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ID PMID Title PublicationDate abstract
10637961 [From acute to chronic pain (in rheumatic diseases)]. 1999 Pain and functional restriction are the main factors leading the patient to the physician. For these patients quality of life is reduced a lot. Pain is a subjective experience and it cannot be objectivated easily. Pain experience lasting more than 3 to 6 months is considered to be chronic. Its causes are individually different and encompass the peripheral nociception, biochemical changes of the neurotransmitters in the spinal range and events in the subcortical and cortical region. For a successful treatment, the proper understanding of the perception and experience of pain is a preliminary condition for the physician and the patient.
9932110 Functional analysis of a human tumor necrosis factor alpha (TNF-alpha) promoter polymorphi 1998 Nov BACKGROUND: Functional heterogeneity in the tumor necrosis factor alpha (TNF-alpha) gene may be responsible for the TNF-alpha response in infectious and autoimmune diseases. Recently, the TNF-238 promoter polymorphism was observed as being associated with a more destructive disease in rheumatoid arthritis (RA). To determine the relation between TNF-238 and disease progression, the extent of joint destruction in a cohort of 101 RA patients followed for 12 years was analyzed. Furthermore, we have attempted to link this polymorphism to TNF-alpha gene transcription in monocytes and lymphocytes in vitro. PATIENTS, MATERIALS, AND METHODS: The extent of joint destruction determined on X-rays of hands and feet assessed after 0, 3, 6, and 12 years was compared with TNF-238 genotypes. Functional consequences of TNF-alpha gene polymorphisms using reporter gene constructs were analyzed in cells of the monocyte and lymphocyte lineage by means of transient transfection systems. RESULTS: The rate of joint damage in -238GA patients was lower than that in the -238GG patients, independent of HLA-DR4. Damage after 12 years was 76 +/- 30 for the -238GA versus 126 +/- 13 for the -238GG patients as determined by the van der Heijde's modification of Sharp's method. Furthermore, TNF-238A was found to be in linkage disequilibrium with an additional polymorphism at position -376. Functional assays revealed no significant differences in the level of inducible reporter gene expression between the TNF-238/-376 promoter constructs in the cell types tested. CONCLUSION: In a prospective study, we show that the TNF-238GG genotype contributes to progression of joint destruction in RA, independent of the presence of HLA-DR4. However, in vitro transfection assays indicate that TNF-238A by itself or in combination with TNF-376A is not likely to be of direct functional relevance for transcriptional activation. Therefore, these polymorphisms may serve as markers for additional polymorphisms in the TNF/LT locus or neighboring genes that may influence disease severity.
9704633 Use of differential subtraction method to identify genes that characterize the phenotype o 1998 Aug OBJECTIVE: To identify the genes that characterize the distinctive phenotype of cultured rheumatoid arthritis (RA) fibroblastoid synoviocytes. METHODS: A representational difference method was used to subtract complementary DNA (cDNA) from cultured RA fibroblastoid synoviocytes with cDNA from noninflammatory osteoarthritis synoviocytes. The genes were identified by DNA sequencing, and their relative expression was determined by Northern blot analysis. RESULTS: Twenty-four genes were identified, including novel genes such as a human homolog of mouse semaphorin E and one homologous to N-acetylglucosamine-6-sulfatase. Eleven of these genes were constitutively overexpressed in the rheumatoid synoviocyte line, including a chemokine, stromal cell-derived factor 1, and several genes capable of mediating synoviocyte-leukocyte interactions, including vascular cell adhesion molecule 1 and Mac-2 binding protein. Three genes (lumican, biglycan, and insulin-like growth factor binding protein 5) encoded extracellular matrix components, suggesting that distinct stromal-synoviocyte interactions may be mediated by this phenotype. Two interferon-inducible genes of unknown function were also found, emphasizing the presence of activation-like features in the phenotype. CONCLUSION: A general method for the identification of differences in patterns of gene expression revealed that cultured RA fibroblastoid synoviocytes overexpress certain proinflammatory genes that are potentially relevant to lymphocyte and monocyte entry and interactions. The features of the genes identified in these mesenchymal cells suggest that they facilitate localization of immune reactions to the joint through leukocyte chemokinesis, cell-cell adhesion, and matrix specialization. The further characterization of these genes should help in resolving whether this phenotype is the consequence of modulation and imprinting by an inflammatory milieu or, more likely, whether it reflects the intrinsic lineage characteristics of intimal lining synoviocytes.
