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ID PMID Title PublicationDate abstract
11114286 Use of anti-citrullinated peptide and anti-RA33 antibodies in distinguishing erosive arthr 2001 Jan OBJECTIVES: Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) can both present with an erosive arthritis with the small joints of the hands affected. Therefore a serological marker would be useful to distinguish between these two diseases at onset. In this study anti-RA33 antibodies, which are found in patients with SLE and RA, and anti-citrullinated peptide antibodies (anti-CCP), which have recently been described as highly specific for RA, were assessed. METHODS: Two hundred and thirty one patients receiving long term follow up for SLE were evaluated for arthritis and classified as erosive and non-erosive disease. Sixty six patients were tested for anti-RA33 and anti-CCP antibodies. All the patients were tested for rheumatoid factor (RF) and HLA-DR4 status. RESULTS: Ten patients had erosive disease, six of whom were RF positive (60%), and six anti-RA33 positive (60%), whereas only two were anti-CCP positive (20%). Two hundred and twenty one patients had non-erosive disease, 40 of whom were RF positive (18%), 14 were anti-RA33 positive (6%), whereas only one patient was found to be anti-CCP positive (0.5%). CONCLUSION: The presence of anti-CCP antibodies may be useful in distinguishing RA from erosive SLE. Anti-RA33 antibodies and RF are unhelpful.
10483027 Lymphocyte apoptosis in systemic lupus erythematosus: relationships with Fas expression, s 1999 Lupus specific autoantigens are exposed on apoptotic cells. The increased number of apoptotic lymphocytes reported in systemic lupus erythematosus (SLE) may be attributable to abnormalities of lymphocyte Fas expression or serum soluble Fas. In the present study we analysed the count of circulating apoptotic lymphocytes in SLE patients (n=50), by flow cytometry using Annexin V, compared to rheumatoid arthritis patients (RA, n=20), inflammatory bowel disease patients (IBD, n=20) and normal controls (n=20). Lymphocyte Fas expression and serum soluble Fas were measured and related to numbers of apoptotic lymphocytes. The percentage of apoptotic lymphocytes, determined by Annexin V binding, was significantly increased in peripheral blood of SLE patients (median=4.2%) compared with normal healthy donors (median=1.1%) and IBD patients (median=2. 0%) but not RA (median=3.9%). SLE lymphocyte Fas expression was not significantly different from RA or IBD patients. Serum soluble Fas in SLE patients correlated positively with apoptotic lymphocytes and antibodies to double stranded DNA. This study suggests that increased apoptotic lymphocytes and increased lymphocyte Fas expression may not be specific to SLE. Serum soluble Fas may have a role in the regulation of lymphocyte apoptosis in SLE.
9918256 Invasive Aspergillus spp infections in rheumatology patients. 1999 Jan OBJECTIVE: The number of immunocompromised patients in hospitals has increased, resulting in a concomitant increase in the number of Aspergillus spp infections, with an exceedingly high death rate. From January 1995 through June 1996, 7 patients acquired invasive aspergillosis at a Maryland hospital (Hospital A). No cases had been detected in 1994. METHODS: To determine risk factors for infection, we conducted a case-control study and an environmental evaluation. A case was defined as histopathologic evidence of invasive Aspergillus spp infection in any Hospital A patient admitted from January 1994 through July 1996. RESULTS: Of 7 case patients identified, 5 were rheumatology patients hospitalized on 2 wards. Rheumatology case patients were more likely than randomly selected rheumatology patients without invasive Aspergillus spp infection (controls) to die (p = 0.004), to have longer hospitalization both in current (p = 0.008) and prior (p = 0.001) admissions, to receive high doses of intravenous immunosuppressive agents (p = 0.03), or to receive immunosuppressive agents for a longer period of time (p = 0.001). The environmental evaluation showed that construction areas were neither sealed off from patient care areas nor under negative pressure relative to patient-care areas. The air flow from patients' rooms was not positive in relation to the hallway and had only 1.6 air changes per hour. CONCLUSION: This investigation suggests that rheumatology patients, particularly those receiving high dose intravenous immunosuppressive agents, are at increased risk of invasive Aspergillus spp infection. A high index of suspicion for the diagnosis of nosocomial aspergillosis should be maintained in these patients and, when hospitalized, they should be assigned to rooms removed from or physically separated from construction activity.
