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ID PMID Title PublicationDate abstract
9749680 ABILHAND: a Rasch-built measure of manual ability. 1998 Sep OBJECTIVE: To apply the Rasch measurement model to the development of a clinical tool for measuring manual (dis)ability (ABILHAND). DESIGN: Manual ability was evaluated in terms of the difficulty perceived by a hand-impaired patient on 57 representative unimanual or bimanual activities. SETTING: A clinical laboratory. PATIENTS: Eighteen rheumatoid arthritis patients (14 women, 4 men) were interviewed after wrist arthrodesis (10 right, 4 left, and 4 both wrists). Their ages ranged from 38 to 77 years, time since diagnosis ranged from 7 to 41 years, and time since surgery ranged from 0.5 to 17 years. MAIN OUTCOME MEASURE: ABILHAND, administered at a mean duration of 7 years after arthrodesis. RESULTS: Forty-six of the 57 items define a common, single manual ability continuum with widespread measurement range and regular item distribution. Items relating to feeding, grooming, and dressing upper body worked consistently with their counterparts in other disability scales. More difficult items extend the measurement range beyond that of most existing manual ability scales. CONCLUSION: Even in a small sample of patients, using the Rasch methodology enabled the investigators to produce a useful scale of manual (dis)ability and to define manual ability as a unique construct, at least in patients with rheumatoid arthritis.
9495579 Antagonism of the IL-6 cytokine subfamily--a potential strategy for more effective therapy 1998 Jan Pro-inflammatory cytokines, some of which have the capacity to modulate cartilage and bone metabolism, are important mediators of the frequently sustained and destructive inflammation that characterises rheumatoid arthritis (RA). Tumour necrosis factor alpha (TNF alpha) and interleukin-1 (IL-1) have been studied extensively in this regard. That these proteins are important is no longer in doubt following the demonstration that the IL-1 receptor antagonist and neutralising antibodies directed against TNF alpha are clinically effective. Recent studies suggest that interleukin-6 (IL-6) and other members of the IL-6 cytokine subfamily are also potentially important cytokines in the pathogenesis of RA. The recognition of shared molecular subunits in the receptors for these cytokines raises the possibility that components of these receptors or their derivatives, either alone or in combination, may be useful for antagonising members of the IL-6 cytokine subfamily. Effective antagonism could be therapeutically beneficial in respect to attenuating inflammation and protecting critically important chondral and skeletal tissue. In this review the rationale and possible strategies for such antagonism are discussed.
9444414 Methotrexate as the initial second-line disease modifying agent in the treatment of rheuma 1997 Nov OBJECTIVE: To assess the efficacy and toxicity profile of methotrexate (MTX) as the initial second-line disease modifying anti-rheumatic drug (DMARD) in rheumatoid arthritis (RA). METHODS: This was an observational retrospective cohort study comparing 28 patients who were treated with MTX as the first DMARD (MTX cases) and 55 matched patients treated with MTX after other DMARDs (MTX controls). RESULTS: The follow-up time was identical in the two groups: 19.4 +/- 14 months (2-56) for the MTX cases and 21.8 +/- 15.3 months (3-87) for MTX controls (NS). MTX efficacy was the same in the two groups, except for a higher incidence of remission in the MTX cases (8/28, 28.6% versus 5/55, 9.1%, p = 0.028). The toxicity profiles, frequencies, and reasons for MTX withdrawals were similar in the two groups. CONCLUSION: The results obtained in this study suggest a benefit from MTX prescribed as an initial second-line agent in the treatment of RA, but studies involving a larger number of patients are needed.