11752508 Prevalence of vertebral deformities and symptomatic vertebral fractures in corticosteroid 2001 Dec OBJECTIVE: This study was designed to determine whether the prevalence of vertebral deformities in patients with rheumatoid arthritis (RA) treated with corticosteroids (Cs) is higher than in RA patients not receiving Cs therapy. PATIENTS AND METHODS: This multicentre cross-sectional study included 205 patients with RA who were receiving Cs orally on a daily basis and 205 patients with RA who did not receive Cs, matched for sex and age. Vertebral deformities were scored according to the Kleerekoper method. RESULTS: Vertebral deformities were found in 52 (25%) patients on Cs and in 26 (13%) patients not on Cs. Sixteen (8%) patients in the group on Cs had experienced clinical manifestations of an acute vertebral fracture in the past vs only three patients (1.5%) among those not on Cs. The use of Cs tended to increase the risk of developing a vertebral deformity [adjusted odds ratio (OR) 1.56, 95% confidence interval (CI) 0.81-2.99] and symptomatic vertebral fracture (adjusted OR 1.42, 95% CI 0.24-8.32). Each 1-mg increase in the current daily Cs dose increased the risk of a vertebral deformity (adjusted OR 1.05, 95% CI 0.98-1.13) and of a symptomatic vertebral fracture (adjusted OR 1.05, 95% CI 0.89-1.24). CONCLUSION: There is a higher prevalence of vertebral deformities and clinical manifestations of vertebral fractures in patients on Cs than in those not on Cs. Our data indicate that the use of Cs and each 1-mg increase in the current daily Cs dose may increase the risk of development of a vertebral deformity and symptomatic vertebral fracture in patients with RA.
11692737 [Clinical assessment of rheumatoid arthritis after cerebral hemisphere exposure to light a 2001 Jul With the purpose of finding out the extent to which the right and left cerebral hemispheres are influential on the course of the inflammatory process, as many as 38 patients with rheumatoid arthritis were subjected to differentiated stimulation of receptor fields of the right and left hemispheres in the retina with red and green light. A decline occurred in the activity of the inflammatory process in activation of the right hemisphere while activation of the left hemisphere resulted in the rise of the above activity.
10380834 Psychological factors in chronic rheumatic diseases--a review. The case of rheumatoid arth 1999 An overview of studies relating psychological factors to perceived well-being among Rheumatoid Arthritis (RA) patients is presented. Most attention has been devoted to the perception of control, coping and the effects of cognitive distortions. The introduction of these constructs have advanced the understanding of psychological distress among RA patients, although they explain only a smaller part. One reason could be that they give an oversimplified picture of adjustment processes in chronic and disabling diseases. This may partly be because their development are based either on studies of depression in a psychiatric sense or on how healthy subjects manage stressful events in daily life. The results therefore have limited relevance for adjustment to a life-long, chronic illness like RA. Recent research has also suggested that personality dispositions, especially neuroticism, play a substantial role in all types of subjective experiences. Finally, some issues for future research are discussed.
9057799 Arthritis patient as an emergency case at a university hospital. 1997 During a 6-month period in 1994-1995, 0.7% of patient visits (51 visits of 47 patients) at the emergency unit of the Department of Medicine, Helsinki University Central Hospital, were due to joint symptoms. Infection seemed to play an important role as the etiologic factor for the joint complaints. Acute joint exacerbation in pre-existing arthritis was the reason for 11.7%, and suspected Baker's cyst for 3.9% of the visits. Confirmed (12.8%) or suspected reactive arthritis (10.6%), septic arthritis/spondylitis (6.4%), arthritis with inflammatory bowel disease (6.4%), and gout (14.9%) were the most common final diagnoses for the patients. In a quarter of the patients, the etiology for joint symptoms could not be confirmed. In conclusion, joint symptoms very seldom lead to visits to an emergency unit. In such cases, infection seems to be an important contributing factor. Patients with chronic rheumatic diseases only occasionally have to seek help at an emergency unit.
9710887 Monoclonal antibodies to CD4. 1998 Aug Animal models of human autoimmune disease suggest that it should be possible to reinduce self-tolerance in these conditions by the use of T-cell directed therapies, in particular with anti-CD4 monoclonal antibodies (CD4-mAb). Many studies have shown that CD4-mAb can prevent and in a treatment setting suppress activity of these disease models, including collagen-induced arthritis.
9537875 Geographic choroiditis and retinal vasculitis in rheumatoid arthritis. 1998 Jan A 37-year-old man developed geographic choroiditis and retinal vasculitis in the left eye while taking 3.5 mg/day oral prednisolone for rheumatoid arthritis. The choroidal lesions stopped growing when the dose of prednisolone was increased to 60 mg/day, while its tapering resulted in the recurrence and enlargement of the choroidal lesions to the macula. The patient experienced further recurrence twice in the following year. Indocyanine green angiography demonstrated the obstruction of choroidal arteries in addition to the complete obstruction of the choriocapillaris in a fresh lesion. This case was the first to have geographic choroiditis on the background of a systemic inflammatory disease.
