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ID PMID Title PublicationDate abstract
10765922 Identification of known and novel genes in activated monocytes from patients with rheumato 2000 Apr OBJECTIVE: To define gene activation patterns of monocytes (MO) in patients with rheumatoid arthritis (RA). METHODS: A complementary DNA (cDNA) library was constructed from first-leukapheresis MO obtained from an RA patient with active disease; 32P-labeled cDNA from first-leukapheresis MO (activated pool) and third-leukapheresis MO (nonactivated pool) were used as probes for differential hybridization. Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to assess gene activation in MO from an additional 26 RA patients and 6 normal controls. RESULTS: Subtraction of genes from first- and third-leukapheresis MO resulted in 482 differentially expressed clones. In first-leukapheresis MO, these clones included the following: 1) interleukin-1alpha (IL-1alpha), IL-1beta, IL-6, tumor necrosis factor alpha, growth-related oncogene alpha (GROalpha)/melanoma growth-stimulatory activity, macrophage inflammatory protein 2/GRObeta, ferritin, alpha1-antitrypsin, lysozyme, transaldolase, Epstein-Barr virus-encoded RNA 1 (EBER-1)/EBER-2-associated-protein, thrombospondin 1, an angiotensin receptor II (ATRII) C-terminal homolog, and RNA polymerase II elongation factor (elongin); 2) two clones homologous to functionally undefined genes (BSK-67 and BSK-83); and 3) three unknown cDNA sequences (BSK-66, 80, 89). In third-leukapheresis MO, the clones included differentiation genes (HOX-B3, thymosin-beta4, PU.1, glucocerebrosidase, MEL-18, and glucose-6-phosphate dehydrogenase) and 3 unknown/functionally undefined sequences. Differential expression of most genes from the activated pool was confirmed in leukapheresis samples from 2 additional RA patients. In MO from RA patients, not only were IL-1beta and the ATRII homolog significantly overexpressed (maximum 36-fold), but also 4 of the unknown/functionally undefined genes (maximum 102-fold). Notably, messenger RNA levels of BSK-89 correlated positively with the erythrocyte sedimentation rate (ESR), whereas those of BSK-83 correlated negatively with the ESR and C-reactive protein level. CONCLUSION: The combined strategy of gene subtraction and semiquantitative RT-PCR may allow the definition of MO activation patterns during different disease phases (including therapy-induced remission) and the identification of novel MO genes with pathogenetic relevance in RA.
9514872 Increased pentosidine, an advanced glycation end product, in plasma and synovial fluid fro 1998 Mar 6 Pentosidine is an advanced glycation end product (AGE) formed by combined processes of glycation and oxidation (glycoxidation) between carbohydrate-derived carbonyl group and protein amino group. Recent studies demonstrated the increased pentosidine levels not only in diabetic patients with hyperglycemia but also in normoglycemic uremic patients due to increased oxidative stress. Rheumatoid arthritis (RA) is a state of increased oxidative stress associated with chronic inflammation. This suggested an enhanced glycoxidation reaction and increased AGE levels in RA patients. In the present study, we therefore determined, by high performance liquid chromatographic (HPLC) assay, the concentrations of pentosidine in plasma and synovial fluid from 22 patients with rheumatoid arthritis (RA) and compared their levels with those in 17 patients with osteoarthritis (OA), 26 diabetic patients, and 25 normal subjects. The levels of inflammatory markers and markers of tissue destruction, metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), were also measured in the same samples. Pentosidine levels in plasma and synovial fluid from RA patients were significantly higher than those in OA patients, diabetic patients, and normal subjects. There was a significant correlation between the pentosidine levels in plasma and those in synovial fluid. Among markers of inflammation and matrix destruction, pentosidine levels in plasma from RA patients were correlated with the levels of C-reactive protein (CRP), erythrocyte sedimentation rate, white blood cell count, and platelet count. Multiple stepwise regression analysis reveals an independent influence of CRP on plasma pentosidine levels. In conclusion, pentosidine levels are significantly higher in plasma and synovial fluid from RA patients and may be useful as a biomarker of chronic inflammation in RA patients.
