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ID PMID Title PublicationDate abstract
11563584 Arthritis and osteonecrosis in a patient with thrombophilia. 2001 Aug This case report describes a very rare entity of thrombophilia manifesting as persistent arthritis and digital ulcers. A 9-year-old Egyptian girl presented with a 2-year history of persistent arthritis and digital ulcers. The case was followed up after 4 years. The clinical manifestations and laboratory investigations are recorded. Thrombophilia with partial protein C deficiency appeared to be responsible for the clinical manifestations with underlying ipsilateral osteonecrosis of patella and calcaneum and resorption of the terminal phalanges. Her older sister showed the same picture with additional pulmonary hypertension. In conclusion, arthritis and osteonecrosis appear as a rare presentation of thrombophilia and protein C deficiency, and ignorance of this may lead to misdiagnosis or confusion with other childhood rheumatic diseases.
11094457 Bone loss. Quantitative imaging techniques for assessing bone mass in rheumatoid arthritis 2000 Osteoporosis is associated with low bone mass and microarchitectural deterioration of bone tissue with clinical manifestation of low trauma fractures. Rheumatoid arthritis (RA) is a risk factor due to generalized and articular bone loss. This minireview presents past and current bone mass measurement techniques in RA. These techniques include: plain radiographs, absorptiometry, quantitative computed tomography (QCT) and ultrasound. The most widely used technique is dual x-ray absorptiometry (DXA). RA patients have lower bone mass as compared with normals and substantial bone loss may occur early after the onset of disease. Measurement of bone mineral density (BMD) at the hand using either DXA or ultrasound maybe a useful tool in the management of RA patients.
9310112 Dermal IgG deposits and increase of mast cells in patients with fibromyalgia--relevant fin 1997 Skin biopsies from 25 patients with fibromyalgia, 5 healthy controls, 8 patients with rheumatoid arthritis, and 9 patients with local chronic pain after whiplash injury, were examined for the occurrence of IgG deposits and collagen types, using direct and indirect immunofluorescence, and for dermal connective tissue mast cells, using semithin Epon sections. Fibromyalgia skin biopsies had significantly higher values of IgG deposits in the dermis and vessel walls and showed a higher reactivity for collagen III. They also had a higher mean number of mast cells. There was a correlation between the percentage of damaged/degranulated mast cells and the individual IgG immunofluorescence scores. These findings support the hypothesis of neurogenic inflammation involvement in fibromyalgia.
9506881 TCRBV14S1 and rheumatoid arthritis revisited: abnormalities in the percentage of transcrib 1998 The purpose of this study was to identify Vbeta gene families that are associated with rheumatoid arthritis (RA). A PCR-based assay was used to compare the Vbeta repertoire of unstimulated PBMC from 18 RA patients and 18 matched controls. The influence of an HLA-DRB1-binding peptide (HA307-319) on the Vbeta repertoire of PBMC in culture was compared in 11 RA patients and 10 controls. There was a larger variance in the percentage of BV14S1 transcripts in unstimulated PBMC from RA patients than from controls (p = 0.0003). The mean percentage of BV14S1 transcripts was higher in RA patients when prednisone-treated RA patients were excluded from the analysis (p = 0.0006). In vitro stimulation with the HA307-319 peptide increased the percentage of BV14S1 transcripts in PBMC from RA patients (+ 1.5 +/- 0.4%, p < 0.005) but not controls (+ 0.3 +/- 0.2%, ns), and the difference between RA patients and controls was significant (p = 0.03). In conclusion, there is an association between RA and the BV14S1 gene family in New Zealand patients.
