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ID PMID Title PublicationDate abstract
11092795 Quality of life measures: use and abuse. 2000 Dec Health status and quality of life measures are widely used in the clinical assessment of rheumatoid and other forms of arthritis. A range of measures is available, mainly as self-administered instruments. Most of these are reliable, valid and sensitive to change. They can be used to assess clinical status, evaluate effectiveness in randomized trials, define outcome and help to plan for health-care needs for people with arthritis. The instruments form a continuum with assessments of disease activity and functional disability. Some instruments are specifically designed for use in rheumatoid arthritis, other instruments are generic and can be used across a range of conditions including arthritis, and some generic instruments can be specifically scored to reflect the problems most prominent in arthritis. There are trade-offs between simplicity and sensitivity and between using familiar and unusual instruments. Against this background, the most widely used disease-specific measure remains the health assessment questionnaire (HAQ), and the most commonly employed generic measure is the SF-36. Evidence currently suggests focusing on these well-known and widely used measures. In both cases, the pain score is the predominant clinical assessment associated with poor health status measured using either instrument. HAQ scores also reflect unchanging aspects of patients' overall status, such as their degree of deprivation. It is sensible for all future clinical trials to include one disease-specific and one generic measure of health status.
11296452 [Evaluation of cerebrovascular events in patients with rheumatoid arthritis]. 2001 Feb OBJECTIVE: We evaluated cerebrovascular events (cerebral infarction or cerebral bleeding) in patients with rheumatoid arthritis (RA). METHODS: Prognosis and the causes of death among 1100 RA patients from 1995 to 1999, were analyzed. 34 RA patients were complicated by cerebrovascular events. About them, hemoglobin, platelet, C-reactive protein, rheumatoid factor, total cholesterol, triglyceride, duration of disease, functional class, and dose of steroids per day were measured. RESULT: Among 1100 patients with RA, 90 died at the age of 70.2. Of these patients, 24 (26.7%) died of cerebrovascular events, 19 (21.1%) of heart failure, 16 (17.8%) of infectious diseases, 10 (11.1%) of malignant tumors, and 9 (10%) of renal failure. When RA patients who died of cerebrovascular events were compared with those who died of other causes, the dose of steroid was significantly lower and the age was higher in RA patients who died of cerebrovascular events. However, there were no significant differences in total cholesterol and triglyceride levels between the two groups. Although the major cause of death in RA patients was reported to be complication by cardiovascular diseases, infectious diseases, or renal failure, the frequency of deaths was higher in elderly RA patients complicated by cerebrovascular events. When the frequency of complication by cerebrovascular events was investigated in all RA patients including those who survived, 24 died and 10 survived. The frequency of complication by cerebral infarction was higher than that of complication by cerebral bleeding in RA patients who died of cerebral events. CONCLUSION: RA patients can live longer with improvements in care and treatment, the number of elderly RA patients who may died of complication by cerebrovascular events may gradually increase.
9243760 Heat shock protein 70 gene polymorphisms in rheumatoid arthritis. 1997 Jul A role for heat shock proteins (hsp) in rheumatoid arthritis has been suggested. In addition, the specific binding of human HSP70 protein to QKRAA and RRRAA motifs within the HV3 region of disease-associated DRB1*0401 and DRB1*1001 molecules, respectively, has been proposed as being relevant to rheumatoid arthritis. The purpose of this work was to analyze the influence of HSP70 gene polymorphism on the susceptibility to or severity of rheumatoid arthritis and to investigate the possible contribution of these HSP70 polymorphisms in determining HLA-DRB1*0401/*1001 disease association. The frequencies of the HSP70-1, HSP70-2 and HSP70-hom genotypes were analyzed by PCR-RFLP using BsrBI, PstI and NcoI enzymes, respectively, in patients with rheumatoid arthritis and in healthy controls. No significant differences were observed when HSP70 allele distribution between the groups under study were compared. Moreover, we did not observe any significant difference in HSP70 allele frequencies between patients positive for HLA-DRB1*0401/*1001 alleles and matched controls. Our data indicate that HSP70 gene polymorphisms do not appear to be relevant in the susceptibility to or severity of rheumatoid arthritis.