11602472 Presenting features of polymyalgia rheumatica (PMR) and rheumatoid arthritis with PMR-like 2001 Nov OBJECTIVE: To evaluate in a prospective study whether patients with polymyalgia rheumatica (PMR) and patients with rheumatoid arthritis (RA) with PMR-like onset show distinctive clinical and laboratory features. METHODS: A cohort of 116 consecutive patients with bilateral girdle pain for at least one month and raised erythrocyte sedimentation rate (ESR) was studied and followed up for 12 months. Laboratory tests included determination of ESR, IgM rheumatoid factor, haemoglobin, white blood cell count, platelet count, percentage of CD8 lymphocytes, serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and glutamyltransferase concentrations. RESULTS: At first examination, RA was diagnosed in 22/116 (19%) patients and PMR in 94 (81%) patients. During the follow up period, 19 additional patients developed RA, and the diagnosis of PMR was confirmed in 65 (56%) patients at the end of the study. Of the clinical and laboratory features, only the presence of peripheral synovitis could differentiate patients who will develop RA from those with "true" PMR, but the positive predictive value of this feature was poor. CONCLUSION: At present, there are no clinical or routine laboratory features allowing early differentiation between PMR and RA with PMR-like onset.
9776115 Serum interleukin-2 receptor for the early diagnosis of rheumatoid arthritis. 1998 The value of measuring soluble interleukin-2 receptor (sIL-2R) in the sera of patients with joint pain as a predicting parameter for the future development of rheumatoid arthritis (RA) was examined. sIL-2R was measured by the ELISA method. Sixty-four patients with joint pain (suspected RA: sus-RA) but no bone or joint destruction were enrolled over 2 years and 47 were selected for the study. Eleven patients whose diagnosis was sus-RA after a year of observation were successively followed-up for 5 years. Two-thirds of the patients whose sIL-2R levels were higher than those of normal healthy adults (< 82 pmol/l; mean +2SD) developed RA within a year. On the other hand, one-quarter of the patients with normal levels of sIL-2R also developed RA within a year. The presence of two or three of the following three items in patients with joint pain without any bone and joint destruction was thus indicated to be useful for the early diagnosis of RA: elevated CRP level (> or = 1.0 mg/dl), positive rheumatoid factor (RF) (> or = 30 IU/ml) and an elevated sIL-2R level (> or = 100 pmol/l). Sensitivity and specificity were 72.7% and 96.0%, respectively. The probability of development of RA is expressed as P = 1/[1 + exp(2.673 - 0.01784 x sIL-2R - 0.4398 x CRP - 0.004835 x RF)], with R2 = 0.3083 and p<0.0005. On the other hand, the sIL-2R levels did not correlate with any future bone or joint changes within a year of observation. The above criteria may therefore hopefully justify the early treatment of patients with joint pain using drugs that can modify the patients' immune function. However, the validity of these criteria still need to be examined more thoroughly in the future.
10368839 The effects of knee extensor and flexor muscle training on the timed-up-and-go test in ind 1999 BACKGROUND AND PURPOSE: Rheumatoid arthritis frequently results in functional impairment. This study investigated the effect of a specific exercise regimen on function. METHOD: A randomized controlled assessor-blinded (N = 36) compared the effect of knee extensor and flexor muscle training on pain, the timed up and go (TUG) test and the Health Assessment Questionnaire in subjects with non-acute rheumatoid arthritis. RESULTS: Knee extensor and flexor muscle training increased isokinetic torques at speeds of 60 degrees/sec-1 and 120 degrees/sec-1 as measured by an isokinetic dynamometer (p = 0.02-0.003). The experimental group experienced a reduction in pain (p = 0.03), an improvement in TUG time (p = 0.01) and in function as measured by the Health Assessment Questionnaire (p = 0.04). CONCLUSIONS: Specific knee muscle training can be administered safely in people with non-acute rheumatoid arthritis, and may produce functional benefits.