9057932 Comparative analysis of CD45RA- and CD45RO-positive CD4+T cells in peripheral blood, synov 1997 Feb To determine whether the predominant infiltration with memory CD4+T cells in joints is specific to the local immune and inflammatory response in rheumatoid arthritis (RA), the proportions of CD45RA+ or CD45RO+ cells in the CD4+T cell populations in three different compartments (i.e., peripheral blood, synovial fluid, and synovial tissue) from patients with RA and osteoarthritis (OA) were compared by two-color flow-cytometric analysis. In the CD4+T cell population of peripheral blood, the number of CD45RO+ cells was relatively higher than CD45RA+ cells in both RA and OA patients, but their percentages did not differ from those found in healthy individuals. However, the great majority of CD4+T cells present in synovial fluid and synovial tissue were CD45RO-positive and CD45RA-negative in both patient groups; although CD4+T cells infiltrating both the disease compartments were markedly greater in RA joints, their mean percentages of CD45RO+ cells were not significantly different from those in OA joints. These data indicate that an accumulation of CD45RO+ memory CD4+T cells is a generalized phenomenon during local inflammatory responses in both RA and OA joints, and may be due mainly to the propensity of these cells to preferentially transmigrate into the inflamed joint via adhesion molecules as compared with CD45RA+ naive CD4+T cells.
11879548 Proinflammatory activity of TWEAK on human dermal fibroblasts and synoviocytes: blocking a 2002 Human tumour necrosis factor (TNF)-like weak inducer of apoptosis (hTWEAK) and two anti-hTWEAK mAbs were tested for their ability to elicit or block inflammatory responses in cultured human dermal fibroblasts and synoviocytes. Incubation with hTWEAK increased the production of prostaglandin E2, matrix metalloproteinase-1 (MMP-1), IL-6, and the chemokines IL-8, RANTES (regulated on activation, normal T expressed and secreted) and interferon-gamma-inducible protein-10 (IP-10) in culture supernatant of fibroblasts and synoviocytes. In combination with TNF or IL-1beta, hTWEAK further stimulated the secretion of prostaglandin E2, MMP-1, IL-6 and IL-8 up to fourfold, and IP-10 and RANTES up to 70-fold compared to TNF or IL-1beta alone. An anti-hTWEAK mAb, BCB10, blocked the effects of hTWEAK, whereas hTWEAK crosslinked by the anti-hTWEAK mAb, BEB3, further stimulated the inflammatory response of fibroblasts and synoviocytes. The anti-hTWEAK mAbs were ineffective in blocking or increasing the responses of TNF or IL-1beta and blocking anti-TNF mAb was ineffective in preventing the responses to TWEAK. These results were also confirmed at the RNA level for MMP-1, macrophage chemoattractant protein-1, RANTES, macrophage inflammatory protein-1alpha, IP-10 and IL-8. TWEAK in synergism with IL-1 and TNF may be an additional cytokine that plays a role in destructive chronic arthritic diseases.
9714349 Pregnancy outcome and anti-Ro/SSA in autoimmune diseases: a retrospective cohort study. 1998 Jul OBJECTIVE: In the present retrospective cohort study, the association of anti-Ro/SSA antibody with pregnancy loss and adverse pregnancy outcome in women with autoimmune diseases was investigated. MATERIALS AND METHODS: Obstetric histories of 154 anti-Ro/SSA-positive women with autoimmune diseases [78 systemic lupus erythematosus (SLE) and 76 non-SLE] were analysed and compared to a control group of 142 anti-Ro/SSA-negative women (71 SLE and 71 non-SLE) matched for disease diagnosis and age at the time of anti-Ro/SSA diagnosis. Obstetric history was also obtained and analysed from a group of healthy women, frequency matched to anti-Ro/SSA-positive women on age at study entry. RESULTS: The rate of pregnancy loss and adverse pregnancy outcome did not differ significantly between anti-Ro/SSA-positive women, anti-Ro/SSA-negative women and healthy controls. Anti-Ro/SSA-positive SLE women reported a significantly higher rate (18.0%) of therapeutic abortions compared to anti-Ro/SSA-negative women (5.6%, P=0.0244) and healthy controls (4.6%, P=0.0013). Anti-Ro/SSA non-SLE-positive women reported a significantly higher rate (23.7%) of recurrent pregnancy loss in comparison to anti-Ro/SSA-negative women (7.04%, P=0.0063) and healthy controls (6.4%, P=0.0004). CONCLUSIONS: Although anti-Ro/SSA antibody does not adversely affect pregnancy outcome in SLE patients, it appears to be associated with recurrent pregnancy loss in non-SLE patients.
