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ID PMID Title PublicationDate abstract
9712090 Health status in rheumatoid arthritis: cross cultural evaluation of a Portuguese version o 1998 Aug OBJECTIVE: To develop a Portuguese version of the Arthritis Impact Measurement Scales 2 (AIMS2) and to evaluate its measurement properties in Brazilian patients with rheumatoid arthritis (RA). METHODS: The BRASIL-AIMS2 was developed through the stages of initial translation, back translation, definition of the first Portuguese version, and committee review. Convergent validity was determined by administering the questionnaire to 32 patients with RA and correlating it with several clinical and laboratory variables. Twenty-five of the 32 patients were interviewed 3 times to evaluate test-retest and interobserver reliability. RESULTS: Six translated questions were replaced due to the lack of cultural equivalence. The mean time of administering the questionnaire was about 30 minutes. The test-retest and interobserver reliability were satisfactory, except for Health Perception, and correlation coefficients ranged from 0.87 to 0.98. The Physical, Symptom, and Role components were statistically correlated with Health Assessment Questionnaire, functional class, morning stiffness, and physician assessed disease activity. CONCLUSION: The Physical, Symptom, and Role subscales of the BRASIL-AIMS2 may be useful in the evaluation of quality of life in Brazilian patients with RA.
10468168 Autologous blood transfusion with recombinant erythropoietin treatment in anaemic patients 1999 The aim of this study was to determine the conditions under which a sufficient preoperative amount of autologous blood could be obtained with administration of rHuEPO (recombinant human erythropoietin) in anaemic patients with rheumatoid arthritis (RA). Thirty-one patients (29 female, two male) with RA who were unable to donate any autologous blood owing to a haemoglobin level of less than 11 g/dl were recruited for this study. Their mean age at the time of operation was 59.3 years. The study protocol for preoperative autologous blood donations started 2.7 weeks before surgery. All patients received 6000 IU rHuEPO intravenously three times a week, supplemented with 40 mg intravenous saccharated ferric oxide at each rHuEPO administration. The protocol also included the provision that 200 g of blood at the first and third donations and 400 g of blood at the second donation were collected. The patients who were able or unable to donate 800 g of blood by this protocol were regarded as having a good or poor response, respectively, to rHuEPO. Patients with a poor response to rHuEPO showed greater clinical symptoms (morning stiffness, the number of swollen joints, Ritchie index) and higher laboratory inflammation parameters (ESR, CRP, platelets, IL-6, TNFalpha, IL-1beta) than patients with a good response to rHuEPO. The poor-response group showed a significant decrease in the progression of inflammation compared with the good-response group. Before treatment with rHuEPO, anaemia in the poor-response group was the same as that in the good-response group, except for impairment of UIBC (unsaturated iron-binding capacity). The poor-response group had a higher blood loss than the good-response group. In conclusion, anaemic RA patients should be considered as candidates for aggressive blood conservation interventions that depend on erythropoietin-modulated erythropoiesis. However, it is important to determine this approach under good control of inflammation.
10090161 Soluble adhesion molecules and anti-endothelial cell antibodies in patients with rheumatoi 1999 Mar OBJECTIVE: To examine whether levels of soluble adhesion molecules and anti-endothelial cell antibodies (AECA) were elevated in rheumatoid arthritis (RA) complicated by peripheral neuropathy compared to controls with no neurological complications. METHODS: Levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), sE-selectin, and AECA were determined by ELISA in 33 patients with RA neuropathy, 23 patients with vasculitis who had no neurological complications, 29 patients with RA without neuropathy, and 25 healthy volunteer controls. RESULTS: The patients with neuropathy had significantly higher levels of serum sVCAM-1 (mean 1119+/-368 ng/ml) than patients without neuropathy (mean 869+/-214 ng/ml) and healthy controls (mean 578+/-204 ng/ml). Serum levels of sE-selectin were higher among neuropathic patients with RA (mean 73+/-34 ng/ml) than RA controls (mean 45+/-27 ng/ml) and healthy controls(mean 32+/-10 ng/ml). There was no significant difference in serum levels of sVCAM-1, sE-selectin, and AECA between patients with RA with neuropathy and patients with vasculitis uncomplicated by neurological disease. Abnormal levels of sVCAM-1, sE-selectin, or AECA were found in sera from 28 (85%) patients with RA neuropathy, 15 (65%) patients with vasculitis, 9 (31%) RA controls, and 2(8%) healthy controls. CONCLUSION: Serum levels of sVCAM-1, sE-selectin, and AECA are higher in patients with RA neuropathy than in patients with RA uncomplicated by neurological disease. These data suggest that development of peripheral neuropathy in RA is associated with increased endothelial cell activation.
