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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
10929343 Unicompartmental arthroplasty. Results in Sweden 1986-1995. 2000 Jun Since 1975 the Swedish Knee Register founded by the Swedish Orthopaedic society records primary knee arthroplasties and their revisions to evaluate indications, type of implants, revision rates etc. In the following, the results of unicompartmental arthroplasties (UKAs) are described. In osteoarthrosis UKAs have higher revision rates than total knee arthroplasties (TKAs), but a lower risk of serious complications and infections. Patients with medial UKA were as satisfied as patients with TKA. Furthermore, UKA is considerably cheaper than TKA. Therefore the use of an UKA seems to be a good alternative in appropriate patients.
11155808 Glucocorticosteroids in pregnant patients with rheumatoid arthritis. 2000 The ameliorating effect of pregnancy on rheumatoid arthritis (RA) has been well known since 1938 and repeatedly confirmed for 75% of RA pregnancies. Improvement of symptoms usually occurs already in the first trimester and increases as pregnancy progresses. A flare of RA is observed within 6 months after delivery in most patients. Originally believed to be due to the increase of cortisol during pregnancy, three studies of the 1950-60s did not find a correlation between cortisol levels and disease activity in pregnant patients. Also the timing of gestational improvement and the postpartum flare does not coincide with the rise and fall of cortisol levels. New research has disclosed neuroendocrine disturbances in RA including a relative glucocorticoid deficiency. The complex hormonal and immunological alterations of pregnancy may temporarily correct the neuroendocrine defects. The precise role of glucocorticoids in pregnancy-induced remission of RA still needs to be clarified.
11764350 Acetabular reconstruction with bone impaction grafting and a cemented cup: 20 years' exper 2001 Dec Acetabular bone stock loss compromises the outcome in primary and revision total hip arthroplasty. In 1979, a biologic method was introduced with tightly impacted cancellous allografts in combination with a cemented polyethylene cup for acetabular reconstruction. With this technique, it is possible to replace the loss of bone and to repair normal hip mechanics and hip function with a standard implant. Based on the authors' 20 years experience, a review of the long-term data is presented in primary total hip arthroplasty with preexisting acetabular bone stock loss, primary total hip arthroplasty in rheumatoid arthritis, patients who had bone impaction when younger than 50 years, and in acetabular revisions. The survival rate with revision of the cup for aseptic loosening as the end point was 94% at 10 to 17 years, 90% at 10 to 18 years, 91% at 10 to 17 years, and 92% at 10 to 15 years. From biopsy specimens from humans and histologic data in animal experiments the incorporation of these impacted bone chips was proven. The acetabular bone impaction technique using large morselized bone chips (range, 0.7-1 cm) and a cemented cup is a reliable technique with favorable long-term outcome.
9658347 Self-assessment of general health status in patients with five common shoulder conditions. 1998 May The SF-36 Health Survey is a patient self-administered general health status evaluation designed to measure the impact of disease on an individual's perception of his or her health. Five hundred forty-four patients with five common shoulder conditions (anterior glenohumeral instability (149 patients), complete reparable rotator cuff tear (111 patients), adhesive capsulitis (100 patients), glenohumeral osteoarthritis (67 patients), and impingement (117 patients)) completed the SF-36 Health Survey before undergoing treatment. When compared with U.S. general population norms, the patients with each of these shoulder conditions had statistically significant decreases in their health for Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, Role-Emotional, and the Physical Component Summary as measured by the SF-36 Health Survey. Comparison with published data demonstrated that these shoulder conditions rank in severity (in terms of affecting a patient's perception of his or her general health) with five major medical conditions (hypertension, congestive heart failure, acute myocardial infarction, diabetes mellitus, and clinical depression). The data presented in this study should serve as a baseline to document the impact of shoulder musculoskeletal conditions and possibly to allow comparison among various methods of operative and nonoperative treatment.
