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ID PMID Title PublicationDate abstract
9089863 Cervical epidural analgesia for management of pain associated with digital vasculitis seco 1997 Mar BACKGROUND AND OBJECTIVES: Cutaneous vasculitis is a devastating extra-articular manifestation of rheumatoid arthritis. The potential consequences of digital vasculitis are necrosis, ischemia, infarction, and eventually gangrene. METHODS: A 54-year-old woman with a long history of rheumatoid arthritis developed an acute onset of severe diffuse occlusive cutaneous vasculitis beyond the head of the metacarpals (documented by angiogram). Despite treatment with high-dose prednisone and Cytoxan, her symptoms were poorly controlled. Cervical sympatholysis via continuous epidural infusion of bupivacaine was then initiated to manage her pain as well as to treat the vasoconstrictive sequelae of the cutaneous vasculitis. RESULTS: The cervical epidural infusion relieved the pain and produced significant resolution of the symptoms. CONCLUSIONS: This case highlights the rational use of continuous cervical epidural block for the management of pain and improvement in blood flow to vasoconstricted upper extremities and digits resulting from vasculitis due to rheumatoid vasculitis.
11156742 Antioxidants in vegan diet and rheumatic disorders. 2000 Nov 30 Plants are rich natural sources of antioxidants in addition to other nutrients. Interventions and cross sectional studies on subjects consuming uncooked vegan diet called living food (LF) have been carried out. We have clarified the efficacy of LF in rheumatoid diseases as an example of a health problem where inflammation is one of the main concerns. LF is an uncooked vegan diet and consists of berries, fruits, vegetables and roots, nuts, germinated seeds and sprouts, i.e. rich sources of carotenoids, vitamins C and E. The subjects eating LF showed highly increased levels of beta and alfa carotenes, lycopen and lutein in their sera. Also the increases of vitamin C and vitamin E (adjusted to cholesterol) were statistically significant. As the berry intake was 3-fold compared to controls the intake of polyphenolic compounds like quercetin, myricetin and kaempherol was much higher than in the omnivorous controls. The LF diet is rich in fibre, substrate of lignan production, and the urinary excretion of polyphenols like enterodiol and enterolactone as well as secoisolaricirecinol were much increased in subjects eating LF. The shift of fibromyalgic subjects to LF resulted in a decrease of their joint stiffness and pain as well as an improvement of their self-experienced health. The rheumatoid arthritis patients eating the LF diet also reported similar positive responses and the objective measures supported this finding. The improvement of rheumatoid arthritis was significantly correlated with the day-to-day fluctuation of subjective symptoms. In conclusion the rheumatoid patients subjectively benefited from the vegan diet rich in antioxidants, lactobacilli and fibre, and this was also seen in objective measures.
9367397 Humanized anti-CD4 monoclonal antibody therapy of autoimmune and inflammatory disease. 1997 Nov We have investigated the biological and therapeutic properties of a humanized anti-CD4 MoAb, hIgG1-CD4, in patients with refractory psoriasis and rheumatoid arthritis (RA). hIgG1-CD4 is a modulating, non-depleting MoAb, which induced a first-dose reaction in most patients treated. It provided brief symptomatic relief in both conditions, and psoriasis appeared easier to control with conventional agents after MoAb therapy. At the doses used, hIgG1-CD4 did not synergize therapeutically with the panlymphocyte MoAb CAMPATH-1H (C1H) in patients with RA treated sequentially with both agents. There were no serious adverse effects definitely attributable to therapy. Our results are compared with those of other CD4 MoAb studies, and factors influencing the outcome of therapy are discussed.
