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ID PMID Title PublicationDate abstract
10908700 Willingness to pay in arthritis: a Danish contribution. 2000 Jul OBJECTIVE: To explore the use of willingness-to-pay (WTP) methods with respect to an antagonist of tumour necrosis factor as an antirheumatic drug. METHODS: One hundred and fifteen rheumatoid arthritis (RA) patients at a tertiary care centre in Odense, Denmark were interviewed using two WTP approaches, the contingent ranking and double-bounded (closed-ended) methods. RESULTS: The average closed-ended WTP value was DKr581 and the average contingent ranking WTP was DKr643. There were no statistically significant differences in the WTP estimates between the two methods. CONCLUSION: It is feasible to use these methods with arthritis patients. If, as suggested in a number of recent reviews, a major effort is to be put into undertaking economic appraisals of arthritis programmes, then this should include more cost-benefit studies using WTP approaches of the kind illustrated in this paper.
11123028 Animal models of rheumatoid arthritis and related inflammation. 1999 Dec The major, extensively studied, experimentally-induced rat and mouse models of arthritis with features resembling rheumatoid arthritis are reviewed here. Etiopathogenetic studies that were recently published are emphasized. In summary, multiple triggering stimuli can induce disease in genetically-prone strains of inbred rats and mice. Multiple genetic loci, including both MHC and non-MHC, regulate disease expression in these animals. By comparison with other models of autoimmune disease, clustering of regulatory loci within and among species is increasingly becoming evident. At the cellular level, both innate and acquired immune systems are involved in the disease manifestations. At the molecular level, unbalanced chronic production of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1, IL-6 and IL-12, as opposed to IL-4 and IL-10, is correlated with arthritis disease susceptibility and severity.
10515039 [Garlic effectiveness in rheumatoid arthritis]. 1999 AIM: To perform of clinical trial of alisate--a garlic preparation produced in Russia. MATERIALS AND METHODS: An open controlled trial of alisate enrolled 30 patients with rheumatoid arthritis (RA). 15 patients with RA of varying clinical form, stage and activity were given alisate in a dose 300 mg (1 tablet) twice a day for 4-6 weeks. 15 control RA patients received conventional antirheumatic therapy. RESULTS: The alisate group achieved a good and partial response in 86.5% of cases. The drug was well tolerated and had no side effects. In control group, some parameters changed for the worse. CONCLUSION: Alisate can be recommended for treatment of RA patients in combined and monotherapy.
10372474 [Knee endoprostheses--advances and questions]. 1999 May 20 Given the complex biomechanical situation of the knee joint, and the peculiarities of the individual patient, implantation of a knee joint endoprosthesis makes great demands on both the implant and the surgeon. The correct choice of implant from among unconstrained, semiconstrained and constrained types of endoprosthesis, as well as from among cemented, hybrid and uncemented anchorage, is essential. In addition, a meticulous preoperative analysis of knee and leg axes, and appropriate detailed presurgical planning is a must, as is uncompromisingly intensive postoperative physiotherapy. Clinical experience identifies the patella, instability and axis deviations as the major problems of knee arthroplasty.
11180282 The glutathione defense system in the pathogenesis of rheumatoid arthritis. 2001 Jan In order to assess a possible role of the natural glutathione defense system in the pathogenesis of rheumatoid arthritis (RA), serum reduced glutathione levels (GSH), glutathione reductase (GSR), glutathione S-transferase (GST), glutathione peroxidase (GSH-Px) and alkaline phosphatase (ALP) activities, lipid peroxidation (MDA content) and indexes of inflammation were evaluated in 58 rheumatic patients. Rheumatoid athritis was associated with significant depletion (ca. 50%) in GSH levels compared with normal control subjects. Serum levels of the detoxifying enzymes GSR and GSH-Px decreased by ca. 50% and 45%, respectively, whereas a threefold increase in the activity of GST was observed. A 1.2-fold increase in ALP was observed in patients with RA. These effects were accompanied by a 3.1-fold increase in serum MDA content. The MDA content was higher in RA patients who were seropositive for rheumatoid factor as well as positive for C-reactive proteins. The erythrocyte sedimentation rate for all patients with RA was approximately 13.8-fold higher than for the control group, and was higher among RA patients who were positive for C-reactive proteins and exhibited seropositivity for rheumatoid factor. Patients with RA receiving gold therapy exhibited significantly lower MDA levels whereas all other factors that were measured were not effected. The results support a hypothesis that defense mechanisms against reactive oxygen species are impaired in RA.