9767955 [Gene therapy in rheumatoid polyarthritis: perspectives]. 1998 Mar 28 THE CONCEPT OF GENE THERAPY: Gene therapy is applicable in diseases involving several genes such as rheumatoid arthritis. Gene transfer is the insertion in vivo of genetic material necessary to produce a molecule with therapeutic action. This strategy is currently in experimental stages; feasibility studies in humans are in the preliminary stage. SEVERAL TARGETS: In experimental models of rheumatoid arthritis, the most widely studied target genes are those which code for inflammation inhibitors such as IL-1 receptor antagonists or anti-inflammatory cytokines (IL-4, IL-10, IL-13). Another interesting target would concern genes coding for molecules inhibiting joint destruction (for example metalloprotease inhibitors). VECTORS: The development of high-performance vectors (both viral and nonviral vectors) will greatly improve the expected benefit/risk potential of gene therapy in general. IN RHEUMATOID ARTHRITIS: The particular problem in rheumatoid arthritis is the choice of the transfection site. An articular site would require multiple injections in the different affected joints. A systemic approach would take into account the general disseminated nature of the disease.
10211878 Expression of the activation antigen CD97 and its ligand CD55 in rheumatoid synovial tissu 1999 Apr OBJECTIVE: Fibroblast-like synoviocytes (FLS) express decay-accelerating factor (CD55) at high levels. Recently, it was found that CD55 is a specific cellular ligand for the 7-span transmembrane receptor CD97. The objective of this study was to define the expression of this receptor-ligand pair in synovial tissue (ST) to provide more insight into the interaction between FLS and surrounding cells. METHODS: Antibodies against CD97 and CD55 were used for immunohistologic analysis of synovial biopsy specimens from 16 patients with rheumatoid arthritis (RA) and 15 patients with osteoarthritis (OA). In addition, an enzyme-linked immunosorbent assay system was used to determine the expression of soluble CD97 (sCD97) in synovial fluid (SF) from 30 patients with RA, 13 with OA, and 10 with reactive arthritis (ReA). RESULTS: In both RA and OA ST sections, strong expression of CD55 was confirmed on FLS in the intimal lining layer, where it was also found that all macrophages expressed CD97. The percentage of macrophages that expressed CD97 was lower in the synovial sublining (P = 0.005). The mean levels of sCD97 in SF were significantly higher in RA patients than in patients with OA or ReA (P < 0.0001). CONCLUSION: These results suggest that FLS are able to interact with macrophages via the CD97/CD55 receptor-ligand system. In this respect, the CD97/CD55 pair may account for the specific architecture of the intimal lining layer and may be of primary importance in maintaining and amplifying synovial inflammation. The specific increase in sCD97 levels in RA SF might be related to the presence of activated proteolytic systems or to the increase in synovial mass, rather than a consequence of local receptor-ligand interaction.
10565345 Clinical use of lipids to control inflammatory disease. 1998 Mar Selective dietary supplementation with lipids has long been used to influence the course of chronic inflammatory diseases. This review describes new aspects of the molecular mechanism of lipids to modulate leukocyte activity and highlights some recent clinical studies on therapeutic lipid administration. New promising advances in parenteral application of lipids as well as the impact on acute inflammatory disorders are discussed.
9623878 Illness perceptions, coping and functioning in patients with rheumatoid arthritis, chronic 1998 May The present cross-sectional study analyzed the extent to which illness perceptions and coping strategies (as measured by the Illness Perception Questionnaire and the Utrecht Coping List, respectively) are associated with levels of daily functioning, as indicated by the Medical Outcomes Study SF-20, and disease-specific measures in 244 adults: 84 with rheumatoid arthritis (RA); 80 with chronic obstructive lung disease (COPD); and 80 with psoriasis. The results of stepwise regression analyses indicated that a strong illness identity, passive coping, belief in a long illness duration, belief in more severe consequences, and an unfavorable score on medical variables were associated with worse outcome on disease-specific measures of functioning and on general role and social functioning. Coping by seeking social support and beliefs in controllability/curability of the disease were significantly related to better functioning. The implications of these findings for future interventions and research are discussed.
11477412 Autoantibodies to GPI in rheumatoid arthritis: linkage between an animal model and human d 2001 Aug In K/BxN T cell receptor-transgenic mice, spontaneous inflammatory arthritis exhibiting many of the features of human rheumatoid arthritis (RA) is initiated by T cells, but is almost entirely sustained by antibodies to the self-antigen glucose-6-phosphate isomerase (GPI). The relevance of these observations to human disease has been questioned. Here we show that 64% of humans with RA, but not controls, had increased concentrations of anti-GPI immunoglobulin G (IgG) in serum and synovial fluid. In addition, the concentrations of soluble GPI in the sera and synovial fluids of RA patients were also elevated, which led to immune complex formation. Using phage-display methods, we cloned a panel of specific high-affinity human monoclonal anti-GPI IgGs from a patient with RA. These antibodies were highly somatically mutated, which was indicative of an affinity-matured response that was antigen driven. Immunohistochemistry of RA synovium showed high concentrations of GPI on the surface of the synovial lining and on the endothelial cell surface of arterioles; this indicated a mechanism by which antibodies to GPI may precipitate joint disease. The results indicate that the immunological events that lead to the development of autoimmune disease in the K/BxN mouse model may also occur in human RA. This data may be used to develop new strategies for therapeutic intervention.