9670330 Validation of the Arabic version of the Health Assessment Questionnaire (HAQ) in patients 1998 Jun Several instruments for measuring functional status in rheumatic diseases have been developed and validated. However, none is as yet available in Arabic. OBJECTIVE: To translate the Health Assessment Questionnaire (HAQ) from English to Arabic and to test the metrological properties, reliability, and validity of the Arabic version. METHODS: The study included 41 consecutive patients seen at the outpatient rheumatology clinic of a large teaching hospital in Kuwait for rheumatoid arthritis meeting 1987 American College of Rheumatology criteria. The HAQ was translated from English to Arabic by three translators who were aware of the intended use of the questionnaire. The translated questionnaire was administered to each patient during two clinic visits seven to ten days apart. Test-retest reliability was assessed based on the intraclass correlation coefficient. Internal consistency of individual items with the overall score was assessed using Cronbach's alpha coefficient. Construct validity was evaluated by determining Spearman's correlation between the Arabic HAQ score and disease activity variables. RESULTS: There were 34 women and seven men, with a median age of 38 years and a median disease duration of 5.3 years. Test-retest reliability was 0.81, internal consistency was 0.93, and construct validity ranged from 0.5 (erythrocyte sedimentation rate) to 0.75 (pain). CONCLUSION: The HAQ-A retains the characteristics of the original American version, and is a reliable and valid instrument for measuring functional disability in Arabic-speaking patients with rheumatoid arthritis.
10648053 Pooled metaanalysis of radiographic progression: comparison of Sharp and Larsen methods. 2000 Jan Metaanalysis refers to the statistical analysis of results from individual studies for the purpose of integrating the findings. However, numerous biases can threaten the internal validity of metaanalyses. This paper specifically addresses the issue of study heterogeneity in metaanalyses of radiographic progression. It considers the validity of pooling studies that have used either the Sharp score (or its variants) or the Larsen score (or its variants) by examining whether the 2 scoring methods are sufficiently concordant for pooling in terms of content of items, scaling and measurement properties. Despite differences between the Sharp and Larsen methods, they essentially measure the construct of radiographic damage, and as long as the spectrum of radiographic damage in the pooled series is similar, then the scoring methods are robust to pooling. However, where the spectrum of damage is not similar, for example, studies of radiographic progression of early disease compared with late disease, pooling should be exercised with caution.
10874761 [Heat shock proteins or "stress proteins"]. 2000 May INTRODUCTION: Heat shock proteins (HSP) are molecular chaperones which facilitate the biosynthesis and maturation of proteins within cells (protein folding). They promote assembly and disassembly of polypeptides and play a major role in cellular function, not only during the stress response but also at basal state. CURRENT KNOWLEDGE AND KEY POINTS: As HSP are immunogenic molecules and can be expressed on cellular membranes, their role in auto-immune and inflammatory diseases, particularly in systemic lupus erythematosus, Behçet's disease and rheumatoid arthritis, has been studied. Cellular immune response of T cells and humoral response with antibodies production against HSP occurring in the course of those diseases have been observed. FUTURE PROSPECTS AND PROJECTS: Anti-HSP immune response might provide better understanding of the pathogenic mechanisms involved in those diseases. At present it is not known whether HSP can trigger them. Indeed, anti-HSP immunity could be induced by the immunological process or be part of a normal immunoregulatory response.
10384145 NF-kappa B regulation by I kappa B kinase in primary fibroblast-like synoviocytes. 1999 Jul 1 NF-kappa B is a key regulator of inflammatory gene transcription and is activated in the rheumatoid arthritis (RA) synovium. In resting cells, NF-kappa B is retained as an inactive cytoplasmic complex by its inhibitor, I kappa B. Phosphorylation of I kappa B targets it for proteolytic degradation, thereby releasing NF-kappa B for nuclear translocation. Recently, two related I kappa B kinases (IKK-1 and IKK-2) were identified in immortalized cell lines that regulate NF-kappa B activation by initiating I kappa B degradation. To determine whether IKK regulates NF-kappa B in primary cells isolated from a site of human disease, we characterized IKK in cultured fibroblast-like synoviocytes (FLS) isolated from synovium of patients with RA or osteoarthritis. Immunoreactive IKK protein was found to be abundant in both RA and osteoarthritis FLS by Western blot analysis. Northern blot analysis showed that IKK-1 and IKK-2 genes were constitutively expressed in all FLS lines. IKK function in FLS extracts was determined by measuring phosphorylation of recombinant I kappa B in vitro. IKK activity in both RA and osteoarthritis FLS was strongly induced by TNF-alpha and IL-1 in a concentration-dependent manner. Activity was significantly increased within 10 min of stimulation and declined to near basal levels within 80 min. Activation of IKK in FLS was accompanied by phosphorylation and degradation of endogenous I kappa B alpha as determined by Western blot analysis. Concomitant activation and nuclear translocation of NF-kappa B was documented by EMSA and immunohistochemistry. Transfection with a dominant negative IKK-2 mutant prevented TNF-alpha-mediated NF-kappa B nuclear translocation, whereas a dominant negative IKK-1 mutant had no effect. This is the first demonstration that IKK-2 is a pivotal regulator of NF-kappa B in primary human cells.