9811057 Treatment of rheumatoid synovitis with anti-reshaping human interleukin-6 receptor monoclo 1998 Nov OBJECTIVE: To examine the effect of anti-reshaping human interleukin-6 receptor monoclonal antibody (anti-rsHuIL-6R mAb) on patients with rheumatoid arthritis (RA), using SCID mice in which human RA synovial tissue has been grafted (SCID-HuRAg). METHODS: Tissue from human RA pannus was implanted subcutaneously in the backs of 69 SCID mice. Differences from human RA were examined pathologically. Anti-rsHuIL-6R mAb (100 microg) was administered intraperitoneally to mice once a week for 4 weeks. The implanted tissue was removed from the SCID-HuRAg mice on the fifth week after the initial treatment and examined pathologically. A group of SCID-HuRAg mice treated with control mAb, an auranofin-treated group, and an untreated group were used as controls. A total of 32 mice (8 in each group) were studied. RESULTS: Histologic characteristics of the implanted tissues in SCID-HuRAg mice were very similar to those of human RA even 2 months after implantation. In addition, the presence of CD4-, CD8-, CD20-, IL-6-, tumor necrosis factor alpha-, tartrate-resistant acid phosphatase (TRAP)-, matrix metalloproteinase 1 (MMP-1)-, and MMP-9-positive cells was confirmed by immunohistochemical staining. A significant decrease in the number of inflammatory cells, MMP-positive cells, and TRAP-positive cells was observed in the anti-rsHuIL-6R mAb treatment group as compared with the control groups. CONCLUSION: The SCID-HuRAg mouse is a useful model for evaluating the effectiveness of antirheumatic drugs. Anti-rsHuIL-6R mAb may have an antiinflammatory effect on RA synovitis and an inhibitory effect on osteoclasts.
10567972 Proposed classification criteria of psoriatic arthritis. A preliminary study in 260 patien 1999 Oct Psoriatic arthritis probably owes to its radioclinical presentation its position as the most controversial and poorly understood of all major chronic inflammatory joint diseases. Differentiating psoriatic arthritis from ankylosing spondylitis and rheumatoid arthritis remains difficult. OBJECTIVE: To conduct a statistical analysis aimed at identifying clinical, radiological, and laboratory criteria for classifying psoriatic arthritis. PATIENTS AND METHODS: 260 patients were studied retrospectively, including 100 cases with psoriatic arthritis and 160 controls with ankylosing spondylitis meeting Amor's criteria (n = 80) or with rheumatoid arthritis meeting American College of Rheumatology criteria (n = 80). Mean disease duration was five years. Thirty-nine variables were recorded for each patient. Multiple logistic regression and discriminant analysis were used to select the classification criteria. RESULTS: Each of the two statistical methods selected the same nine criteria. After assigning a weighting coefficient to each of these criteria, sensitivity and specificity were better with the multiple logistic regression model (95% and 98%, respectively) than with the discriminant analysis model. CONCLUSION: Our classification criteria require further evaluation in multicenter prospective studies.
11748549 Getting a grip on arthritis pain can be costly. 2001 Dec Although the scientific community has ushered in a great new era in the control of rheumatoid arthritis (RA) pain with the discovery of new drugs, the advances are futile if those who need these drugs cannot gain access to them because of the incredible cost. Pharmaceutical treatments for RA include nonsteroidal anti-inflammatory drugs and biologic therapy. A means must be found to improve drug coverage options for all of those suffering from this disease. As nurses, we have an important role to play as advocates for those suffering from RA. We can speak for those who have reduced access to these medications because of the increasing costs. We are able to explain to those in government, the pharmaceutical industry, private insurers, employers, the corporate world, Congress, our state and local communities, and our family and friends the many issues involved. We can advocate for further research on cost-effectiveness, and we can lobby those in Congress and state governments for improved benefits.
