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ID PMID Title PublicationDate abstract
11735673 A cost-cost study comparing etanercept with infliximab in rheumatoid arthritis. 2001 OBJECTIVE: The objective of this study was to compare the total costs associated with the administration of two different tumour necrosis factor (TNF) strategies used in the treatment of rheumatoid arthritis (RA): etanercept, a soluble TNF receptor that can be administered at home by subcutaneous injection, versus infliximab, an antibody that requires an intravenous infusion in a hospital outpatient setting. DESIGN AND SETTING: The main analytical framework of the study was a cost-cost analysis comparing the total annual costs associated with the administration of etanercept and infliximab in adult RA patients. The perspective of the study was that of the Dutch society. An economic model was constructed to determine the costs of both treatments. The cost evaluation included direct medical costs, direct nonmedical costs and indirect costs. The base-case analysis compared monotherapy with etanercept versus a combination therapy with infliximab and methotrexate. Data for the economic model came from published literature, expert opinion and official price and tariff lists. All costs were in 1999 values. PATIENTS AND PARTICIPANTS: The analysis was performed for the adult RA population eligible for treatment with etanercept or infliximab in The Netherlands. MAIN OUTCOME MEASURES AND RESULTS: The analysis showed that the total annual drug costs per patient do not differ substantially between infliximab and etanercept, with costs of Netherland guilders (NLG)31,526 (12,610 US dollars) and NLG31,334 (12,534 US dollars), respectively. However, the other medical costs (i.e. excluding the costs of the two drugs themselves) are substantially higher for infliximab due to the additional costs associated with administration in an outpatient clinic and the use of methotrexate [NLG 12,621 (5048 US dollars) versus NLG269 (107 US dollars) for etanercept]. The impact of direct nonmedical costs (transportation) and indirect costs were negligible. Overall treatment with infliximab is more expensive than treatment with etanercept with total costs of NLG45 115 (18,046 US dollars) and NLG3I,621 (12,648 US dollars), respectively (42.7% increase). CONCLUSIONS: Based on the assumptions used in the model, we may conclude that the use of etanercept compares favourably with infliximab from a budgetary and health economic perspective: the total costs are substantially lower when the efficacy of etanercept is assumed to be at least equivalent to the efficacy of infliximab.
10792391 Intra-articular IL-10 gene transfer regulates the expression of collagen-induced arthritis 2000 May We studied the effects of local IL-10 application, introduced by a recombinant human type 5 adenovirus vector, in the mouse knee joint during the early phase of CIA. One intra-articular injection with the IL-10-expressing virus (Ad5E1mIL-10) caused substantial over-expression of IL-10 in the mouse knee joint, using virus dosages which did not induce distracting inflammation. High expression of IL-10 was noted for a few days, being maximal at day 1. One intra-articular injection of Ad5E1mIL-10 in the knee joints of collagen type II (CII)-immunized mice, before onset of CIA was noted, reduced the incidence of collagen arthritis in that knee. Of high interest, the protective effect of local IL-10 expression by Ad5E1mIL-10 was not restricted to the knee joint alone. The arthritis incidence in the ipsilateral paw was highly suppressed. In contrast, local IL-10 over-expression was not effective when treatment was started after onset of CIA. Further analysis in the acute streptococcal cell wall-induced arthritis model revealed that local IL-10 over-expression markedly suppressed the production of tumour necrosis factor-alpha (TNF-alpha) and IL-1alpha, but had no significant effect on IL-1beta and IL-12 production in the inflamed synovium. These data indicate that local over-expression of IL-10 in the knee joint of mice regulates the expression of collagen arthritis, probably through down-regulation of TNF-alpha.