11173051 The economic implications of cyclooxygenase-2-specific inhibitors. 2001 Feb 19 Rheumatoid arthritis and osteoarthritis are prevalent and costly conditions. A large proportion of the direct costs associated with these conditions relates to management of iatrogenic side effects. The cyclooxygenase (COX)-2-specific inhibitors lead to equivalent control of pain and disability compared with traditional NSAIDs. However, the COX-2-specific inhibitors have significant potential to reduce health-care costs, principally through the reduction of side effects. These cost savings are most likely to be realized through reductions in costs associated with dyspepsia and upper gastrointestinal ulcers and bleeding. Reduced indirect costs through improved disability scores and improved health-related quality of life are also predictable with the use of COX-2-specific inhibitors. This is accomplished without the attendant increase in risk to the gastrointestinal tract associated with traditional NSAIDs.
9295453 Coordinated individual education with an arthritis passport for patients with rheumatoid a 1997 Aug OBJECTIVE: To evaluate the effects of a program for individual education in combination with the use of an arthritis passport. METHODS: We studied 3 groups of patients with rheumatoid arthritis. The first experimental group received educational materials and followed the program under the guidance of their regular providers of health care whose activities were coordinated through arthritis passports. The second experimental group only received education materials; the control group received only usual care. RESULTS: There were no effects on self-efficacy expectations, knowledge, health status, or behavior in either experimental group. Opinions of general practitioners, physiotherapists, and visiting nurses concerning the arthritis passport were very positive, but rheumatologists' opinions were not. Opinions on coordination of care were more positive among the physiotherapists of the experimental group. CONCLUSIONS: Individual education for patients with rheumatoid arthritis by health care providers during routine consultations, as implemented in this program, had no effect on self-efficacy expectations, knowledge, health status, or health behavior. Likewise, the distribution of educational materials by itself without the involvement of health care providers had no effect. The use of the arthritis passport improved coordination of care, especially for physiotherapists.
10446869 Treatment of early seropositive rheumatoid arthritis with minocycline: four-year followup 1999 Aug OBJECTIVE: Rheumatoid arthritis (RA) causes substantial morbidity and mortality, and current treatments are suboptimal. Recent studies have demonstrated the short-term efficacy of minocycline in the treatment of patients with early RA. This study was undertaken to compare patients treated with conventional therapy in the early phase of their RA and those treated with minocycline, after 4 years of followup. METHODS: Forty-six patients with seropositive RA of <1 year's duration had been enrolled in a double-blind study of minocycline (100 mg twice daily) versus placebo. After the blinded portion of the study (3-6 months, depending upon response), all patients were treated with conventional therapy. This report compares those patients randomized to receive placebo for 3 months and then conventional therapy for the duration of 4 years versus those originally randomized to receive minocycline. RESULTS: Twenty of the 23 original minocycline-treated patients and 18 of the 23 original placebo-treated patients were available for followup (mean 4 years). At followup, RA was in remission (American College of Rheumatology criteria) without disease-modifying antirheumatic drug (DMARD) or steroid therapy in 8 of the patients originally treated with minocycline compared with 1 patient in the placebo group (P = 0.02). Ten patients in the minocycline group versus 16 in the original placebo group currently require DMARD therapy (P = 0.02). CONCLUSION: Among patients with seropositive RA, remissions are more frequent and the need for DMARD therapy is less in those treated early in the disease course with minocycline compared with those treated with conventional therapy delayed by an average of only 3 months. Minocycline appears to be an effective therapy for early RA; further investigation into its mechanism of action is needed.
9457327 What destroys the joint in rheumatoid arthritis? 1998 The immunological disturbance in rheumatoid arthritis (RA) gives rise to a nonspecific inflammatory reaction mediated by cells and cytokines. This immunological nonbacterial synovitis, however, does not destroy the articular cartilage. The destruction of joint structures is the effect of tumor-like aggressive synoviogenic cell elements (TLP). These TLP formations are not observed in any other type of arthritis. TLP formations are strictly avascular and short-lived. After they have decayed, a collagenous pannus remains. Invasion and destruction of joint structures are brought about by several types of proteases, synthesized and secreted by highly active TLP cells. The TLP formations possess more than twice the affinity for adjacent bone than for the articular cartilage. In these formations, four oncogenes could be identified. In the course of RA disease, TLP formations can recur. Thus, the joint damage can summate with time. The oncological character of the aggressive process in RA demands new therapeutical considerations to protect RA patients from destruction of their joints.