11292975 [New drugs require nw follow-up surveillance]. 2001 Feb 28 The marketing of new drugs has been sped up considerably, partly as a consequence of the common EU regulatory system. At the time of approval the documentation concerning long-term effects and health economic outcomes of a new drug is scanty. This is of particular relevance to chronic and debilitating diseases like rheumatoid arthritis. In the field of rheumatology new, expensive, and clinically effective drugs have been marketed recently. This has lead to subsequent problems in the setting of priorities at the clinical as well as the administrative level. The demand for appropriate systems for following up of effects, toxicity and economy of these drugs has compelled the Swedish Society for Rheumatology and the Medical Products Agency to establish a surveillance system for TNF-blockers. This was implemented already in the pre-marketing phase, and is presently being continued as an observational study after approval. Experience from the development phase of this system and some preliminary results are presented.
10882166 Infliximab: a review of its use in the management of rheumatoid arthritis. 2000 Jun Infliximab is a chimaeric monoclonal antibody to human tumour necrosis factor-alpha (TNFalpha). It binds to both soluble and transmembrane forms of TNFalpha at picomolar concentrations in vitro. Secondary to inhibition of TNFalpha, infliximab reduces serum levels of inflammatory mediators and vascular endothelial growth factor, decreases the expression of chemokines in the synovial tissue and reduces lymphocyte migration into the joints of patients with rheumatoid arthritis. In 2 multicentre randomised double-blind trials conducted over 26 and 30 weeks, infliximab plus methotrexate was significantly more effective than placebo plus methotrexate according to American College of Rheumatology response criteria in patients with active rheumatoid arthritis. A substantial response to infliximab-containing regimens was evident within 2 weeks. Extension phases of these studies indicate sustained clinical efficacy for up to 54 weeks. Of considerable importance are preliminary 1-year radiographic findings that show zero median progression of joint damage in infliximab plus methotrexate recipients compared with a 7 to 8% deterioration in placebo plus methotrexate recipients. Headache, nausea, upper respiratory tract infection and infusion-related reactions are the most commonly reported adverse events with infliximab. Serious events occurred in 4.4% of infliximab versus 1.8% of placebo recipients. In the largest clinical trial, 2 patients died from disseminated infection and 3 developed new or recurrent malignancies, although the exact relationship between infliximab and these events is unknown. To date, 2 patients with rheumatoid arthritis have developed drug-induced lupus. About 10% of patients may develop antibodies to infliximab, although the clinical significance of these is presently unknown. CONCLUSION: Infliximab represents an important advance in the treatment of rheumatoid arthritis, with tolerability concerns raised by early studies having been eased somewhat by more recent data in larger patient numbers. If preliminary results indicating that infliximab is able to arrest joint destruction in patients with rheumatoid arthritis are corroborated, the drug will likely become an integral component of future management strategies for this difficult-to-treat condition.
10914502 The colony-stimulating factors and collagen-induced arthritis: exacerbation of disease by 2000 Jul There is increasing evidence that the colony-stimulating factors (CSFs) may play a part in chronic inflammatory autoimmune diseases, such as rheumatoid arthritis (RA). We examined the involvement of macrophage CSF (M-CSF or CSF-1) and granulocyte CSF (G-CSF) in collagen-induced arthritis (CIA), a murine model of RA. Daily injections of M-CSF or G-CSF, 20-24 days postprimary immunization with type II collagen, exacerbated disease symptoms in suboptimally immunized DBA/1 mice. Support for the involvement of endogenous M-CSF in CIA was obtained by studies in which neutralizing monoclonal antibody reduced the severity of established CIA and also by studies showing the resistance of M-CSF-deficient op/op mice to CIA induction. These studies show that M-CSF and G-CSF can be proinflammatory in CIA and provide evidence that macrophage- and granulocyte-lineage cells can exacerbate CIA. Our results also show that M-CSF-dependent cells are essential for CIA development, suggesting M-CSF may be a suitable target for therapeutic intervention in RA.
