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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
17984880 The humeral joint in rheumatoid arthritis: Diagnostics and treatment. 2000 Dec 30 This article presents the clinical picture of inflammatory changes to the anatomical structures comprising the shoulder joint in patients with rheumatoid arthritis. The author discusses the symptomatology, diagnosis, and treatment of inflammatory changes in the synovial sheath and tendon of the long head of the biceps, the subacromial bursa, and the rotator cuff, and in the humeroscapular joint.
19078179 Listeria monocytogenes Infection In a Prosthetic Knee Joint In Rheumatoid Arthritis During 1997 Jun A 70-year-old man with rheumatoid arthritis developed Listeria monocytogenes septic arthritis in his prosthetic right knee. He initially responded well to ampicillin, but later developed relapse of Listeria joint infection. The prosthesis was removed, and arthrodesis was performed. This report suggests that prolonged antimicrobial treatment is necessary to cure this rare cause of septic arthritis of prosthetic joints in immunocompromised patients.
19078380 Disseminated herpes zoster and s. Aureus septic arthritis in a rheumatoid arthritis patien 1999 Jun A recalcitrant rheumatoid arthritis patient taking low dose weekly methotrexate was given oral 2-chlorodeoxyadenosine (cladribine) for 8 months in a multicenter trial. He developed dual infections over the course of the trial: disseminated herpes zoster and staphylococcal arthritis of the right elbow. His disseminated herpes zoster started with severe, unremitting abdominal pain caused by a gastric ulcer, followed by disseminated cutaneous herpes, hepatitis, pancreatitis, encephalitis, homonymous hemianopsia, the syndrome of inappropriate secretion of antidiuretic hormone (ADH), and malabsorption. Both the herpes zoster and S. aureus infections required prolonged proper chemotherapies. Serious, complicated viral, bacterial, or other unusual infections should be considered in patients with severe rheumatoid conditions treated with combination immunosuppressive therapy.
9066903 Identification of childhood arthritis in archaeological material: juvenile rheumatoid arth 1997 Feb The opportunity to examine the defleshed skeleton of an individual diagnosed in life (Hamann-Todd collection, individual 2036) afforded a unique opportunity to demonstrate the bone damage characteristic of at least one form of juvenile rheumatoid arthritis (JRA). Characteristics helpful for recognition of JRA in archaeological material include peripheral articular marginal and subchondral erosions, axial (e.g., zygapophyseal or sacroiliac) joint erosions, fusion of axial (cervical zygapophyseal) and/or peripheral joints, premature epiphyseal closure and/or ballooned epiphyses, growth retardation with underdeveloped (short and overtubulated) long bones, short mandibular rami with underdeveloped condyles and concomitant micrognathia, and demineralization (osteopenia). Distinguishing between JRA and juvenile spondyloarthropathy, however, is not always possible, as illustrated by this case.
10936986 Juvenile rheumatoid arthritis presented with thrombocytopenia. 2000 Apr Leukopenia and thrombocytopenia are rare findings in systemic onset juvenile rheumatoid arthritis (S-JRA), and if present, bone marrow (BM) examination is necessary to exclude malignant diseases. We report here a 13.5-year-old boy with S-JRA who had severe thrombocytopenia and mild leukopenia, without arthritis, at the onset of the disease. BM was hypercellular with increased numbers of myeloid precursors and megakaryocytes. After treatment with acetylsalicylic acid, leukocyte and platelet counts returned to normal levels, and after two months chronic arthritis developed.
11455148 Persistent plaques and linear pigmentation in adult-onset Still's disease. 2001 A 25-year-old Japanese man presented with high spiking fever, arthralgia and a skin rash. A pruritic edematous erythema with persistent plaques was found mainly on the trunk; these lesions persisted even when the fever subsided, with prominent linear pigmentation. As marked neutrophilia and a high level of serum ferritin were detected, a diagnosis of adult-onset Still's disease (AOSD) was made, even though the persistent eruption was not characteristic of the disease. Oral prednisolone, together with low-dose methotrexate, was given with good results. In the literature, a similar atypical rash has been reported in 11 cases in Japan. All of them required high-dose administration of corticosteroids or other immunosuppressive agents. Severe systemic complications were seen in 3 patients, and 2 cases died of the disease. Persistent plaques and linear pigmentation are some of the manifestations of AOSD, which cannot be overlooked. This appearance could be an indication that suggests an increased risk of systemic complications and a prolonged time to clinical remission.