10537249 Total knee arthroplasty in the presence of severe flexion contracture: a report of 37 case 1999 Oct From 1987 to 1994, 37 total knee arthroplasties were performed in 23 patients with severe, fixed flexion contractures averaging 78 degrees (range, 60 degrees -100 degrees). Fourteen of the knees had flexion contractures of greater than 90 degrees and 7 were fused at 90 degrees. There were 19 women and 4 men. The average age at surgery was 42 years (range, 20-57 years). The diagnoses were rheumatoid arthritis in 17 patients, juvenile rheumatoid arthritis in 3, and ankylosing spondylitis in 3. Preoperatively, all patients were Knee Society Category C, with 14 being nonambulatory and 9 minimally ambulatory. Follow-up averaged 4.3 years (range, 2-8 years). Postoperatively, patients were immobilized in extension when not in continuous passive motion or physical therapy. Flexion contractures were corrected to an average of 7 degrees postoperatively (range, 0 degrees -15 degrees). Arc of motion improved from 25 degrees preoperatively to 82 degrees postoperatively. The average Knee Society knee scores improved from 25 points preoperatively to 78 points postoperatively, and the functional scores improved from 0 points preoperatively to 71 points postoperatively. Five knees were manipulated under anesthesia postoperatively. Complications included 3 transient peroneal nerve palsies, 1 transient episode of vascular insufficiency, 6 delayed wound healings, and 1 deep infection. There were no aseptic loosenings. We conclude that although technically difficult, total knee arthroplasty can be performed successfully in this challenging and highly debilitated subset of patients, giving them marked improvement in quality of life.
9457152 Rheumatologic disorders in women. 1998 Jan This article reviews common rheumatic diseases that most frequently occur in women including fibromyalgia, rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus and the antiphospholipid antibody syndrome. Many of these women are of child bearing potential and special considerations concerning pregnancy often arise. Rheumatic conditions that frequently affect older women such as osteoarthritis and polymyalgia rheumatica are discussed as well. Osteoporosis, which has emerged as a significant women's health issue, is also reviewed.
9811140 Quantification of synovistis by MRI: correlation between dynamic and static gadolinium-enh 1998 Sep Dynamic and static gadolinium-diethylenetriaminepentaacetic acid(Gd-DTPA)-enhanced magnetic resonance imaging (MRI) were evaluated as measures of joint inflammation in arthritis, by a comparison with macroscopic and microscopic signs of synovitis. Furthermore, the importance of the size of the evaluated synovial areas was investigated, as was the optimal time for enhancement measurements. Seventeen rheumatoid arthritis knees and 25 osteoarthritis knees, scheduled for arthroscopy or arthrotomy, were included. Macroscopic and microscopic synovial inflammation as well as nine histologic tissue characteristics were graded at four preselected biopsy sites. Preoperative T1-weighted dynamic fast low angle shot and static spin-echo Gd-enhanced MRI were performed. The dynamic enhancement rate and the static enhancement were measured in the entire synovial membrane of a preselected slice as well as at the four biopsy sites, and compared to synovial pathology. The rate of early enhancement of the total synovial membrane of the preselected slice, determined by dynamic MRI, was highly correlated with microscopic evidence of active inflammation (Spearman p = 0.73; p < 10(-7). Dynamic MRI could distinguish knees with and without synovial inflammation with a high predictive value (0.81-0.90). Moderate and severe inflammation could not be differentiated. The early enhancement rate was correlated with histologic features of active inflammation, particularly vessel proliferation and mononuclear leucocyte infiltration. Dynamic evaluation of small synovial sections at the biopsy sites and static spin-echo MRI resulted in considerably weaker correlations to histologic inflammation than dynamic evaluation of the total synovium. The optimal time for enhancement measurements was one-half to one minute after Gd injection, as the highest correlation coefficients to histologic inflammation were observed in this interval. Dynamic MRI can be used to determine synovial inflammation. Evaluation of large synovial areas one-half to one minute after Gd injection best reflects joint inflammation.
10997430 Rheumatoid arthritis of the craniocervical region: assessment and characterization of infl 2000 The aim of this study was to depict and characterize inflammatory soft tissue proliferations caused by rheumatoid arthritis (RA) in the craniocervical region by unenhanced and contrast-enhanced CT. Computed tomography of the craniocervical region was performed in 35 patients in the axial plane before and after the i.v. administration of contrast material. According to the densities and contrast enhancement of the inflammatory soft tissue proliferations, four groups were classified. Ancillary findings, such as a compression of the dural sac or spinal cord, erosions of the bony structures, and atlantoaxial subluxation, were also evaluated. Inflammatory soft tissue proliferations were depicted in 28 of 35 patients and could be differentiated by unenhanced and contrast-enhanced CT according to the above defined criteria: effusion in 6 patients (17%); hypervascular pannus in 8 (23%); hypovascular pannus in 5 (14%); and fibrous tissue in 9 patients (26%). A compression of the dural sac was seen in 11 (31%) patients; 3 of these had neurological symptoms. Erosions of the odontoid process were found in 20 (57%) patients; 16 (80%) of these also showed erosions of the atlas. Atlantoaxial subluxation was seen in 11 (31%) patients. Inflammatory soft tissue proliferations in the craniocervical region caused by RA can be reliably demonstrated and classified by unenhanced and contrast-enhanced CT, which can differentiate between joint effusion and various forms of pannus and depict ancillary findings. Computed tomography is an alternative method for patients unable to undergo an MRI examination.
