein-family described to play an immunosuppressive role via inhibition cytokines. A relevance of this finding towards the pathogenesis of RA is discussed.
9636977 Functional turbo spin echo magnetic resonance imaging versus tomography for evaluating cer 1998 Jun 1 STUDY DESIGN: Comparison of findings in plain radiography and conventional tomography with findings in plain radiography and magnetic resonance imaging of the upper cervical spine in consecutive patients with rheumatoid arthritis and with known or suspected abnormalities of the cervical spine. OBJECTIVES: To determine whether plain radiography and magnetic resonance imaging provide enough information to dispense with tomography in investigations of cervical spine involvement in rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: With the recent advances in magnetic resonance imaging technology and the proliferation of magnetic resonance imaging techniques for specific clinical conditions. METHODS: Twenty-eight patients with rheumatoid arthritis and with known or suspected abnormalities of the cervical spine underwent a clinical neurologic examination; plain radiography, including full flexion lateral radiography; anteroposterior and lateral tomography at C1-C2; and magnetic resonance imaging at the same level in neutral position and in flexion. Two radiologists evaluated one image set consisting of plain radiography and conventional tomographic images and another image set consisting of plain radiography and magnetic resonance images, for each patient. RESULTS: Compared with conventional tomography and plain radiography, magnetic resonance imaging and plain radiography showed cystic lesions and erosions of the odontoid process and vertical atlantoaxial subluxation more often, showed anterior subluxation as often, and showed lateral atlantoaxial subluxation less often. CONCLUSION: Magnetic resonance imaging produces sufficiently distinct images of destruction of the odontoid and subluxations for it to replace conventional tomography in investigations of upper cervical spine involvement in rheumatoid arthritis.
9213381 A role for histamine receptors in rheumatoid arthritis. 1997 Jun Although neurotransmitters and various chemical mediators play an important role in the pathogenesis of rheumatoid arthritis (RA), precise underlying mechanisms have yet to be determined. Histamine is a classical mediator of inflammation and three types of receptors are known. We investigated the presence and functions of histamine receptors of lymphocytes, bone marrow cells, synovial fibroblasts, and chondrocytes in experimentally-induced arthritis and human RA. The function of H2 receptors in peripheral blood lymphocytes and bone marrow cells were down regulated as measured by increments of intracellular cAMP and IL-6 production. Synovial fibroblasts from RA patients did not respond to H2 agonist to synthesize hyaluronic acid. It is evident that H2 receptors are down-regulated in lymphocytes, bone marrow cells, and synovial fibroblasts. The reduced function of H2 receptors in collagen-induced arthritis was normalized by transfer of the receptor-bearing lymphocytes and bone marrow cells. These data suggest that histamine is involved in the pathogenesis of RA.
11812014 Transcription factors. 2001 Dec The regulation of gene expression by transcription factors is fundamental to the phenotype of all cells. The activated phenotype of cells engaged in inflammatory processes is characterized by induced expression of a diverse set of genes, including cytokines, enzymes and cell adhesion molecules. A relatively small number of inducible transcription factors, particularly NF-kappaB, AP-1, NFATs and STATs, are responsible for the expression of a wide variety of inflammatory phenotypic characteristics and therefore play a central role in the pathogenesis of rheumatic diseases. Each of these transcription factors can be modified by existing anti-rheumatic and anti-inflammatory drugs, although adverse effects and limited efficacy remain problems. The future development of therapeutic agents with specificity for transcription factors, especially NF-kappaB, might lead to safer and more effective treatment.