11709451 Sicca symptoms and secondary Sjögren's syndrome in systemic lupus erythematosus: comparis 2001 Dec OBJECTIVE: Firstly, to study the prevalence of ocular and oral sicca symptoms, reduced tear and saliva production, and the minimum frequency of secondary Sjögren's syndrome (sSS) in systemic lupus erythematosus (SLE). Secondly, to compare sicca symptoms and findings with those of matched patients with rheumatoid arthritis (RA), and sicca symptoms with those in healthy controls. Finally, to study possible associations of clinical variables with sicca symptoms and sSS in SLE. METHODS: Self reported sicca symptoms were recorded in 81 patients with SLE aged < or =70, 81 matched patients with RA, and 81 matched healthy controls. Other study variables included Schirmer-I test (S1T), unstimulated whole saliva, health status measures (in SLE and RA), disease activity, accumulated organ damage, and serological markers (in SLE). RESULTS: A significantly higher proportion of patients with SLE reported sicca symptoms than healthy controls. Further, a significantly higher proportion reported ocular sicca symptoms (43 and 21%, respectively) and had pathologically reduced S1T compared with RA (46 and 21%, respectively). No difference was seen in oral sicca symptoms and saliva production. In SLE, sicca symptoms were associated with fatigue, and sSS with anti-SSB or anti-SSA antibodies, or both. CONCLUSIONS: An increased prevalence of sicca symptoms was found in patients with SLE compared with controls, and a higher prevalence of ocular sicca symptoms and reduced tear production in SLE compared with RA. Sicca problems should be considered in the care of patients with SLE, especially those with anti-SSB and/or anti-SSA antibodies who have sicca symptoms and fatigue.
10229188 From systemic T cell self-reactivity to organ-specific autoimmune disease via immunoglobul 1999 Apr Rheumatoid arthritis is a common and debilitating autoimmune disease whose cause and mechanism remain a mystery. We recently described a T cell receptor transgenic mouse model that spontaneously develops a disease with most of the clinical, histological, and immunological features of rheumatoid arthritis in humans. Disease development in K/BxN mice is initiated by systemic T cell self-reactivity; it requires T cells, as expected, but B cells are also needed, more surprisingly. Here, we have identified the role of B cells as the secretion of arthritogenic immunoglobulins. We suggest that a similar scenario may unfold in some other arthritis models and in human patients, beginning with pervasive T cell autoreactivity and ending in immunoglobulin-provoked joint destruction.
9133932 Histologic liver abnormalities in an autopsy series of patients with rheumatoid arthritis. 1997 Feb A retrospective review was performed on 188 autopsied cases of rheumatoid arthritis at our institutions during 1958-1985, prior to the widespread use of methotrexate. Hepatic histology was reported in 182 cases. All available microscopic liver slides from cases in which the autopsy report described portal tract inflammation, fibrosis, cirrhosis, tumour, amyloid, vasculitis, or infections involving the liver were examined and graded by a hepatic pathologist blinded to the original diagnosis, along with a representative sample of cases with reports describing fatty change or no hepatic pathologic abnormalities. Ninety normal and abnormal cases were reviewed from the 182 for which hepatic histology was available. Fifteen cases of diffuse fibrosis were identified upon blinded review. Two cases were graded as severe fibrosis (grades 3 or 4 on a scale of 0-4) without an identifiable pathologic cause, in both of which the liver disease was suspected premortem (alcohol abuse and viral hepatitis). Although the incidence of fibrosis in this series is slightly higher than that previously described, serious fibrotic liver disease was rare. These results support the current practice of limiting pre-treatment liver biopsies prior to methotrexate therapy to patients with suspected liver disease.