11704283 Human leukocyte antigen-DQ and DR polymorphisms predict rheumatoid arthritis outcome bette 2001 Nov Conflicting data have been published on the value of the shared epitope (SE) hypothesis in predicting disease outcome in rheumatoid arthritis (RA). Recently we have proposed an alternative hypothesis, referred to as the RA protection (RAP) model. In this model, the HLA-DQ loci carry predisposition while HLA-DRB1 alleles encoding the motif DERAA provide protection against severe RA. In the present study, we have compared the respective values of the models in predicting both remission and erosions in early RA patients. We made use of an early arthritis clinic in which 158 RA patients and 138 patients with undifferentiated arthritis were enrolled. Patients were typed for HLA-DQ and -DR using high resolution DNA typing methods. Homozygosity for predisposing HLA-DQ alleles was associated with no remission and high erosion score. The presence of DERAA-bearing DRB1 alleles was negatively associated with erosions in otherwise predisposed individuals and increased the chance of being in remission. We found that the RAP model was significantly better than the SE model in predicting remission rate and erosion scores at one and two years in early RA patients. We conclude that HLA polymorphism does not only affect RA susceptibility, but also protects against severe disease at early stage.
10519677 Unusual cause of a stroke in a patient with seronegative rheumatoid arthritis. 1999 Oct The case of a patient who suffered a severe cerebrovascular accident caused by an aortic rheumatoid granuloma is presented.
11665967 Early joint erosions and serum levels of matrix metalloproteinase 1, matrix metalloprotein 2001 Oct OBJECTIVE: To further evaluate the roles of matrix metalloproteinase 1 (MMP-1), MMP-3, and tissue inhibitor of metalloproteinases 1 (TIMP-1) in the pathogenesis of joint inflammation and articular erosions in early inflammatory arthritis. METHODS: Untreated patients with joint symptoms for <2 years were evaluated at presentation and followed up prospectively for 18 months. Swollen joint count and serum levels of C-reactive protein (CRP) were determined every 6 months. Serum levels of MMP-1, MMP-3, and TIMP-1 were measured by double-antibody sandwich enzyme-linked immunosorbent assay at the same time intervals. The number of joint erosions in serial radiographs of the hands and feet was also recorded. Analysis of synovial fluid levels of MMPs and TIMP-1 at presentation was completed in some patients. RESULTS: Of 175 patients evaluated at baseline, 85 had rheumatoid arthritis (RA), 39 had seronegative spondylarthropathy, 38 had undifferentiated arthritis, and 13 had self-limiting arthritis. Of 164 patients with available radiographs of the hands and feet at presentation, 33 (20.1%) had joint erosions. Baseline levels of MMP-1, MMP-3, and TIMP-1 were significantly higher (P = 0.0001, P = 0.013, and P = 0.0001, respectively) and ratios of TIMP-1:MMP-1 and TIMP-1:MMP-3 were significantly lower (P = 0.0001 and P = 0.013, respectively) in RA versus non-RA patients. In RA patients, serum levels of CRP correlated with MMP-3 and TIMP-1 levels, but not with MMP-1 levels. The number of erosions at presentation correlated with baseline levels of both MMP-1 and MMP-3, but not with levels of TIMP-1. One hundred one patients were followed up for the next 18 months. The number of patients with erosions and the number of erosions per patient increased significantly during this period. Area under the curve (AUC) measurements of MMP-1 and TIMP-1 levels, but not of MMP-3 levels, yielded significantly higher values in RA than in non-RA patients. In RA patients, only the AUC level of MMP-3 correlated with the AUC CRP level (r = 0.67, P = 0.0001), while only the AUC level of MMP-1 correlated with the number of new joint erosions (r = 0.28, P = 0.034). CONCLUSION: These data suggest an uncoupling of the pathophysiologic mechanisms associated with joint inflammation and articular erosion. Treatments that inhibit the production and activity of MMP-1 may preferentially limit the formation of new joint erosions and improve the long-term functional outcome of some patients with inflammatory arthritis.