14635284 Evaluation of health-related quality of life of rheumatoid arthritis patients treated with 2000 Apr OBJECTIVE: To study the functional status and health-related quality of life (HRQOL) of patients with rheumatoid arthritis (RA) after treatment with celecoxib, compared with placebo and naproxen. METHODS: This was a prospective, randomized, double-blind, parallel group trial conducted at 79 sites in the United States and Canada over a 12-week treatment period. Patients were randomly assigned to 5 groups: placebo, 100 mg twice a day of celecoxib, 200 mg twice a day of celecoxib, 400 mg twice a day of celecoxib, and 500 mg twice a day of naproxen. The Health Assessment Questionnaire (HAQ) disability index was used to measure functional status. The Medical Outcomes Study Short Form 36 (SF-36) was used to measure general HRQOL. RESULTS: Enrollees were 1,149 patients with diagnosed and active RA. At the end of the treatment period, patients in the 4 active treatment groups had significant improvement in both functional status and overall HRQOL in comparison with the placebo group. Patients in the twice-daily 100 mg celecoxib group significantly differed from placebo at weeks 2 and 6 on HAQ scores and at week 12 on 5 domains and both summary scores of the SF-36. Patients treated with twice-daily 200 mg celecoxib had significantly better functional status than placebo at all times of testing with the HAQ, and also had significantly better function than those treated with naproxen after 2 and 12 weeks of treatment. Patients in the twice-daily 200 mg and 400 mg celecoxib groups showed similar improvement in HRQOL as determined by the 8 domain scores and 2 summary scores of the SF-36. CONCLUSION: Celecoxib was better than placebo and comparable with naproxen in improving functional status and overall HRQOL among RA patients.
11832175 [Posterior atlantoaxial facet screw fixation in rheumatoid arthritis]. 2000 Nov OBJECTIVE: To clarify the characteristics of the clinicopathological factors in cases of atlantoaxial instability due to rheumatoid and to introduce a new method for the treatment of this disease. METHODS: Fifteen patients with atlantoaxial instability due to rheumatoid were treated with posterior facet screws to obtain immediate rigid fixation of C(1 - 2). In this series of patients, screw fixation was augmented with an interspinous C(1 - 2) strut graft which was wired in place to provide three-point stabilization and to facilitate bone fusion. RESULTS: In each patient fixation was satisfactory, and C(1 - 2) alignment and stability were restored without complication due to instrumentation. All patients showed osseous union (a mean follow-up period of 10 months; range 6 - 14 months). CONCLUSION: Posterior atlantoaxial facet screw fixation provides immediate three-dimension rigid fixation of C(1 - 2) that is biomechanically superior to wiring or other fixation.
10415591 Macrophages as effectors of the immunoendocrinologic interactions in autoimmune rheumatic 1999 Jun 22 An intricate balance between soluble mediators, released by activated cells of the immune/inflammatory systems, and products of the neuroendocrine system is implicated in the presence of an autoimmune rheumatic disease. Monocytes/macrophages contribute to autoimmune events in rheumatic diseases, such as rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), mainly acting as antigen-processing and presenting cells in the presence of an autoimmune rheumatic disease. Clinical symptoms such as morning stiffness and gelling, at least in RA, that peak during the late night and early morning, are consistent with the hypothesis that the immune function of activated cells (i.e., Th1 cells and monocytes/macrophages) and their mediators (cytokines and reactive oxygen intermediates) is increased at these times in relation to neuroendocrine pathway rhythmicity. Therefore, monocytes/macrophages seem to be the "link" between the steroid hormone environment (i.e., gonadal hormones) and the immune response effectors. If gonadal hormones, along with cytotoxic agents, do modulate macrophage apoptosis, such an approach might offer an important pathway to the control of autoimmune diseases. In conclusion, on the basis of a more complete understanding of macrophage effector and immunoregulatory activities, on both a local and systemic level, new hopes arise from the possible development of more sophisticated antimacrophage treatments for the management of autoimmune rheumatic diseases.
11197756 Immediate effects of the serotonin antagonist granisetron on temporomandibular joint pain 2000 Dec 22 The aim of this study was to investigate if the 5-HT3 antagonist granisetron reduces temporomandibular joint (TMJ) pain in patients with systemic inflammatory joint disorders. Sixteen patients with systemic inflammatory joint disease with pain localized over the TMJ region and tenderness to digital palpation of the TMJ were included. The current resting pain (VASRest) and the pain during maximum mouth opening (VAS(MVM)) of the TMJs were assessed with a 100 mm visual analogue scale. An electronic pressure algometer was used to estimate the pressure pain threshold (PPT) over the lateral aspect of the TMJ. Venous blood was collected for measurement of the plasma and serum levels of 5-HT, erythrocyte sedimentation rate, rheumatoid factor and C-reactive protein. The selective 5-HT3 receptor antagonist granisetron or saline were injected into the posterior part of the upper TMJ compartment in a randomized double-blind manner. The patients in the granisetron group had lower VASRest than the patients in the saline group after 10 min. In the granisetron group, VASRest was decreased after 10 min, while VAS(MVM) was decreased and PPT increased after 20 min. In the saline group, VAS(MVM) was decreased after 20 min. In conclusion, granisetron has an immediate, short-lasting and specific pain reducing effect in TMJ inflammatory arthritis. The 5-HT3 receptor may therefore be involved in the mediation of TMJ pain in systemic inflammatory joint disorders.