9117173 Effects of disease and corticosteroids on appendicular bone mass in postmenopausal women w 1997 Jan The potential value of measurements of peripheral bone mass in rheumatoid arthritis (RA) as an assessment of long-term disease activity has recently received renewed attention. This study examines the effects of RA and corticosteroid therapy on newer methods of measuring peripheral bone mass, comparing the results with dual-energy X-ray absorptiometry (DXA) at axial sites. Peripheral quantitative computed tomography of the radius, ultrasound of the calcaneus, and DXA of the hip and spine were compared between 29 controls and 46 women with RA of whom 25 were receiving low-dose corticosteroid therapy. Bone mass was significantly reduced in the RA groups for: (i) radial trabecular (36.1%) and total (15.6%) measurement sites; (ii) calcaneal ultrasound attenuation (31.7%) and velocity (6.6%); and (iii) femoral neck (15.4%) bone mineral density. Lumbar spine and radial cortical measurements were not significantly affected. There were no significant differences between the RA groups. Disease activity and physical activity did appear to be responsible for much of the reduction in bone mass. These results demonstrate that RA is associated with significant bone loss at the hip, radius and calcaneus, but not at the lumbar spine. In this small study, low-dose corticosteroids had little additional deleterious effect.
11177773 Apoptosis and rheumatoid arthritis: past, present, and future directions. 2001 Feb The current studies of apoptosis in rheumatoid arthritis (RA) suggest that molecules (Fas-related or TNF-related), pathways (activation of pro-apoptosis or anti-apoptosis pathway), cell types (lymphocytes or synovial fibroblast), and the mechanism that triggers apoptosis (tolerance induction-related, down-modulation of inflammation-related, or DNA damage-related) all play a fundamental role to determine the induction or prevention of RA. These series of defects at different levels and in different cells lead to hyperproliferation, defective apoptosis, or hyperapoptosis. This review summarizes the available knowledge of apoptosis and RA to help identify candidate target cells and target molecules for delivery of gene constructs or modified biological or chemical reagents to the target site for effective modification of these cells.
9706288 Soft-tissue balancing in total shoulder arthroplasty. 1998 Jul When a total shoulder arthroplasty is performed, restoration of the anatomy to near normal is important in order to achieve a stable implant. So as not to sacrifice stability, it is not uncommon for soft tissues to be either over tightened or insufficiently released. This article analyzes the various factors to consider in order to obtain appropriate soft-tissue balancing for a successful total shoulder arthroplasty.
11764205 Identification of radiologic healing phenomena in patients with rheumatoid arthritis. 2001 Dec OBJECTIVE: Conventional radiographic scoring methods in rheumatoid arthritis (RA) are designed to quantify progression and disregard any improvement. Reparative changes observed during longterm followup of RA have rarely been described as healing phenomena. Healing may become increasingly important with the availability of more potent antirheumatic drugs. We investigated whether radiologic healing phenomena can be identified by different observers in a blinded fashion. METHODS: Healing phenomena were defined as (1) reappearance (and sclerosis) of the cortical plate, (2) partial or complete filling in of an erosion, or (3) subchondral bone sclerosis with osteophyte formation (secondary osteoarthritis). Pairs of radiographs of hands, wrists, and forefeet [taken 2 to 8 (mean 4.8) yrs apart] of 34 patients were selected from longterm studies: 24 sets with healing phenomena and 10 with progressive disease without healing. The radiographs were blinded and read in pairs in random order by 3 observers unaware of the patients selected for the study. One observer read the set a second time after 8 weeks, resulting in a total of 4 observations. Thirty-eight joints were rated 0 to 5 depending on the amount of surface destruction. In addition an attempt was made to identify joints with healing phenomena. The data were analyzed with help of descriptive statistics such as means, standard deviations, and frequency tables. RESULTS: Out of 1292 joints scored at the second time point, 74 had healing phenomena. These joints were identified in a mean of 89% (95/89/88/82%, respectively) in the 4 observations performed by the 3 readers. Patients without healing phenomena were correctly identified by all observers. In 54 joints less typical healing phenomena were seen in all observations. Sixty-two joints with healing in addition to the 74 joints were seen in 3 observations, 76 in 2, and 127 in one observation. All observers agreed that 1090 joints had no healing phenomenon. The 24 patients with healing had a slight reduction in the Ratingen score, while the 10 patients without healing showed a moderate progression. In the group with healing an increase and decrease in the score occurred in the same patients at different joints. CONCLUSION: In patients with RA followed for several years healing or reparative changes of erosions can be observed. These phenomena can be identified by different observers with high sensitivity even when the observers are blinded to chronological sequence of the films.
