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ID PMID Title PublicationDate abstract
10403259 HLA-DRB1 alleles associated with susceptibility or resistance to rheumatoid arthritis, art 1999 Jul OBJECTIVE: To study the genetics (HLA-DRB1 allele associations) of rheumatoid arthritis (RA) susceptibility and severity among Mexican Americans, an important, but understudied, US population. METHODS: HLA-DRB1 alleles were compared between 141 Mexican American patients with RA and 54 unrelated Mexican Americans without RA, and the association of these alleles with articular deformities and disability was examined. HLA-DRB1 alleles were typed using polymerase chain reaction-sequence-specific primer amplification and were classified according to the 1996 World Health Organization nomenclature. RESULTS: Of the 141 patients, 105 (74%) had at least 1 copy of the shared epitope (SE) sequence, compared with 29 (54%) of the 54 controls (P = 0.007). A significant gene-dose effect was observed, with 31 patients (22%) being homozygous for the SE compared with 1 (2%) of the controls (P = 0.004). In terms of disease severity, only 3% of RA patients who were "null" for the SE were outliers in the rate of development of articular deformities, compared with 10% of heterozygotes and 27% of homozygotes (P = 0.002). Patients who were DRB1*08 positive had significantly fewer deformities per year of disease and a slower rate of development of disability than did patients with other DRB1 alleles. CONCLUSION: HLA-DRB1 alleles containing the SE are associated with susceptibility to RA in Mexican Americans, and may also be associated with a more rapid development of articular deformities and disability. HLA-DRB1*08 appears to have a protective influence on RA susceptibility and disease severity in Mexican Americans.
11398621 [Total ankle joint replacement]. 2001 Apr We evaluated the short- to mid-term results of an unconstrained total ankle prosthesis (S.T.A.R.) with uncemented fixation. Seventy-nine consecutive ankle replacements were performed in 76 patients between 1996 and 2000. The initial diagnosis was posttraumatic osteoarthrosis in 51 cases (64%), primary osteoarthrosis in 14 cases (18%), and systemic joint affection in 14 cases (18%). Although 29 revision operations were necessary, all implants became fix, and no implants have been removed. At the last follow-up control, 38 patients (62%) were very satisfied, 20 patients (33%) were satisfied, and 3 patients (5%) were satisfied with reservations. The obtained range of motion was 35 degrees (range, 15 to 55 degrees), with a maximal plantarflexion of 27 degrees (range, 15 to 45 degrees) and dorsiflexion of 8 degrees (-3 to 20 degrees). The AOFAS-Hindfoot-Score of the 61 patients scored 84 points (range, 51 to 100 points). After settling of the implants within 6 weeks, no migration was noted in any case, and all implants were considered to be stable. The favorable results were considered to be a result of the mechanical properties of the S.T.A.R. total ankle prosthesis that allow for unconstrained motion. The rate of revisions, however, was too high, and it was considered to be a result of the design of tibial and talar component, the tibial fixation and the poor instrumentation. Nevertheless, total ankle replacement was shown to be a viable alternative to ankle arthrodesis. A longer follow-up is, however, mandatory to evaluate the long-term prognosis.
9870867 Functional subsets of CD4 T cells in rheumatoid synovitis. 1998 Dec OBJECTIVE: To identify the functional properties of CD4+ CD28- T cells, which accumulate and clonally expand in patients with rheumatoid arthritis (RA). METHODS: The gene expression of molecules involved in T cell effector functions was compared in CD4+ CD28- and CD4+ CD28+ T cell clones. The expression of differentially up-regulated genes was confirmed by flow cytometry of T cells and by 2-color immunohistochemistry of rheumatoid synovial tissue. Cytotoxicity of CD4+ CD28- T cells was tested by anti-CD3 redirected lysis of Fc receptor-positive target cells. RESULTS: CD4+ CD28- T cell clones lacked messenger RNA for the CD40 ligand (CD40L) but transcribed the perforin gene. Perforin was also found in freshly isolated CD4+ CD28- peripheral blood lymphocytes from RA patients. CD4+ CD28-, but not CD4+ CD28+, T cell clones lysed Fc receptor-bearing target cells. CD4+ perforin-positive T cells were present in the synovial tissue, where their frequency correlated with the expansion of the CD4+ CD28- compartment in the periphery. Among tissue-infiltrating CD4+ T cells, only the CD40L-negative subset expressed perforin transcripts. CONCLUSION: Clonally expanded CD4+ CD28- T cells are functionally specialized for killing, while they lack the ability to provide B cell help. Tissue-infiltrating CD4+ T cells can be subdivided phenotypically and functionally into at least 2 distinct subsets based on their expression of perforin and CD40L. Because the expansion of CD4+ CD28- T cells is associated with extraarticular RA, T cell-mediated cytotoxicity may be particularly important in these most severe complications of RA.