11526269 Knee in early juvenile rheumatoid arthritis: MR imaging findings. 2001 Sep PURPOSE: To determine the magnetic resonance (MR) imaging findings in the knee in early juvenile rheumatoid arthritis. MATERIALS AND METHODS: MR imaging (1.5 T) was performed in the more symptomatic knee in 30 children with juvenile rheumatoid arthritis with a symptom duration 1 year or less. Conventional, fast spin-echo, three-dimensional gradient-echo, and gadolinium-enhanced T1-weighted images were assessed. Two radiologists independently read the images, and a third resolved disagreements. These images were compared with knee radiographs in 27 children. RESULTS: Mean maximal synovial thickness was 4.8 mm +/- 2.4 (SD). Mean synovial volume was 15.4 mL +/- 10.8. Suprapatellar joint effusions were seen in 26 (87%) of 30 knees, meniscal hypoplasia in 11 (37%) of 30 knees, and abnormal epiphyseal marrow in eight (27%) of 30 knees. Three knees had articular cartilage contour irregularity, fissures, and/or thinning. One knee had a bone erosion. Knee radiographs showed suprapatellar fullness in 78% of the knees, joint space narrowing in one knee, and no bone abnormalities. CONCLUSION: Synovial hypertrophy and joint effusions are the most frequent MR imaging findings of knees in early juvenile rheumatoid arthritis. Early in the disease, radiographically occult cartilage and bone erosions are uncommonly seen at MR imaging. The potential relationship of synovitis to cartilage abnormalities deserves further study.
11774654 [Subclinical Sjögren's syndrome]. 1998 Sep OBJECTIVE: To investigate various manifestations and treatment of subclinical Sjögren's syndrome (SS). METHODS: A long term clinical, laboratory and sialographic observations were performed in 24 patients with subclinical SS. Injectin of thymosin intramusularly was used to treat the patients and clinical effect of this treatment was evaluated. RESULTS: All of 24 cases had experienced recurrent parotid swellings (RPS) for 2-17 years (mean 7 years) before dry mouth and dry eyes occurred and all of them were misdiagnosed as chronic suppurative parotitis or sialadenitis. Follow-up showed that all of these patients developed SS. Vasculitis was found in 8 cases, purpura in 2 cases. The vascular involvement was relatively common in subclinical SS. Main sialographic findings was sialectasis of terminal ducts with irregular dilation of main duct. Frequency of RPS was markedly decreased in the patients treated with thymosin. CONCLUSION: The proposal of subclinical SS has theoretical value for understanding the entity and reclassification of chronic suppurative parotitis, and has guide value for diagnosis and treatment of SS in the early stage. Injection of thymosin is considered an effective therapy to reduce RPS in subclinical SS.
9068291 Methotrexate treatment in patients with adult onset Still's disease--retrospective study o 1997 Feb OBJECTIVE: To evaluate methotrexate treatment in patients with active adult onset Still's disease (AOSD). METHODS: Methotrexate was initially given as a single weekly oral dose of 5 mg and adjusted individually afterwards in 13 patients with active AOSD. Symptoms and laboratory findings were investigated. RESULTS: Signs of AOSD activity disappeared (remission) in eight patients between 3 and 16 weeks after starting methotrexate. In these patients, significant improvements in C reactive protein, erythrocyte sedimentation rate, white blood count, and serum ferritin were observed at 8, 12, 14, and 16 weeks after starting methotrexate, respectively. In six of these eight patients, steroids or non-steroidal anti-inflammatory drugs could be reduced or discontinued. In four patients methotrexate was not effective despite 12 or 16 weeks of treatment, and one patient discontinued treatment after 2 weeks because of severe nausea. Five patients suffered from adverse reactions, including acute interstitial pneumonia (one patient) and liver toxicity (two patients). Five out of eight patients successfully treated with methotrexate were HLA-DR4 positive (four homozygotes), and all the unsuccessfully treated patients were DR2 positive. CONCLUSIONS: Methotrexate is useful for controlling disease activity in AOSD, not only for refractory patients but also for patients who have never taken steroids or for those with steroid associated toxicity. However, serious adverse reactions can occur, as with rheumatoid arthritis. It is important to determine the critical factors, such as the immunogenetic background, that are associated with response to methotrexate treatment.