10796400 Sulfasalazine for rheumatoid arthritis. 2000 OBJECTIVES: To estimate the short-term efficacy and toxicity of sulfasalazine for the treatment of rheumatoid arthritis (RA). SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group trials register, and Medline, up to July 1997, using the search strategy developed by the Cochrane Collaboration (Dickersin 1994). The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles. SELECTION CRITERIA: All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing sulfasalazine against placebo in patients with RA. DATA COLLECTION AND ANALYSIS: Two reviewers determined the studies to be included based on inclusion and exclusion criteria (GW, MSA). Data were independently abstracted by two reviewers (EB, MSA), and checked by a third reviewer (BS) using a pre-developed form for the rheumatoid arthritis sub-group of the Cochrane Musculoskeletal Group. The same two reviewers, using a validated scale (Jadad 1996) assessed the methodological quality of the RCTs and CCTs independently. Rheumatoid arthritis outcome measures were extracted from the publications. The pooled analysis was performed using standardized mean differences (SMDs) for joint counts, pain, and global and functional assessments. Weighted mean differences (WMDs) were used for erythrocyte sedimentation rate (ESR). Toxicity was evaluated with pooled odds ratios (OR) for withdrawals. A chi-square test was used to assess heterogeneity among trials. Fixed effects models were used throughout and random effects for outcomes showing heterogeneity. MAIN RESULTS: Six trials, including 468 patients were included. A statistically significant benefit was observed for sulfasalazine when compared to placebo for tender and swollen joint scores, pain and ESR. The standardized weighted mean difference between treatment and placebo was -0.49 for tender and swollen joint scores, and -0.42 for pain. The difference for ESR was -17.6mm. Withdrawals from adverse reactions were significantly higher in the sulfasalazine group (OR=3.0). Patients receiving placebo were four times more likely to discontinue treatment because of lack of efficacy than patients receiving sulfasalazine. REVIEWER'S CONCLUSIONS: Sulfasalazine appears to have a clinically and statistically significant benefit on the disease activity of patients with RA. Its effects on overall health status and radiological progression are not clear at this time, but would appear to be modest.
11209969 Autologous blood stem cell transplantation as therapy for autoimmune diseases. 2000 Dec Autologous stem cell transplantation (ASCT) is starting to be investigated as a potential therapy for severe refractory autoimmune disease including rheumatological, neurological and haematological diagnoses. Increasing numbers of cases are now reported in the literature. Data from all transplanted patients are being collated in a centralized register by the European Group for Blood and Marrow Transplantation (EBMT) and the European League against Rheumatism (EULAR) to enable effective evaluation of the safety and efficacy of this promising technique. Thus far, results have been encouraging; however, more treatment-related deaths were reported in multiorgan diseases such as scleroderma and less in diseases such as rheumatoid arthritis, which confirms the importance of careful patient selection. Optimization of mobilization, conditioning regimen and graft manipulation is required to maximize efficacy without increasing mortality and morbidity. The use of maintenance therapy after ASCT in order to prevent relapse needs to be explored. Following individual case reports and small cohort studies, the next step is likely to involve multicentre randomized controlled trials.
9228535 Immunolocalization of bradykinin receptors on human synovial tissue. 1997 Jun Kinins have been implicated in the pathogenesis of experimental and clinical inflammatory arthritis. Previous studies have reported increased amounts of plasma and tissue kallikreins in synovial fluid, raised kinin levels and an upregulation of kinin B2 receptors on synovial fluid neutrophils in rheumatoid arthritis. Bradykinin binding sites have been identified on human synovial cells by autoradiographic localization and Scatchard analysis. This study was undertaken to localize immunohistochemically kinin B1 and B2 receptors on human synovial tissue. Synovial tissue was obtained at the time of joint replacement surgery or arthroscopic synovectomy in six patients (two RA, two OA and two with avascular necrosis). Tissue sections were immunolabelled for kinin B1 and B2 receptors and viewed by light and confocal microscopy. No immunolabelling of the kinin receptors was observed in the method controls. In all patients labelling for kinin B2 receptors was observed in the synovial lining cells, fibroblasts and endothelial lining cells of blood vessels. There was no immunolabelling for kinin B1 receptors in all samples. These findings further support a role for the B2 receptors in joint diseases. There did not appear to be an induction of the kinin B1 receptor in human synovial tissue obtained from patients with chronic arthritis. However, further studies are required to assess the role of B1 receptors in active joint inflammation.