9808403 Vascular endothelial growth factor in patients with rheumatoid arthritis. 1998 To examine the role of vascular endothelial growth factor (VEGF), an endothelial cell specific growth factor, in rheumatoid arthritis (RA), serum concentration of VEGF was examined in patients with RA, osteoarthritis (OA), systemic lupus erythematosus (SLE), systemic sclerosis (SS) and control subjects. Serum C-reactive protein (CRP) level, erythrocyte sedimentation rate, white blood cell count and rheumatoid factor titer were also determined in patients with RA. The serum concentration of VEGF was significantly higher in patients with RA than in controls (p < 0.01), and patients with OA (p < 0.05), SLE (p < 0.05), and SS (p < 0.05). The serum concentration of VEGF correlated with serum levels of CRP (r = 0.698, p < 0.0001). The serum concentration of VEGF before treatment was significantly higher than that after treatment in patients with RA who experienced clinical remission (p < 0.05). Our data suggest that VEGF is involved in the pathogenesis of RA and that measurement of serum concentration of VEGF is a noninvasive, useful method for monitoring the disease activity of RA.
10186459 Choice of NSAID and management strategy in rheumatoid arthritis and osteoarthritis. The im 1998 Aug OBJECTIVE: Although nonsteroidal anti-inflammatory drugs (NSAIDs) are an effective therapy for rheumatoid arthritis, they are associated with significant adverse effects, the management of which imposes additional costs on the healthcare system. Prescribing NSAIDs which have a lower risk of major adverse effects as the first-line NSAID for patients with rheumatoid arthritis and osteoarthritis may be expected to lead to an improvement in clinical outcomes and reduce overall treatment costs. This analysis examines data from a published randomised controlled trial of 5 NSAIDs to explore these hypotheses. DESIGN AND SETTING: Data from a clinical trial comparing 5 NSAIDs were combined with published cost data to construct 2 clinical decision models, reflecting alternative approaches to the management of major and minor adverse effects in the UK. INTERVENTIONS: The 5 NSAIDs evaluated in the analysis were nabumetone, diclofenac, ibuprofen, piroxicam and naproxen, although only the results for ibuprofen and nabumetone are reported. MAIN OUTCOME MEASURES AND RESULTS: The total cost of care per patient receiving nabumetone was estimated to be between 25 pounds sterling (Pound) and 41 Pounds more expensive than ibuprofen. In a hypothetical cohort of 100,000 patients, there were between 690 and 821 more major adverse effects using ibuprofen than nabumetone. The cost per life-year gained (LYG) from using nabumetone rather than ibuprofen ranged between 1880 Pounds and 2517 Pounds (1995 values), depending upon the management of adverse effects. CONCLUSIONS: These results indicate that: (i) prescribing the newer, currently more expensive, NSAIDs will not necessarily lead to cost savings; (ii) the management of adverse effects can have a significant impact on costs; and (iii) the additional cost may be justifiable in terms of the mortality and morbidity gains associated with the new lower-risk NSAIDs.
9336420 Combination treatment of severe rheumatoid arthritis with cyclosporine and methotrexate fo 1997 Oct OBJECTIVE: To determine whether the clinical benefit and favorable safety profile previously noted with the combination of cyclosporine (CSA) and methotrexate (MTX) given for 24 weeks in patients with rheumatoid arthritis (RA) would be maintained for a further 24 weeks, and whether the addition of CSA in patients who had previously been randomized to receive placebo + MTX would result in clinical benefit. METHODS: Eligible subjects from the initial study (weeks 0-24), in which the addition of placebo or CSA to MTX therapy was compared in patients with RA that was partially responsive to MTX, were enrolled. Patients who had received CSA + MTX continued this regimen for a further 24 weeks (weeks 24-48) (group 1; n = 48), and patients who had initially received placebo + MTX now received CSA + MTX for 24 weeks (weeks 24-48) (group 2; n = 44), in an open-label extension study. The primary outcome measures were the number of tender joints, number of swollen joints, physician and patient global assessments, pain, functional disability as measured by the modified Health Assessment Questionnaire, and erythrocyte sedimentation rate. RESULTS: Of the 92 patients enrolled, 80 (87%) completed the extension study. In patients in group 1, the clinically and statistically significant improvement in response outcomes previously noted at week 24, ranging from 25% to 50%, was maintained through week 48. In patients in group 2, the addition of CSA resulted in significant clinical improvement. By week 48, most outcome measures in group 2 patients were similar to those in group 1 patients. CSA treatment resulted in a small increase in serum creatinine levels, but only 1 patient was withdrawn from the study for this reason. CONCLUSION: The clinical improvement previously observed in patients treated with the CSA + MTX combination for 24 weeks was maintained for 24 subsequent weeks, without serious adverse effects, and was also observed in the patients whose treatment was switched from placebo + MTX to CSA + MTX.