9605105 Apoptosis induction in synovial fibroblasts by ceramide: in vitro and in vivo effects. 1998 May Several lipid second messengers are important mediators of extracellular signals. Among them ceramide, which is formed by cell membrane sphingomyelin, influences the apoptotic signal pathway through Fas antigen. We examined the apoptotic effect of cell-permeable C2-ceramide on rheumatoid synovial fibroblasts in vitro and in vivo. Exposure of cultured human rheumatoid synovial fibroblasts to C2-ceramide for 24 hours produced internucleosomal DNA fragmentation and morphologic changes characteristic of apoptosis. This C2-ceramide-mediated apoptosis was dose dependent as confirmed by analysis of cytosolic oligonucleosome-bound DNA of treated synovial fibroblasts. We also demonstrated that intra-articular administration of C2-ceramide into Fas-deficient MRL lpr/lpr mice produced a profound reduction of synovial hyperplasia within 24 hours. In situ nick end labeling analysis confirmed the induction of apoptosis in synovial lining cells. Our results indicate that C2-ceramide may function as a potent inducer of apoptosis in the synovium and suggest that pharmacologically-induced apoptosis may be useful as a new therapeutic modality for rheumatoid arthritis.
9485081 Expression of the C5a receptor (CD88) on synovial mast cells in patients with rheumatoid a 1998 Feb OBJECTIVE: To analyze the immunophenotype and functional properties of synovial mast cells (SyMC) in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). METHODS: Synovial tissue was obtained from 25 patients with RA and 17 patients with OA. Tissue was dispersed by enzymatic digestion using collagenase. Surface receptor expression on SyMC was analyzed by monoclonal antibodies (MAb) and indirect immunofluorescence staining. Histamine release experiments were performed using the MC agonist recombinant human (rHu) stem cell factor (SCF), the anaphylatoxin rHuC5a, and an anti-IgE antibody. RESULTS: In both groups of patients (RA and OA), SyMC were found to react with MAb to IgE, SCF receptor (c-kit, CD117), as well as CD antigens likewise expressed in lung MC (CD9, CD29, CD33, CD43, CD44, CD45). However, a significantly increased proportion of SyMC from RA patients reacted with MAb against C5a receptor (C5aR; CD88), compared with SyMC from OA (mean +/- SD percentage of SyMC reacting with CD88 MAb S5/1 in RA 27.5 +/- 8.6% versus 0.0% in OA, and with CD88 MAb W17/1 in RA 58.3 +/- 15.2% versus 12.5 +/- 15.0% in OA; P < 0.05). Furthermore, in RA, significant histamine release from SyMC above control was induced by rHuC5a, anti-IgE, and rHuSCF, whereas SyMC in OA released histamine after stimulation with anti-IgE and rHuSCF, but not rHuC5a. CONCLUSION: SyMC exhibit phenotypic and functional properties similar to MC in other tissues. In patients with RA, but not OA, SyMC express significant amounts of C5aR (CD88) and release histamine in response to rHuC5a. These results indicate a role for SyMC and C5a/C5aR in the pathogenesis of RA.
11386773 A comparison of metacarpophalangeal joint silastic arthroplasty with or without crossed in 2001 Jun Forty-three hands in 36 adults undergoing Silastic interposition arthroplasty of the index, middle, ring and little finger metacarpophalangeal joints for rheumatoid arthritis were randomly allocated to undergo replacement with or without crossed intrinsic transfer. The patients were reviewed at a median of 17 (range, 7-50) months after surgery. The demographic characteristics and pre-operative clinical measurements of the two groups were indistinguishable. Both groups showed improvement in ulnar drift and an altered arc, but no change in total range of motion at the metacarpophalangeal joints. Grip strength and pulp to pulp pinch were significantly and comparably improved in both groups. There was no difference in pain scores or perceived function between the treatment groups. It is concluded that crossed intrinsic transfer does not significantly affect the outcome of Silastic interposition arthroplasty of the metacarpophalangeal joints in rheumatoid patients.
