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ID PMID Title PublicationDate abstract
9566667 Uncooked, lactobacilli-rich, vegan food and rheumatoid arthritis. 1998 Mar We tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid patients randomized into diet and control groups. The intervention group experienced subjective relief of rheumatic symptoms during intervention. A return to an omnivorous diet aggravated symptoms. Half of the patients experienced adverse effects (nausea, diarrhoea) during the diet and stopped the experiment prematurely. Indicators of rheumatic disease activity did not differ statistically between groups. The positive subjective effect experienced by the patients was not discernible in the more objective measures of disease activity (Health Assessment Questionnaire, duration of morning stiffness, pain at rest and pain on movement). However, a composite index showed a higher number of patients with 3-5 improved disease activity measures in the intervention group. Stepwise regression analysis associated a decrease in the disease activity (measured as change in the Disease Activity Score, DAS) with lactobacilli-rich and chlorophyll-rich drinks, increase in fibre intake, and no need for gold, methotrexate or steroid medication (R2=0.48, P=0.02). The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms of rheumatoid arthritis. Large amounts of living lactobacilli consumed daily may also have positive effects on objective measures of rheumatoid arthritis.
10399221 [The prevalence of rheumatoid arthritis and the rheumatoid factor in the native inhabitant 1999 AIM: The study of rheumatoid arthritis (RA) and rheumatoid factor (RF) prevalence among residents of eastern Chukotka--Eskimos and Chukchi. MATERIALS AND METHODS: Simultaneous total survey covered 974 of 1176(83.3%) residents of 4 villages in the eastern Chukotka. RESULTS: RA was diagnosed in 7(0.7%) examines. Clinical picture of the disease was characterized by for the most part symmetric affection of hand and feet joints, absence of systemic manifestations, favourable course and frequent absence of RF. RF positive titers (1:160 and higher) occurred in 23 of 804 examinees (2.9%), among Eskimos--6%. This was significantly higher than in Chukchi (2.0%) and in subjects of mixed nationality (1.3%). CONCLUSION: Prevalence and clinical picture of RA in residents of northeast Siberia were comparable with such observed in other epidemiological surveys in Russia and Alaska.
9517761 Dispersion of ventricular repolarization: a new marker of ventricular arrhythmias in patie 1998 Mar OBJECTIVE: To determine the value of dispersion of ventricular repolarization as a diagnostic tool to assess the risk for ventricular arrhythmias in patients with rheumatoid arthritis (RA). METHODS: We examined 42 patients with RA (age 44+/-4.8 yrs; 32 women and 10 men) and 42 age matched healthy subjects as the control group. Repolarization dispersion variables were calculated based on the difference between maximal and minimal values of QT, QTc, JT, and JTc (QTd, QTc-d, JTd, and JTc-d, respectively) from 12 lead electrocardiographic (ECG) recording at 50 mm/s. The frequency of ventricular arrhythmias by means of 24 h ambulatory ECG monitoring was investigated. A grade of > 3 ventricular arrhythmias according to modified Lown and Wolf classification was accepted as complex arrhythmias. RESULTS: We found QT and QTc intervals 392+/-20 and 409+/-38 ms in patients; values in controls were 387+/-22 and 400+/-14 ms, respectively; p > 0.05. QTd, QTc-d, JTd, and JTc-d intervals were 61.6+/-1.6, 77.6+/-1.1, 72.5+/-1.8, and 93.3+/-1.5 ms in patients and 40.3+/-0.9, 55+/-1.2, 42.6+/-0.4, and 52.9+/-0.8 ms in controls, respectively; p < 0.001. Thirty-two of the patients had complex premature ventricular complexes during 24 h ECG and the prevalence of premature ventricular complexes was found to be higher than in controls (p < 0.001). No correlation was found between complex premature ventricular complexes and QT, but there was a correlation between complex premature ventricular complexes and dispersion variables in patients with RA. CONCLUSION: Striking increases in QT dispersion indicating regional inhomogeneity of ventricular repolarization were noted in patients with RA. QT dispersion might be a useful marker of cardiovascular morbidity and mortality due to complex ventricular arrhythmias in patients with RA.