10368430 Enhanced evolvability in immunoglobulin V genes under somatic hypermutation. 1999 Jul Darwinian theory requires that mutations be produced in a nonanticipatory manner; it is nonetheless consistent to suggest that mutations that have repeatedly led to nonviable phenotypes would be introduced less frequently than others-if under appropriate genetic control. Immunoglobulins produced during infection acquire point mutations that are subsequently selected for improved binding to the eliciting antigen. We and others have speculated that an enhancement of mutability in the complementarity-determining regions (CDR; where mutations have a greater chance of being advantageous) and/or decrement of mutability in the framework regions (FR; where mutations are more likely to be lethal) may be accomplished by differential codon usage in concert with the known sequence specificity of the hypermutation mechanism. We have examined 115 nonproductively rearranged human Ig sequences. The mutation patterns in these unexpressed genes are unselected and therefore directly reflect inherent mutation biases. Using a chi2 test, we have shown that the number of mutations in the CDRs is significantly higher than the number of mutations found in the FRs, providing direct evidence for the hypothesis that mutations are preferentially targeted into the CDRs.
9344705 Low-level production of interleukin-13 in synovial fluid and tissue from patients with art 1997 Nov Rheumatoid arthritis (RA) is a chronic, aggressive disease characterized by inflammatory cells in the synovial tissue (ST) and synovial fluid (SF). Interleukin (IL)-13 inhibits the production of proinflammatory cytokines, chemokines, and hematopoietic growth factors by activated human monocytes. The aim of this study was to determine the production of IL-13 in various forms of arthritis. The presence of IL-13 in RA was found to be low, in that 18 of 26 RA SF samples and 10 of 14 RA peripheral blood (PB) samples had nondetectable levels (
11454640 Valgus deformity and proximal subluxation of the rheumatoid elbow: a radiographic 15 year 2001 Aug OBJECTIVE: To evaluate the nature of positional changes of humeroulnar (HU) and humeroradial (HR) joints in a cohort of 74 patients with seropositive and erosive rheumatoid arthritis (RA) followed up prospectively. METHODS: At the 15 year follow up standard anteroposterior and lateral radiographs of 148 elbow joints were evaluated. The mediolateral HU angle of the elbow was measured from anteroposterior radiographs. The proximal subluxation of the HU joint was measured from lateral radiographs as the distance between the posterior aspect of the olecranon process and the posterior surface of the humerus. The anteroposterior subluxation of the HR joint was measured from lateral radiographs as the relation of the midpoint of head of the radius to the midpoint of the capitellum of the humerus. Destruction of the elbow joints was assessed with the Larsen method on a scale of 0 to 5 and compared with the measurements. RESULTS: Mean HU angle in 148 elbows of patients with RA was 11.5 degrees (SD 6.1), range -21 degrees (varus) to 34 degrees (valgus); 9.9 degrees (SD 4.3) in men and 12.0 degrees (SD 6.4) in women. The mean HU angle, 14.4 degrees (SD 6.0) of the affected joints (Larsen grades 2-4), showed more valgus than the mean 9.8 degrees (SD 2.5) of the non-affected (Larsen grades 0 to 1) joints; totally destroyed and unstable Larsen 5 joints were excluded. Mean HU and HR subluxations, 2.0 mm (SD 3.8) and 0.8 mm, of the affected joints (Larsen 2-5) were greater than the means, -1.1 mm (SD 1.5) and -0.4 mm (SD 0.9), of the non-affected joints. Both the HU proximal subluxation and the HR anterior subluxation correlated, r(s)=0.64 (95% CI 0.53 to 0.73 ) and r(s)=0.48 (95% CI 0.34 to 0.60), with the destruction of the elbow joint. CONCLUSIONS: The elbow seems to turn into valgus during rheumatoid destruction and excision of the radial head may speed up this process. However, totally unstable Larsen grade 5 joints may also have varus deformity owing to mutilating bone destruction. The ulna subluxates proximally in relation to the humerus, whereas the radius moves slightly anteriorly as a consequence of elbow involvement.