11192540 Increased incidence of autoantibodies to interleukin-1a in rheumatoid arthritis with inter 2000 Dec OBJECTIVE: To clarify the clinical significance of autoantibodies (auto-Ab) to interleukin-1alpha (IL-1alpha) in rheumatoid arthritis (RA) with interstitial lung disease (ILD), we examined the IL-1alpha auto-Ab level in serum of patients with RA with/without ILD. METHODOLOGY: We investigated the level of IL-1alpha auto-Ab in serum of 70 patients with RA with/without ILD and 40 control patients (CP). Levels of IL-1alpha auto-Ab were measured by radioimmunoassay, and serum was regarded as IL-1alpha auto-Ab positive at an auto-Ab level of more than 5 ng/mL. RESULTS: Interleukin-1alpha auto-Ab was detected in the serum of 30 out of 70 RA patients (42.9%), and six out of 40 CP (15%) (P < 0.05). Interleukin-1alpha auto-Ab were detected in the serum of 18 out of 32 patients with RA with ILD (56.2%) and 12 out of 38 patients with RA without ILD (31.5%). The positive rate of these autoantibodies in RA with ILD was significantly higher than that in RA without ILD (P < 0.05). Although C-reactive protein, immunoglobulin G, rheumatoid factor and rheumatoid arthritis particle agglutination levels in serum from patients with RA with ILD were not significantly different between the IL-1alpha auto-Ab-positive and -negative groups, the lactate dehydrogenase level (LDH) and AaDO, in the IL-1alpha auto-Ab-positive group were significantly higher than those in the negative group (LDH: P < 0.001, AaDO2: P < 0.05). CONCLUSION: These results suggest that IL-1alpha auto-Ab are generated in response to the immunoinflammatory process of ILD in RA, and these autoantibodies may neutralize and regulate the IL-1alpha activity.
9375863 Gene transfer to human rheumatoid synovial tissue engrafted in SCID mice. 1997 Nov OBJECTIVE: To assess the feasibility of gene therapy in rheumatoid arthritis (RA) and determine the appropriate vector. METHODS: Human rheumatoid synovial tissue from 6 patients with RA was transduced ex vivo with a recombinant retroviral vector (pMFG.nlsLacZ) containing the Escherichia coli beta-galactosidase (beta-gal) gene in a coculture assay in the presence of 20 ng/ml tumor necrosis factor alpha (TNF-alpha) for promoting cell division. We also conducted in vitro infection experiments using an adenoviral vector (AdCMVSpl.LacZ) containing the beta-gal gene. After gene transduction, the synovial tissue was engrafted subcutaneously in 8-week-old severe combined immunodeficiency (SCID) CB17 mice. Beta-gal expression was then monitored as a function of time (up to 21 days) and of virus dose [up to 50 colony forming units (cfu)/cell]. The efficacy of direct in vivo gene transfer was also tested by injection of 10(6) cfu of pMFG.nlsLacZ into rheumatoid synovial tissue engrafted in SCID mice. RESULTS: When recombinant retroviral vector was used, 30 +/- 5% of ex vivo infected synovial cells were positive for staining. In synovial tissue implanted in SCID mice, beta-gal expression declined to 5% after one week, but persisted for at least 21 days. Direct injection of pMFG.nlsLacZ vector into the rheumatoid synovial tissue implanted in SCID mice allowed efficient and stable in vivo infection of the synovial tissue. Ex vivo gene transfer with adenoviral vector resulted in a 98% infection rate of the synovial lining cells. However, beta-gal activity declined 7 days after subcutaneous implantation. CONCLUSION: Highly efficient gene transfer in rheumatoid synovial tissue is achievable with both adenoviral and retroviral vectors, but the results were transient. Exogenous gene transfer through retroviral vectors required stimulation with TNF-alpha for synovial cell division and proviral integration. Direct in vivo gene transfer with recombinant retrovirus was shown to be efficient. Transduction of human synovial tissue engrafted in SCID mice is a potent tool for developing preclinical models of gene therapy in RA.