9397618 Total knee arthroplasty in a rheumatoid arthritic knee with large geode: a case report. 1997 Sep Geodes (subchondral cysts) are a well-known manifestation of rheumatoid arthritis. Solitary cysts or cysts larger than 2 cm are not generally found in the knee joint of patients with rheumatoid arthritis (RA). We report a case of RA involving both knees with a giant geode over the right proximal tibia. Surgical treatment was performed including synovectomy, cyst enucleation and packing of autogenous bone chips followed by primary total knee arthroplasty. The postsurgical result was excellent with the knee restored to good function and complete healing of the cystic lesion.
11690569 Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: compari 2001 Oct 15 PURPOSE: To compare the effect of delayed and early treatment strategies on disease outcome in patients with rheumatoid arthritis. SUBJECTS AND METHODS: Between 1993 and 1995, 109 patients diagnosed with probable or definite rheumatoid arthritis of recent onset were initially treated with analgesics; if they had persistent active disease, they were treated subsequently with the disease-modifying drugs chloroquine or salazopyrine (delayed treatment). Between 1996 and 1998, similar patients (n = 97) were promptly treated with either chloroquine or salazopyrine (early treatment). RESULTS: The median lag to the initiation of disease-modifying treatment was 15 days in the early treatment group and 123 days in the delayed treatment group. There was less radiologic joint damage after 2 years in the early treatment group (median Sharp score, 3.5; 95% confidence interval [CI]: 1 to 7) compared with the delayed treatment group (median Sharp score, 10; 95% CI: 5 to 15; P <0.05). The median area under the curve of the 2-year disease activity score was lower in the early treatment group (64 units; 95% CI: 59 to 69 units) compared with the delayed treatment group (73 units; 95% CI: 69 to 77 units; P = 0.002). CONCLUSION: In this nonrandomized comparison, early introduction of disease-modifying antirheumatic drugs was associated with a better disease outcome after 2 years.
10088946 The use of two different Health Assessment Questionnaires in Turkish rheumatoid arthritis 1999 The aim of this study was to compare and evaluate the Health Assessment Questionnaire (HAQ) and Arthritis Impact Measurement Scale (AIMS) in our patient population with rheumatoid arthritis (RA) and also to find some associations with clinical assessment of disability. One hundred and twenty-three consecutive adult patients with RA were included in the study. Pain, and global assessments by patients and physicians were recorded using a 10 cm visual analogue scale. Each patient completed the HAQ and AIMS questionnaires. Correlations among tender and swollen joint counts, erythrocyte sedimentation rate, pain, and AIMS anxiety and depression scores were all investigated. Pearson correlation was used to assess the possible correlations between each questionnaire and clinical variables. Pain and the AIMS subscales of mobility, dexterity, social activity and activities of daily living correlated with global assessments by patients and physicians, and tender joint counts. Depression correlated with pain and disability (HAQ). It was also of note that we observed high intercorrelation between the global assessments of physicians and patients. It was concluded that a measure of functional status, patient global assessment and pain score should be considered as important in the evaluation of RA patients. Measuring psychological well-being also provides further information. The HAQ, with the addition of the anxiety and depression sections of AIMS (CLINHAQ), provides the advantage of a global evaluation of these chronically ill patients.