10679127 High levels of IL-17 in rheumatoid arthritis patients: IL-15 triggers in vitro IL-17 produ 2000 Mar 1 Recent data suggest that IL-15 plays an important role in the pathogenesis of rheumatoid arthritis. In the present study, we hypothesized that elevated in the joints of rheumatoid arthritis, but not osteoarthritis, patients, IL-15 may exert its proinflammatory properties via the induction of IL-17, a cytokine known to stimulate synoviocytes to release several mediators of inflammation including IL-6, IL-8, GM-CSF and PGE2. To test this hypothesis, we first measured the levels of IL-17 and IL-15 using specific ELISA and found that synovial fluids of patients with rheumatoid arthritis, but not with osteoarthritis, contain high levels of these cytokines. A strong correlation between IL-15 and IL-17 levels in synovial fluids was observed. Among tested factors, LPS and TNF-alpha failed, IL-15 and IL-2 were equipotent, and PMA + ionomycin was far more efficient in the induction of IL-17 secretion by PBMCs isolated from healthy blood donors. Interestingly, synovial fluid cells, in contrast to PBMCs isolated from patients with rheumatoid arthritis, but not osteoarthritis, respond to PMA + ionomycin with much lower, comparable to IL-15-triggered IL-17 secretion. Moreover, PMA + ionomycin-triggered IL-17 secretion is completely or partially blocked in the presence of low doses of cyclosporin A or high doses of methylprednisolone, respectively. IL-15-triggered IL-17 secretion by PBMCs was completely inhibited by these drugs. Thus, our results suggest for the first time that IL-15 may represent a physiological trigger that via cyclosporin A and steroid sensitive pathways leads to the overproduction of IL-17 in the joints of rheumatoid arthritis patients.
10470596 Clinical and gastroscopic evaluation of amtolmetin guacyl versus diclofenac in patients wi 1999 Jun AIM: Amtolmetin guacyl (2-[2[1-methyl-5-(4-methylbenzoyl) pyrrol-2-yl] acetamido] acetic acid 2-methoxyphenyl ester) is a recently developed drug which, in preliminary studies, has shown effective anti-inflammatory properties with improved gastrointestinal safety. Our study was designed to investigate the efficacy and tolerability of amtolmetin guacyl 600 mg bid when compared to diclofenac 50 mg tid for 4 weeks. PATIENTS AND METHODS: A total of 64 patients aged 18-80 years, suffering from rheumatoid arthritis for more than 6 months and American Rheumatism Association functional class I, II or III were randomized in a double blind manner to amtolmetin guacyl or diclofenac for 4 weeks. Clinical and endoscopic evaluation were performed at baseline and at the end of the treatment. The mucosa was graded by means of a rating system emphasizing mucosal erosions. Only patients with endoscopy grade 0-1 entered the trial. RESULTS: The median post-treatment endoscopy injury scores were 0 (range 0-4) in the amtolmetin guacyl-treated patients and 2 (range 0-4) in the diclofenac-treated patients (p = 0.005). There were nine gastric ulcers: 1/32 (3%) in the amtolmetin guacyl group and 8/32 (25%) in the diclofenac group (p < 0.05; 95% confidence interval, -30-5%). 16/32 (50%) patients in amtolmetin guacyl group and 8/32 (25%) in diclofenac group had normal gastroduodenal findings (score = 0) (p < 0.05; 95% confidence interval, 5-50%). In patients with a history of peptic ulcer, a recurrence of gastric damage (score 3-4) was observed in 18% in the amtolmetin guacyl and in 53% in the diclofenac group (p < 0.05). The incidence of gastrointestinal symptoms did not differ in the two groups. Amtolmetin guacyl significantly reduced the number of swollen and painful joints, and the functional disability index; diclofenac significantly reduced the number of painful joints and the functional disability index score (p = ns). CONCLUSIONS: Amtolmetin guacyl effectively controlled the symptoms of rheumatoid arthritis, with very limited gastric toxicity. If these findings are confirmed on a wider scale, the drug might become a valid alternative to current therapies, especially for patients at risk, such as those with rheumatoid arthritis simultaneously requiring steroids and second-line drugs, or those with a history of peptic ulcer.