10986309 Reduced incidence and prevalence of atopy in rheumatoid arthritis. Results of a case-contr 2000 Sep OBJECTIVE: To determine the cumulative incidence and the point prevalence of atopy in patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: A standardized questionnaire was sent to 300 RA patients. Questions concerned previous or present characteristics of atopy (hay fever, asthma and constitutive eczema) and RA. RA patients were matched with genetically unrelated controls (sister- or brother-in-law, neighbour or friend). The same questionnaire (except for questions about RA) was sent to the control subjects. In cases of atopy, patients, controls and the treating physicians were contacted by a physician to check the validity of the responses. RESULTS: Paired responses were obtained in 173 cases. Information about atopy was obtained for 69 other RA patients. The characteristics of RA were similar for patients who responded and those who did not respond. The frequency of atopy was significantly lower in RA patients than in controls, both for cumulative incidence (RA 7.5%, controls 18.8%; P: < 0.01) and point prevalence (RA 3.5%, controls 16.2%; P: < 0.0001). The clinical manifestations of atopy stopped before the onset of RA in eight of the 17 RA patients with an allergic condition, and there was no subsequent relapse. No effect of RA treatment could account for the remission of atopy. CONCLUSION: These data support the concept that atopy protects against the future development of RA and that the two diseases could counterbalance one another.
10907351 [Quantitative ultrasound densitometry (QUS) and dual X-ray densitometry (DXA) in patients 2000 The aim of this study was to assess of bone mineral content (BMC) and bone mineral density (BMD) of the forearm using DXA technique (DTX-200) and to evaluate broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the heel using QUS technique (DTU-ONE). We examined 83 RA patients: 73 women and 10 men, at average age (55.0 +/- 12.2 yrs), ranging from 29 to 85 yrs. Average disease duration was 112.6 +/- 98.1 months. Disease activity was assessed according to Mallya and Mace index and radiological stage of the disease according to Steinbrocker index. We found significant correlation between BMC, BMD and BUA (r = 0.6572, r = 0.6081, respectively) and between BMC, BMD and SOS (r = 0.4704, r = 0.4723, respectively). IN CONCLUSION: quantitative ultrasound parameters (BUA and SOS) significant correlate with BMC and BMD values of the forearm assessed by DXA technique in rheumatoid arthritis patients.
10864087 Severity of synovium and bone marrow abnormalities of the temporomandibular joint in early 2000 May PURPOSE: Our goal was to evaluate the efficacy of dynamic contrast-enhanced fat-suppressed MRI of the temporomandibular joint (TMJ) in detecting early joint involvement in patients with rheumatoid arthritis (RA). METHOD: Conventional T1- and T2-weighted, gadolinium-enhanced T1-weighted, and dynamic gadolinium-enhanced fat-suppressed SE imaging sequences were performed in 22 patients with RA. RESULTS: The dynamic gadolinium-enhanced fat-suppressed T1-weighted SE sequence was more sensitive than the other techniques in detecting early changes in inflamed synovium of periarticular tissue and in detecting condylar bone marrow involvement. In patients with RA, 17 joints with joint pain showed synovial proliferation in 10 (59%) cases and joint effusion in 4 (24%). Of 14 joints with joint sound, 4 (29%) showed synovial proliferation and 7 (50%) showed joint effusion. A lower positional change of the disk was observed in joints with RA than in those with TMJ disorders (82 patients). CONCLUSION: Gadolinium-enhanced fat-suppressed MRI was extremely effective in diagnosing early changes of the inflamed TMJ.