11776280 Anakinra: interleukin-1 receptor antagonist therapy for rheumatoid arthritis. 2001 May (1) Anakinra is an interleukin-1 receptor antagonist (IL-1ra), which blocks interleukin-1 (IL-1), a protein involved in the inflammation and the joint destruction associated with rheumatoid arthritis (RA). (2) The manufacturer's submission for drug approval is currently under review by Health Canada and the FDA. (3) In randomized controlled trials, patients with severe RA were treated with anakinra. Significant improvement was demonstrated in several clinical, radiologic and health-related quality of life measures in patients treated with anakinra versus placebo. (4) Minimal adverse effects, mainly injection site reactions, were reported.
9378862 Dilemma: a concept analysis. 1997 Sep In nursing practice we find different kinds of difficult situations. What is the difference between such kinds of situations? it is important to know what kind of situation one is confronting because the answer and solution depend on it. In the literature the term 'dilemma' has different meanings. I am therefore interested in what constitutes a dilemma, and have conducted a concept analysis. The defining attributes were engagement, equally unattractive alternatives, awareness of alternatives, need for a choice and uncertainty of action.
9487248 Tranexamic acid, an inhibitor of plasminogen activation, reduces urinary collagen cross-li 1998 Jan The plasminogen activation system is one of the enzyme systems held responsible for bone and cartilage degradation in rheumatoid arthritis (RA). In this study, we evaluated the effect of tranexamic acid (TEA), an inhibitor of plasminogen activation, on urinary collagen cross-link excretion and radiological joint damage in rat adjuvant arthritis (AA) and on urinary collagen cross-link excretion in patients with RA. In the animal study, adjuvant arthritis was induced in male Lewis rats. From day 7 onward, high-dose TEA (500 mg/kg body weight, once daily) or placebo was administered orally. Study groups consisted of TEA-treated normal rats (C + TEA), placebo-treated normal rats (C + plac), AA rats treated with TEA (AA + TEA) or with placebo (AA + plac). To monitor joint destruction, urinary collagen cross-link excretion (pyridinoline, HP; deoxypyridinoline, LP) was measured by high-performance liquid chromatography at days 14 and 21. Radiological evaluation of joints was performed at day 21. In the patient study, TEA was administered to nine patients with RA as adjuvant medication (approximately 20 mg/kg body weight, three times daily) for 12 weeks. Urinary HP and LP excretion levels were measured before and during TEA treatment, and 4 weeks after the cessation of TEA treatment. In AA + TEA rats, a significant reduction of HP and a tendency towards a reduction of LP excretion were found compared with AA + plac rats (P < 0.05), at day 14, whereas the HP/LP ratio did not change. No difference was observed in HP, LP excretion, HP/LP ratio and radiological damage score between the TEA- and placebo-treated AA rats at day 21. In RA patients, a significant reduction of HP and LP excretion was found during the TEA treatment period (P < 0.05). After the cessation of TEA treatment, HP and LP excretion increased towards baseline levels. No effect on disease activity was observed. The plasmin antagonist TEA reduced the excretion of collagen pyridinoline cross-links in both experimental and rheumatoid arthritis. As such, this study not only supports the involvement of the plasminogen activation system in the destructive phase of arthritis, but also suggests a beneficial effect of therapeutic strategies directed against inhibition of matrix proteolysis.