11783300 [Clinical observation of side effects of Tripterygium preparation]. 1999 Feb OBJECTIVE: To observe the side effects of Tripterygium preparation (TP) in the course of treatment. METHODS: Two hundred and seventy-one cases of patients with rheumatoid arthritis (RA) were treated using various TP to observe the occurrence of adverse reaction. RESULTS: The influence on reproductive system with TP extracted from the leaf ester tab were less than that from the root (TP tab and TP multiglycoside tab, TPMG). In group of TPMG the rate of side effect of 60 mg daily dosage was more than 30 mg daily (P < 0.01). The main influence on digestive tract and irregular menstruation was before age of 50 years and on renal function was after age of 50 years. Those adverse reactions mainly occur within first ten years in long therapy period. The side effects of TPMG produced in the Dampness-Heat type of RA were lower than Yin-Deficiency of Liver and Kidney type of RA (P < 0.05). CONCLUSION: TP ester tab is available for young woman and TPMG tab is suitable for the Dampness-Heat type of RA with lower dosis maintenance therapy.
9133923 Symmetrical synovial fluid cell cytokine messenger RNA expression in rheumatoid arthritis: 1997 Feb To investigate the complex intra-articular immune activity in rheumatoid arthritis (RA), we analysed the expression of a wide range of cytokine mRNAs in synovial fluid cells from patients with rheumatoid arthritis. To minimize in vitro artefact, mRNA was rapidly extracted from synovial fluid leucocytes taken from single joints of seven patients and simultaneously from both knee joints of four patients. Expression of interleukin (IL) 1 beta, IL-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, tumour necrosis factor-alpha and interferon-gamma (IFN-gamma) was detected using the reverse transcription/polymerase chain reaction. The expression of cytokines varied between patients. IFN-gamma mRNA was detected in 60% of the patients and IL-4 mRNA in 10%. Cytokine expression in both knees was very similar. These results suggest that T-cell activity in RA is detectable using sensitive techniques and that the intra-articular immunopathology of RA is systemically very similar.
11091285 Reduced expression of the complement receptor type 2 (CR2, CD21) by synovial fluid B and T 2000 Nov The expression of CR2 (CD21) by synovial B and T lymphocytes of patients suffering from various forms of arthritis was analysed with cytofluorometry and with reverse transcriptase-polymerase chain reaction. CR2 (CD21) cell surface protein was detected in normal quantities on peripheral B cells, but was almost absent on synovial B lymphocytes of the same patients. This reduction was most severe in patients with rheumatoid arthritis, but also observed in all other cases. CR2 (CD21) did not reappear after in vitro culture. CR2 (CD21) mRNA was also strongly reduced in synovial B and T lymphocytes. Synovial fluid B lymphocytes were larger than peripheral blood B lymphocytes, while T cells from the same patients showed no size differences. We conclude that synovial fluid B lymphocytes have undergone an irreversible step towards terminal differentiation. The presence or absence of CR2 (CD21) mRNA in peripheral versus synovial T cells indicates that CR2 (CD21) is also differentially expressed by T lymphocytes.
9862686 The development of autoimmune inflammatory arthropathy in mice transgenic for the human T 1998 Dec 15 Previously, we reported that human T cell leukemia virus type-1 env-pX region-introduced transgenic (pX-Tg) mice develop an inflammatory polyarthropathy. Although autoimmune pathogenesis was suggested, the detailed mechanisms remain to be elucidated. In this report, we examined effects of the MHC and fas genes on the development of the disease. When pX-Tg mice were backcrossed with different inbred strains, the incidence of arthritis differed among strains; 64% and 72% in BALB/cAn (H-2d), 25% and 46% in C3H/HeN (H-2k), and 0% and 2% in C57BL/6J (H-2b) background at 3 and 6 months of age, respectively. Rheumatoid factor levels in the serum correlated with the susceptibility to the disease, whereas IL-1beta and MHC gene expression were similarly elevated in all of these strains, suggesting involvement of immune regulatory genes in this strain difference. However, introduction of the H-2d locus into C57BL/6J pX-Tg mice did not increase the incidence of arthritis, and substitution of the BALB/cAn H-2 locus with the H-2b did not decrease it. The results indicate that the H-2 locus is not the major determinant of the disease. Then, since previous study indicated a defect in Fas-mediated apoptosis of transgenic T cells, the effects of fas gene modification on the disease were examined. The incidence increased when these pX-Tg mice were crossed with lpr/lpr mice, while it decreased when crossed with fas-transgenic mice. These observations suggest that aberration of Fas-mediated apoptosis of peripheral lymphocytes, rather than negative selection in the thymus, is involved in the development of autoimmune arthropathy in pX-Tg mice.