10952746 Long-term efficacy of radon spa therapy in rheumatoid arthritis--a randomized, sham-contro 2000 Aug OBJECTIVE: To quantify the efficacy of a series of baths containing natural radon and carbon dioxide (1.3 kBq/l, 1.6 g carbon dioxide/l on average) versus artificial carbon dioxide baths alone in patients with rheumatoid arthritis. SUBJECTS: Sixty patients participating in an in-patient rehabilitation programme including a series of 15 baths were randomly assigned to two groups. DESIGN: Pain intensity (100 mm visual analogue scale) and functional restrictions [Keitel functional test, Arthritis Impact Measurement Scales (AIMS questionnaire)] were measured at baseline, after completion of treatment and 3 and 6 months thereafter. To investigate whether the overall value of the outcomes was the same in both groups, the overall mean was analysed by Student's t-test for independent samples. RESULTS: The two groups showed a similar baseline situation. After completion of treatment, relevant clinical improvements were observed in both groups, with no notable group differences. However, the follow-up revealed sustained effects in the radon arm, and a return to baseline levels in the sham arm. After 6 months, marked between-group differences were found for both end-points (pain intensity: -16.9%, 95% confidence interval -27.6 to -6.2%; AIMS score: 0.57, 95% confidence interval 0.16 to 0.98). The between-group differences were statistically significant for both overall means (pain intensity, P: = 0.04; AIMS, P: = 0.01). CONCLUSION: Marked short-term improvements in both groups at the end of treatment may have masked potential specific therapeutic effects of radon baths. However, after 6 months of follow-up the effects were lasting only in patients of the radon arm. This suggests that this component of the rehabilitative intervention can induce beneficial long-term effects.
11563580 The cervical spine in mutilant rheumatoid arthritis. 2001 Aug The purpose of this study was to detect the frequency of inflammatory cervical spine changes and characteristic features such as resorption in rheumatoid arthritis (RA) with arthritis mutilans (AM) hand deformity. The series included 23 patients with AM hand deformity who fulfilled the 1987 American Rheumatism Association criteria for RA. Cervical spine radiographs were evaluated for subluxations, atlantoaxial impaction (AAI), and apophyseal joint ankylosis. Assessment of the severity of inflammatory changes in the cervical spine was based on former radiographic criteria for operation. Twenty patients (87%) showed subluxations, AAI, or apophyseal joint ankylosis in the cervical spine. Anterior atlantoaxial subluxation (aAAS) was observed in nine (39%), AAI in 13 (57%), and apophyseal joint ankylosis in 12 (52%). Six (26%) had been operated on the cervical spine. Patients with AM hand deformity evinced frequent and severe inflammatory cervical spine changes often requiring operation. Resorptive change (AAI) in the upper cervical spine and ankylosis of apophyseal joints were the most characteristic abnormalities in these patients.
9158086 Effects of rapamycin on apoptosis of rheumatoid synovial cells. 1997 May In the present study, we investigated the effects of an immunosuppressant, rapamycin, on bcl-2 expression and the susceptibility of human rheumatoid synovial fibroblasts to Fas-mediated apoptosis. Rapamycin treatment down-regulated bcl-2 expression on rheumatoid synovial cells in a dose-dependent manner. In contrast, Fas antigen expression was not influenced by rapamycin treatment. Rapamycin treatment also enhanced the susceptibility of rheumatoid synovial cells to anti-Fas monoclonal antibody-mediated apoptosis. Our results suggest that rapamycin augments the sensitivity of rheumatoid synovial fibroblasts to apoptosis by down-regulating bcl-2 expression. This pharmacological alteration of sensitivity to apoptosis in the rheumatoid synovium may represent a new therapeutic approach for rheumatoid arthritis.
9407574 Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physi 1997 Nov OBJECTIVE: Two recent reports have found associations between fibromyalgia and sexual victimization, but had methodologic characteristics that limited their interpretation. METHOD: We compared 36 patients with fibromyalgia and 33 patients with rheumatoid arthritis by using structured interviews for sexual, physical, and emotional victimization histories, as well as dimensional self-report measures of victimization severity. RESULTS: Compared with the patients with rheumatoid arthritis, those with fibromyalgia had significantly higher lifetime prevalence rates of all forms of victimization, both adult and childhood, as well as combinations of adult and childhood trauma. Although childhood maltreatment was found to be a general risk factor for fibromyalgia, particular forms of maltreatment (eg, sexual abuse per se) did not have specific effects. Experiences of physical assault in adulthood, however, showed a strong and specific relationship with unexplained pain. Trauma severity was correlated significantly with measures of physical disability, psychiatric distress, illness adjustment, personality, and quality of sleep in patients with fibromyalgia but not in those with rheumatoid arthritis. CONCLUSIONS: Fibromyalgia seems to be associated with increased risk of victimization, particularly adult physical abuse. Sexual, physical, and emotional trauma may be important factors in the development and maintenance of this disorder and its associated disability in many patients.