10491360 Utility of disease modifying antirheumatic drugs in "sawtooth" strategy. A prospective stu 1999 Oct OBJECTIVES: To study long term utility of early, continual, and serial use of disease modifying antirheumatic drugs (DMARDs) in early rheumatoid arthritis (RA) in clinical setting. METHODS: A total of 135 patients with early RA were treated according to the "sawtooth" strategy and prospectively followed up to 15 years. DMARD survivals as well as reasons for drug terminations were documented and are reported here. RESULTS: During 1401 person years of follow up, a DMARD or a combination of two or several DMARDs (COMBOs) was started 606 times. A total of 528 drug periods were terminated because of inefficacy, adverse effects, remission, and other reasons in respective 270 (51.1%), 149 (28.2%), 32 (6.1%), and 77 (14.6%) cases. Severe drug related adverse events were rare. The median duration of DMARD periods of individual DMARDs or COMBOs was 10 months ranging from six to 18 months. Not a single DMARD/COMBO stood out favourably from the others with respect to ineffecacy, toxicity or drug survival. CONCLUSION: The use of serial DMARDs/COMBOs was safe even in the long run. Inefficacy rather than toxicity was the leading reason for drug terminations. More powerful drug therapies are needed.
9101511 The Juvenile Arthritis Quality of Life Questionnaire--development of a new responsive inde 1997 Apr OBJECTIVE: To develop a disease specific measure of quality of life for application in children with juvenile rheumatoid arthritis and juvenile spondyloarthritides-the Juvenile Arthritis Quality of Life Questionnaire (JAQQ). METHODS: Patients and their parents were interviewed by a trained interviewer using a questionnaire focusing on physical function, psychosocial function, and general symptoms to determine the most appropriate items to include in the JAQQ. Respondents volunteered items and scored them for frequency of occurrence and importance. Items so generated were scored by a panel of experts for potential responsiveness and categorized into dimensions. Item number was reduced using this scoring system. The product was then pretested to confirm its construct validity and responsiveness. Thereafter, it was distributed to clinical experts to establish face and content validity. RESULTS: 91 patients, mean age 10.35 years (range 1.25-18.0), mean disease duration 3.99 years, and their parents were included in the interview process. 220 items generated were ultimately reduced to 85. Pretesting this version of the instrument in a further 30 patients showed it to have construct validity and responsiveness and led to a further reduction in items to 74, distributed in 4 dimensions: gross motor function (17 items), fine motor function (16 items), psychosocial function (22 items), and general symptoms (19 items). Face and content validity were established in 20 clinicians. Scaling was by 7 point Likert scale to enhance responsiveness. English and French versions were developed. CONCLUSION: The JAQQ measures physical and psychosocial function and an array of general symptoms. Preliminary data suggest it is valid and responsive and thus might have potential in clinical trials.
9259417 Association of rheumatoid arthritis with an amino acid allelic variation of the T cell rec 1997 Aug OBJECTIVE: To investigate allelic variations of T cell receptor residues for a contribution to rheumatoid arthritis (RA) susceptibility. METHODS: We conducted an RA case-control study involving 1,579 northwest Europeans: 766 patients with erosive and rheumatoid factor-positive disease and 813 control subjects. Productive changes of segments TCRAV6S1, TCRAV7S1, TCRAV8S1, TCRAV10S2, and TCRBV6S1, TCRBV6S7 were investigated by single-strand conformation polymorphisms. The TCRAV8S1 association was confirmed by restriction fragment length polymorphism. RESULTS: In the systematic study (77 patients and 119 controls), an increase in 1 TCRAV8S1 genotype was found in the RA patients (P = 0.0004). This finding was replicated in 2 further populations, one from France (212 patients and 254 controls) and the other from Britain (477 patients and 440 controls), with a similar odds ratio (OR), which allowed pooling of the data and confirmation of the association (OR 1.3 [95% confidence interval 1.1-1.7], P = 0.008). CONCLUSION: These findings show evidence that TCRA is an RA susceptibility locus.
