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ID PMID Title PublicationDate abstract
10914412 Neurology of systemic autoimmune disorders: a pediatric perspective. 2000 Jun Autoimmune disorders can involve patients of any age and organs of any organ system. The central and peripheral nervous systems are frequently among the targets of these diseases. Immune dysfunction often presents in childhood or adolescence. Among the autoimmune disorders that present during childhood and adolescence, systemic lupus erythematosus, dermatomyositis, and Behcet's disease affect the nervous system with some degree of frequency. Furthermore, although juvenile rheumatoid arthritis only rarely affects the nervous system during childhood, it and its adult-onset counterpart may have profound long-term neurological consequences. Both symptomatic and pathophysiologically aimed therapies are important in the treatment of the nervous system sequelae of systemic autoimmune disorders.
10914498 The effects of NO synthase inhibitors on murine collagen-induced arthritis do not support 2000 Jul DBA/1 mice deficient in expressing the interferon-gamma (IFN-gamma) membrane receptor (IFN-gammaR KO mice) are more susceptible to collagen-induced arthritis (CIA) than wild-type mice, indicating that endogenous IFN-gamma plays a protective role in the pathogenesis of CIA. In IFN-gammaR KO mice, nitric oxide (NO) production during CIA is impaired. Because NO is known to exert immunosuppressive and anti-inflammatory effects in certain model systems, the protective effect of IFN-gamma might be mediated by NO. Here, we tested in wild-type mice whether inhibition of NO production by metabolic inhibitors, aminoguanidine (AG) and L-N-(1-iminoethyl)lysine (L-NIL), could mimic the ablation of the IFN-gamma receptor. A high-dose regimen of AG supplied in the drinking water inhibited NO production, disease development, and anticollagen antibody production but was also associated with transient body weight loss. At a dose and time regimen that still inhibited NO production but did not cause body weight loss, AG failed to affect disease scores. Treatment with L-NIL, which more specifically than AG affects inducible NO production, caused a slight increase in anticollagen antibody production although not significantly affecting disease occurrence. These data indicate that the diminished capacity of the IFN-gammaR KO mice to produce NO following immunization with collagen is unlikely to account for their higher susceptibility to CIA.
9217553 Office evaluation of the patient with musculoskeletal complaints. 1997 Jan 27 Many musculoskeletal complaints are accompanied by classic signs and symptoms that can be readily diagnosed by the primary care physician. Others are much less obvious and present a diagnostic challenge. In the office evaluation of patients with musculoskeletal complaints, the history is the most informative element. Least helpful are laboratory tests. Although erythrocyte sedimentation rate (ESR), rheumatoid factor, and other widely available tests are sensitive to the presence of rheumatic diseases, they are not specific for any of them. In the initial office evaluation, helpful points of differentiation include the number of joints involved, their location, and, when multiple joints are involved, whether they are symmetric or asymmetric. An acute monarthritis is associated mainly with trauma, infection, or a crystal-induced synovitis such as gout or pseudogout. Patients with polyarthritis may have symptoms that come and go very quickly, sometimes in < 24-36 hours. This migratory pattern characterizes diseases such as gonococcal arthritis, viral disease, and sarcoidosis. "Rheumatoid variants" such as Reiter's syndrome, psoriatic arthritis, and spondylitis may affect no more than a few joints and are accompanied by other signs, such as nail and skin lesions (psoriasis) or urogenital and enteric infections (Reiter's). Like erosive osteoarthritis, the rheumatoid variants may also cause swelling and inflammation of the distal interphalangeal joints. The classic example of symmetric joint disease is rheumatoid arthritis (RA). While RA often occurs in a progressive and additive pattern, its onset may be followed by a remission several months later. Patients who present with the "algias" may have no physical signs but manifest extensive musculoskeletal pain. Fibromyalgia occurs typically in younger women; polymyalgia rheumatica rarely occurs in patients < 50 years of age and is usually accompanied by a strikingly high ESR. Age and gender should be noted in the office evaluation because they can provide clues not only to these "algias," but other rheumatic diseases seen more frequently in one age or gender group than another.