10646489 How may quality of life for rheumatoid arthritis patients be enhanced by current and futur 1999 Nov Health-related quality of life is best thought of simply as 'health'. Life quality in patients with rheumatoid arthritis (RA) is affected, for good or ill, by treatment effects. Health status now is readily and validly measurable, using the Health Assessment Questionnaire or other instruments. Disability and pain are reduced by disease-modifying anti-rheumatic drugs (DMARDs) much more than by non-steroidal anti-inflammatory drugs (NSAIDs). Toxicity considerations vary among individual drugs but are roughly comparable between NSAIDs and DMARDs, mandating DMARD-based treatment strategies. Future therapies must accentuate the positives (reduction in pain and disability) while reducing the negatives (unwanted effects) if the health of RA patients is to be improved.
9228137 Expression of N-acetyl-D-galactosamine associated epitope in synovium: a potential marker 1997 Jul OBJECTIVE: To investigate synovial glycoprotein production in situ, a novel monoclonal antibody (Mab), A13D8, was used to evaluate the expression of an epitope containing N-acetyl-D-galactosamine (GalNAc) in normal and pathological synovium. METHODS: Immunohistological and cytochemical analysis of synovial tissue samples was undertaken with single and double staining techniques using the A13D8 Mab, anti-CD68, vascular cell adhesion molecule-1 (VCAM-1), the hyaluronan associated enzyme uridine diphosphoglucose dehydrogenase (UDPGD), and the anti-Golgi Mab SSN/HR-1992. The specificity of the A13D8 Mab was established through blocking studies using carbohydrate residues, including GalNAc and N-acetylglucosamine (GlcNAc). RESULTS: A13D8 is expressed intensely in the cytoplasm of normal type B lining cells, which coexpress VCAM-1 and UDPGD, and is not expressed by CD68+ type A lining cells. In the lining layer of RA synovium, there is a negative correlation between A13D8 expression and the level of lymphocytic infiltration in the sublining areas (r = -0.43, p < 0.001). The endothelium of a subset of venules, typically in lymphocyte-rich aggregates, also stains intensely for A13D8. Pretreatment of the Mab with GalNAc completely eliminates the tissue staining, as well as the 110 kDa band seen on immunoblot, whereas pretreatment of A13D8 with GlcNAc and lactose has no effect. Double staining of HEp-2 cells with A13D8 and the anti-Golgi Mab SSN/HR-1992 reveals co-localization of the A13D8 epitope to the Golgi apparatus. CONCLUSION: Type B synovial lining cells and selected synovial endothelium express GalNAc containing epitope identified by Mab A13D8. Marked reduction in the expression of this epitope in the lining layer of inflamed RA synovium suggests that the synovial production of GalNAc containing glycoproteins, such as mucins, may be altered in this disorder.
10662880 Discriminating ability of composite indices for measuring disease activity in rheumatoid a 2000 Jan OBJECTIVE: To compare the discriminating ability of the chronic arthritis systemic index (CASI), an index that uses the Health Assessment Questionnaire (HAQ) as the main variable, with the disease activity score (DAS) and Thompson's articular index (TAI) to detect high and low disease activity in rheumatoid arthritis (RA). METHODS: Two hundred and two RA patients were examined. According to criteria proposed previously, they were divided into two subgroups: those with active disease and those with low activity. The areas under receiver operating characteristic (ROC) curves were employed to assess the diagnostic accuracy of the CASI in comparison with the DAS and TAI for the discrimination of disease activity. RESULTS: The difference between areas under the ROC curves of the CASI and TAI (0. 897+/-0.023 vs 0.780+/-0.032) and between the DAS and TAI (0.933+/-0. 018 vs 0.780+/-0.032) was highly significant (P=0.0001), thus reflecting the accuracy of the diagnostic assessment. No difference arose between areas under the ROC curves of the CASI and the DAS (difference between areas=0.036+/-0.022; P=0.103). CONCLUSION: The CASI discriminates just as well between high and low disease activity as does the DAS. Either index consisting of more than one variable performs better than TAI. We conclude that even including the HAQ, a severity parameter in the long term, it is possible to construct an index that, at any time point, evaluates disease activity as well.