9195506 Routine measurement of IgM, IgG, and IgA rheumatoid factors: high sensitivity, specificity 1997 Jun OBJECTIVE: To determine the isotype specificity and clinical utility of routine testing by ELISA of IgM, IgG, and IgA rheumatoid factors (RF). METHODS: The test was performed on 619 individual specimens: blood bank donors (n = 130); rheumatoid arthritis (RA, n = 139); connective tissue diseases (CTD, n = 71); miscellaneous rheumatic disorders (MRD, n = 91); and 188 consecutive clinical laboratory specimens that tested positive by latex agglutination. Rabbit IgG was used as the antigen attached to the solid phase, and rabbit IgG antibody-enzyme conjugates against IgM (Fc5mu), IgG[F(ab')2], and IgA (alpha chain) were used, respectively, to detect IgM, IgG, and IgA RF. The serum was digested with pepsin to facilitate the measurement of IgG RF. RESULTS: All 3 isotypes were specifically identified; IgM RF was destroyed by pepsin and IgG RF was specifically measured, without interference from IgA RF. Using data obtained from 98 RA specimens and 162 disease controls, the 3 main clinical variables--sensitivity, specificity, and predictive value--were stratified according to 3 combinations of RF isotypes: IgM only (91, 76, and 62%); IgM+IgA (79, 89, and 80%), and IgM+IgG+IgA (53, 99, and 96%). For patients with the 3 isotypes plus > 150 U of IgM and/or IgA the clinical variables were 70, 97, and 93%. In patients with RA the IgG RF was found only in association with IgM RF, i.e., there was no "hidden" RF, and IgA RF was always accompanied by IgM RF. There was a continuous decline in all 3 RF isotypes during treatment with gold salts. The sensitivity of ELISA for IgM RF exceeded that of nephelometry or latex agglutination. CONCLUSION: Routine measurement of IgM, IgG, and IgA RF by ELISA with rabbit IgG as the antigen and pepsin digestion for the detection of IgG RF provides useful information in the differential diagnosis of patients with arthritis.
11466382 Essential role of neutrophils in the initiation and progression of a murine model of rheum 2001 Aug 1 Neutrophils are prominent participants in the joint inflammation of human rheumatoid arthritis (RA) patients, but the extent of their role in the inductive phase of joint inflammation is unknown. In the K/BxN mouse RA model, transfer of autoreactive Ig from the K/BxN mouse into mice induces a rapid and profound joint-specific inflammatory response reminiscent of human RA. We observed that after K/BxN serum transfer, the earliest clinical signs of inflammation in the ankle joint correlated with the presence of neutrophils in the synovial regions of recipient mouse ankle joints. In this study, we investigated the role of neutrophils in the early inflammatory response to transferred arthritogenic serum from the K/BxN transgenic mouse. Mice were treated with a neutrophil-depleting mAb before and following transfer of arthritogenic serum and scored for clinical indications of inflammation and severity of swelling in ankle joints and front paws. In the absence of neutrophils, mice were completely resistant to the inflammatory effects of K/BxN serum. Importantly, depletion of neutrophils in diseased recipient mice up to 5 days after serum transfer reversed the inflammatory reaction in the joints. Transfer of serum into mice deficient in the generation of nitrogen or oxygen radicals (inducible NO synthase 2 or gp91(phox) genes, respectively) gave normal inflammatory responses, indicating that neither pathway is essential for disease induction. These studies have identified a critical role for neutrophils in initiating and maintaining inflammatory processes in the joint.
9779843 Employment patterns and their effect on health outcomes among women with rheumatoid arthri 1998 Oct OBJECTIVE: To evaluate the effect of employment on health outcomes in a sample of women with rheumatoid arthritis (RA) and to test the hypothesis that employment confers a health benefit to women. METHODS: Seven hundred sixty women with a diagnosis of RA were recruited from a national random sample of private rheumatology practices in 1988, and 416 remained in the study after 7 years of followup in 1994. Women were interviewed each year by telephone to collect data on demographic variables, health status, and employment status. Clinical data were provided by referring physicians. RESULTS: Most women (175, 42%) were not employed outside the home 1988-94, although 96 of those women (23% of the sample) had been employed previously. Twenty-seven percent (n = 112) were employed all 7 years and 31% (n = 129) had been employed between one and 6 years. Women who were employed had significantly better health outcomes measured by pain, disability, role functioning, and clinical status compared to those who were never employed and those who had been employed before the study. Women who were previously employed, but not employed during the study period experienced the worst health outcomes. This difference in health status, however, appeared before entry into this study. CONCLUSION: Employed women with RA had better health status than women who were not employed outside the home. Previously employed women had worse health outcomes than both working women and women who were never employed, suggesting that loss of employment is associated with worse health. Further research is needed to investigate underlying factors contributing to worse health status among unemployed women and to better health among employed women.