11337628 The use of traction methods to correct severe cervical deformity in rheumatoid arthritis p 2001 May 1 STUDY DESIGN: A case series is presented. OBJECTIVES: To describe the methods of correction used in this study for flexible severe cervical deformity, and to report the results in patients with rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: Long-standing rheumatoid arthritis can lead to severe cervical deformity, causing significant functional deficits and poor cosmesis. Information on the use of traction combined with surgical stabilization to achieve correction of flexible deformity in rheumatoid patients is sparse in the English literature. METHODS: A review of five cases, including pertinent history, physical examination, radiographic evaluation, traction techniques, surgical stabilization, and outcomes, was conducted. RESULTS: Excellent correction of deformity and radiographic union were achieved in all the patients. One patient had minimal loss of correction after surgery and thereafter remained stable. Pin tract infections were the only significant complication. CONCLUSIONS: Severe cervical flexible deformity in rheumatoid patients can cause significant disability and can be treated successfully with a combination of traction techniques and surgical stabilization.
9433406 The effect of HLA-DRB1 disease susceptibility markers on the expression of RA. 1997 The study was designed to examine the effect on clinical expression of rheumatoid arthritis (RA) of HLA alleles, particularly DR4 and DR1 that contain susceptibility sequences for RA in the third hypervariable region (HVR3) of HLA-DRB1. We studied 114 consecutive Australian patients with RA attending a hospital outpatient clinic. The effects on indices of disease severity and activity of HLA DR4 and DR1, the DRB1*04 subtypes, and the polymorphism in the RA susceptibility sequence (QRRAA or QKRAA) were examined. The patients were initially divided into 6 groups, DR4,4; DR4,1; DR1,1; DR4/X; DR1,X, and DRX/X, and then further subdivided according to the actual HVR3 susceptibility sequence. The high risk conferred by the HVR3 susceptibility sequence, present in 76%, was confirmed, but 24% of the patients with long-standing seropositive erosive RA lacked this sequence. Among these those with DR2 had early-onset severe disease, and those with DR3 had late-onset milder disease. Differences in expression correlated with polymorphisms in the susceptibility sequence, in that active RA was associated more with QRRAA than QKRAA. There was no correlation of any HLA allele with disease severity. Our finding that the presence of the HVR3 sequence confers susceptibility and also influences the clinical expression and tempo of progression of RA suggests a role in pathogenesis for antigen presentation, whether of an autoantigenic molecule or a persisting infection.
11501337 An audit of the use of antirheumatic drugs in a north Indian referral hospital. 2001 May OBJECTIVE: This study was conducted with the aim of auditing the pattern of use of antirheumatic drugs in a tertiary care hospital in Northern India. METHODS: The study was carried out in 1000 patients recruited sequentially from the clinic for a period of 1 year (January to December 1999). Patient data such as age, sex, income, family size, diagnosis, duration of illness, drugs prescribed/duration, adverse drug reaction were noted and used to calculate core drug use indicators and pattern of drug use. RESULTS: The pattern of drug use was in accordance with the standard practices followed internationally. In rheumatoid arthritis the most common prescriptions were for non-steroidal antiinflammatory drugs (NSAIDs) alone, followed by the combination of NSAIDs, disease modifying agents (DMARDs) and steroids. Of the NSAIDs diclofenac was the most frequently prescribed drug, while chloroquine was the most commonly used DMARD. The most commonly seen adverse drug reactions were gastritis, Cushings syndrome and decreased visual acuity. CONCLUSION: In conclusion, this study has demonstrated that in this clinic, the pattern of use of antirheumatic drugs follows standard guidelines.