11549374 Mosaic chromosomal aberrations in synovial fibroblasts of patients with rheumatoid arthrit 2001 Chromosomal aberrations were comparatively assessed in nuclei extracted from synovial tissue, primary-culture (P-0) synovial cells, and early-passage synovial fibroblasts (SFB; 98% enrichment; P-1, P-4 [passage 1, passage 4]) from patients with rheumatoid arthritis (RA; n = 21), osteoarthritis (OA; n = 24), and other rheumatic diseases. Peripheral blood lymphocytes (PBL) and skin fibroblasts (FB) (P-1, P-4) from the same patients, as well as SFB from normal joints and patients with joint trauma (JT) (n = 4), were used as controls. Analyses proceeded by standard GTG-banding and interphase centromere fluorescence in situ hybridization. Structural chromosomal aberrations were observed in SFB (P-1 or P-4) from 4 of 21 RA patients (19%), with involvement of chromosome 1 [e.g. del(1)(q12)] in 3 of 4 cases. In 10 of the 21 RA cases (48%), polysomy 7 was observed in P-1 SFB. In addition, aneusomies of chromosomes 4, 6, 8, 9, 12, 18, and Y were present. The percentage of polysomies was increased in P-4. Similar chromosomal aberrations were detected in SFB of OA and spondylarthropathy patients. No aberrations were detected in i) PBL or skin FB from the same patients (except for one OA patient with a karyotype 45,X[10]/46,XX[17] in PBL and variable polysomies in long-term culture skin FB); or ii) synovial tissue and/or P-1 SFB of normal joints or of patients with joint trauma. In conclusion, qualitatively comparable chromosomal aberrations were observed in synovial tissue and early-passage SFB of patients with RA, OA, and other inflammatory joint diseases. Thus, although of possible functional relevance for the pathologic role of SFB in RA, these alterations probably reflect a common response to chronic inflammatory stress in rheumatic diseases.
10488672 Age, pain, and coping with rheumatoid arthritis. 1999 Sep The purpose of this study was to examine the relationship of age and pain severity (i.e. mild versus severe pain) in predicting coping strategies of individuals with rheumatoid arthritis (RA). An age-stratified sample (N = 121) of individuals diagnosed with rheumatoid arthritis completed a modified version of the Coping Strategies Questionnaire (CSQ). Individuals were asked to report the coping strategies used for mild versus severe pain. Findings included: (1) older adults were more likely than younger adults to report use of maladaptive coping strategies in the context of mild, but not severe, RA pain, (2) older adults' reported patterns of coping reflected less-than-anticipated expertise in dealing with RA pain, and (3) individuals, regardless of age, reported use of more active coping strategies in the context of mild pain and use of more maladaptive coping strategies in the context of severe pain. The present study suggests that research regarding illness and coping is most informative when it captures the individual-situational interaction of dealing with stressors such as chronic pain.
10854495 Rheumatoid arthritis in workers exposed to silica in the pottery industry. 2000 Jul OBJECTIVE: To investigate the relation between rheumatoid arthritis and occupational exposure to silica in pottery and related industries. METHODS: Medical records of 8325 men and women born 1916-45 and employed in pottery, refractory material (aluminosilicate or silica), and sandstone industries were examined to identify cases of rheumatoid arthritis. Medical and employment histories were extracted for cases and matched referents. Indices of duration, cumulative exposure, and mean silica concentration were compiled. Conditional logistic regression was used to investigate the relation between rheumatoid arthritis and indices of exposure, having allowed for potential confounders of smoking, employment in the coal mining industry, and number of pregnancies. RESULTS: 58 Cases of rheumatoid arthritis (43 men, 15 women) were identified. Cases had significantly shorter duration of exposure than referents. There was no significant difference between cases and referents in mean silica concentration. Men who had worked in the coal mining industry were particularly at risk (odds ratio 5.36, 95% confidence interval 1.92 to 15.03). CONCLUSION: There was no evidence of increased risk of developing rheumatoid arthritis after occupational exposure to silica at mean exposures within the current United Kingdom exposure limits.