11740799 Rheumatoid arthritis in African Colombians from Quibdo. 2001 Dec OBJECTIVES: Little data is available on the prevalence and incidence of rheumatoid arthritis (RA) or the genetic and environmental factors that influence RA risk and severity in non-Caucasian populations. The prevalence of RA in Caucasians and some Native American populations is 1% or more; in contrast, low prevalences of RA have been reported in some African populations. We determined the hospital incidence (HI) and period prevalence (PP) of RA in African Colombians in Quibdo, Colombia, by using data collected at the Hospital San Francisco de Asis, a primary-to-tertiary care center. Genetic and immunologic studies of factors that influence RA risk and severity, such as HLA genes, immunoglobulin-A (IgA) rheumatoid factor (RF), and antikeratin antibodies (AKA) were performed. African Colombians with RA also were compared with Mestizo RA patients from Medellín, Colombia. METHODS: To determine the HI, all the outpatient charts for 1995 were reviewed (n = 3,044). PP during 1996 (Jan-Dec) was assessed by stratified sampling of all African Colombians aged 18 or more having arthralgia. Participants completed a survey and a pretested standard questionnaire, had hands and feet X-rays, and provided a blood sample. Total and IgA RF were measured by turbidimetry and ELISA, respectively; AKA were assessed by indirect immunofluorescence on rat esophagus. HLA-DRB1 and DQB1 alleles were determined by polymerase chain reaction technique with primers of specific sequence and by reverse dot blot. RESULTS: The HI was 0.65 cases per 1,000 person years. There were 321 individuals with arthralgia (0.3%; 95% CI, 0.28-0.3), 18 of whom fulfilled the American College of Rheumatology criteria for RA (PP in the general population, 0.01%; 95% CI, 0.008-0.02). Lower erosion scores were seen in African Colombian patients compared to Mestizos (n = 56), although duration of disease was similar in each group. No association between any HLA allele and RA risk or RA severity or between autoantibodies and RA severity was observed in African Colombians. Comparisons showed no significant differences between African Colombians and Mestizo patients in the presence of RF (total and IgA), AKA, age at onset, extra-articular manifestations, formal education level, and history of malaria. CONCLUSIONS: These results suggest that RA in African Colombian patients from Quibdo is rare, may be less severe in terms of radiographic damage than in Colombian Mestizo patients, and lacks association to HLA-DRB1 and DQB1 alleles. Additionally, RF (total and IgA) and AKA are not markers of progression and activity of the disease in this population.
10609067 The prognostic value of the antiperinuclear factor, anti-citrullinated peptide antibodies 1999 Nov OBJECTIVE: To study the prognostic value of the antiperinuclear factor (APF), determined by an indirect immunofluorescence test (IIF) and a recently developed anti-citrullinated cyclic peptide (CCP) ELISA, in combination with rheumatoid factor (RF) status, in early RA (< 1 year). METHODS: A total of 249 participants in a randomized trial of treatment strategies were divided into 4 groups according to their APF (or CCP) and RF status at baseline. Differences in disability, joint involvement and radiological damage over a 3-year period were analysed. RESULTS: APF-IIF results differed from CCP-ELISA in 42 cases (17%); 38 of the 42 had a positive IIF and negative ELISA value. Disability after 3 years did not differ significantly between the RF and APF groups. APF- patients had significantly lower Thompson joint scores compared to APF+ patients (6 vs 24 for CCP-ELISA; 2 vs 24 for IIF). RF+APF+ patients exhibited more radiological damage compared to RF-APF- patients. RF+APF- and RF-APF+ patients had intermediate scores. Within the RF+ and RF- groups, APF+ was associated with more radiological damage and thus yielded prognostic information in addition to RF. In this respect, the results of ELISA and IIF were comparable. Thirty percent of the RF+APF+ patients had a radiological score higher than 45, compared to 13% of the RF+APF-, none of the RF-APF+, and 2% of RF-APF- patients (p < 0.001). In addition, more large joints were affected in APF+ than in APF- patients, while no difference was observed between RF+ and RF- patients. CONCLUSION: APF has prognostic value in addition to RF for joint involvement and radiological damage in early RA. The CCP-ELISA technique for APF assessment may facilitate its use in clinical practice. However, the prognostic value of the two tests lies in their ability to predict mild disease. Reliable identification at baseline of individual patients with progressive disease is still not possible.