9567589 Serodiagnosis and immune profile in rheumatoid arthritis. 1997 Nov One hundred and seventy-five cases of clinically diagnosed rheumatoid arthritis, 82 non-rheumatoid cases suffering from various other diseases and 40 healthy normal controls were investigated for detection of rheumatoid factor, quantitation of serum immunoglobulin, demonstration of antinuclear antibody (ANA) and LE cell phenomenon. Microlatex agglutination test of serum for rheumatoid factor (RF) showed 64% positivity in rheumatoid group and 1.2% positivity in non-rheumatoid group. All three immunoglobulins (IgG, IgM, IgA) were found to be raised in serum of patients with rheumatoid arthritis, whereas only IgA level was elevated in serum of patients with non-rheumatoid diseases. ANA and LE cell phenomenon were observed in 3.4% and 2.8% cases respectively in cases of clinically diagnosed rheumatoid arthritis who had been suffering from severe active rheumatoid arthritis. In non-rheumatoid group RF was positive in significant titre in only one case of leprosy. Synovial fluid and synovium were found to be heavily infiltrated by plasma cells and lymphocytes. RF appears first in synovial fluid and then in serum. Hence RF titre in blood may not attain significant level for the first several months.
11780482 [Histopathological study of temporomandibular joint in early stage of polyarthritis rats]. 2000 Mar OBJECTIVE: To furnish an experimental basis of the early effects of rheumatoid arthritis (RA) on the temporomandibular joint (TMJ) by observing the histopathological changes of TMJ in the early stage of polyarthritis (PA) rats. METHODS: The animal model of PA was established by injecting Freund's complete adjuvant (FCA) into rats. The histopathological changes of the rats' ankle joint and TMJ were studied. RESULTS: (1) The paw volume and the articular index of PA rats increased significantly, and symptoms of pronounced inflammation were present in the ankle joint specimens, which included proliferation of the synovium, infiltration with inflammatory cells, erosion into the articular cartilage and bone, and inflammatory exudation into the articular cavities. (2) The histopathology of TMJ of PA rats showed pronounced proliferation of the synovium cells, some lytic collagenous fibers and degenerative chondrocytes in the condyles, and exudated protein and desquamating cells in the articular cavities with some fibrinous adhesions. CONCLUSION: Pronounced inflammation occurs in bilateral TMJ in early stage of PA rats. The examination, protection and treatment of TMJ for RA patients should be taken into account in the early stage.
9460598 [Effect of pyrimidine derivatives on the regulation of active transport of calcium in the 1997 Nov Experiments with guinea pig immunocompetent cells and nonadherent and adherent mononuclear fractions of the peripheral blood of healthy donors, and patients with rheumatoid arthritis and purulent surgical infection disclosed different levels of Ca(2+)-ATPase activity. Thymectomy in adult guinea pigs led to diminution of activity of the enzyme in all lymphoid organs. The effect of ximedon (30 mg/kg) on Ca(2+)-ATPase activity depended on the thymus and duration of treatment with the drug, and was of a two-phase character.
10334676 Glucocorticosteroids in the management of rheumatoid arthritis. 1999 Jan Glucocorticosteroids are used frequently in the management of patients with rheumatoid arthritis. Data supporting their efficacy and safety are still meagre. Glucocorticosteroids may be used systemically with different routes of administration (oral, i.m. and i.v.), in different doses and for different periods of time. The effectiveness of glucocorticosteroids in reducing inflammation in the short term has been shown for oral treatment in a dose of 7.5 mg prednisolone daily or more, for i.m. pulses (120 mg methylprednisolone every 4 weeks) and for i.v. methylprednisolone pulses. For longer periods of treatment, the evidence suggesting effectiveness of low-dose oral glucocorticosteroids is more limited. Some data suggest that different regimens of glucocorticosteroids may retard the development of erosions in patients with rheumatoid arthritis. The toxicity of short-term treatment is relatively low. For long-term treatment, the development of osteoporosis is a serious problem. Concomitant therapy with either calcitriol or bisphosphonates may reduce this risk.