11826745 [Combined basic therapeutic drugs. From individual hope to targeted use]. 2001 Dec Accumulating evidence suggests that treatment of rheumatoid arthritis (RA) with two or more disease-modifying antirheumatic drugs (DMARDs) is more efficient than single agent therapy. Randomized clinical trials demonstrated the efficacy of various combinations such as methotrexate plus sulfasalazine plus hydroxychloroquine, methotrexate plus ciclosporine or methotrexate plus infliximab, respectively. In contrast to these data, however, most German rheumatologists use combination therapy in a small percentage of patients with active RA. Thus, consensus criteria should be defined when and how to use combination therapy in the treatment of active disease. We suggest that combination therapy should be started if active disease is still present after three months of treatment with a single standard DMARD, mostly methotrexate, plus low dose prednisolone and that combination DMARD therapy should be used before TNF blocking agents.
9034993 The clinical spectrum of remitting seronegative symmetrical synovitis with pitting edema. 1997 Feb OBJECTIVE: To describe the clinical and laboratory features and outcome of patients with remitting seronegative symmetrical synovitis with pitting edema (RS3PE). METHODS: A retrospective multicenter study of patients with RS3PE fulfilling the following criteria: (1) bilateral pitting edema of both hands, (2) sudden onset of polyarthritis, (3) age > 50 years, (4) seronegative for rheumatoid factor (RF). RESULTS: 27 patients with RS3PE were included, mean age 71.7 years (58-92), 18 men (66.6%) and 9 women (33.3%). Relevant history was noted in 2 patients with polymyalgia rheumatica. Main clinical features were polyarthritis and edema of both hands. Polyarthritis involved metacarpophalangeal joints in 22 patients (81.5%), proximal interphalangeal joints in 19 (70.4%), wrists in 15 (55.5%), shoulders in 13 (48%), elbows in 3 (11.1%), knees in 9 (33.3%), and ankles in 7 (25.9%). All patients were RF negative. Antinuclear antibodies were positive at low titer in 8 patients. Erosions were present in one patient. Two patients developed T lymphoma and one myelodysplastic syndrome. CONCLUSION: RS3PE is a heterogeneous syndrome the clinical history, presence of erosions, and evolution to hematological diseases in our patients suggest that RS3PE may not be a distinct clinical entity.
10025108 [Contribution of databases to regional and supra-regional quality improvement in rheumatol 1998 Dec The uniform database of the German Collaborative Arthritis Centers is an important instrument for health services research, the observation of outcomes of daily rheumatological care, and for quality assessment in rheumatology. Deficits concerning modern medical and comprehensive therapy in non-specialized outpatient care were shown. The data give evidence of the benefits of the initiation of rheumatological care. Data of practice variation in rheumatology are used for internal quality assessment.
9313397 Satisfaction with abilities and well-being: development and validation of a questionnaire 1997 Apr OBJECTIVE: To develop a questionnaire to measure satisfaction with abilities and well-being of persons with rheumatoid arthritis (RA). METHODS: We used data from a panel study of persons with RA (n = 446). The 13 items of the Satisfaction with Abilities and Well-Being Scale (SAWS) were based on problematic aspects of RA and domains of life activities. RESULTS: The SAWS demonstrated internal consistency (Cronbach's alpha = 0.93). Two subscales were identified, Satisfaction with Abilities and Satisfaction with Well-Being, which also demonstrated internal consistency (alpha = 0.91 and alpha = 0.82, respectively). Construct validity was supported by significant correlations with psychosocial and clinical variables. After controlling for demographic, psychosocial, and clinical characteristics, there was a significant inverse association between SAWS scores and depressive symptoms scores. CONCLUSIONS: The SAWS appears to be a valid and reliable measure of satisfaction with abilities and well-being among persons with RA. Longitudinal studies will examine the role of satisfaction in the development of depressive symptoms.