11035124 The effects of pulse methylprednisolone on matrix metalloproteinase and tissue inhibitor o 2000 Oct OBJECTIVE: To investigate the effects of a 1000 mg i.v. pulse of methylprednisolone succinate (pulse therapy) on the expression of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in the synovial membrane of the knee in patients with rheumatoid arthritis (RA). METHODS: Sequential arthroscopic biopsies of the knee were taken before and 24 h after pulse therapy (11 patients), at disease relapse (three patients) and after retreatment with pulse therapy (one patient). Immunoperoxidase staining for MMP-1 (interstitial collagenase), MMP-3 (stromelysin-1) and TIMP-1 was performed and the immunoreactive staining quantified by colour video image analysis. RESULTS: In the synovial lining layer, MMP-1 and TIMP-1 immunostaining was reduced by a mean of 47% (P = 0.02) and 72% (P = 0.05), respectively, 24 h after pulse methylprednisolone therapy. In the synovial sublining layer, MMP-1 was reduced by a mean of 51% (P = 0.08) and TIMP-1 by a mean of 73% (P = 0.02) 24 h after pulse methylprednisolone therapy. There was no change in MMP-3 staining in the synovial lining or sublining layer. CONCLUSIONS: High-dose pulse methylprednisolone therapy is associated with a rapid (within 24 h) and substantial decrease in the expression of MMP-1 and TIMP-1 but not MMP-3 in the synovial membrane in RA.
11440118 Suppression of collagen-induced arthritis in DBA/1J mice by preimmunization with house dus 2001 May Collagen-induced arthritis (CIA) can be induced in DBA/1J mice by immunization with bovine type II collagen (bCII) and is a model of some types of human autoimmune rheumatoid arthritis. In this study we examined whether preimmunization of the mice with various antigens could inhibit the development of CIA. Preimmunization of the mice with an extract of the house dust mite Dermatophagoides farinae (mite antigen), chicken ovalbumin, or keyhole limpet hemocyanin strongly inhibited CIA development, but hen egg lysozyme, beta-lactoglobulin from bovine milk or myelin basic protein from guinea pig brain did not substantially affect CIA development. Splenic T cells and serum antibodies specific for mite antigen did not cross-react with bCII. Preimmunization of the mice with mite antigen did not affect the IFN-gamma and proliferative response of splenic T cells to bCII, nor serum antibody responses. The most inhibitory constituent had a molecular weight between 1,000 and 10,000.
9135224 Influence of the HLA-DR beta shared epitope on susceptibility to and clinical expression o 1997 Mar OBJECTIVE: To analyse the influence of shared epitope positive HLA-DRB1 alleles (QKRAA or QRRAA)) on rheumatoid arthritis (RA) susceptibility and severity in Chileans, a population that exhibits a weak association with HLA-DR4. METHODS: Prevalence of alleles DRB1*01 and DRB1*04 alleles was determined by polymerase chain reaction amplification and sequence specific oligonucleotide hybridisation in 129 RA patients with defined clinical features and in 97 healthy controls. RESULTS: The shared epitope was found in 70 (54%) of the RA patients and in 29 (30%) of controls (odds ratio (OR) = 3; 95% confidence intervals (CI) = 1.5, 5.1; p = 0.0004), and was present in a double dose in 20% of patients versus 4% of controls (OR = 6; 95% CI = 2, 21; p = 0.0009). HLA-DRB1*0403 was the most prevalent DR4 subtype in controls (19%). HLA-DRB1*0403 or *0408 were the alleles most prominently associated with RA, 19% versus 6% in controls (OR = 3; 95% CI = 1.3, 10; p = 0.01). The risk of RA in those carrying a double dose of the shared epitope was 7.5 times that seen in patients lacking the epitope. Disease severity was moderate: 33% had extra-articular manifestations. The double dose was associated with an increased risk of vasculitis or extra-articular manifestations. However, 59 patients (46%) did not carry the shared epitope and 18 of them (31%) had extra-articular manifestations. CONCLUSIONS: The weak association of RA with DR4 in Chileans seems to relate to a relatively high frequency of the DRB1*0403 allele among DR4 subtypes. As in other populations, the shared epitope in double dose is associated with RA development, especially in its more severe forms. However, both development and expression of severe forms of the disease were independent of the shared epitope in a high proportion of patients, thus emphasising the genetic heterogeneity of the disease and the possible involvement of other genetic elements.