11196706 CCR5 (chemokine receptor-5) DNA-polymorphism influences the severity of rheumatoid arthrit 2000 Chemokines are critical for the inflammatory process in autoimmune diseases such as rheumatoid arthritis (RA). The chemokine receptor-5 (CCR5) mediates chemotaxis by CC-chemokines and is expressed by lymphocytes with the Th1 phenotype and monocyte/macrophages. A 32 bp deletion in the CCR5 (CCR5-delta 32 allele) abolishes receptor expression in homozygotes, while CCR5-delta 32 carriers would express less receptor than wild-type homozygotes. This polymorphism is related to the resistance to HIV-1 infection and progression towards AIDS. We hypothesized that the CCR5-delta 32 allele may modulate the severity of disease in RA. A total of 160 RA-patients (71 and 89 with severe and non-severe phenotypes, respectively) and 500 healthy individuals from the same Caucasian population (Asturias, northern Spain) were genotyped. Carriers of the CCR5-delta 32 allele were at a significantly higher frequency (P = 0.012) in non-severe compared to severe patients (17% vs 4%). Our results suggest that the CCR5-delta 32 polymorphism is a genetic marker related to the severity of RA.
11468898 [Long-term outcome of Swanson prosthesis management of the rheumatic wrist joint]. 2001 May Silicone-wrist arthroplasty has dominated reconstructive surgery of the rheumatoid wrist for a long time. Silicone interposition wrist arthroplasty yielded good clinical results in short and midterm studies. The durability and longevity of the prosthesis however is limited and progressive X-ray deterioration and silicone synovialitis are the main shortcomings. We present the ten-year follow-up results of 102 rheumatoid wrists operated between 1984 and 1992. 72 patients with 82 wrist arthroplasties were clinically and radiologically examined. The mean age at operation was 56.9 years. The average onset of R.A. was 16.1 years. Each wrist was rated on a 100-point scale, with points based on wrist balance, range of motion, pain relief and extensor strength. The postoperative Clayton score averaged 69.4 points. Including revision cases, 51% of the Swanson implants were rated good or excellent, 16% fair, and 33% were judged poor because of pain or prosthesis breakage. Patient satisfaction and pain relief were achieved in 68.2%. Active motion with unrevised implants was 21 degrees extension and 31 degrees flexion. We noticed a moderate increase (7 degrees) for ulnar-radial deviation. There was a progressive deterioration in the radiographic appearance. Implant fracture occurred in 31% of the patients. Subsidence of the implant and significant reduction of carpal height was noticed in 82.5% of the prosthesis. Revision procedures were performed in eleven cases. We conclude that the clinical and radiological results of Swanson silicone interposition arthroplasty will deteriorate with the passage of time. Beyond the potential deleterious effects of silicone, long-term radiological complications such as implant fracture, subsidence and carpal collapse are the main disadvantages of Swanson arthroplasty of the wrist. We therefore currently recommend the MPH-total wrist design in patients with rheumatoid arthritis.
10796385 Balneotherapy for rheumatoid arthritis and osteoarthritis. 2000 BACKGROUND: Balneotherapy (hydrotherapy or spa therapy) for patients with arthritis is one of the oldest forms of therapy. One of the aims of balneotherapy is to soothe the pain and as a consequence to relieve patients' suffering and make them feel well. OBJECTIVES: To perform a systematic review to assess the effects of balneotherapy for rheumatoid arthritis and osteoarthritis. SEARCH STRATEGY: Using the Cochrane search strategy, studies were found by screening: 1) The Medline CD-ROM database from 1966 to June 1999 and 2) the database from the Cochrane Field 'Rehabilitation and Related Therapies', which contains also studies published in journals not covered by Medline. Also, 3) reference checking and 4) personal communications with authors was carried out to retrieve eligible studies. To perform an adequate assessment of the methodological quality the languages of the publications had to be: Dutch, English, French or German. Date of the most recent literature search: June, 1999 SELECTION CRITERIA: Studies were eligible if they were randomized controlled trials (RCT) comparing balneotherapy with any intervention or with no intervention. Patients included had rheumatoid arthritis (RA), osteoarthritis (OA) or some other form of arthritis. Trials incorporating patients with definite or classical rheumatoid