9748789 [Comparison of the results of PCA knee joint endoprosthesis in patients with rheumatoid ar 1998 May Hundred and forty two porous-coated anatomic (PCA) total condylar arthroplasties were performed from 1985 to 1991 in hundred and twenty-four patients, ninety-seven women and twenty-seven men. The diagnosis was osteoarthritis in 96 cases and rheumatoid arthritis in 46 cases. The mean follow-up was 88 months, range from 51 to 137 months. All operated patients were evaluated based on survivorship of the endoprosthesis with the cumulative survivorship method according to Kaplan-Meier method. The end point was defined as endoprosthesis in situ. The overall cumulative survival rate for mean follow up time was 77%. The survival rate of the rheumatoid arthritis group was significantly higher (82.5%) than that of the osteoarthritis group (73.8%). 108 PCA arthroplastes were evaluated regarding Baltimore's score. The mean postoperative Baltimore's score was 68.7. In the rheumatoid arthritis group score was 74.8 and in the osteoarthritis group it was 65.9 but this difference is not statistically significant (p = 0.06).
11128659 Mycoplasma fermentans in rheumatoid arthritis and other inflammatory arthritides. 2000 Dec OBJECTIVE: To evaluate the association between infection with Mycoplasma fermentans (Mf) and rheumatoid arthritis (RA) and other inflammatory arthritides. METHODS: Screening of synovial fluid samples (SF) for Mf was done by culture and by polymerase chain reaction (PCR) in 38 and 34 RA patients, respectively, 8 undifferentiated arthritis (UDA), 9 reactive arthritis (ReA), and in 40 other arthritides. The prevalence of antibodies to Mf in these SF was determined by both ELISA and immunoblotting (IB). Antibodies were measured also in sera of 88 RA patients, 28 ReA, 14 UDA, 71 other arthritides, and in 102 healthy blood donors. RESULTS: All SF were culture-negative for Mf, while 7 SF were positive by PCR (6/34 RA and 1/8 UDA). SF from patients with other arthritides and ReA were PCR-negative. The prevalence of anti-Mf antibodies in SF of RA patients was significantly higher than in SF of other arthritides (p = 0.01). In 47% (17/38) of all RA (including the 6 PCR-positive patients), the level of antibodies to Mf in their SF was higher than that in sera, compared to 7.5% (3/40) in other arthritides (p = 0.0002). There was no significant difference in the prevalence of serum antibodies to Mf between patients with RA, other arthritides, and healthy controls. By IB with Mf sonicate, binding to Mf peptides P107, P48, and P29 was detected in SF of 7/11 RA patients but not in 11 patients with traumatic arthritis. Specific binding to Mf membrane lipoproteins was also more prevalent in SF of RA patients than in other arthritides (p = 0.038). CONCLUSION: The finding that both Mf DNA and specific antibodies to Mf were present in the SF of RA patients suggests that in some RA patients Mf may play a role in initiating or perpetuating synovitis.