10502019 [Long-term results of open knee synovectomy in later cases of rheumatoid arthritis]. 1999 Aug Open synovectomy of the knee in early cases has become a standard procedure in rheumatoid patients. Therefore, this study was performed to evaluate long-term results of open knee synovectomy in later cases of rheumatoid arthritis. Clinical findings in 93 knees after late open synovectomy are presented. The average follow-up was 10.1 (6.4-12.7) years. The failure rate was 39.8 per cent and so in 60.2 per cent (56 knees) no further operation was necessary. In 12 of 37 cases the revision was done by resynovectomy and reconstructive surgery. Thus during the follow-up period (10.1 years) in 73.1 (n=68) per cent of knee synovectomy no knee arthroplasty was performed. Patients reported as well reduction of pain and swelling with a high grade of satisfaction. Despite these reasonable functional results, radiographic progression of disease (Larsen stage 2.2 to 3.7) is common after synovectomy. Our study shows that late open synovectomy can delay the need for definite replacement surgery in nearly three-quarters of the patients.
9159542 Are rheumatoid arthritis patients more willing to accept non-steroidal anti-inflammatory d 1997 Apr One hundred and thirty-four patients with either osteoarthritis or rheumatoid arthritis, and with a history of current or past non-steroidal anti-inflammatory drug (NSAID) treatment, were interviewed regarding the benefits, expectations and side-effects of NSAID therapy. Their willingness to accept risks in medical treatment was also evaluated. Both groups experienced positive effects of the NSAID treatment corresponding to their expectations. However, rheumatoid arthritis patients were significantly more willing to accept gastrointestinal side-effects when given an effective NSAID than the osteoarthritis patients, and they were also more willing to take risks in trying a hypothetical new NSAID that had been shown to be effective in clinical trials.
11481991 [Endoprostheses for one hip and both knee joints in a patient with rheumatoid arthritis af 2001 The paper presents a case of hip prosthesis and ambilateral knee prosthesis after ambilateral supracondylar fractures of the femur healed in malposition in a patient with rheumatoid arthritis. The knee prosthesis were implanted without application of the femoral intramedullare rod. Three prosthesis were successfully implanted over a period of 8 weeks, obtaining pain relief and satisfactory range of movement.
10728758 A comparative study into the mechanisms of action of anti-tumor necrosis factor alpha, ant 2000 Mar OBJECTIVE: Anti-tumor necrosis factor alpha (anti-TNFalpha) therapy is very effective in rheumatoid arthritis (RA), whereas depleting anti-CD4 therapy is relatively ineffective. To explain the differences in efficacy between these 2 therapies, we used an animal model of RA to compare their effects on different aspects of the disease process. METHODS: Mice with collagen-induced arthritis were treated with depleting anti-CD4 monoclonal antibodies (mAb), anti-TNFalpha mAb, or phosphate buffered saline. Another group was given a combination of anti-TNFalpha plus anti-CD4. The treatments were compared for their ability to down-regulate the expression of proinflammatory cytokines and adhesion molecules, reduce the cellularity of the joint, and inhibit Th1 activity. RESULTS: Anti-TNFalpha significantly reduced the numbers of cells expressing TNFalpha, interleukin-1beta (IL-1beta), very late activation antigen 4 (VLA-4), vascular cell adhesion molecule 1 (VCAM-1), and numbers of CD4+ T cells and macrophages in the joint. Anti-CD4 treatment led to a small reduction in the expression of TNFalpha, IL-1beta, VLA-4, and VCAM-1, but this did not reach statistical significance. Depleting anti-CD4 was also surprisingly ineffective in eliminating CD4+ T cells from the joint. Anti-TNFalpha therapy was also more effective than anti-CD4 in reducing Thl activity, as assessed by the production of interferon-gamma in lymph node cell cultures. There was a synergistic relationship between anti-TNFalpha and anti-CD4 in the reduction of histologic score and inhibition of TNFalpha/IL-1beta expression in the joints. CONCLUSION: The efficacy of the 3 treatments correlated with their ability to modulate the expression of inflammatory cytokines and adhesion molecules in the joint, reduce the cellularity of the joint, and inhibit Th1 activity. This kind of analysis may prove useful in the testing of novel therapies for RA.