arthritis (RA) as defined by the American Rheumatism Association Criteria (ARA) (Ropes 1958) (these criteria have changed over time) or by the criteria of Steinbrocker (1949) were regarded as a separate group. At least one of the WHO/ILAR core set of endpoints for RA clinical trials had to be the main outcome measures. DATA COLLECTION AND ANALYSIS: A criteria list used to assess the methodological quality was the one developed at the Department of Epidemiology at the Maastricht University, called "the Maastricht list". The quality scores and data abstraction of the studies were carried out independently by two reviewers (HdV, RdB). Disagreements were solved by consensus. MAIN RESULTS: Ten trials with 607 patients were included in this review. Most trials reported positive findings, but were methodologically flawed to some extent. A 'quality of life' outcome was reported by two trials. Just one of the randomized trials mentioned an intention-to-treat analysis and only three performed a comparison of effects between groups. Pooling of the data was not performed, because of heterogeneity of the studies, multiple outcome measurements, and, apart from two studies, the overall data presentation was too scarce to enable pooling of the data. REVIEWER'S CONCLUSIONS: One cannot ignore the positive findings reported in most trials. However the scientific evidence is weak because of the poor methodological quality, the absence of an adequate statistical analysis, and the absence, for the patient, of most essential outcome measures (pain, quality of life), Therefore, the noted "positive findings" should be viewed with caution. Because of the methodological flaws an answer about the efficacy of balneotherapy cannot be provided at this time. Flaws found in the reviewed studies could be avoided in future trials.
10536480 [Investigation of plasma levels of etodolac and urine PGE2 in patients with rheumatoid art 1999 Aug 13 women patients (containing high-aged, mean age 71.9 years) with rheumatoid arthritis (RA) (10 with normal renal function and 3 with moderate renal insufficiency) participated in a 5-day study to assess the effects of etodolac on renal function and the necessity of dose adjustment. After no drug-free day, etodolac, 200 mg b.i.d. was started. The plasma levels of etodolac were similar in both normal control in phase I studies and throughout this study. Although the mean urine PGE2 concentration in renal insufficient group was significantly lower than that of normal renal function group, the mean urine PGE2 concentration in after etodolac administration was not different from that in before its administration in each group. This result suggested that renal adverse reactions with etodolac were low in incident. Moreover, it was required to consider that glucocorticoid might influence renal and/or hepatic excretion of etodolac. In this study the glucocorticoid was tend to be administrated in the patients with moderate renal insufficiency. Those glucocorticoid group showed lower levels of etodolac in blood serum (monitored by AUC0-8, day 4 Cmin and day 5 Cmin) than non-glucocorticoid group did, but not significantly. Interestingly, there is a negative correlation (r = -0.442) between AUC0-8 at day 1 and urine PGE2 at day 5 in glucocorticoid group. The levels of etodolac in blood serum in normal renal function group were also not significant in difference from that in the moderate renal insufficient group. These results suggest that the dose adjustment of etodolac in high-aged RA patients with moderate renal insufficiency can be excluded.
11826740 [Evidence-based medicine and applying new therapies in general practice: wish and reality] 2001 Dec In the last years some important therapies were introduced in the treatment of rheumatoid arthritis (RA), which represent a significant clinical advance. This concerns the introduction of TNF blockade with etanercept and inflixmab, the combination of DMARDs, leflunomide and the COX-2-specific inhibitors. In the year 2000 the restrictive social law in Germany, the collective and individual budgets for medicaments, did prevent a broader use of the very expensive therapy with TNF blockade. A rising number of international healthcare studies shows a profound potential for saving costs by improving the functional capacity (HAQ) in patients with RA. The biologicals and leflunomide have this potential. To realise the potential of reducing healthcare costs by an optimal therapy of RA some modification of the restrictive social law is necessary as well as the introduction of disease-management programs.