10356661 Increased levels of lactoferrin in synovial fluid but not in serum from patients with rheu 1999 Lactoferrin is a multifunctional immunoregulatory protein, stored in specific granules of neutrophil granulocytes, from which it is released following cell activation. As activated neutrophils play a crucial role in the destruction of synovial joints in rheumatoid arthritis, we evaluated lactoferrin concentration in synovial fluid and sera from 21 patients with rheumatoid arthritis and 11 patients with osteoarthritis. We also measured lactoferrin levels in sera from 12 healthy controls. Lactoferrin was measured by a solid-phase inhibition immunoassay. Median lactoferrin levels were significantly higher in synovial fluid from rheumatoid arthritis than from osteoarthritis patients (P = 0.0002). In contrast, no significant difference was found between serum lactoferrin from patients with rheumatoid arthritis or osteoarthritis compared with normal controls. In patients with rheumatoid arthritis, lactoferrin concentrations were higher in synovial fluid than in sera (P = 0.036). In both rheumatoid arthritis and osteoarthritis no correlation was found between serum and synovial fluid lactoferrin (P = 0.51 and P = 0.5, respectively). In synovial fluid from patients with rheumatoid arthritis, lactoferrin concentrations correlated with neutrophil granulocyte count (P < 0.0001), but neither serum nor synovial lactoferrin levels correlated with disease activity (P = 0.32 and P = 0.25, respectively). In conclusion, lactoferrin is a reliable marker of neutrophil activation at sites of inflammation in rheumatoid synovitis, but does not represent a marker of disease activity.
10728756 Reduced expression of the regulatory CD4+ T cell subset is related to Th1/Th2 balance and 2000 Mar OBJECTIVE: To elucidate the involvement of the regulatory CD4+ T cells that produce high levels of interleukin-10 (IL-10) and low levels of IL-4 and IL-2 in the pathogenesis of rheumatoid arthritis (RA), we investigated whether the frequency of this type of CD4+ T cell subset in peripheral blood lymphocytes (PBL) or synovial lymphocyte infiltrates of patients with RA correlated with disease severity and histologic features in rheumatoid synovium. METHODS: PBL and synovial lymphocyte infiltrates were isolated from peripheral blood samples and synovial tissues obtained from 25 patients with RA. Control specimens were obtained from 18 patients with osteoarthritis (OA) and 10 patients with traumatic injuries of the knee joint. CD4+ T cell subsets were categorized as Th1 (production of interferon-gamma [IFNgamma], but not IL-4), Th2 (production of IL-4, but not IFNgamma), or CD4+ T cell subsets producing IL-10, IL-2, or IL-4. The percentages of these T helper subsets among PBL and among synovial infiltrating lymphocytes were determined by an intracellular staining assay with flow cytometric analysis. RESULTS: The level of expression of CD4+ T cells producing IL-10 but not IL-2 and IL-4 in the peripheral blood and synovial tissue was significantly lower in RA patients than in OA patients and trauma patients. In RA patients, the frequency of this type of CD4+ T cell subset among synovial infiltrating CD4+ T cells was inversely correlated with the frequency of Th1 cells and the Th1/Th2 balance in synovial lymphocytes, serum C-reactive protein value, disease activity score, and the degree of synovial lining hyperplasia and lymphocyte infiltration in rheumatoid synovium. There was a reciprocal relationship between the frequency of Thl cells and CD4+ T cells producing IL-10 but not IL-2 and IL-4 in the peripheral blood of RA patients. CONCLUSION: In RA, reduced expression of the CD4+ T cell subset producing IL-10 but not IL-2 and IL-4 may be responsible for the dominance of Th1 over Th2 cells at sites of inflamed synovium and in the peripheral blood. Decreases in this type of CD4+ T cell subset may induce the down-regulation of T cell tolerance and exacerbate the inflammatory process in RA.
9424821 [A clinical and experimental analysis of the effects of laser therapy]. 1997 Jul Thymus area was exposed to laser radiation in 180 Wistar male rats. Intact animals experienced a stress response to a single laser procedure (a rise in the levels of hydrocortisone, a fall in those of insulin, triiodothyronine and thyroxine). Longer exposure to laser radiation caused a break of the hydrocortisone mechanism. Similar effects were seen in the course exposure. The immune system was unchanged. In adjuvant arthritis laser radiation induced similar hormonal shifts and additional suppression of immunity. In 82 children with active juvenile rheumatoid arthritis laser therapy produced an insignificant effect, while in adults with moderate rheumatoid arthritis the response was good.