10895375 Insufficiency fractures in rheumatic patients: misdiagnosis and underlying characteristics 2000 May OBJECTIVE: To report 9 patients with rheumatic diseases referred to our observation due to presumed exacerbation of their rheumatic disease, subsequently diagnosed as stress insufficiency fractures, and to characterize the clinical profile of patients prone to this complication. METHODS: The medical history of the patients was reviewed with special emphasis on their rheumatic disease, its course, duration and management, their menopausal state, location and characteristics of the fracture, its presentation and the initial presumed diagnosis, the delay in diagnosis, imaging diagnostic tests performed and outcome. Three representative case reports are presented. RESULTS: All 9 patients were women, 8 of them aged 50 years old or more, 8 with rheumatoid arthritis and 1 with polymyalgia rheumatica. They were all treated with corticosteroids and had reduction in their bone mass density when evaluated. Three of the patients presented with subcapital fracture of the femur, 4 had fractures of metatarsal bones and 2 had fractures of the distal tibia. In only one patient was a stress fracture initially suspected. Diagnosis was delayed by a mean of 31 days. CONCLUSION: The diagnosis of stress fractures in patients with rheumatic diseases may often be delayed or missed, and thus improperly treated. Increased awareness of this entity is of importance for prompt diagnosis and correct management.
11341419 Long-term results of Kinematic Condylar knee replacement. An analysis of 404 knees. 2001 Apr We present the long-term results of the Kinematic Condylar Knee Arthroplasty followed in a prospective fashion. Between October 1982 and March 1988, 404 consecutive replacement arthroplasties were carried out on 335 patients. Of these, 354 knees had osteoarthritis, 45 rheumatoid arthritis and five other diagnoses. At the time of final follow-up 158 patients (188 knees) had died. No patient was lost to follow-up. The minimum follow-up for all living patients was ten years (10 to 17). The mean age at surgery was 68 years (30 to 92). There were seven complications (1.7%). Sixteen knees (3.9%) were revised, four because of infection. Survivorship was 99.4% (CI 97.9 to 99.8) at five years, 98.2% (CI 96.1 to 99.2) at ten years and 92.6% (CI 87.6 to 95.6) at 17 years.
9569066 Hypothalamic-pituitary-mediated immunomodulation: arginine vasopressin is a neuroendocrine 1998 Feb Organisms respond to a variety of environmental agents, such as those that cause inflammation, by mounting a coordinated complex series of adaptive responses involving the immune, nervous and endocrine systems. These adaptations are aimed at restoring the homeostatic balance and the return to the status quo ante. This interaction is facilitated by cytokines, hormones and neurotransmitters, as well as receptors that are endogenous to the neural, immune and endocrine systems. These shared ligands and receptors provide the molecular basis of this cross-talk. Studies of animal models of autoimmune diseases have shown that defects in the neuroendocrine immune communications contribute to the development of chronic inflammatory autoimmune disease. By analogy, similar observations have now been made in patients with inflammatory rheumatic disorders. For instance, patients with rheumatoid arthritis have abnormally low cortisol responses to inflammation, whilst the production of prolactin is excessive and dysregulated. Prolactin is a pro-inflammatory neuropeptide. This paper reviews the evidence to support the viewpoint that the neuropeptide arginine vasopressin, which is also produced by the hypothalamus, should be considered to be another neuroendocrine modulator of immune and inflammatory responses. It is also being hypothesized that the production of arginine vasopressin might be dysregulated and excessive in rheumatoid arthritis, and that this could be another additional neuroendocrine factor contributing to the pathophysiology of the disease.