9134821 Hyperprolactinemia in systemic lupus erythematosus. 1997 Jan BACKGROUND: Recent evidence demonstrates that hyperprolactinemia was found in active systemic lupus erythematosus (SLE). This indicates prolactin (PRL) is an important immunoregulator and may play a role in the pathogenesis of SLE. However, study of the prevalence and the clinical significance of hyperprolactinemia in SLE and other rheumatic disease has rarely been carried out. METHODS: From January 1995 to January 1996, 79 individuals were enrolled in this study. PRL levels of 30 cases of SLE were compared with those in 29 rheumatoid arthritis (RA) and 20 normal healthy volunteers. Moreover, a correlation between levels of PRL and SLE disease activity index (SLEDAI) in SLE patients was studied. RESULTS: The mean value of serum PRL level in SLE patients (19.35 +/- 11.33 ng/dl) was significantly higher than in RA patients (12.33 +/- 8.30 nd/dl, p < 0.05). The difference was more pronounced between SLE patients and healthy individuals (12.01 +/- 7.53 ng/dl, p < 0.01). However, patients with RA had no significant difference from the control group. Analysis made between SLEDAI and PRL levels in SLE patients revealed no significant correlation (r = 0.537, p = 0.07). Furthermore, no significant correlation was found between antinuclear antibody (ANA), C3, C4, anti-DNA and hyperprolactinemia. CONCLUSIONS: This study has shown that hyperprolactinemia is prevalent in random SLE patients, but not in RA patients. The elevated PRL levels seem not to be associated with disease activity and ANA positivity.
10658353 Arthrosonography in the evaluation of osteoarticular and soft-tissue structures in rheumat 1998 BACKGROUND: Real-time ultrasonography is a widely available, reliable, diagnostically sensitive and specific noninvasive modality which allows measuring of the thickness of different anatomical landmarks which form joints, of the periarticular soft tissue and connective tissue structures, of their echogenicity and the amount of joint effusion. The present study was designed to assess the clinical and diagnostic applicability of high-frequency ultrasonography in rheumatology. METHODS: We used SONOACE 1500 (Medison Europe GmbH) with a 7.5 MHz transducer. RESULTS: We demonstrate the most characteristic ultrasonographic patterns which have diagnostic significance in the seven most common rheumatologic disorders. DISCUSSION: The pathological ultrasonographic patterns of the joints, periarticular and soft-tissue structures in rheumatologic disorders we present give an insight into the clinical applicability of arthrosonography and its inherent advantages over the conventional radiological examination--namely, ultrasonography is noninvasive, uses no radiation, which allows reproducibility and follow-up, widely available and relatively inexpensive and as such can be performed at bedside or on an outpatient basis.
11550967 Fas promoter -670 polymorphism is associated with development of anti-RNP antibodies in sy 2001 Sep OBJECTIVE: To evaluate whether the polymorphism of Fas promoter -670 is associated with susceptibility to systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and their clinical features. METHODS: A polymerase chain reaction of a genomic DNA-restriction fragment length polymorphism was used to determine genotypes of the Fas promoter -670 in 87 patients with SLE, 87 with RA, and 87 healthy controls. A second cohort of SLE patients (n = 85) was included. Clinical manifestations were analyzed in each patient and correlated with the genotypes. RESULTS: The genotype distribution of the Fas promoter -670 did not differ between patients with SLE and control subjects (AA, GA, GG genotypes 31, 54, 15% vs 30, 55, 15% controls, respectively; chi-squared = 0.03, 2 df, p = 0.99) and between RA patients and controls (AA, GA, GG genotypes 38, 44, 18% vs 30, 55, 15% controls, respectively; chi-squared = 2.30, 2 df, p = 0.32). Regarding the clinical status of lupus patients according to Fas promoter -670 genotypes, there was no significant difference in age at onset, anti-dsDNA titer, C3, C4 level, renal involvement, number of American College of Rheumatology (ACR) criteria met, SLE Disease Activity Index, SLE International Collaborating Clinics/ACR Damage Index, or autoantibody profiles. However, the frequency of anti-RNP antibody was significantly different in the AA, GA, and GG groups (71, 25, 30%; chi-squared = 13.29, 2 df, p = 0.001). To confirm this finding, the Fas promoter -670 genotype was examined in a second cohort of SLE patients (n = 85). The result in the second cohort replicated the association shown in the first. In patients with RA, there was no significant difference in clinical and laboratory findings according to the Fas promoter -670 genotypes. CONCLUSION: Our data suggest that the Fas promoter -670 polymorphism is associated with development of anti-RNP antibodies in SLE.