10982661 Wear of high-dose gamma-irradiated polyethylene in total hip replacements. 2000 Between 1971 and 1978, 62 patients underwent total hip replacements (THRs) with high-dose (100 Mrad) gamma-irradiated polyethylene sockets. After a mean follow-up of 17. 3 years (range, 6-23 years), 28 hips in 26 patients were available for radiographic wear measurement. Twenty-three THRs with non-irradiated sockets were used as controls, although all these hips had loosened within 13 years. The rate of linear wear in irradiated sockets was significantly lower throughout the follow-up period (less than 2 years, 0.16 and 0. 38 mm/year; 2-6 years, 0.05 and 0.29 mm/year; more than 6 years, 0. 05 and 0.28 mm/year, respectively; mean, P < 0.0001). This result has demonstrated that high-dose gamma-irradiated, cross-linked polyethylene is a promising articulating material for THRs.
9567076 [Clinico-pathological analysis of interstitial pneumonia associated with collagen vascular 1997 Dec We investigated interstitial pneumonia associated with collagen vascular disease (IP-CVD) in association with lung cancer. Seventy-three cases of IP-CVD were included in this study. Nine (12%) of the 73 cases were associated with lung cancer, one of which had double lung cancers. The histological types of the cancers were adenocarcinoma (5 cases), epidermoid carcinoma (2 cases), small cell carcinoma, large cell carcinoma and large cell neuroendocrine carcinoma (one case each). The lesions were located in the central or peripheral lung in 3 and 7 of the ten cancers, respectively. Of the seven cases diagnosed as having IP-CVD followed by lung cancer, five had stage I disease, and one each of the remaining two cases was in stage IIIA and stage IV. Six of the seven peripheral cancer lesions which were resected or autopsied could be analyzed with regard to the topographical relationship between the primary site and fibrotic lesions. Only three cancers were encased by or in close proximity to, honeycomb lung, although most of the lung cancers arose in relation to fibrotic lesions. Moreover, the acute exacerbation of IP-CVD after operation or chemotherapy without thoracic irradiation should be monitored carefully.
9663335 Heat-aggregated human IgG as immunosorbent for rheumatoid arthritis. 1998 Jul In order to selectively remove pathogenic rheumatoid factors (RF) from plasma of rheumatoid arthritis (RA) patients, a new immunosorbent was developed by immobilizing heat-aggregated human IgG (HAH IgG) on epichlorohydrin-activated agar gel. Different parameters influencing ligand coupling were studied, i.e., ligand concentration, reaction time, temperature and pH. The maximum amount of HAH IgG immobilized on the carrier was 2.7 mg/ml. Adsorption capacity was evaluated by ELISA technique. After incubation of 3.0 ml of RA plasma with 1.0 ml of the adsorbent, the RF IgM, IgG, and IgA were removed by 88%, 74%, and 50%, respectively. The decrease of total immunoglobulins and albumin were less than 7% and 9%. In vitro, perfusion of 10.0 ml plasma at 37 degrees C through 3.0 ml of adsorbent, at a flow rate of 5.0 ml/min for 60 min, resulted in the removal of 49% of RF IgM, 72% of RF IgG and 58% of RF IgA. No leakage of ligand and no decline in adsorption capacity and mechanical strength were observed after steam-sterilization.
11131474 Surgical treatment of hallux valgus deformity in rheumatoid arthritis: clinical and radiog 2000 Nov The authors evaluated a modified Lapidus technique for 21 rheumatoid hallux valgus deformities. The technique corrects the deformity by performing arthrodesis of the first tarsometatarsal joint and preservation of the first metatarsophalangeal (MTP) joint. The authors clinically studied patients' subjective improvement of pain and footwear comfort, as well as their satisfaction with the outcome of the surgery. The study also analyzed radiographic changes of the hallux valgus angle (HVA) and two intermetatarsal angles, one between the first and the second (M1/2) and the other between the first and the fifth (M1/5). They were measured before the surgery, 3 weeks after the surgery, and at the last follow-up. Pain relief was great or moderate in 17 feet and footwear comfort was improved in 16 feet. Fifteen patients were satisfied or satisfied with some reservations. The average HVA significantly decreased from 44.1 degrees preoperatively to 10.6 postoperatively and significantly increased again to 29.1 at the last follow-up. The average M1/2 and M1/5 significantly decreased postoperatively (from 13 to 8.3 and from 32.2 to 21.1, respectively), and the reduction of M1/2 remained at the last follow-up (8.7), while M1/5 significantly increased again (28.3). This modified Lapidus technique is a useful method for rheumatoid hallux valgus deformity, which can preserve the first MTP joint.