11577403 [Minocycline for the treatment of bronchiolitis obliterans associated with rheumatoid arth 2001 Aug We discribe a rare case of rheumatoid arthritis (RA) complicated with bronchiolitis obliterans that was successfully treated with minocycline. Sixty four-year old woman with a four-years history of RA was admitted to the hospital because of dyspnea on exertion and polyarthritis. Pulmonary function test revealed marked decrease in V25 (0.10 l/s: 6.9%) and MMFR (12.6%). High resolution CT of the lung showed scattered centri-lobular micronodules in both lung fields, mucoid impaction, and hyperinflation. These findings indicated the presence of bronchiolitis obliterans. After 3 months of the treatment with minocycline, the patient showed a significant improvement of both arthritis and pulmonary function. Chest CT findings also improved after 1 year. The present case suggests that minocycline is effective for the treatment of bronchiolitis obliterans seen in patients with RA.
10765926 Expression of osteoclast differentiation factor at sites of bone erosion in collagen-induc 2000 Apr OBJECTIVE: To investigate the cellular mechanism of bone destruction in collagen-induced arthritis (CIA). METHODS: After induction of CIA in DA rats, a histologic study of the advanced arthritic lesion was carried out on whole, decalcified joints from the hindpaws of affected animals. To conclusively identify osteoclasts, joint tissue sections were stained for tartrate-resistant acid phosphatase (TRAP) enzyme activity, and calcitonin receptors (CTR) were identified using a specific rabbit polyclonal antibody. The expression of messenger RNA (mRNA) for the osteoclast differentiation factor (also known as receptor activator of nuclear factor kappaB ligand [RANKL]) was investigated using in situ hybridization with a specific riboprobe. RESULTS: TRAP-positive and CTR-positive multinucleated cells were invariably detected in arthritic lesions that were characterized by bone destruction. Osteoclasts were identified at the pannus-bone and pannus-subchondral bone junctions of arthritic joints, where they formed erosive pits in the bone. TRAP-positive multinucleated cells were detected within synovium and at the bone erosive front; however, CTR-positive multinucleated cells were present only at sites adjacent to bone. RANKL mRNA was highly expressed in the synovial cell infiltrate in arthritic joints, as well as by osteoclasts at sites of bone erosion. CONCLUSION: Focal bone erosion in CIA is attributed to cells expressing definitive features of osteoclasts, including CTR. The expression of RANKL by cells within inflamed synovium suggests a mechanism for osteoclast differentiation and activation at sites of bone erosion. Inhibitors of RANKL may represent a novel approach to treatment of bone loss in rheumatoid arthritis.
11753539 [Establishment of an in vitro model for rheumatoid arthritis as test system for therapeuti 2001 In our Tissue Engineering group a 3D in vitro model for rheumatoid Arthritis (in vitro pannus) was established with the aim to develop a standardized drug-screening test to analyze the effects of drugs and different biological substances. The advanced model consists of chondrocyte pellet cultures interacting with rheumatoid arthritis (RA) synovial cell cultures. To establish interactive 3D co-cultures defined rheumatoid arthritis synovial cell populations were centrifuged directly on chondrocyte pellet cultures. Histochemical stainings during time of co-culture revealed obvious invasion by RA synovial cell populations into the chondrocyte matrix. Gene expression analysis showed a downregulation of collagen type II expression in chondrocytes within 2 weeks after co-culture with RA synovial cells. Those interactive co-cultures allow the study of single cell populations as well as the cellular interactions in this system under in vitro conditions. Thus, the established co-culture model may be suitable for routine screening tests, which can be useful in supplementing animal experiments in basic research and drug testing.