11171678 The national database of the German Collaborative Arthritis Centres: I. Structure, aims, a 2001 Mar OBJECTIVE: To describe the aims, principles, and content of the German rheumatological database and to present data on patient mix and healthcare provision for the year 1998. METHODS: The German rheumatological database contains clinical and patient derived data of the outpatients with inflammatory rheumatic diseases seen at one of the 24 collaborative arthritis centres. The case mix, institutional context, and demographic features of 25 653 patients from the year 1998 were analysed. RESULTS: 51% of the patients had rheumatoid arthritis, 23% seronegative spondyloarthropathies, including ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, and 19% had vasculitis, including SLE (5%). The distribution of the age at onset of patients with RA with < or = 2 years' disease duration was comparable with recent incidence data from population studies. The case mix differed between university departments and rheumatology hospitals as well as individual practices. 65% of the male and 46% of the female patients at ages 18-60 were still in gainful employment, the rates of employment were 14% below the population rates for women, and 11% below those for men. 62% of all patients had seen a rheumatologist within the first year of disease, 73% within the first two years. Ankylosing spondylitis was seen in rheumatological care much later than all other diseases (only 39% within the first year). The mean number of contacts with a rheumatologist was five a year; rheumatologists in individual practices saw their patients seven times a year on the average. Together with visits to the non-specialist doctor mainly treating the patient, the mean number of visits to the doctor for a rheumatic condition was 20 a year. CONCLUSION: Large databases like this one give information about the patient case mix in different healthcare settings, about treatment practice, and about the consequences of disease. Patients treated in specialised rheumatology units in Germany are referred earlier than in the past, which probably reflects better regional cooperation due to the implementation of arthritis centres. University departments and outpatient clinics of rheumatology hospitals contribute considerably to the specialised care of patients with arthritis and connective tissue diseases.
11052466 Improvement of periarticular osteoporosis in postmenopausal women with rheumatoid arthriti 2000 The effect of zinc on bone metabolism in patients with rheumatoid arthritis (RA) is unknown. In the present pilot study, we investigated the effect of two antiulcer drugs, beta-alanyl-L-histidinato zinc (AHZ) and cimetidine, on bone metabolism in postmenopausal women with RA who had bilateral wrist pain. Eight patients were enrolled in a prospective, single-blind study consisting of 6-month cimetidine treatment (400 mg/day) followed by 6-month AHZ treatment (300 mg/day). Biochemical markers and bone mineral density (BMD) by dual energy X-ray absorptiometry were measured at baseline, 6 months, and 12 months. Three patients withdrew, and five patients (mean age 60: range 55-64 years) were analyzed. Their disease activity including wrist pain and dosages of prednisolone and disease-modifying antirheumatic drugs remained unchanged during the 12-month treatment. The AHZ treatment increased serum zinc (AHZ vs cimetidine, +48.0% vs +5.6%), and resulted in significant increases of serum bone-specific alkaline phosphatase (+93.5% vs -14.7%) and BMD of the bilateral ultradistal radius (+4.9% vs -5.6%). However, the AHZ treatment had no effect on BMD of the lumbar spine (-2.0% vs +1.5%) or the bilateral distal third of radius (-2.1% vs +0.2%). In the AHZ treatment, the percentage change in BMD of the unilateral ultradistal radius with more severe wrist pain was positively correlated with the percentage change in serum zinc (r = 0.97). These findings suggest for the first time that AHZ treatment improves periarticular osteoporosis, probably through an increase of bone formation, in postmenopausal women with RA. Randomized double-blind controlled trials are needed.
11224733 Evaluating the quality of care in rheumatic diseases. 2001 Mar An understanding of the level of health care quality and the factors that affect it is necessary for providers and insurers to optimize health outcomes for patients and should be carefully considered when making decisions about resource allocation. Additionally, information about health care quality can be used by patients and others to inform decisions about the purchase of health care. Although much work has been done to characterize the quality of health care, little is known about the quality of care for the rheumatic diseases. This paper reviews what is known about health care quality for these diseases.