11005782 Data driven attempt to create a clinical algorithm for identification of women with rheuma 2000 Oct OBJECTIVES: To examine relations between osteoporosis and low bone mass and demographic and clinical variables in patients with rheumatoid arthritis (RA), in an attempt to develop a data driven clinical tool for identification of patients at high risk of osteoporosis. METHODS: All patients were recruited from a county based register and were examined cross sectionally with a variety of clinical and health status measures as well as bone density measures (anteroposterior spine L2-4, total hip, and femoral neck). Associations between osteoporosis (T score < or = -2.5SD) and low bone mass (T score < or = -1SD), on the one hand, and demographic and clinical measures, on the other, were examined bivariately and by logistic regression analyses. RESULTS: 394 patients with a mean age of 54.8 years were examined. The percentages having osteoporosis/low bone mass were 16.8/45.8, 14.7/54.5 and 14.7/55.5 in spine L2-4, total hip, and femoral neck, respectively. Osteoporosis and low bone mass were bivariately related to age, body mass index (BMI), disease duration, disease process measures, presence of deformed joints, physical disability, current use of corticosteroids, and history of non-vertebral fracture. In multivariate analyses, age >60 years, low BMI, and current use of corticosteroids were consistently related to osteoporosis and to low bone mass at all sites. The presence of deformed joints was associated with osteoporosis at the total hip, and a history of previous non-vertebral fracture with osteoporosis at the femoral neck. The Modified Health Assessment Questionnaire (MHAQ) > or = 1.5 and non-vertebral fracture were also independently associated with low bone mass at the hip. The logistic regression analyses models could, however, only predict osteoporosis with a sensitivity of about 50-60% and a specificity of 80-90% at the various measurement sites, and low bone mass with a sensitivity and specificity of about 70%. CONCLUSION: Consideration of demographic and disease markers may be of some help in predicting presence of osteoporosis or low bone mass, but a combination of markers cannot be used as a clinical tool with sufficient sensitivity and specificity for the identification of osteoporosis or low bone mass in patients with RA.
11320856 [Rheumatoid arthritis. Recent findings and new pathogenic concepts]. 2001 Mar The etiology of rheumatoid arthritis (RA) is still unknown, and many uncertainties regarding its pathogenetic mechanisms persist. During the past decade, various hypotheses have been advanced, yet none of these has been able to explain the complexity of the disease. In light of the most recent research, a sub-division of the pathogenesis of RA, in four phases, has been proposed. The first phase is that of tissue damage, induced by unknown infective or traumatic factors with the liberation of possible arthrogenic antigens that are presented to the immune system. In the second phase the immune and inflammatory mechanisms should begin to function and, if they are effective, they should determine the resolution of the process; the failure of these mechanisms would create a further amplification of the immuno-inflammation response (the third phase). The fourth phase would then be a chronic inflammatory with progressive articular destruction, as well as anatomical and functional damage. This evolution, in response to common pathogenic agents, is dependent upon a particular hereditary genetic asset (not only the HLA system) that is able to control the production of citokines and also upon the neuroendocrine system. The final outcome of the process is, therefore, determinated by multiple interference between the inflammatory/immune system and other systems that also interact with it (the integrated pathogenetic hypothesis). This hypothesis reflects the complexity of the immune/inflammatory system that must be considered to be an acting part of an integrated network of diverse systems. A better knowledge of these interactions needed for the discovery of potential new therapies for RA.
9666413 Early arthritis therapy: rationale and current approach. 1998 Jul Rheumatoid arthritis (RA) is a disease that seriously affects patients' quality of life and may lead to disability or even premature death, despite the availability of effective treatments. Evidence suggests that delay of treatment may be the main contributing factor for poor outcome. Delay is caused primarily by the erroneous belief that the course of RA may be controlled in many cases by mild measures such as nonsteroidal antiinflammatory drugs, physiotherapy, and rest. While this may be true in a certain percentage of patients, many patients with RA progress to severe disability. To prevent progression of disease, early treatment of RA, particularly in patients at high risk, seems mandatory. Therefore, early arthritis clinics (EAC) have been established in a number of countries. We discuss the rationale for early intervention and our experiences in Austrian EAC.
9917959 Pulmonary manifestations of rheumatoid arthritis. 1998 Dec Rheumatoid arthritis (RA) is the most common of the classic connective tissue diseases. Its manifestations in the chest are varied as the pleura, lung parenchyma, airways, and pulmonary vasculature can all be involved. The approach to a patient with RA and respiratory complaints, radiographic findings, or physiologic abnormalities requires a broad understanding of these manifestations. Moreover, the potential for therapy-related toxicity adds further complexity to the pulmonary evaluation of these patients.