11107747 [Interleukin-18 and new drugs. Protective effect against tumor growth and infections]. 2000 Oct 11 IL-18, originally identified as interferon-gamma inducing factor (IGIF), is related to the IL-1 family in terms of its structure as well as its processing, receptor, signal transduction pathway and pro-inflammatory properties. IL-18 is also functionally related to IL-12, as it induces the production of Th1 cytokines and participates in cell-mediated immune cytotoxicity. A summary is made of recent advances in the understanding of IL-18 structure, processing, receptor expression and immunoregulatory functions. It focuses on the role of IL-18 modulation in tumours, infections and autoimmune and inflammatory diseases.
10817774 A 1-year follow-up study of dynamic magnetic resonance imaging in early rheumatoid arthrit 2000 Apr OBJECTIVES: Dynamic magnetic resonance imaging (MRI) allows visualization of the synovial membrane and measurement of synovitis within the joint. A cohort of patients with early rheumatoid arthritis (RA) were studied using MRI of the dominant wrist and clinical assessments. Associations between synovitis and the shared epitope genotype (SE) were looked for and synovitis as a predictor of joint erosion was examined. METHODS: Gadolinium-enhanced MRI scans of the dominant wrist were performed in 42 early RA patients at baseline (median disease duration = 4 months) and after 1 yr. Images were obtained at 42-s intervals over the first 6 min after gadolinium-diethylenetriamine pentaacetic acid injection using six cuts in the coronal plane, 2 mm apart. The site of maximal synovial enhancement was selected as the region of interest (ROI). The rate of enhancement (E-rate) was calculated and compared with synovitis scores from static MRI scans, clinical disease activity scores and HLA-DRB1*04/01 genotyping [sequence-specific primer polymerase chain reaction (SSP-PCR) and DNA sequencing]. RESULTS: Reproducibility of the E-rate measurement was assessed by re-evaluating 10 randomly selected scans in a blinded fashion. Intra-observer reliability was high with an intraclass correlation coefficient of 0.91, 95% confidence interval (CI) 0.65-0.97. The E-rate correlated strongly at baseline with the maximum level of synovial enhancement (E-max) (r = 0.88, P < 0.0001) and the static MRI synovitis score (r = 0.52, P = 0.0004). There was also a weaker but significant correlation between E-rate and the pain score (r = 0.29, P = 0.04). The E-rate fell from baseline to 1 yr (P = 0.02) concordant with clinical improvement after treatment with standard therapies. E-rate scores were higher in SE+ than SE - patients (F(1,25) = 5.19, P = 0.03) and were predictive of MRI erosions at 1 yr [chi-square = 5.0 (1 d.f.), P = 0.03]. The baseline C-reactive protein (CRP) was also predictive of MRI erosions at 1 yr to a similar degree [chi-square = 4.7 (1 d.f. ), P = 0.03] but the mean static synovitis score at baseline was the strongest predictor [chi-square = 9.2 (1 d.f.), P = 0.003]. CONCLUSIONS: These results show that dynamic MRI can be used to score synovitis objectively in early RA patients. Synovitis was greater in SE+ patients, suggesting an early genetic influence on joint inflammation, and was predictive for the development of erosions at 1 yr.
10513802 Global statistical tests for comparing multiple outcomes in rheumatoid arthritis trials. M 1999 Sep OBJECTIVE: To evaluate global statistical tests (GSTs) of treatment effectiveness for rheumatoid arthritis (RA) trials measuring multiple outcomes. METHODS: Using outcome measures from American College of Rheumatology (ACR) core set variables available in 3 RA trials, GSTs were calculated using the O'Brien ranking procedure and a procedure for binary data. GSTs take correlations among outcomes into account. Power calculations using 1 trial data set provide comparisons of GSTs and ACR criteria for improvement. RESULTS: Spearman correlations among outcomes ranged from 0.21 to 0.73. Erythrocyte sedimentation rate had the lowest correlation with other outcomes in all 3 trials. Within a trial, joint swelling and joint tenderness or patient and physician assessment had the highest correlations, depending on the trial. Results were consistent with results using the ACR criteria, although the GST was more powerful. CONCLUSION: GSTs are a useful tool for comparing treatment effects across multiple clinically meaningful outcome measures. The GST allows easy inclusion of validated, reliable new measures that are not a part of ACR criteria, such as quality of life, and can be computed with or without selecting a cutoff point defining patient improvement. GSTs should be considered for rheumatic disease treatment trials.