11727537 Interleukin-1 receptor antagonist as therapy for inflammatory disorders. 2001 Mar IL-1 is a pivotal mediator of the immune response and has been implicated in inflammatory and infectious diseases. As a consequence, the administration of IL-1 receptor antagonist (IL-1ra), a recombinantly synthesised endogenous inhibitor of IL-1, has appeal as a therapeutic strategy in these conditions. To date, the largest clinical experiences with IL-1ra have been in the setting of sepsis and rheumatoid arthritis (RA). Like other anti-inflammatory agents that target a specific mediator, IL-1ra was found to lack efficacy when given in conjunction with standard therapy in patients with sepsis and septic shock. In contrast, recent studies enrolling patients with RA suggest that IL-1ra significantly ameliorates disease activity and retards joint destruction. Whether the respective lack of efficacy and success of IL-1ra in these two diseases is a result of differences in the pathologic processes involved, or reflects the nature in which the clinical studies were conducted, is unclear. Further, the effectiveness of IL-1ra compared to other anticytokine and conventional treatments in RA remains to be clarified. Nonetheless, the recent finding that IL-1ra has the ability to favourably influence a chronic inflammatory disease supports the hypothesis that inhibition of a single mediator of the immune response may have clinical impact.
10968191 Simultaneous bilateral total knee replacement. 1998 Sep This paper summarises our experience of twenty one patients with degenerative arthritis treated by bilateral simultaneous total knee replacement (BSTKR) in Tawakal Hospital in a period of twenty two months vis. January 1994 to November 1995. The results were analysed according to the scoring system of Hospital for Special Surgery. The preliminary observations were encouraging, 90% excellent, 8% good and 2% fair results. The benefits, safety and cost effectiveness of the procedure as compared to the unilateral staged knee replacement are discussed. We recommend that BSTKR be routinely practised for appropriate situations in all institutions where the expertise and facilities are available.
10665719 OP-1 for cervical spine fusion: bridging bone in only 1 of 4 rheumatoid patients but predn 1999 Dec We used OP-1 (also called BMP-7) on a collagen type-1 carrier in atlanto-axial posterior fusions to promote bony healing after wire fixation. 4 patients who had instability between the atlas and axis due to rheumatoid disease received the implants. The patients were examined with conventional radiography postoperatively at 2, 6 and 10 months. In 3 patients, no new bone formation was detectable. In 1 patient, new bone bridged the fusion site at 6 months. 3 patients were on chronic steroid treatment, including the patient in whom bone formation was detected. To determine whether steroid treatment could be responsible for the low rate of bone induction, 24 rats each received OP-1 implants in an abdominal muscle pouch. They were divided into 3 groups receiving saline, 0.1 or 1.0 mg/kg BW of prednisolone daily until they were killed 3 weeks postoperatively. Specimens were decalcified for histology and the amount of calcium in the decalcifying solution was measured. All groups showed ossicles induced by OP-1, and no effect of prednisolone was detected. Thus the failures in the patients may have causes other than prednisolone treatment.
10036639 T cell receptor repertoire in rheumatoid arthritis. 1998 CD4+ T cells are a major component of the inflammatory infiltrate in rheumatoid synovitis. Within synovial lesions, clonal CD4+ T cell populations are detectable, supporting the notion of an antigen specific recognition even in the joint. In general, the clonal size of individual T cell clones is small and does not lead to a marked distortion of the synovial T cell receptor (TCR) repertoire. Comparison of TCR sequences derived from different patients has not provided evidence for common sequences. Either multiple antigens are recognized or the TCR repertoire is sufficiently plastic with a multitude of different TCR structures responding to the same antigen(s). However, within one individual, the repertoire of clonal T cell populations is restricted. Identical T cell clones can be identified in different joints and at different timepoints of the disease, emphasizing that the spectrum of antigens recognized is conserved over time and that the T cell response pattern is not subject to evolution. Characterization of antigens involved in the latter stages of the disease may thus provide critical information on disease-initiating events. Recent data have led to the new concept that the role of T cells in rheumatoid arthritis (RA) is not limited to synovial inflammation. Evidence has been provided that the premorbid TCR repertoires of RA patients and normal controls can be distinguished. The T cell repertoire in RA patients is prone to recognize certain microbial products and autoantigens. The selection of this response pattern can only partially be attributed to the disease associated HLA-DRB1 alleles. Additional factors common in RA patients but not in HLA-DR matched control individuals seem to be important in shaping the TCR repertoire. Furthermore, the repertoire of mature T cells in RA patients is characterized by oligoclonality which involves T cells in the peripheral blood compartment. Possibly, these clonal T cell populations react to widespread autoantigens, raising the possibility that RA patients have a defect in controlling peripheral tolerance and an anomaly of lymphoproliferation. In contrast to joint residing CD4+ T cells, expanded clonotypes isolated from the blood of different patients have been described to share TCR beta chain structures. How these characteristic features of the global TCR repertoire in RA patients translate into mechanisms of disease remains to be elucidated.