9393904 Synovectomy of the elbow and radial head excision in rheumatoid arthritis. Predictive fact 1997 Nov We carried out a survival analysis of elbow synovectomy (ES) and excision of the radial head (RHE) performed on 171 rheumatoid elbows. The failure criteria were revision surgery (performed or desired) and/or the presence of significant or severe pain. The cumulative survival was 81% at one year which thereafter decreased by an average of 2.6% per year. The strongest predictor for success was a low preoperative range of supination-pronation when corresponding survival curves were compared. A low range of flexion-extension also predicted failure. Combining both factors gave better prediction (failure: 6.3% v 67%), but a long duration of elbow symptoms before surgery predicted failure (72%, p = 0.04). At review, there was a mean gain of 50 degrees in supination-pronation and 11 degrees in flexion-extension; both correlated with success. Failure correlated with recurrence of synovitis, elbow instability, ulnar neuropathy, poor general mobility and poor upper-limb function. The last was independently affected by the severity of RA in the ipsilateral shoulder. Our findings show that although the short-term result of ES and RHE in rheumatoid arthritis is good, the long-term outcome is poor except in a subgroup with more than 50% limitation of forearm rotation.
10403268 Fat conversion of femoral marrow in glucocorticoid-treated patients: a cross-sectional and 1999 Jul OBJECTIVE: To study the changes in hematopoietic marrow in patients given glucocorticoid (steroid) therapy. METHODS: In a cross-sectional study, high-resolution T1-weighted magnetic resonance imaging (MRI) images of the proximal femur were obtained in an unselected series of 29 premenopausal female patients with systemic lupus erythematosus (SLE) and in a series of 29 age-matched healthy female subjects. In a longitudinal analysis, 2 MRI studies were performed 19 months apart in 11 patients with SLE (including 9 patients from the cross-sectional study who were evaluated before treatment) and in 7 patients with rheumatoid arthritis (RA). The percentage of fat marrow and the index of marrow conversion (IMC) were derived from the MRI images to estimate the degree of transformation of hematopoietic into fatty marrow in the area of the femoral neck. Values observed in the cross-sectional study and their changes over time were correlated with treatment data. RESULTS: The cross-sectional study performed in SLE patients indicated that their mean (+/- SD) percentage of fat marrow (48+/-36%) and IMC (82+/-12) were significantly more elevated than those in the healthy control subjects (18+/-16% and 75+/-6, respectively) (P<0.01). The magnitude of fat conversion correlated positively with the mean daily dose of oral prednisolone, and was higher in patients with ischemic bone lesions. The longitudinal study performed in SLE and RA patients revealed that IMC changes over time correlated positively with daily prednisolone intake (r = 0.71; P = 0.001), fat conversion occurring exclusively in patients receiving a mean prednisolone dose < or =7.5 mg/day. CONCLUSION: MRI indicates that fat conversion occurs in the proximal femur of steroid-treated patients. The magnitude of fat conversion correlates with steroid intake and is higher in patients with ischemic bone lesions.
9008613 Methotrexate-associated appearance and rapid progression of rheumatoid nodules in systemic 1997 Jan Rheumatoid nodules are a rare extraarticular manifestation of juvenile rheumatoid arthritis (JRA), usually detected in patients with polyarticular-onset disease and positive rheumatoid factor (RF). To date, there has not been a published report of rheumatoid nodules in systemic-onset JRA. Low-dose methotrexate (MTX) is generally considered to be the most useful second-line drug in the treatment of polyarticular JRA. In adult RA, MTX has been shown to be associated with appearance and progression of rheumatoid nodules. This report describes a 3-year-old girl with RF-negative, antinuclear antibody-negative systemic JRA who developed multiple rheumatoid nodules on the scalp and trunk during MTX therapy. The first nodule developed on the scalp 6 months after MTX treatment was initiated. Previous treatment with azathioprine was not associated with nodulosis. This represents an atypical case of MTX-associated accelerated nodulosis in systemic JRA, and raises the problem of treatment plan modification in the presence of this side effect.