11380120 Long-term results of retention of the posterior cruciate ligament in total knee replacemen 2001 May We analysed the long-term results with a mean follow-up of 10.2 years, of 66 total knee replacements in 42 patients with rheumatoid arthritis. In all cases the posterior cruciate ligament was retained. There were only three complications (4.5%). Revision surgery was necessary in five knees (7.6%), including one (1.5%) with infection. At the final follow-up, 75.8% of knees were rated excellent clinically. Only 15% had an excellent function score. The survival rate of the implant was 90.7% at 19 years. The clinical, radiological and survivorship analysis shows that the posterior-cruciate-retaining knee arthroplasty performs well in rheumatoid arthritis.
9831171 New tumor necrosis factor-alpha biologic therapies for rheumatoid arthritis. 1998 Sep Continued research towards new and better tolerated therapies to attenuate the inflammation and pain associated with rheumatoid arthritis and to halt the progression of erosive joint damage has led to the development of anticytokine strategies. Of these therapies, the most promising appear to be those targeted towards blocking the effects of TNF-alpha. Trials with etanercept, which showed significant, rapid and sustained reductions in disease activity, have produced particularly encouraging results.
10543597 Prosthetic adaptability: a new concept for shoulder arthroplasty. 1999 Sep An anatomic study of 65 cadaveric humeri allowed determination of the main features of the superior part of the humerus and design of a modular and adaptable humeral prosthesis. This cemented prosthesis is made in 3 different stem sizes, 7 humeral head sizes, and a variable humeral neck component. The 4 different humeral necks (125 degrees, 130 degrees, 135 degrees, and 140 degrees) allow the head to be cut at the level of the anatomic neck and adaptation of the prosthesis to the patient's anatomy with respect to the variable inclination and retroversion. An eccentric dial is located on the undersurface of the head; 8 positions are possible reproducing the posterior and medial offset of the humeral head with regard to the diaphysis. The large variety of components used for the first 101 implanted prostheses confirm the extreme variability of the anatomy and the need for a flexible shoulder prosthesis system. The glenoid component is made of polyethylene and is available in 3 different sizes to be used with a cemented keel. Eighty-six shoulders, which were monitored from 24 to 65 months, were evaluated with the Constant score. Primary glenohumeral arthritis (46 cases) and avascular necrosis (11 cases) yielded the best results, with scores of 95% and 86%. Rheumatoid arthritis (20 cases) scored 78%, although post-traumatic arthritis (11 cases) and cuff tear arthropathy (13 cases) had a less satisfactory result: 66% and 61%, respectively. Radiologic results showed 2 glenoids loosening and 48% of glenoids with radiolucent lines, with half of them being partial. An 8% complication rate has been observed, leading to 6 revisions (6%), in 2 cases for infection, 2 cases for secondary rupture of the subscapularis, and 2 cases for glenoid loosening.
10493691 Reversible pancreatitis, hepatitis, and peripheral polyneuropathy associated with parenter 1999 Sep A 63-year-old man with seronegative rheumatoid arthritis developed acute pancreatitis, severe hepatitis, and sensorimotor polyneuropathy after receiving 150 mg of intramuscular aurothioglucose (gold). Positive lymphocyte transformation test to gold indicated a cell mediated hypersensitivity to the drug, while multiple investigations ruled out other underlying causes for his illness. After cessation of gold therapy a complete recovery occurred.
10328137 Inhibitors of tumor necrosis factor for rheumatoid arthritis. 1999 May Clinical trials of tumor necrosis factor (TNF) inhibitors for rheumatoid arthritis (RA) have produced consistently outstanding results with no major side effects in patients refractory to other available treatments. The improvement, determined using either the Paulus or the American College of Rheumatology evaluation criteria, is rapid and has persisted over the 2 years of followup data currently available. Trials of 2 drugs are reviewed--infliximab, currently approved for treatment of Crohn's disease, and etanercept, recently approved for RA therapy.