11317015 Methotrexate osteopathy demonstrated by Technetium-99m HDP bone scintigraphy. 2001 May The authors report a case of methotrexate osteopathy as revealed by Tc-99m HDP bone scintigraphy in a patient with rheumatoid arthritis. Methotrexate is used widely in high doses as a chemotherapeutic agent. Lower doses are given in rheumatoid and psoriatric arthritis. Methotrexate affects bone metabolism, resulting in methotrexate osteopathy, characterized by osteoporosis, osseus pain, and even spontaneous (micro)fractures. Radiographic visualization of microfractures is difficult. Tc-99m HDP bone scans have been shown to be very sensitive in the visualization of changes in bone metabolism as a result of methotrexate osteopathy.
11294089 Impaired cutaneous cell-mediated immunity in newly diagnosed rheumatoid arthritis. 2000 Dec BACKGROUND: Rheumatoid arthritis is characterized by an impaired immune response and a defective cutaneous cell-mediated immunity has been reported. This study was realised in order to determine the characteristics of cutaneous cell-mediated immunity in patients affected by recent-onset and untreated rheumatoid arthritis. METHODS: Forty-eight patients affected by newly diagnosed rheumatoid arthritis were studied by skin testing with seven common recall antigens. The skin tests were performed before the administration of disease modifying anti-rheumatic drugs (methotrexate, cyclosporine-A, hydroxychloroquine) and were repeated after four months of therapy. RESULTS: 43.75% of the RA patients (21 out of 48) were defined as anergic compared with 2% of the normal control subjects and the rate of depression of cutaneous cell-mediated immunity was not related either with the markers of disease activity or with the clinical assessment. The impaired cutaneous cell-mediated immunity shows a slight improvement after methotrexate therapy, while cyclosporine-A and hydroxychloroquine were not able to achieve the same result. CONCLUSIONS: Rheumatoid arthritis shows a defective cutaneous cell-mediated immunity when the patients are studied in the early phase of the disease and before a second-line of therapy with disease modifying anti-rheumatic drugs. The anergy does not correlate either with the disease activity or with the short-term response to treatment. The prognostic significance of these data remains uncertain.
11268413 The hypothalamic-pituitary-adrenal and gonadal axes in rheumatoid arthritis. 2000 The hypothalamic-pituitary-adrenal (HPA) and the hypothalamic-pituitary-gonadal (HPG) axes involvement or response to immune activation seems crucial for the control of excessive inflammatory and immune conditions such as autoimmune rheumatic diseases, including rheumatoid arthritis (RA). However, female patients seem to depend more on the HPA axis, whereas male patients seem to depend more on the HPG axis. In particular, hypoandrogenism may play a pathogenetic role in male RA patients because adrenal and gonadal androgens, both products of the HPA and HPG axes, are considered natural immunosuppressors. A significantly altered steroidogenesis of adrenal androgens (i.e., dehydroepiandrosterone sulfate, DHEAS and DHEA) in nonglucocorticoid-treated premenopausal RA patients has been described. The menopausal peak of RA suggests that estrogens and/or progesterone deficiency also play a role in the disease, and many data indicate that estrogens suppress cellular immunity, but stimulate humoral immunity (i.e., deficiency promotes cellular Th1-type immunity). A range of physical and psychosocial stressors are also implicated in the activation of the HPA axis and related HPG changes. Chronic and acute stressors appear to have different actions on immune mechanisms with experimental and human studies indicating that acute severe stressors may be even immunosuppressive, while chronic stress may enhance immune responses. The interactions between the immunological and neuroendocrine circuits is the subject of active and extensive ongoing research and might in the near future offer highly promising strategies for hormone-replacement therapies in RA.
11009113 A novel immunoadsorbent for rheumatoid arthritis therapy--preparation and efficacy evaluat 2000 Sep AIM: To develop a novel immunoadsorbent for rheumatoid arthritis (RA) therapy. METHODS: A RA immunoadsorbent was developed by binding heat-aggregated human IgG(HAHIgG) to porous agar gel beads. Its adsorption capacity for rheumatoid factors (RFs), storage stability and blood compatibility were evaluated. RESULTS: The coupling yield of HAHIgG on the carrier was 6.0 mg/g wet gel. Saturation adsorption capacity of the adsorbent for IgMRF, IgGRF and IgARF were 3400, 2240 and 2400 IU/g, respectively. The adsorbent can be stored at 4 degrees C for three months without significant variance in its activity. Its fine permeability and hemocompatibility were demonstrated by extracorporeal hemoperfusion on rabbits. CONCLUSION: HAHIgG/agar gel is a safe and effective immunoadsorbent for RA therapy, its potential clinical use is promising in the future.