10475553 Humeral hemiarthroplasty of the elbow joint in young patients with rheumatoid arthritis: a 1999 Aug This article evaluates the early results of 7 humeral hemiarthroplasties of the elbow joint in 5 female rheumatoid patients using only the humeral component of the capitellocondylar prosthesis. The follow-up period was 25 to 109 months. All patients were 50 years old or younger; 3 patients were between 22 and 26 years. Because all patients were rather young, the intention was to perform a procedure that conserves a maximal amount of bone stock for future salvage procedures. One prosthesis had to be removed because of an infection unrelated to the primary procedure. The remaining bone stock provided a stable and pain-free excision arthroplasty. The other arthroplasties showed good pain relief; however, postoperative motion was not as reliable as described for total capitellocondylar prostheses.
11903494 Serum amyloid A and high-density lipoprotein cholesterol: serum markers of inflammation in 2001 Dec Hypocholesterolemia has been observed in several inflammatory diseases such as rheumatoid arthritis, myeloproliferative disorders, systemic lupus erythematosus and sarcoidosis. Serum amyloid A is an acute-phase reactant that is related to the high-density lipoprotein cholesterol. This review discusses the relationship between the activation of the cells of the monocyte-macrophage system, determined by the serum amyloid A levels, and the lipid metabolism, measured as alterations in plasma lipoprotein concentrations. The mechanisms of this association during acute inflammation are also discussed in this review.
9680067 Synthesis of novel derivatives of aroylaminoalcohols and 3-amino-substituted 1-phenylpropa 1998 Jun The synthesis of aroylaminoalcohols and 3-amino-substituted 1-phenylpropanols is described. These novel basic compounds have potent anti-inflammatory activity, significantly inhibiting rat paw oedema induced by a variety of phlogistic agents as a result of the release of inflammatory mediators such as histamine, 5-hydroxytryptamine, kinins, prostaglandins or leukotrienes. The biological activity of a selected, representative number of these compounds was examined on adjuvant-induced arthritis, a good animal model for rheumatoid arthritis in man. The results show that 3-(1-hydroxymethylpropylamino)-1-phenylpropan-1-one hydrochloride (2) and 3-(3-hydroxypiperidin-1-yl)-1-phenylpropan-1-one hydrochloride (4) effectively suppress the secondary lesions of adjuvant arthritis. 2-(3-Hydroxy-3-phenylpropylamino)-butan-1-ol hydrochloride (6) had no preventive activity in this animal model. In addition, several of the compounds suppressed the mitogenic responses of T-lymphocytes to concanavalin A, suggesting direct or indirect action on lymphocytes and therefore possible immunosuppressive properties. Finally, we investigated the in-vitro effects of compounds 2 and 4 on production of interleukins 1 and 2 (IL-1 and IL-2). We found that compound 4 suppressed the in-vitro production or action of IL-2 and IL-1. In contrast, compound 2 significantly increased the IL-1 activity of arthritic macrophages while reducing the ability of normal and arthritic splenocytes to produce or release IL-2. Our data suggest that compounds 2 and 4 have immunomodulatory properties that influence T lymphocyte functions.
11384204 Tachykinin activation of human monocytes from patients with rheumatoid arthritis: in vitro 2001 Apr Three types of tachykinin receptors, namely NK1, NK2 and NK3, are known to preferentially interact with substance P (SP), neurokinin A (NKA) and neurokinin B (NKB), respectively. We previously demonstrated that NK1 and NK2 receptors are present on human monocytes, SP and NKA inducing superoxide anion production and tumor necrosis factor-alpha (TNF-alpha) mRNA expression. NK2 receptor stimulation also triggered an enhanced respiratory burst in monocytes isolated from rheumatoid arthritis (RA) patients. This study was aimed to evaluate the in vitro and ex-vivo effects of cyclosporin A (CsA) on tachykinins-evoked TNF-alpha release from monocytes of healthy donors and RA patients. CsA (100 ng/ml) potently inhibited phorbol ester- and tachykinin-evoked TNF-alpha secretion. In RA patients treated with CsA (Sandimmun Neoral 2.5 mg/kg/day, a significant time-dependent reduction in TNF-alpha secretion from monocytes was measured. This may contribute to the CsA therapeutic activity in RA.