10211882 Expression of murine HOXD9 during embryonic joint patterning and in human T lymphotropic v 1999 Apr OBJECTIVE: To characterize the expression of murine HOXD9 during normal joint development and in arthritic joints of human T lymphotropic virus type I (HTLV-I) tax transgenic mice and the role of HTLV-I tax in HOXD9 expression. METHODS: Expression of HOXD9, HOXD1O, HOXD11, HOXD12, and HOXD13 genes in joint tissues at the ankle/foot regions of mouse embryos at day 10 to day 18 of gestation (E10-E18) and neonates within 10 days after birth was determined by reverse transcriptase-polymerase chain reaction and in situ reverse transcription methods. Adult synovial tissues from 5 HTLV-I tax transgenic mice with chronic polyarthritis and 4 nontransgenic (normal) mice were also examined for expression of these HOXD genes. The effect of HTLV-I on HOXD9 expression in cultured synoviocytes was studied by in vitro infection and transfection experiments. RESULTS: Expression of HOXD9 was detected in embryonic joints, preferentially on articular cartilage, only during the early stages of joint development (up to E15), whereas other HOXD genes were expressed throughout the embryonic and neonatal stages. In adult mice, transcripts of HOXD9 were specifically detected in synovial tissues from 4 of 5 arthritic mice, especially in the lining and sublining synovial cells, but not in synovial tissues of normal mice. Activation of HOXD9 was observed in cultured synoviocytes infected with HTLV-I in vitro as well as in those transfected with HTLV-I tax. CONCLUSION: Our findings suggest that HOXD9 is involved not only in the early stages of normal joint development, but may also be involved in the pathologic process of arthritis. HTLV-I tax appeared as an activator of this HOX gene in cultured synoviocytes.
10599382 Joint replacement. The final solution? 1999 Joint replacement is now a well established procedure that provides pain relief, mobility and stability to arthritic joints. The development of hip and knee replacement surgery is used to highlight some basic principles of joint replacement. The results of total knee replacements performed by the senior author were analysed in two separate, 2 to 5 year follow-up studies using the Scoring System of The Knee Society of America. Both studies confirm the reproducible, good results of this procedure. Indeed, the demand for this type of surgery has increased and in Malta, at present, the number of knee replacements performed out-numbers hip replacements by two to one. After total knee replacement rheumatoid arthritis patients have results that compare well with those of osteoarthritis patients. These patients, in particular, should benefit from early joint replacement.
9135911 Recent clinical trials in the rheumatic diseases. 1997 Mar This paper reviews clinical trials that have been published during the course of the past year on the rheumatologic diseases. The greatest number of clinical trials were done in rheumatoid arthritis. These trials show promising results for combination therapy with disease-modifying antirheumatic drugs, whereas results of studies with monoclonal antilymphocyte antibodies have been disappointing. The role of oral collagen remains to be defined. Nonsteroidal anti-inflammatory drugs with selective cyclooxygenase-2 (Cox-2) inhibition may have a more favorable toxicity profile and are likely to find wide use. As adjuvant therapy, trimethoprim-sulfamethoxazole appears to be useful in preventing relapses in Wegener's granulomatosis, and patients develop fewer infections. With the exception of juvenile rheumatoid arthritis, intravenous immunoglobulin therapy appeared ineffective in the diseases studied. The inclusion of more standardized and disease-specific outcome measures has enhanced the quality of clinical trials in rheumatology and their applicability to rheumatologic practice.
9549372 [Monoclonal antibodies as an immunotherapy of rheumatoid arthritis]. 1998 Mar Rheumatoid arthritis(RA) is a chronic, deforming and destructive arthritis of unknown etiology. For the medical treatment of RA, NSAID has been the first choice of drug. Recently it has been known that early use of DMARD may result in clinical remission. Understanding of the pivotal role of cytokines and adhesion molecules for the rheumatoid joint destruction enabled us to target these cytokines and molecules as therapeutic measures. Monoclonal antibodies were produced against the cytokines and adhesion molecules such as IL-1, IL-6, IL-6R, TNF-alpha, as well as CD4 molecules. Clinical use of these monoclonal antibodies was found to be effective for rheumatoid arthritis. However these therapeutic measures have several disadvantages such as transient efficacy and side effect.