9626629 Fractal dimension as a measure of altered trabecular bone in experimental inflammatory art 1998 Jun Our previous studies in experimental inflammatory arthritis (EIA) and in human rheumatoid arthritis demonstrated rapid remodeling with a 5-fold increase in bone resorption and bone formation. Normal condylar trabecular bone is typically anisotropic, with its orientation along lines of stress; rapid remodeling in a pathological state could disturb the usual order of trabeculae. This study assessed change in the structure of trabecular bone of the distal femoral epiphysis after induction of EIA, using a measure of "fractal dimension," which may be considered a quantitative description of the degree of irregularity of complex surfaces. Data was obtained from specimens in which EIA had been induced in the rabbit knee by 10 injections of carrageenan over 49 days. Photographic enlargements of embedded undecalcified cross-sections of the distal femur were digitized, and software written on a Sun workstation was used to define repeatable regions of interest (ROIs) in the images. The ROIs were subjected to fractal analysis by a power law method. The fractal dimension of the trabecular bone pattern within the ROI was estimated by fitting an equation of the form A (epsilon) = lambda epsilon (2-D) to the data. In this equation, A (epsilon) is the area of the "surface" formed by modeling the ROI data as a three-dimensional structure with the grey-level magnitude providing the third dimension, lambda is a scaling constant, epsilon is the size of the measuring "tool" used to measure the area, and D is the fractal dimension. A Mann-Whitney U-test applied to the average of the data from all ROIs showed that the two distributions of fractal dimension were significantly different (p < 0.005). There were only two overlaps between data points for arthritis (with these values higher) and normal groups (n = 11 for each group). Since Howship's lacunae were too small to be resolved in the system utilized, we consider the difference in fractal dimension to be primarily related to trabecular surface orientation, rather than to the increased number of asperities (resorptive foci) occurring due to increased turnover in bone affected by inflammatory arthritis. The results suggest that fractal dimension may be a useful tool for assessing the degree of structural damage to trabeculae in conditions similar to EIA.
9759990 Blood pressure changes at the Dead Sea (a low altitude area). 1998 Aug The Dead Sea (barometric pressure: 800 mm Hg) is an important balneotherapeutic centre for chronic dermatologic and arthritic diseases. In the past, hypertensive patients have complained sporadically of weakness and dizziness during a stay in the Dead Sea. It was therefore recommended that hypertensives do not stay at these health centres. The aim of our study was to investigate the changes in blood pressure (BP) parameters of 72 hypertensive and normotensive osteoarthritic and rheumatoid arthritic elderly patients during a 2-week stay in the Dead Sea, and to further evaluate the effect of different balneotherapeutic means on these BP changes. Following a primary BP assessment at the out-patient clinic (Beer Sheva barometric pressure: 745 mm Hg), the patients were divided into four groups: (1)thermomineral pool; (2)Dead Sea water baths; (3) combination of the aforementioned treatments; and (4) controls (no balneotherapy). We demonstrated that the systolic BP (SBP) of hypertensives and normotensives decreased by an average of 17 mm Hg and that diastolic BP (DBP) decreased by an average of 8 mm Hg from their basic clinic-measured values. These favourable results were sustained during the first 10 days duration, and by the end of their stay they had diminished slightly. Thermomineral water had an additional lowering effect on the BP of the normotensives, but the SBP of hypertensives increased. Immediately following Dead Sea bath immersion, we noted a temporary increase of SBP in normotensives only. No patient, hypertensive or normotensive, complained of dizziness, malaise, or any other complaint. In our experience, patients feel well at low altitudes, and there is no justification in upholding hypertension as a contraindication to balneotherapy in the Dead Sea.
9663860 A causal model of coping and well-being in elderly people with arthritis. 1998 Jun The purpose of this longitudinal study was to test a model of the relationships among social economic status, gender, severity of impairment, stress emotions, coping strategies and psychological well-being. A sample of 78 elderly women and men, 60 years old or over, and diagnosed as having rheumatoid arthritis since mid-life, volunteered to participate in the study. Twelve months later, 64 of these elderly people were re-interviewed. Path analysis was used to examine the empirical import of the Lazarus and Folkman theory of stress and coping. Analysis of variance for repeated measures was used to test for changes over time among the study variable. A consistent relationship between severity of impairment, emotions, coping strategies and psychological well-being emerged from the data at time one and time two. Choice of coping strategies and psychological well-being were primarily influenced by emotions. The best predictor of psychological well-being at both time periods was the stress emotion of challenge. At both time periods, optimistic and self-reliant coping strategies were used most often and evasive and emotive strategies the least.