10534546 The effects of dothiepin on subjects with rheumatoid arthritis and depression. 1999 Oct BACKGROUND: The relative importance of direct analgesic and antidepressant effects of antidepressant drugs in rheumatoid arthritis (RA) is not clear. METHOD: Forty-eight female out-patients with RA, with depression and/or anxiety, were entered into a double-blind, placebo-controlled study of dothiepin in doses up to 150 mg daily to assess the effects on mood [Hospital Anxiety and Depression (HAD) scale and Hamilton Rating Scale (HRS) for Depression], pain [visual analogue scale (VAS)] and disability [Health Assessment Questionnaire (HAQ)]. RESULTS: Repeated measures multivariate analysis of variance revealed that treatment had a significant effect on pain (F(d.f. 1,39) =5.7, P=0.02). There were further interaction effects between treatment and time on pain (F(d. f. 3,117) =3.3, P=0.03), disability (F(d.f. 3,117)=4.2, P=0.008) and duration of early morning stiffness (F(d.f. 3,117) =3.3, P=0.03). Depression (HRS) was considerably reduced in both the dothiepin and placebo groups, and there was no significant difference between groups. Post hoc analyses using analysis of covariance revealed that, in the dothiepin group, pain was significantly reduced by week 4 and remained so at week 12. Disability scores and duration of early morning stiffness were consistently lower in the dothiepin group, although differences failed to reach statistical significance at any follow-up assessment. In the group as a whole, reductions in pain were highly significantly correlated with reductions in HAD depression (r =0.63, P<0.0005), HAD anxiety (r=0.46, P=0.001) and HRS depression (r=0.37, P=0.01). CONCLUSION: Dothiepin is effective in relieving pain, disability and reducing the duration of early morning stiffness in out-patients with RA. Although there is a general association between pain reduction and improved anxiety and depression, the analgesic effect of dothiepin is independent of its antidepressant effect. Individual variation is considerable and further research should try to identify mechanisms of interaction between the antidepressant and analgesic effects of treatment in different patient groups.
9645410 Allergic disorders in primary Sjögren's syndrome. 1998 Allergic disorders have been described in a variety of connective tissue disorders. Although an association between allergy and primary Sjögren's syndrome has been suggested, it has not been well documented. The purpose of this study was to analyze the prevalence of several types of allergic disorders in a cohort of primary Sjögren's syndrome patients. The presence of an allergic disorder was evaluated by a specific questionnaire in 65 randomly selected primary Sjögren's syndrome patients and was compared to control groups of 67 rheumatoid arthritis patients, 53 patients with rheumatoid arthritis and sicca symptoms, and 31 patients with osteoarthritis. At least one type of allergic manifestation was reported by 42 of the 65 Sjögren's syndrome patients (65%). This rate was significantly higher than each of the three control groups (p < 0.01). Only drug allergy and skin contact allergy were found to be more prevalent in Sjögren's syndrome patients than in the control groups (p< 0.05). Allergic reactions were more common in Sjögren's syndrome patients who were anti-Ro positive (p < 0.05). As drug and skin contact allergies are a frequent finding in Sjögren's syndrome patients, obtaining a careful history is needed before prescribing drugs in these patients.
9310105 A 20-year follow-up study of subtalar changes in rheumatoid arthritis. 1997 The destruction of the subtalar joints in 103 seropositive RA patients with recent (< or = 6 months) disease was evaluated radiographically in a prospective follow-up study at onset and at 1, 3, 8, 15, and 20 years from entry. A total of 83 patients attended the 15-year follow-up and 68 the 20-year follow-up. The Larsen grades of the joints were evaluated and the need for surgical treatment considered. At the 15-year follow-up the mean Larsen grade was 1.2 (median 0) and at the 20-year follow-up 1.3 (median 0); at the 20-year follow-up 77 subtalar joints were still assessed as Larsen grade 0. In this series, subtalar fusions were performed in 12 patients only. Spontaneous fusions occurred in 5 hindfeet in 3 patients. The destruction rate of the subtalar joint was lower than in previous retrospective or cross-sectional studies. The need for routine radiographs of ankles in RA patients is questioned.
11197789 Multiseptate gallbladder with cholelithiasis diagnosed incidentially in an elderly patient 2000 Dec A 70-year-old woman with rheumatoid arthritis was admitted to our hospital because of gastric ulcers. Abdominal echography incidentally revealed that the patient's gallbladder was multiseptate, an extremely rare anomaly. The diagnosis was confirmed by endoscopic retrograde cholangiography. This is the 26th case of multiseptate gallbladder in the world literature, but the patient is the oldest yet recorded with this condition. Furthermore, unlike most patients with multiseptate gallbladder, she had no biliary symptoms with concomitant cholelithiasis.