10069413 Inhibition of IL-6 and IL-8 induction from cultured rheumatoid synovial fibroblasts by tre 1999 Feb Gold compounds have long been used in the treatment of rheumatoid arthritis (RA). However, their actions in RA have not been clarified. In this study, we examined the effect of one of the monovalent gold compounds, aurothioglucose (AuTG), on the IL-1-induced production of IL-6, IL-8 and granulocyte macrophage colony stimulating factor (GM-CSF) from rheumatoid synovial fibroblasts (RSF) isolated from three RA patients. IL-6 and IL-8 induction but not GM-CSF induction was inhibited in most of the RSF after pretreatment with AuTG. Since gene expression of these cytokines is known to be under the control of a common transcription factor, NF-kappaB, the effect of AuTG on the cellular localization of NF-kappaB (p65 subunit) and on NF-kappaB-DNA binding was examined. Although AuTG treatment did not prevent NF-kappaB nuclear translocation, AuTG blocked the DNA-binding activity of NF-kappaB when examined in vitro. Morphologically, both metal-specific cell staining using p-dimethylaminobenzylidene rhodamine and transmission electron microscopic examinations demonstrated the accumulation of metal gold in the cytoplama and some organella (mitochondria and lysosomes) of the AuTG-treated RSF. These results indicate that one of the anti-rheumatic actions of AuTG might be through its inhibitory action on NF-kappaB.
10817772 Major histocompatility complex haplotypic associations in Felty's syndrome and large granu 2000 Apr OBJECTIVE: To investigate the role of HLA class I in susceptibility to Felty's syndrome (FS) and large granular lymphocyte (LGL) syndrome. METHODS: Fifty caucasoid FS patients, and 55 patients with LGL syndrome, of whom 26 had arthritis and 29 did not, were studied. Complete HLA class I and HLA-DR typing including, where relevant, DRB1*04 subtyping was carried out by molecular methods. Comparison was made with 78 unselected healthy caucasoid controls and a further 29 DRB1*0401+ individuals. RESULTS: A significant association was found between HLA-A*02 and FS [odds ratio (OR) 3.9, 95% confidence interval (95% CI) 1.8-8.4, P = 0.0004]. At the B locus, there was an association between B*44 and LGL with arthritis [OR 3.5 (1.3-9.2), P = 0.01]. For HLA-Cw*0501, there was an association with FS [OR 4 (1. 7-9.2) P = 0.0008]. For both FS and LGL with arthritis, the extended haplotype HLA-A*02;B*44;Cw*0501;DRB1*0401 was significantly associated [OR 9.5 (2.6-35), P = 0.0001; OR 4.6 (1-22.4), P = 0.05, respectively]. There was no association between HLA class I or II and LGL without arthritis. All the allelic and haplotypic associations were lost on comparison with HLA-DRB1*0401+ controls. The strongest HLA association was with HLA-DRB1*0401 for FS [OR 27.9 (10.3-75.5), P = 10(-13)], and LGL with arthritis [OR 35.4 (9.6-131. 3), P = 10(-10)]. CONCLUSIONS: The major histocompatibility locus (MHC) associations with FS reported here are due to linkage disequilibrium with HLA-DRB1*0401. LGL syndrome with arthritis shows identical class II associations with FS, although there may be subtle immunogenetic differences between the two in the class I region. One of the extended haplotypes reported in a number of studies for FS and rheumatoid arthritis (summarized as HLA-A*02;Cw*0501; B*44;TNFb5;TNFa6;TNFd4;C4A*3;C4BQ*0;DRB1*0 401;DQB1*0301) is likely to be attributable to strong primary association with HLA-DRB1*0401, rather than to epistatic interaction between these loci.
10093810 Pathological fracture of a lumbar vertebra caused by rheumatoid arthritis--a case report. 1998 We describe a case of rheumatoid arthritis (RA) with collapse of the L3 lumbar vertebra for which surgery was performed. The pathogenesis of lumbar lesions affected by RA is discussed and the literature reviewed.