10589356 Methotrexate and emerging therapies. 1999 Nov More publications in the medical literature have described the clinical efficacy and toxicity of methotrexate (MTX) than of any other drug ever used for rheumatic diseases. A knowledgeable clinical can thus rely on evidence-based medicine to guide the use of this agent. Because MTX is not remission-inducing, many new therapies are being combined with it in order to achieve a greater therapeutic response. This trend will likely continue and expand as more novel agents are introduced.
11502606 Radiographic scoring methods as outcome measures in rheumatoid arthritis: properties and a 2001 Sep BACKGROUND: Use of scored radiographs as an outcome measure can help estimate the progression of rheumatoid arthritis (RA). Radiographs not only provide permanent records with which to evaluate RA serially, but can also be randomised and blinded, a major advantage in clinical trials. OBJECTIVES AND METHOD: Medline was searched for information about the principal methods of assessing joints affected by RA. Each technique was evaluated for its measurement properties, advantages, and limitations. MAIN FINDINGS: The most commonly used methods are those devised by Sharp, Larsen, and van der Heijde/Sharp, and their variants. Methods based on the Sharp technique provide separate scores for erosion and for joint space narrowing. Larsen and variants, together with the Simple Erosion Narrowing Score (SENS) method, provide an overall score. Each method's measurement properties (feasibility, time consumption, etc) depend on the degree of detail it considers. Authors consistently recommend taking a posteroanterior view of hand and foot radiographs, and the use of trained raters. Intra- and interrater reliability values are generally higher than 0.70 (less often assessed by the intraclass correlation coefficient than the correlation coefficient). Sensitivity to change is calculated by several techniques (standardised response mean (SRM), adjusted SRM, minimal detectable change, smallest detectable difference). Most methods assessed with SRM reach a value of 0.80 or more. CONCLUSION: Standardised procedures are available for performing and reading radiographs in RA. The choice of scoring method depends on the time and staff available, and the required degree of reliability and sensitivity to change.
11469740 A technique for frameless stereotaxy and placement of transarticular screws for atlanto-ax 2001 Jun The aim of the present study was to outline a new surgical technique and describe how, in a clinical setting, computer-generated image-guidance can assist in the planning and accurate placement of transarticular C1/C2 screws inserted using a minimally invasive exposure. Forty-six patients with atlanto-axial instability due to rheumatoid arthritis underwent posterior stabilisation with transarticular screws. This was achieved with a minimal posterior exposure limited to C1 and C2 and percutaneous screw insertions via minor stab incisions. The Stealth Station (Medtronic Sofamor Danek, Memphis, Tenn., USA) was used for image guidance to navigate safely through C2. Reconstructed computed tomographic (CT) scans of the atlanto-axial complex were used for image guidance. It was possible to perform preoperative planning of the screw trajectory taking into account the position of the intraosseous portion of the vertebral arteries, the size of the pars interarticularis and the quality of bone in C2. Screws could be inserted percutaneously over K-wires using a drill guide linked to the image-guidance system. Preoperative planning was performed in all 46 patients and accurate registration allowed proposed screw trajectories to be identified. Thirty-eight patients had bilateral screws inserted and eight had a unilateral screw. A total of 84 screws were inserted using the Stealth Station. There were no neurovascular injuries. This technique for placing transarticular screws is accurate and safe. It allows a minimally invasive approach to be followed. Image guidance is a useful adjunct for the surgeon undertaking complex spinal procedures.