10663941 [Progression of foot deformities in rheumatoid arthritis--a radiologic follow-up study ove 1999 Dec OBJECTIVE: The typical changes of the foot in patients with rheumatoid arthritis (RA) are the rear foot valgus and the flattening of the longitudinal arch as well as the splayfoot with hallux valgus and little toe deformities. These foot deformities are not so much a cosmetic problem, but are very painful and limit the patient's mobility. METHODS: The progression of rheumatic foot deformities with a follow-up of five years was described in 36 patients (70 feet) with RA and an average duration of the disease of 19.2 years (+/- 9.8 years). The analysis was based on standardized X-rays of the feet using the index of Larsen, Dale, and Eek. The number of affected joints and their predominant locations were evaluated. RESULTS: In the course of the follow-up, the first MTP joint was affected most frequently in 57%. Especially the tarsometatarsal joints of the Lisfranc-joint-line showed progressive changes. Altogether, a radiological progression of arthritic changes and a worsening of the foot statics were observed in 97% of the patients. CONCLUSION: In view of the rapid progression of rheumatic foot disorders, there is need not only for a consequent pharmacotherapy but also for strict clinical controls and a disease stage oriented local therapy.
11124283 Renal toxicity associated with disease-modifying antirheumatic drugs used for the treatmen 2000 Dec OBJECTIVE: To provide a review of the renal toxicity of disease-modifying antirheumatic drugs (DMARDs) currently used for the treatment of rheumatoid arthritis. METHODS: Papers in American and European medical journals related to renal toxicity of DMARDs used for the treatment of rheumatoid arthritis were reviewed. Specific DMARDs reviewed were cyclosporine, gold, D-penicillamine, methotrexate, azathioprine, antimalarials, sulfasalazine, leflunomide, etanercept, infliximab, and DMARD combination therapy. RESULTS: The renal toxicity of DMARDs varies widely. Cyclosporine, gold, and D-penicillamine all have a serious potential for renal side effects, particularly in the elderly or in patients with compromised renal function. Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the potential for renal damage. In contrast, methotrexate, azathioprine, antimalarials, sulfasalazine, leflunomide, etanercept, and infliximab have relatively little renal toxicity. CONCLUSIONS: The potential for renal toxicity should always be considered when determining which DMARD to use for RA therapy. DMARDs that combine efficacy with negligible renal adverse effects should be used for the treatment of patients susceptible to DMARD-associated renal damage.
10659447 Does using an ejector chair affect muscle activation patterns in rheumatoid arthritic pati 2000 Feb The present study examined knee and arm extensor muscle activation patterns displayed by 12 elderly female rheumatoid arthritic patients (mean age = 65.5 +/- 8.6 yr) rising from an instrumented Eser ejector chair under four conditions: high seat (540 mm), low seat (450 mm), with and without ejector assistance. Electromyographic (EMG) signals were sampled (1000 Hz) for vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF) and triceps brachii (TB) using a Noraxon Telemyo System (bandwidth 0-340 Hz). Muscle onset, offset and peak activity relative to loss of seat contact (SS), and integrated EMG, were calculated for each muscle burst before SS. A high seat significantly (p < or = 005) decreased VL and TB intensity but did not change muscle activation patterns compared with rising from a low seat. Ejector assistance significantly increased VM and RF burst duration and RF intensity but had no effect on vastii muscle intensity. It was concluded that concerns pertaining to muscle disuse when rising with ejector assistance were unfounded in the present study. However, further research is required to investigate the effects of habitual use of a mechanical ejector device on muscle activation patterns.