10640117 Pain, coping and analgesic medication usage in rheumatoid arthritis patients. 1999 May The major purposes of this study were to describe pain characteristics and coping strategies used in rheumatoid arthritis (RA) patients. Further purposes were to examine relationships among pain, coping and analgesic medication intake. Sixty-eight consecutively sampled subjects with RA participated in the study. The Pain-O-Meter was used to evaluate pain intensity and quality, and the Coping Strategies Questionnaire (CSQ) to determine coping strategies. The results showed that the patients with RA scored more intense sensory than affective pain although they used more affective pain descriptors. The sensory and total pain components were related to coping self-statements and increased pain activities. There were significant relationships between analgesic medication intake and all coping strategies used in the RA patients. The findings' implication for education and treatment are discussed.
9203515 Lymphocytotoxic antibodies in Israeli patients with rheumatoid arthritis. 1997 Jan The presence, antigenic specificity, and clinical role of lymphocytotoxic antibodies (LCAs) were studied in 72 Israeli patients with rheumatoid arthritis (RA). Using the microlymphocytotoxicity assay on a cell panel of 47 donors, LCAs were found in 55% of the 72 RA sera, each displaying a distinct pattern of anti-lymphocytic reactivity, mostly against B lymphocytes. Human lymphocytic antigens (HLA) analysis of donors' lymphocytes suggested that activity of LCA-positive RA sera is HLA directed in 60% of cytotoxic sera. The anti-HLA antibodies found were not autoreactive and were not restricted to a particular class I or class II antigen. Relating the presence of LCAs to selective clinical features revealed that LCAs are inversely associated with the presence of an erosive disease (P <0.01) and with the patients' HLA-DQw1 (P <0.01). These findings suggest that LCAs in Israeli patients with RA are very common, multispecific and may have a protective role not mediated through interaction with self-HLA antigens.
9753758 Total wrist arthroplasty. 1998 Sep Although arthroplasty is a well-established procedure for many joints, its use in the wrist is less common, and the indications are less well defined. The standard procedure for the painful arthritic wrist remains radiocarpal arthrodesis. However, as technology and surgical procedures improve, wrist arthroplasty is being used more frequently. The authors provide a brief history of total wrist arthroplasty and review the arthroplasties most commonly used in the United States. Results with total wrist implants, the complications related to arthroplasty, technical aspects of the procedure, and salvage options are also discussed.
9198490 [Sacroiliitis:the key symptom of spondylarthropathies. 2: morphological aspects]. 1997 Apr Because of their curved course and segmental convolution of articular surfaces, the anatomy of the sacroiliac joints is complex. An important part of the diagnosis of sacroiliitis of spondyloarthropathy patients relies on radiographic imaging techniques: x-ray, conventional tomography, computed tomography (CT) and scintigraphy. Diagnosis can be difficult in early and acute stages of sacroiliitis because radiographic findings may be normal, although dynamic magnetic resonance imaging (MRI) of the sacroiliac joints certainly enables to detect chronic as well as acute inflammatory changes. In spondyloarthropathy patients with acute sacroiliitis or acute exacerbation of chronic sacroiliitis who do not respond to or do not tolerate non-steroidal antiinflammatory drugs, CT-guided corticosteroid injection into the sacroiliac joints has proved to be an effective therapy.