10380835 Muscle strength characteristics and central bone mineral density in women with recent onse 1999 Muscle strength and bone mineral density (BMD) at the lumbar spine (BMDspine) and femoral neck (BMDfem) were determined in 20 healthy women and in 20 women with recent onset rheumatoid arthritis (RA). The mean duration of articular symptoms of the patients was eleven months and none of them had used glucocorticoids or disease modifying antirheumatic drugs. BMDs were measured by dual x-ray absorptiometry (DXA). Knee extension, trunk extension, and flexion as well as grip strength were measured with David 200 and Digitest dynamometers. BMDspine (1.17 g/cm2 and 1.20 g/cm2) and BMDfem (0.98 g/cm2 and 0.96 g/cm2) between the women with early RA and healthy women did not differ. However, knee extension strength was 46%, grip strength 31%, trunk extension strength 14% and overall muscle strength index 29% lower in RA women (p < 0.020-0.001) than in healthy subjects. Femoral neck BMD correlated statistically significantly with knee extension strength and muscle strength index in both groups and with trunk extension and flexion strength as well as rapid force development in RA women. The data indicates that the loss of muscle strength is clearly visible during the first months of disease but the significant bone loss at central bone regions develops later.
11380140 Recurring synovitis as a possible reason for aseptic loosening of knee endoprostheses in p 2001 May We evaluated histologically samples of synovial tissue from the knees of 50 patients with rheumatoid arthritis (RA). The samples were taken during revision for aseptic loosening. The findings were compared with those in 64 knees with osteoarthritis (OA) and aseptic loosening and in 18 knees with RA without loosening. The last group had been revised because of failure of the inlay or the coupling system of a constrained prosthesis. All the patients had had a total ventral synovectomy before implantation of the primary prosthesis. In all three groups a foreign-body reaction and lymphocellular infiltration were seen in more than 80% of the tissue samples. Deposits of fibrin were observed in about one-third to one-half of the knees in all groups. Typical signs of the reactivation of RA such as rheumatoid necrosis and/or proliferation of synovial stromal cells were found in 26% of knees with RA and loosening, but not in those with OA and loosening and in those with RA without loosening. Our findings show that reactivation of rheumatoid synovitis occurs after total knee replacement and may be a cofactor in aseptic loosening in patients with RA.
11351775 Tumour necrosis factor as a therapeutic target in rheumatoid arthritis and other chronic i 2001 Apr Therapeutic strategies that aim to neutralise the important pro-inflammatory cytokine tumour necrosis factor alpha (TNF alpha) have gained considerable prominence in the therapy of chronic inflammatory diseases, notably rheumatoid arthritis and Crohn's disease. This drug focus review will concentrate on the antitumour necrosis factor antibody infliximab (Remicade), which has been approved for the treatment of rheumatoid arthritis and Crohn's disease in both the US and Europe. In addition, infliximab is under investigation for several other indications, mainly inflammatory rheumatic diseases. Clinical trials have been persuasive that infliximab is both safe and effective, and it has been proven to be far superior to the conventional drug therapy in both rheumatoid arthritis and Crohn's disease. Remarkably, infliximab in combination with methotrexate controls both the inflammatory joint symptoms and the progression of joint damage, which renders it a very attractive therapeutic option in moderate to severe, therapy-resistant rheumatoid arthritis.
10092832 EBV gene expression not altered in rheumatoid synovia despite the presence of EBV antigen- 1999 Mar 15 T cells infiltrating the rheumatoid arthritis (RA) joint are oligoclonal, implicating an Ag-driven process, but the putative joint-specific Ags remain elusive. Here we examine expression of selected EBV genes in RA synovia and find no abnormal expression in RA. DNA of CMV and EBV was detectable by PCR in the synovial tissue of RA. RNA of several latent and lytic EBV genes was also detectable. However, there were no differences in EBV gene expression in synovial tissues or peripheral blood when comparing RA with osteoarthritis, Gulf War syndrome, and other disease controls. RA synovia with highly expanded CD8 T cell clones reactive with defined EBV peptide Ags presented by HLA class I alleles lacked evidence of abnormal mRNA expression for the relevant EBV Ag (BZLF1) or lacked amplifiable mRNA (BMLF1). Thus, local production of EBV Ags in synovial tissues may not be the cause of the accumulation of T cell clones specific for these Ags. Instead, APCs loaded with processed EBV peptides may migrate to the synovium. Alternatively, EBV-specific T cells clones may be generated in other tissues and then migrate to synovia, perhaps due to cross-reactive joint-specific Ags or because of expression of homing receptors.