9779311 Commonly used disease-modifying antirheumatic drugs in the treatment of inflammatory arthr 1998 Sep Although disease-modifying drugs are extensively used in the treatment of inflammatory arthritides such as rheumatoid arthritis (RA), the actual underlying mechanisms of action of these agents remains somewhat unclear. Many investigators have studied the effects of these agents, often with particular attention being paid to alterations in inflammatory cytokine production, cell proliferation and activation, signal transduction pathways, and enzyme inhibition. By gaining a more complete understanding of these mechanisms, further information may be had regarding the pathophysiology of RA as well as other autoimmune diseases. In the following review we will examine some of the more recent studies of drug mechanisms, focusing on the most commonly used anti-rheumatic medications in the treatment of RA.
9202061 Aggrecan degradation in human cartilage. Evidence for both matrix metalloproteinase and ag 1997 Jul 1 To examine the activity of matrix metalloproteinases (MMPs) and aggrecanase in control and diseased human articular cartilage, metabolic fragments of aggrecan were detected with monospecific antipeptide antibodies. The distribution and quantity of MMP-generated aggrecan G1 fragments terminating in VDIPEN341 were compared with the distribution of aggrecanase-generated G1 fragments terminating in NITEGE373. Both types of G1 fragments were isolated from osteoarthritic cartilage. The sizes were consistent with a single enzymatic cleavage in the interglobular domain region, with no further proteolytic processing of these fragments. Both neoepitopes were also detected by immunohistochemistry in articular cartilage from patients undergoing joint replacement for osteoarthritis (OA), rheumatoid arthritis (RA), and in cartilage from adults with no known joint disease. In control specimens, the staining intensity for both G1 fragments increased with age, with little staining in cartilage from 22-wk-old fetal samples. There was also an increase with age in the extracted amount of MMP-generated neoepitope in relation to both aggrecan and collagen content, confirming the immunohistochemical results. After the age of 20-30 yr this relationship remained at a steady state. The staining for the MMP-generated epitope was most marked in control cartilage exhibiting histological signs of damage, whereas intense staining for the aggrecanase-generated fragment was often noted in adult cartilage lacking overt histological damage. Intense staining for both neoepitopes appeared in the more severely fibrillated, superficial region of the tissue. Intense immunostaining for both VDIPEN- and NITEGE- neoepitopes was also detected in joint cartilage from patients with OA or RA. Cartilage in these specimens was significantly more degraded and high levels of staining for both epitopes was always seen in areas with extensive cartilage damage. The levels of extracted VDIPEN neoepitope relative to collagen or aggrecan in both OA and RA samples were similar to those seen in age-matched control specimens. Immunostaining for both types of aggrecan fragments was seen surrounding the cells but also further removed in the interterritorial matrix. In some regions of the tissue, both neoepitopes were found while in others only one was detected. Thus, generation and/or turnover of these specific catabolic aggrecan fragments is not necessarily coordinated. Our results are consistent with the presence in both normal and arthritic joint cartilage of proteolytic activity against aggrecan based on both classical MMPs and "aggrecanase."
11848387 Long-term measurement of metacarpophalangeal joint motion in the normal and rheumatoid han 2001 Low-profile flexible goniometers were used in an instrumented glove to monitor metacarpophalangeal (MCP) joint usage in patients with rheumatoid arthritis and control subjects over 3 days. Statistical analysis of the results provided descriptors of total joint motion per hour, the number of movements per hour and their duration, amplitude and angular velocity. The results show the patient group to have less overall joint usage than the control group, with movements being slower and smaller and with a restricted range. Yearly rates of joint usage were derived; these values are considerably higher than predicted in prosthetic joint testing protocols.
9489811 Ultrasound detection of plantar bursitis of the forefoot in patients with early rheumatoid 1998 Feb OBJECTIVE: To study the plantar forefoot of patients with early rheumatoid arthritis (RA) by ultrasound to detect bursitis and to correlate sonographic findings with symptoms and clinical observations. METHODS: Clinical examination, dorsoplantar radiographs, and transverse sonographic scans of the plantar region of the forefoot were performed on 30 healthy persons as well as 25 patients with early RA and forefoot symptoms. RESULTS: In 8 patients the examiner could clinically suspect plantar bursitis. Ultrasound revealed 22 incidents of plantar bursitis in 14 of the 25 patients. Except for bursitis in the forefoot no inflammatory findings were detected by ultrasound in 6 patients. CONCLUSION: Not only metatarsophalangeal arthritis or flexor tenosynovitis but also plantar bursitis can promote symptoms of the forefoot. Ultrasound is a more objective procedure than clinical examination in diagnosing plantar bursitis. This finding has diagnostic and therapeutic implications.