11930442 Treatment of rheumatoid arthritis: etanercept a recent advance. 2000 Oct PURPOSE: To review the specific mechanism of action of biologic response modifiers and help clinicians place these new drugs in the context of established therapies for rheumatoid arthritis (RA). DATA SOURCES: Review of scientific literature, including all the clinical trials for these drugs. CONCLUSIONS: Biologic response modifiers target key inflammatory events involved in joint destruction. They have the potential to revolutionize the management of RA. IMPLICATIONS FOR PRACTICE: Referral to a rheumatologist should be strongly considered as soon as the diagnosis of RA is made. Early referral to a specialist has been associated with improved health status for patients with RA due to early and aggressive therapy with these new agents.
10778914 Human mast cell subsets--distinct functions in inflammation? 2000 Jan That mast cells participate in inflammatory reactions is beyond argument. A major question posed by mast cell biologists is whether specific functions in inflammation are subserved by different subsets of the mast cell population. We have investigated the two major subsets of human mast cells (MC(T) and MC(TC)), in the chronic inflammatory processes associated with rheumatoid arthritis (RA). Whereas normal synovium contains mainly MC(TC) mast cells, the MC(T) subset is selectively expanded in early RA, in numbers that correlate with synoviocyte hyperplasia and T-lymphocyte infiltration. In contrast, in RA of long duration, MC(TC) mast cells predominate in numbers that correlate with clinical indices of rapidity of disease progression. We suggest that MC(T) mast cells participate in active inflammatory events, whereas MC(TC) mast cells may be more relevant in repair or damage to connective tissues.
9783647 Decreased prevalence of symptomatic atherosclerosis in arthritis patients on long-term asp 1998 Oct To determine the effect of long-term aspirin therapy on the prevalence of symptomatic atherosclerosis, autopsy results from 44 arthritis patients taking aspirin were compared with a cohort from the general autopsy population. No decrease in the prevalence of symptomatic atherosclerosis was noted in patients with less than 8 years of arthritis, compared with controls. In contrast, the prevalence of symptomatic atherosclerosis was significantly decreased in arthritis patients with 8 or more years of arthritis and aspirin use. In these subjects, the prevalence of symptomatic atherosclerosis was inversely related to duration of arthritis. The inverse relationship between prevalence of symptomatic atherosclerosis and duration of aspirin therapy, as well as the decrease in all forms of symptomatic atherosclerosis, raise the possibility that this decrease is due to primary prevention of atherosclerosis.
9598884 The effect of a static wrist orthosis on hand function in individuals with rheumatoid arth 1998 May OBJECTIVE: To determine the effect of a wrist orthosis on work performance, hand dexterity, and pain during task performance, 40 individuals with rheumatoid arthritis were studied using a 2 period, crossover design. METHODS: Each patient was fitted with a Futuro wrist orthosis. Dexterity was measured with and without the orthosis using the Jebsen Hand Function Test. Work performance was assessed using 2 tasks (one simulating the use of shears, the other the use of a screwdriver) on a work simulator. All tasks were performed both with and without the orthosis, with the order of orthosis versus no orthosis randomly assigned. Pain before and after performing tasks was assessed using a 10 cm horizontal visual analog scale. RESULTS: While on the screwdriver task work performance was less with the orthosis (p = 0.0002); on the shears task there was no significant difference in work performance with and without the orthosis. The average pain after performing both tasks was significantly less with the orthosis on. A 2 factor analysis of variance model with repeated measures suggested that taking into account the reduced work performance during splint wear, pain was still significantly reduced with splint wear. The average time to complete all 7 tasks on the Jebsen Hand Function Test was longer when the subjects wore the splint compared to when they did not (62.0 vs 57.6 s, respectively; p = 0.0086). CONCLUSION: The results suggest that the effect of splint wear on work performance is highly task specific, and thus the ergonomic demands of the individual's daily life must be considered if a splint is to provide maximal effectiveness.