10648024 Incidence of chronic inflammatory joint diseases in Finland in 1995. 2000 Jan OBJECTIVE: To investigate trends in the incidence of chronic inflammatory joint diseases. METHODS: Subjects entitled to receive drug reimbursement for chronic inflammatory joint diseases in 5/21 central hospital districts (population base about 1 million adults) in Finland during 1995 were studied. The mean age at disease onset was compared with figures from 1975, 1980, 1985, and 1990. Incidence rates were compared with those from 1980, 1985, and 1990. RESULTS: A total of 710 subjects were entitled to drug reimbursement for chronic inflammatory joint disease that had started at the age of 16 or over. The total incidence was 65/100,000 (95% confidence interval 60.7-70.4); the figures for rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and undifferentiated chronic poly/oligoarthritis were 34, 6, 7, and 13/100,000, respectively. In RA, the mean age at diagnosis was 59.0 years and was the same in rheumatoid factor (RF) positive and RF negative disease. The mean age at diagnosis had increased by 8.8 years from 1975 to 1995 (p<0.001). A 14% decline was evident in the incidence of RA in 1990 and 1995 compared with the earlier years (p = 0.013). In the younger age groups (35-54 years), the incidence declined by 50% compared with the year 1980. The incidence of spondyloarthropathies remained similar during 1980-95. CONCLUSION: Continuous monitoring of sickness insurance data provides information on the epidemiology of inflammatory joint diseases that will be useful in assessing demand for and supply of health services.
9295451 Correlates of fear of falling and activity limitation among persons with rheumatoid arthri 1997 Aug OBJECTIVES: To examine factors associated with fear of falling, activity limitation due to fear of falling, and how persons modified their activities in response to fear of falling, among older persons with rheumatoid arthritis (RA). METHODS: Participants in a panel study of RA who were over age 50 (n = 570) were questioned about whether they experienced fear of falling and whether and how they limited activities due to fear of falling. RESULTS: Fifty percent reported fear of falling, and 38% modified activities due to fear of falling. Correlates of fear of falling included female gender, depressive symptoms, poor physical functioning, minor fall-related injuries, and a greater number of painful joints. Correlates of limiting activities due to fear of falling included worse self-rated health, poor physical functioning, and high painful joint count. Activities commonly affected included stair climbing, walking, and outings. CONCLUSIONS: Fear of falling and limiting activities are common problems for persons with RA. Persons at risk should be targeted for appropriate interventions.
9181480 Molecular abnormalities of human plasminogen isolated from synovial fluid of rheumatoid ar 1997 May Plasminogen (Pg) in the synovial fluid of patients with acute inflammatory disease, including rheumatoid arthritis, osteoarthritis, and gout, was purified by affinity chromatography techniques. The Pg isolated from patients with osteoarthritis and gout has affinities for L-lysine Sepharose and structural properties similar to those of normal plasma Pg. However, Pg from rheumatoid synovial fluids is abnormal in that it does not bind to L-lysine Sepharose. Analyses of rheumatoid synovial fluid Pg purified by immunoaffinity chromatography indicate that the molecule has size and folding properties similar to those of normal plasma Pg. However, we detected abnormalities in the molecule using two different criteria. First, isolated kringles 1-3 fragments are unable to bind L-lysine Sepharose. Second, reactivity toward a monoclonal antibody against a region in kringles 1-3 is decreased. In addition, rheumatoid synovial fluid Pg competes with normal plasma Pg for binding to the receptor on rheumatoid synovial fibroblasts but not on normal synovial fibroblasts. We also found that binding and activation of rheumatoid synovial fluid derived Pg on the surface of rheumatoid synovial fibroblasts elicits a rise in the concentration of cytosolic free Ca2+ similar to that of normal plasma Pg. Our data suggest that the inability of rheumatoid synovial fluid Pg to bind to L-lysine Sepharose is due to minor structural changes in kringle 1-3. These changes do not affect the physiological properties or the binding ability of synovial fluid Pg to cellular receptors on cells obtained from rheumatoid synovial tissue.