10319097 [Subclinical interstitial lung involvement in rheumatic diseases. Correlation of high reso 1999 Jan INTRODUCTION: Rheumatic diseases are frequently associated with interstitial lung disease. Since interstitial fibrosis is an irreversible process, understanding the mechanisms leading to fibrosis is necessary for the development of treatment strategies to prevent irreversible pulmonary damage. High-resolution Computed Tomography (HRCT) is superior to chest radiography in assessing the presence and extent of parenchymal abnormalities in diffuse infiltrative lung diseases and provides a sensitive and noninvasive method of quantifying global disease extent. PURPOSE: The aims of this study were to quantify the severity and extent of subclinical interstitial lung disease as depicted on HRCT and to study the relationship between the patterns of lung disease quantified by HRCT and the functional parameters and bronchoalveolar lavage findings in patients with rheumatic diseases. PATIENTS: Eighty nonsmoking patients (24 patients with systemic sclerosis, 24 with primary Sjögren's syndrome, 20 with rheumatoid arthritis and 7 with dermatopolymyositis) were examined. No patient had any signs or symptoms of pulmonary disease. RESULTS: Thirty-three of 80 patients (41.2%) had abnormal HRCT findings, namely isolated septal/subpleural lines, irregular pleural margins and ground-glass appearance. Chest X-ray showed parenchymal abnormalities in only 15 patients (18.7%) who had evidence of fibrosis on HRCT. Abnormal differential cell counts (alveolitis) at bronchoalveolar lavage were found in 46 of 80 patients (57.5%). Three types of alveolitis were observed: pure lymphocyte alveolitis, pure neutrophil alveolitis, and neutrophil alveolitis associated with lymphocytosis (mixed alveolitis). The patients with neutrophil alveolitis had more extensive disease on HRCT than those with lymphocyte alveolitis or with normal cellular patterns at bronchoalveolar lavage. The extent of a reticular pattern on HRCT correlated with the neutrophil rate (p = 0.001) and total count (p = 0.003) on bronchoalveolar lavage. Eosinophil and lymphocyte rate and total count correlated (p < 0.05) with the extent of the ground-glass pattern on HRCT. Lung volumes were not significantly different among patients with ground-glass pattern and those with reticular patterns on HRCT, while the diffusing capacity for carbon monoxide was significantly lower (p < 0.05) in the latter. CONCLUSIONS: HRCT is a sensitive tool in detecting interstitial lung disease in patients with rheumatic diseases with no signs and symptoms of pulmonary involvement. The relationship between the different HRCT patterns and bronchoalveolar lavage cell profiles can identify patients at higher risk of developing irreversible lung fibrosis. A long-term, prospective follow-up study is needed to determine whether these patients will develop over pulmonary disease.
9361157 Methotrexate in the treatment of juvenile rheumatoid arthritis and other pediatric rheumat 1997 Nov The goal of treatment for juvenile rheumatoid arthritis (JRA) and other pediatric rheumatic disorders is to minimize joint destruction, pain, and deformity and to maximize all aspects of growth and development. Oral and injectable methotrexate are now often given early in the treatment of JRA, childhood dermatomyositis, difficult-to-control arthritis in the pediatric spondyloarthropathies, SLE, sarcoidosis, several of the vasculopathies, and idiopathic iritis. Weekly low-dose MTX has become a mainstay of long-term improved control of these disorders, and is associated with strikingly few documented long-term side effects. Dosages, pharmacology, side effects, efficacy, and treatment strategies are discussed. Although formal studies are lacking, MTX for the pediatric rheumatic disorders seems to be associated with less frequent physician visits, lower total costs, improved function, and fewer late reconstructive surgeries.
10071640 [Kinematic versus static MRI study of the cervical spine in patients with rheumatoid arthr 1999 Jan PURPOSE: The objective of this study was to compare the diagnostic value of cinematic magnetic resonance imaging with static MRI examinations in patients with rheumatoid arthritis and concomitant attack of the cervical spine. METHODS: Dynamic functional MRI examinations of the cervical spine were performed one five subjects without complaints and 20 patients with rheumatoid arthritis. For the functional studies, a positioning frame was used that allowed infinitely variable forward and backward inclinations of the head. RESULTS: Functional magnetic resonance imaging made possible a sufficiently good differentiation of the extension of pannus tissue cranial, ventral, and dorsal of the dens with possible displacing and impinging effects on the spinal cord during flexing and stretching movements. In addition, it is suitable for demonstration of the degree of instability in the atlanto-occipital and atlanto-axial planes. In contrast to conventional X-rays, CT, and static MRI, basilary impression as well as compressions and angulations of the cervical bone marrow are better visualized by cinematic magnetic resonance tomography. CONCLUSIONS: Functional magnetic resonance tomography is an important diagnostic method for the induction of the cervical spine in patients with rheumatoid arthritis. In particular, fusion and instabilities as well as compressions of the bone marrow often can only be detected with the help of functional MRI.