9549387 [Combined drug therapy in recent-onset rheumatoid arthritis. Evaluation after 1 year of tr 1998 Jan The aim of our study is to evaluate the efficacy and safety of a combination therapy with hydroxycloroquine, gold sodium thiomalate and methotrexate in patients affected by recent onset active rheumatoid arthritis. Twenty-five patients (6 men e 19 women, average age 46.2 +/- 12.2) were enrolled in this study and 18 of them have been treated for 1 year with the three above-mentioned drugs at optimal doses. Drug toxicity was carefully monitored. Clinical and hematochemical parameters of efficacy were evaluated every three months. Radiographic joint study was performed at the beginning and at the end of the study. Seven patients dropped out, six of them for side effects, due to hydroxycloroquine in 1 case and to gold sodium thiomalate in 5 cases; 1 patient withdrew his consent. No life-threatening or irreversible adverse reactions were observed. The eighteen patients who completed the one year trial presented a remarkable improvement of clinical and hematochemical parameters. In only 1 case one erosion appeared at the end of the study. In conclusion, the combination therapy with hydroxycloroquine, gold sodium thiomalate and methotrexate seems to be effective and burdened by an acceptable level of toxicity.
9754554 Interleukin-16, produced by synovial fibroblasts, mediates chemoattraction for CD4+ T lymp 1998 Sep The massive infiltration of synovium with CD4+ T cells during the course of rheumatoid arthritis (RA) implies the expression of chemoattractant factors by resident synovial cells. Therefore, we analyzed the expression of IL-16, a potent chemoattractant for CD4+ T cells, to account for the accumulation of CD4+ T cells in RA. Indeed, IL-16 was found to be significantly elevated in synovial fluid (SF) from patients with RA as compared to non-RA arthritis (p < 0.001), osteoarthritis (p < 0.001) and controls (p < 0.001). Chemotaxis studies showed IL-16 to contribute to the strong chemotactic activities of RA-SF. In situ hybridization (ISH) revealed IL-16 mRNA-expressing cells located within the lining layer of rheumatoid synovial tissue. In the sublining area, only scattered IL-16 transcript-positive cells could be detected, mainly adjacent to blood vessels. By a double-labeling technique, combining ISH for IL-16 mRNA and immunohistochemistry for CD68, synovial fibroblast-like, CD68-negative cells were identified as a major source of IL-16 mRNA within RA synovium. This study demonstrates that synovial fibroblasts produce IL-16 in RA and thus mediate chemoattraction of CD4+ cells into synovial tissue.
9417407 [Orthopedic therapy in rheumatic diseases]. 1997 Sep 20 The treatment of rheumatic disease requires an interdisciplinary approach in which the orthopedic surgeon is also involved. His contribution includes both conservative and operative procedures. Early synovectomy applied to joints and tendons is considered a preventive measure. Arthroscopic synovectomy belongs in the hands of an experienced operator. Joints that are not directly involved in weight-bearing can be treated by means of arthroplastic procedures, provided the cooperation of the patient is ensured. Arthrodesis is used preferentially to treat articular destruction of the ankle joint, the metacarpophalangeal joint of the thumb and the middle joints of the finger. Osteoporosis represents a relative contraindication. The treatment of rheumatic diseases of the joints using endoprostheses produces good primary results. The rate of loosening is not significantly increased, but late infection is somewhat higher than in other forms of articular disease.
10674788 Dolichoodontoid. A rare cranio-cervical anomaly--MRI findings. 2000 Jan The case of a 40-year-old woman with a dolichoodontoid, a rare congenital anomaly of the cranio-cervical region, is presented. Due to summation image and overlying bony structures, plain radiographs in two planes were inconclusive. MRI revealed the hyperplasia of the odontoid process, allowed a grading of the subtype of this disorder and demonstrated its relationship to the neural structures within the foramen magnum and the upper cervical spine. Additional inflammatory disease, suspected in this patient with long standing rheumatoid arthritis could be excluded by MRI.