9385695 Chronic immunity-driven polyarthritis in hairy cell leukemia. Report of a case and review 1997 Oct Hairy cell leukemia can be responsible for polyarthritis due either to leukemic infiltration or to immunity-drive inflammation. The second variant can antedate or post-date the clinical onset of leukemic symptoms and usually presents as rheumatoid arthritis, more rarely as lupus or scleroderma. The presence of hairy cells in the joint fluid does not rule out autoimmune polyarthritis. The main differential diagnoses are Felty's syndrome and large granular lymphocyte leukemia. We report a case of hairy cell leukemia with seropositive rheumatoid arthritis.
9336419 A phase 1 study to address the safety and efficacy of granulocyte colony-stimulating facto 1997 Oct OBJECTIVE: To examine the safety and efficacy of granulocyte colony-stimulating factor (G-CSF) alone for the mobilization of peripheral blood progenitor cells in patients with resistant active rheumatoid arthritis (RA). METHODS: Five patients with resistant active RA were studied. A dose of 5 microg/kg of G-CSF (Filgrastim) was given subcutaneously each day for 5 days, and the number of stem cells mobilized into the peripheral blood was assessed by daily CD34 counts. RA disease activity was assessed by standard clinical methods. RESULTS: The absolute numbers of peripheral blood CD34+ cells peaked on day 4, with a mean value of 0.025 x 10(9)/liter (range 0.013-0.048 x 10(9)/liter). There was no significant change in disease activity during the study or in the month following therapy. CONCLUSION: Using G-CSF alone, CD34+ progenitor peripheral blood cells were mobilized in numbers suitable for leukopheresis. G-CSF therapy was well-tolerated in patients with active RA, and was not associated with a flare during treatment or in the month following treatment.
10513799 Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of 1999 Sep OBJECTIVE: To investigate the evolution of functional capacity, disease activity, and joint destruction over time in a 12-year prospective cohort of rheumatoid arthritis (RA) patients, and to study the relative contribution of disease activity and joint destruction to the loss of functional capacity. METHODS: One hundred thirty-two female patients with recent-onset RA were assessed at 0, 3, 6, and 12 years of followup for functional capacity (Health Assessment Questionnaire [HAQ] score), disease activity (Disease Activity Score [DAS]), and joint destruction (Sharp score of radiologic damage). RESULTS: The Sharp score deteriorated steadily over time, while the HAQ score and DAS showed a variable course. The DAS correlated strongly with the HAQ score throughout the disease course. The correlation between the Sharp score and the HAQ score was weak at study start, but became strong after 12 years. After 12 years of followup, disease activity was the main determinant of the HAQ score when entered in a multivariate analysis. CONCLUSION: Functional capacity is strongly influenced by disease activity throughout the course of RA. Even in longstanding RA, disease activity proves to be the main determinant of the HAQ score for functional capacity.
9336422 Magnetic resonance imaging-determined synovial membrane and joint effusion volumes in rheu 1997 Oct OBJECTIVE: To evaluate the relationship between synovial membrane and joint effusion volumes determined by magnetic resonance imaging (MRI) and macroscopic and microscopic synovial pathologic findings in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). METHODS: Synovial biopsies were performed, and macroscopic grades of synovitis assigned, at preselected knee sites during arthroscopy or arthrotomy in 17 knees with RA and 25 with OA. Synovial inflammation and 9 separate tissue characteristics were graded histologically. Synovial membrane and joint effusion volumes were determined by preoperative MRI, enhanced with intravenous gadopentetate dimeglumine. RESULTS: MRI-determined synovial membrane volumes were correlated with the overall histologic assessment of synovial inflammation (Spearman's sigma = 0.55, P < 0.001), with fibrin deposition, with subsynovial mononuclear and polymorphonuclear leukocyte infiltration (sigma = 0.51-0.59), and less significantly with macroscopic synovitis, vessel proliferation, and granulation tissue formation (sigma = 0.40-0.42). No correlation with synovial lining multiplication, perivascular edema, villous formation, or fibrosis was found (sigma < 0.30). CONCLUSION: MRI-determined synovial volumes are correlated with synovial inflammatory activity. Synovial volumes probably mainly reflect the mass of cell-infiltrated, vascularized subsynovial tissue, but may also be influenced by the cumulative synovial proliferative activity. MRI-determined synovial membrane and effusion volumes may be sensitive markers and/or predictors of disease activity and treatment outcome in RA.