11155812 Low dose prednisolone therapy (LDPT) retards radiographically detectable destruction in ea 2000 OBJECTIVE: To test if continuous LDPT decreases radiographically detectable joint destruction in early RA. METHODS: Patients with active RA (< 2 years from symptom onset) were treated with prednisolone 5 mg daily or placebo for 2 years in a double blind, randomized, multi-center study. At the same time in all patients DMARD treatment with either gold sodium thiomalate (GSTM) or methotrexate (MTX) was started; in the case of side effects or inefficacy the medication could be switched to the other DMARD. Radiographs of hands and forefeet were taken at baseline and after 6, 12 and 24 months. All radiographs were evaluated by one observer (S.W.) knowing the time sequence of the film but unaware of the patient identity or treatment using the Ratingen score and van der Heijde's modification of Sharp's method. RESULTS: 196 patients were included; 76 patients completed the study per protocol. Of these patients 34 were treated with prednisolone, 42 with placebo, 48 initially with GSTM, 28 with MTX. 17 patients switched from GSTM to MTX, 1 from MTX to GSTM. The mean values of the radiographic scores of both groups are given in the table. During the first year, especially during the first 6 months, the radiographic progression within the prednisolone group was significantly lower than in the placebo group: the Sharp erosion score increased by 0.4% of the maximum possible score during the first and the second 6 months in the prednisolone group, while in the placebo group there was an increase of 1.8% during the first 6 months and 0.8% during the second 6 months. During the second year the progression was significantly lower (-0.1% in the prednisolone group, 0.2% in the placebo group). After 24 months the total score had increased by 2.6% of the maximum score in the placebo group and by 1.1% in the prednisolone group. The results of the completers were confirmed by the intention-to-treat analysis (80 patients in the prednisolone group, 86 patients in the placebo group). CONCLUSION: Continuous low dose prednisolone treatment with 5 mg daily over 2 years administered in addition to conventional DMARD treatment with MTX or GSTM decreases radiographic progression in early RA. The results of the study also show that in the placebo group there is a sharp decrease of the progression after 6-12 months as a result of the DMARD treatment. During the second year there is nearly no progression in this group. The data of the "completers" are confirmed by the analysis of the "intention to treat" population.
9558163 Longterm health outcomes of patients with rheumatoid arthritis treated in managed care and 1998 Apr OBJECTIVE: To compare health care utilization and longterm health outcomes among patients with rheumatoid arthritis (RA) treated in managed care and fee-for-service practice settings. METHODS: We compared levels of health care utilization, treatments, and health outcomes between 57 patients with RA treated predominantly in managed care settings and 125 patients with RA treated predominantly in fee-for-service practice settings. These patients were participants in a community based cohort study of health outcomes in RA, and had been followed prospectively for up to 13 years (mean followup 10.3 yrs). Information on physician visits, hospitalizations, diagnostic testing, treatments, and 3 measures of health status (global arthritis status, pain, functional disability measures of the Health Assessment Questionnaire) was collected using biannual mailed questionnaires. RESULTS: All measures of health care utilization were similar between the managed care and fee-for-service groups, as was the use of the major types of arthritis treatments. Average global arthritis status scores, pain scores, and functional disability scores were closely comparable in the 2 groups. Over time, global arthritis status scores and disability scores worsened in both groups, but the rates of worsening did not differ between groups. CONCLUSION: In this cohort, longterm health outcomes, as well as treatments and health care utilization, were similar among persons with RA who were treated in managed care and fee-for-service practice settings.
10408067 [Radiosynoviorthesis in the treatment plan of chronic inflammatory joint diseases]. 1999 Apr The effectiveness of radiosynovirothesis in the local treatment of chronically inflammatory joint diseases, especially rheumatoid arthritis, was evaluated. SUBJECTS AND METHODS: Follow-up examinations of 415 joints in 115 patients up to 4.5 years after intraarticular application of beta-emitting yttrium-90, rhenium-186, and erbium-169 were evaluated. The examination protocol included estimation of joint circumference, range of active joint moving capability, fist-bending power, and radiological assessment of joint destruction. Subjective assessment of pain, swelling, and joint function by the patients was evaluated by means of a score with three levels. RESULTS: The mean range of active joint moving capability increased in all joint subgroups, compared with the initial examination, with exception of ankle joints examined more than 30 months after therapy. The mean joint circumference decreased in all joint subgroups. Good to excellent results were achieved in up to 66% of joints, satisfying results in up to 21%, and no improvement or further deterioration was noted in 13% according to subjective assessment by patients themselves. Treatment proved most effective in joints with poor or no alteration in X-ray examinations. CONCLUSIONS: In the local treatment of chronically inflammatory joint diseases--especially beyond systemic drug therapy and local corticoid therapy--, radiosynoviorthesis is a low-invasive method, which may provide long-term relief of pain and swelling as well as improvement of joint function.