9034982 IgA rheumatoid factor correlates with changes in B and T lymphocyte subsets and disease ma 1997 Feb OBJECTIVE: To analyze the relationship between lymphocyte subsets, different rheumatoid factor (RF) isotypes, and clinical features in patients with rheumatoid arthritis (RA). METHODS: Patients with established RA (n = 95) were examined clinically and blood samples were collected for measurements of RF by ELISA and for analysis of lymphocyte subsets by flow cytometry. RESULTS: IgA RF positive patients had more severe disease and higher prevalence of extraarticular manifestations than the other patients. Patients with elevated IgA RF had a higher percentage of CD5+ B cells and of CD4+CD45RO+ T cells compared to the other patients with RA or controls. High percentage of CD4+CD45RO+ T cells was also significantly associated with extraarticular manifestations. Patients with the sicca syndrome had significantly higher ratio of CD5+ B cells than patients without or with other types of extraarticular manifestations. CONCLUSION: Different disease manifestations in RA may be associated not only with certain RF isotypes and RF isotype combinations but also with changes in lymphocyte subsets in the blood. The relative increase of CD4+CD45RO+ T cells in the blood of IgA RF positive patients with RA might reflect preferential recruitment of CD8+CD45RO+ T cells to inflammatory sites.
11575596 Inflammatory and hormonal measures predict neuropsychological functioning in systemic lupu 2001 Sep Abnormalities of inflammatory and hormonal measures are common in SLE patients. Although cognitive dysfunction has been documented in SLE patients, the biological mechanism of these deficits has not been clarified. The goal of this study was to explore the relationship between inflammatory and hormonal activity and measures of learning, fluency, and attention in systemic lupus erythematosus patients without neuropsychiatric symptoms (non-CNS-SLE), patients with rheumatoid arthritis (RA), and healthy controls (HC). Fifteen non-CNS-SLE patients, 15 RA patients and 15 HC participants similar in age, education, and gender (female) were compared on tests of cognition, depression, and plasma levels of interleukin-6 (IL-6), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S) and cortisol. Non-CNS-SLE patients demonstrated lower learning and poorer attention. Furthermore, non-CNS-SLE and RA patients had significantly lower levels of DHEA and DHEA-S than HC participants. Hierarchical regression analysis demonstrates that DHEA-S and IL-6 accounts for a unique portion of the variance in subject performance on measures of learning and attention after controlling for depression and corticosteroid treatment. This data highlights the value of hierarchical analyses with covariates, and provides evidence in humans of a relationship between peripheral cytokine levels and cognitive function.
10949724 HLA class III region and susceptibility to rheumatoid arthritis. 2000 Jul OBJECTIVE: We examined the contribution of the HLA class III region in susceptibility to rheumatoid arthritis (RA). METHODS: Patients with RA, healthy subjects and homozygous typing cell (HTC) lines were typed for HLA class I (A, B, C), class II (DR, DQ) and class III (D6S273, Bat 2, and TNFa microsatellites, and HSP70 promoter region) alleles by molecular techniques. RESULTS: Based on the distribution of microsatellites D6S273, Bat2 and TNFa, and HSP70 promoter region alleles in HTCs and homozygous unrelated individuals, a class III region haplotype, D6S273 138-HSP70c-Bat2 138-TNFa2 was identified. This haplotype showed a significant primary association with susceptibility to RA in DRB 1 QKRAA/QRRAA epitope-negative patients. CONCLUSION: Since the QKRAA/QRRAA epitope does not provide any risk for disease susceptibility in RA-susceptibility DRB1 epitope-negative patients, the present data suggest that the class III region haplotype D6S273 138-HSP70c-Bat2 138-TNFa2 provides an additional risk for the development of RA. These results show that two regions in MHC, class II (DRB1) and class III (D6S273 138-HSP70c-Bat 2 138-TNFa2), contribute to susceptibility to RA and more completely define the risk for development of the disease.