11291327 [ARPE prosthesis: preliminary results]. 2001 Feb Preliminary results of 45 trapeziometacarpal "ARPE" prostheses are reported with a mean follow-up of 22.4 months. Pain and mobility before and after operation were analysed. A special questionnaire was used to assess the result in activity of daily living. Pre and postoperative special X rays were also compared. Pain decreased in frequency and intensity and mobility improved. 97.1% of the patients were satisfied with their prosthesis after the operation. Comparison are pre- and postoperatives radiographs showed a tendency for both cup and stem to progressively sink into the bone.
11710708 The C677T mutation in the methylenetetrahydrofolate reductase gene: a genetic risk factor 2001 Nov OBJECTIVE: To study the possible relationship between the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene and the toxicity and efficacy of treatment with methotrexate (MTX) in patients with rheumatoid arthritis (RA). METHODS: Genotype analysis of the MTHFR gene was done in 236 patients who started MTX treatment with (n = 157) or without (n = 79) folic or folinic acid supplementation. Outcomes were parameters of efficacy of MTX treatment, patient withdrawal due to adverse events, discontinuation of MTX treatment because of elevated liver enzyme levels, and the total occurrence of elevated liver enzyme levels during the study. Multivariate logistic regression analysis was used to study the relationship between the presence of the MTHFR C677T mutation and toxicity outcomes of MTX treatment. RESULTS: Forty-eight percent of the patients showed the homozygous (T/T) or heterozygous (T/C) mutation. The presence of the C677CT or C677TT genotypes was associated with an increased risk of discontinuing MTX treatment because of adverse events (relative risk 2.01; 95% confidence interval 1.09, 3.70), mainly due to an increased risk of elevated liver enzyme levels (relative risk 2.38; 95% confidence interval 1.06, 5.34). Efficacy parameters were not significantly different between the patients with and those without the mutation. CONCLUSION: The C677T mutation is the first identified genetic risk factor for elevated alanine aminotransferase values during MTX treatment in patients with RA. We postulate that the incidence of clinically important elevation of liver enzyme levels during MTX treatment is mediated by homocysteine metabolism. Supplementation with folic or folinic acid reduced the risk of toxicity-related discontinuation of MTX treatment both in patients with and in patients without the mutation.
10609066 Long-term efficacy and toxicity of cyclosporin A + fluocortolone + methotrexate in the tre 1999 Nov OBJECTIVE: The therapeutic efficacy and tolerability of the combination of cyclosporin A, methotrexate and fluocortolone was evaluated after 96 months of treatment in 140 patients with rheumatoid arthritis. METHODS: The initial dose of CyA was 5 mg/kg per day and was subsequently modified on the basis of the individual clinical response. Fluocortolone was initially administered at a dose that was sufficient to control disease activity (80-130 mg/week) and then was gradually tapered down to a maintenance dose of 15-20 mg/week. MTX was given intravenously at a dose of 15 mg once weekly for 4 consecutive weeks and then, after a 2-week interval, every 2 weeks or every month depending on the evolution of the disease. RESULTS: At the end of the study a statistically significant improvement was observed in both clinical (VAS, grip-strength, duration of morning stiffness, number of swollen joints, number of painful joints, Ritchie's index and Lee's functional index) and laboratory parameters: ESR (p = 0.000); alpha 2 globulins (p = 0.000); hemoglobin (p = 0.000); CRP (p < 0.001); and rheumatoid factor (p = 0.000). Radiological evaluation revealed little progression in anatomic lesions (Larsen score p = 0.699; number of erosions p = 0.344), thus suggesting that our protocol may be capable of showing down both bone resorption and cartilage loss. Renal toxicity, defined as an increase in plasma creatinine concentrations of more than 50% of the baseline value, was observed in 12 patients (8.5%), but the drug was discontinued in only one, who simultaneously presented high blood pressure. CONCLUSION: The positive results so far achieved in our study must be interpreted as being due to the combined action of the individual drugs, which made it possible for them to be used at relatively low dosages that minimised the onset of their side effects while maintaining the efficacy of their suppressive action.