10643695 Response to methotrexate treatment is associated with reduced mortality in patients with s 2000 Jan OBJECTIVE: This study investigated whether efficacious methotrexate (MTX) treatment has an impact on mortality of patients with severe rheumatoid arthritis (RA). METHODS: In this prospective, observational, one-center study, patients with severe RA refractory to other disease-modifying antirheumatic drugs started MTX treatment between 1980 and 1987. Patients were divided into 4 different groups according to their response to MTX treatment after 1 year (>50% improvement [n = 99], 20-50% improvement [n = 70], no improvement [n = 52], and discontinued treatment [n = 35]). After a followup of 7.5-15.3 years (mean 10 years), the numbers of deaths were assessed in the different groups. Standardized mortality ratios (SMR) were calculated by comparing the number of observed deaths in the study with the number of expected deaths in an age- and sex-matched sample of the general population. RESULTS: Two hundred seventy-one patients entered the study between 1980 and 1987. In 1995/1996, outcomes for 256 patients (94.5%) could be documented; 88 patients (34.4%) had died. In patients with >50% improvement after 1 year, the SMR was 1.47, while in patients with 20-50% improvement, the SMR was 1.85. In both groups combined, the SMR was 1.64 (95% confidence interval [95% CI] 1.11-2.17), compared with 4.11 (95% CI 2.56-5.66) in patients without improvement. Patients who had discontinued MTX treatment during the first year had an SMR of 5.56 (95% CI 3.29-7.83). CONCLUSION: Patients with severe RA who do not respond to MTX treatment have a poor prognosis, with >4-fold increased mortality compared with the general population, while RA patients who respond to MTX treatment have only a moderately increased mortality rate.
9564773 [The efficacy of combination therapy with prednisolone (PSL) and methotrexate (MTX) on rad 1998 Feb A case-controlled study was performed, based on early active RA patients treated with MTX; Prednisolone (PSL) was also given in sixteen patients (PSL + MTX group) and each of them was matched for age and sex with a control who have never received PSL (MTX group). No significant differences in radiographic progression were found between the 2 groups. Analysis of radiographic parameters showed that CRP, erythrocyte sedimentation rate, and titers of serum rheumatoid factors after 6 months treatment and their integral amounts during cource were significantly high in the patients with marked radiographic progression. There was no relationship between radiographic progression and treatment with PSL. These results suggested that the indication of PSL therapy for RA is limited for patients with the poor decrease in the level of CRP, erythrocyte sedimentation rate, and rheumatoid factor by MTX treatment.
10555884 Evaluation of bone turnover and osteoclastic cytokines in early rheumatoid arthritis treat 1999 Nov OBJECTIVE: Osteoporosis is a frequent complication of rheumatoid arthritis (RA). We investigated the effect of oral alendronate (AL) therapy on bone turnover and osteoclast activating factors in early RA. METHODS: A 90 day randomized placebo controlled trial of 40 mg oral AL/day compared with placebo in 32 patients with early mild disease. Serum interleukin 1alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha), IL-6, beta2microglobulin (beta2m), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), osteocalcin/bone gla protein (BGP), urinary crosslinks, and urinary hydroxyproline (HP) measured at 30 and 90 day intervals were the variables measured. RESULTS: A significant decrease of IL-1, IL-6, TNF-alpha, and beta2m was observed after 30 days, persisting after 90 days in the AL group, but with no significant variation in the placebo group. A significant decrease of ESR and CRP was observed after 90 days in the AL group, but with no significant variation after 30 days in the AL group, and after both 30 and 90 days in the placebo group. A significant decrease of BGP, HP, and urinary crosslinks was observed after 30 days, persisting after 90 days in the AL group, but with no significant variation in the placebo group. CONCLUSION: Our study demonstrates that alendronate reduces bone turnover in early RA and may have a possible antiarthritic effect. Because of the mild early form of the disease in the study cohort, further evaluations are required to confirm this effect.