10573759 Why I would want to use complementary and alternative therapy: a patient's perspective. 1999 Nov People are increasingly turning to complementary therapy as an adjunct to traditional care, but a large percentage do not share that information with their physician. People with rheumatic disease use alternative and complementary therapies for many reasons, and they use a wide variety of therapies. Chronic diseases are among the most difficult to treat with traditional Western medications that attack symptoms, while more alternative and complementary therapies offer relief through other means. Everyone involved--medical doctor, patient, and complementary practitioner--needs to know about the entire treatment regimen and handle it with the patient's overall, long-term health and quality of life in mind. Organizations such as the Arthritis Foundation and professional holistic groups can partner to increase knowledge and further enhance quality of life for people with rheumatic disease.
9631754 Rheumatic manifestations in the course of anaphylaxis caused by Anisakis simplex. 1998 May Human anisakidosis is a parasitic infection caused by the larvae of Anisakis simplex. Classical clinical manifestations include epigastric pain, occlusion, diffuse abdominal pain, appendicitis, and anaphylactoid reactions. Arthralgias or arthritis have been infrequently reported. We present three patients with proven hypersensitivity to A. simplex together with rheumatologic complaints after ingestion of parasitized fishes. A. simplex must be considered in the differential diagnosis of arthralgias/ arthritis especially if associated with urticaria.
9542777 Anti-collagenolytic mechanism of action of doxycycline treatment in rheumatoid arthritis. 1998 Tetracyclines exert, independently of their antimicrobial activity, anti-collagenolytic effects by inhibiting activities of human interstitial collagenases and by preventing the oxidative activation of latent pro-collagenases. We tested the clinical response to a 3-month doxycycline in concert with collagenase activity in 12 rheumatoid arthritis (RA) patients. Patients received 150 mg/day of doxycycline for 3 months. Clinical assessments at zero, six and 12 weeks comprised classification of the functional class, joint score index, Hb, CRP, ESR, health assessment questionnaire, visual analogue scale (VAS) of pain, pain disability index, comprehensible psychopathological rating scale (CPRS), SDS-PAGE laser densitometric collagenase activity measurements and Western blots. Significant reductions were seen in joint score index (P < 0.01), pain VAS (P < 0.05) and some CPRS parameters. Furthermore, collagenase activities measured from saliva by quantitative SDS-PAGE electrophoresis were significantly reduced during the 12-week intervention (P < 0.01). Western blots demonstrated intact 75-80 kDa enzyme protein (classic neutrophil collagenase), but also a newly discovered mesenchymal, less glycosylated 40-55 kDa MMP-8 subtype of fibroblast/chondrocytic origin. These results indicate that the documented favourable clinical response may in part be due to in vivo inhibition of classic neutrophil and mesenchymal collagenase/MMP-8 activities produced by doxycycline. This anti-collagenolytic doxycycline effects is mediated through inhibition of the enzyme activity and not through degradation of the enzyme, which may have contributed to the reportedly reduced tissue destruction, as has been seen in clinical studies concerning RA as well as reactive arthritis.
10777124 Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthrit 2000 OBJECTIVE: To introduce dynamic magnetic resonance imaging (MRI) as an indicator of inflammatory activity in the metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) or early unclassified polyarthritis, and to compare the results with a healthy control group. MATERIALS AND METHODS: We examined 42 RA and 23 early unclassified polyarthritis patients, and 12 healthy controls in a cross-sectional study. Dynamic MRI (repeated FLASH-MR images after injection of a contrast agent) was performed through the 2nd to the 5th MCP joint. Two methods for identification of the enhancing synovial membrane were compared: 1) outlining of enhancing synovial membrane on subtraction images and 2) automated recognition by principal component analysis (PCA). The early enhancement (EE) rate was calculated on the basis of the first method. RESULTS: Method 1) and 2) were closely associated (P<0.00001). From the healthy control group, an upper limit (mean+2SD) of normal enhancement was established for the 2nd to 5th MCP joints, which served to identify abnormal EE rates in the corresponding joints of patients. The patients had higher EE rates in the 2nd to 5th MCP joints than had the healthy controls (P<0.01). There were no significant differences between the two patient groups (P>0.09). CONCLUSION: PCA seems to be a promising method for automated identification of enhancing tissue. EE rates of the finger joints may be useful in the assessment of the inflammatory activity in the joints of patients with RA and early unclassified polyarthritis and may reflect other aspects of disease activity than clinical evaluation.