9150100 Psychological measures: practical issues in observational studies and clinical monitoring. 1997 May Psychological measures are important because they can influence the expression of pain and physical function in patients with arthritis. A number of instruments are now available that measure psychological distress and how we as individuals manage stress. These instruments have undergone extensive validation, although more work is required to evaluate the performance of these instruments measuring change over time. One way to interpret psychological measures and to evaluate how they change over time is to use normative comparisons that are conditional on time and other relevant covariates, using statistical methods such as quantile regression. Such methods have been used to interpret the developmental, educational, and physical growth of children. We can use similar methods to interpret observational studies and to guide decisions within the context of clinical practice.
9104817 Diversification of T cell responses to carboxy-terminal determinants within the 65-kD heat 1997 Apr 7 The T cell response to the 65-kD mycobacterial heat-shock protein (Bhsp65) has been implicated in the pathogenesis of autoimmune arthritis. Adjuvant arthritis (AA) induced in the Lewis rat (RT-1(l)) by injection of Mycobacterium tuberculosis serves as an experimental model for human rheumatoid arthritis (RA). However, the immunological basis of regulation of acute AA, or of susceptibility/resistance to AA is not known. We have defined the specificity of the proliferative T cell responses to Bhsp65 during the course of AA in the Lewis rat. During the early phase of the disease (6-9 d after onset of AA), Lewis rats raised T cell responses to many determinants within Bhsp65, spread throughout the molecule. Importantly, in the late phase of the disease (8-10 wk after onset of AA), there was evidence for diversification of the T cell responses toward Bhsp65 carboxy-terminal determinants (BCTD) (namely, 417-431, 441-455, 465-479, 513-527, and 521-535). Moreover, arthritic rats in the late phase of AA also raised vigorous T cell responses to those carboxy-terminal determinants within self(rat) hsp65 (Rhsp65) that correspond in position to the above BCTD. These results suggest that the observed diversification is possibly triggered in vivo by induction of self(Rhsp65)-reactive T cells. Interestingly, another strain of rat, the Wistar Kyoto (WKY/NHsd) rat (RT-1(l)), with the same major histocompatibility complex class II molecules as the Lewis rat, was found to be resistant to AA. In WKY rats, vigorous responses to the BCTD, to which the Lewis rat responded only in the late phase of AA, were observed very early, 10 d after injection of M. tuberculosis, Strikingly, pretreatment with the peptides comprising the set of BCTD, but not its amino-terminal determinants, provided significant protection to naive Lewis rats from subsequent induction of AA. Thus, T cell responses to the BCTD are involved in regulating inflammatory arthritis in the Lewis rat and in conferring resistance to AA in the WKY rat. These results have important implications in understanding the pathogenesis of RA and in devising new immunotherapeutic strategies for this disease.
9173751 [Acupuncture in treatment of inflammatory rheumatic diseases]. 1997 Jan Seventeen studies were examined with regard to efficacy and scientific quality of acupuncture in rheumatoid arthritis, spondarthropathy, lupus erythematosus, local and progressive systemic scleroderma. Acupuncture cannot be recommended for treatment of these diseases. By far, the most studies examined failed to show sufficient quality.
11010061 Secondary health conditions among middle-aged individuals with chronic physical disabiliti 1999 Data from the Aging with Disability (AwD) Study are used to examine variations in the types and frequency of secondary conditions experienced by 301 middle-aged individuals living with the effects of three disabling conditions: polio (n = 124), rheumatoid arthritis (RA) (n = 103), and stroke (n = 75). All respondents were randomly selected from a county rehabilitation hospital or a community-based subject pool. Secondary conditions are operationalized as (1) the number of new health problems diagnosed or treated since the onset of the primary disability and (2) the amount of change/decline in basic and instrumental daily activities since a previous reference period in the disability trajectory. Also analyzed are changes in use of assistive devices and unmet needs for services. Differences in secondary conditions are examined within the AwD sample by impairment group and between samples by comparing AwD rates to national estimates for the same cohort. Results reveal significant differences in the types of new health problems reported by persons living with polio, RA, and stroke and document marked disparities, or accelerated aging, between disabled and nondisabled adults. Findings are discussed in terms of the changing health care needs of persons aging with disability and the importance of improving access to preventive services, ongoing rehabilitation, and assistive technology.
11502613 What is the fate of erosions in early rheumatoid arthritis? Tracking individual lesions us 2001 Sep OBJECTIVES: To investigate the progression of erosions at sites within the carpus, in patients with early rheumatoid arthritis (RA), using magnetic resonance imaging (MRI) and plain radiology over a two year period. METHODS: Gadolinium enhanced MRI scans of the dominant wrist were performed in 42 patients with RA at baseline (within six months of symptom onset) and one year. Plain wrist radiographs (x rays) and clinical data were obtained at baseline, one year, and two years. Erosions were scored by two musculoskeletal radiologists on MRI and x ray at 15 sites in the wrist. A patient centred analysis was used to evaluate the prognostic value of a baseline MRI scan. A lesion centred analysis was used to track the progression of individual erosions over two years. RESULTS: The baseline MRI erosion score was predictive of x ray erosion score at two years (p=0.004). Patients with a "total MRI score" (erosion, bone oedema, synovitis, and tendonitis) > or =13 at baseline were significantly more likely to develop erosions on x ray at two years (odds ratio 13.4, 95% CI 2.65 to 60.5, p=0.002). Baseline wrist MRI has a sensitivity of 80%, a specificity of 76%, a positive predictive value of 67%, and a high negative predictive value of 86% for the prediction of wrist x ray erosions at two years. A lesion centred analysis, which included erosions scored by one or both radiologists, showed that 84% of baseline MRI erosions were still present at one year. When a more stringent analysis was used which required complete concordance between radiologists, all baseline lesions persisted at one year. The number of MRI erosion sites in each patient increased from 2.1 (SD 2.7) to 5.0 (4.6) (p<0.0001) over the first year of disease. When MRI erosion sites were tracked, 21% and 26% were observed on x ray, one and two years later. A high baseline MRI synovitis score, Ritchie score, and erythrocyte sedimentation rate were predictive of progression of MRI erosions to x ray erosions over one year (p=0.005, 0.01, and 0.03 respectively), but there was no association with the shared epitope. Progression of MRI erosions to x ray erosions was not seen in those with transient polyarthritis. CONCLUSIONS: MRI scans of the wrist, taken when patients first present with RA, can predict radiographic erosions at two years. MRI may have a role in the assessment of disease prognosis and selection of patients for more or less aggressive treatment. However, only one in four MRI erosions progresses to an x ray erosion over one year, possibly owing to healing, observer error, or technical limitations of radiography at the carpus. Progression of MRI erosions to x ray erosions is greatest in those with high baseline disease activity.
11178124 Anti-cytokine therapy in chronic destructive arthritis. 2001 Tumor necrosis factor (TNF) and interleukin-1 (IL-1) are considered to be master cytokines in chronic, destructive arthritis. Therapeutic approaches in rheumatoid arthritis (RA) patients have so far focused mainly on TNF, which is a major inflammatory mediator in RA and a potent inducer of IL-1; anti-TNF therapy shows great efficacy in RA patients. However, it is not effective in all patients, nor does it fully control the arthritic process in affected joints of good responders. Directed therapy for IL-1, with IL-1 receptor antagonist, mainly reduces erosions and is marginally anti-inflammatory. It is as yet unclear whether the limited effect is akin to the RA process or linked to suboptimal blocking of IL-1. Analysis of cytokine patterns in early synovial biopsies of RA patients reveals a marked heterogeneity, with variable staining of TNF and IL-1 beta, indicative of TNF-independent IL-1 production in at least some patients. Evidence for this pathway emerged from experimental arthritises in rodents, and is summarized in this review. If elements of the models apply to the arthritic process in RA patients, it is necessary to block IL-1 beta in addition to TNF.