24383594 Combined treatment with cyclophosphamide and prednisolone is effective for secondary amylo 2000 Sep Abstract A 41-year-old woman, who had been diagnosed with rheumatoid arthritis (RA), was admitted because of proteinuria, and rheumatoid and gastrointestinal symptoms just 1 year after onset. Renal biopsy revealed marked amyloid deposits of AA (amyloid A)-type. Genotyping of serum amyloid A (SAA) showed that she was homozygous for SAA1γ. Combined treatment with cyclophosphamide and prednisolone led to remission of both RA disease activity and proteinuria. Since the renal dysfunction arose from amyloidosis, arrested renal deterioration and a remission of proteinuria would result from a reduction of amyloid deposits. Therefore, early usage of immunosuppresive therapy such as a combined treatment with these two medicines would be useful against systemic amyloidosis secondary to RA, even if the patient has the risky SAA1γ/γ genotype.
15775553 [Periarticular and generalized osteoporosis in rheumatoid arthritis]. 2001 May Patients with rheumatoid arthritis (RA) develop both periarticular and generalized osteoporosis. Periarticular osteopenia in appendicular bones occurs early in the course of RA and is one of the earliest radiological signs of RA. Periarticular osteoporosis might be mediated through an increased productions of inflammatory cytokines and prostaglandins by synovium and bone marrow. Generalized osteoporosis is also common in RA and leads to increased risk of fractures. Generalized osteoporosis considered to be multifactorial. Corticosteroids and menopausal state are important risk factors for lumbar osteoporosis. Rheumatoid activity and reduced physical activity are also important determinants.
12819820 Alpha(v)beta(3) integrin in angiogenesis and restenosis. 2001 Apr Various integrins are thought to be intimately involved in several pathological processes, including cancers (solid tumors and metastasis), cardiovascular diseases (stroke and heart failure), inflammatory diseases (rheumatoid arthritis) and ocular pathologies. The mechanism of the involvement of integrins in these acute and chronic disease states is slowly being elucidated. Recently, various therapeutic candidates, including antibodies, cyclic peptides and peptidomimetics, have been clinically evaluated and have been shown to successfully modulate certain disease processes. This review focuses on the key role of the alpha(v) integrin (alpha(v)beta(3)) in the angiogenic processes in diseases such as cancer, restenosis following percutaneous transluminal coronary angioplasty, stroke, ocular disease and rheumatoid arthritis.
11060756 Psoriatic arthritis. 2000 Jul Psoriatic arthritis occurs in 5 - 42% of patients with psoriasis. It is an inflammatory arthritis distinct from rheumatoid, being usually sero-negative, asymmetrical and often affecting the spine, sacro-iliac and distal interphalangeal joints. It runs a very variable course, from a mild non-destructive disease to a severe rapidly progressive erosive arthropathy, producing an 'arthritis mutilans' with a combination of bone lysis and joint ankylosis. Its pathogenesis is not as well understood as rheumatoid arthritis, but is thought to be similarly immune driven, with a qualitatively similar immunomodulatory cascade and cytokine profile. Quantitatively, however, there are distinct differences in cell ratios and cytokine levels that may well impact on therapeutic strategies. Current therapies, such as methotrexate and sulphasalazine, have yet to be shown to be significantly more effective than placebo in delaying damage and produce only marginal improvements in symptoms. The newer specific biological agents, such as the anticytokine antibodies, interleukins and more specific anti-T-cell therapies, are starting to be studied in psoriatic arthritis. The rationale for their use comes mostly from extrapolation of their efficacy in rheumatoid arthritis. It has yet to be seen whether they will be efficacious in treating the osteolysis, fibrosis and new bone formation particular to psoriatic arthritis. Any treatment for the arthritis must also help the skin. Greater understanding of psoriatic arthritis, its pathogenesis and natural history is required if we are to target these exciting but expensive therapies effectively.
9558186 Juvenile rheumatoid arthritis in a Canadian First Nations (aboriginal) population: onset s 1998 Apr OBJECTIVE: To determine onset subtypes and HLA associations of juvenile rheumatoid arthritis (JRA) in a First Nations (aboriginal) population; to determine whether population frequencies of HLA antigens may explain the distribution of subtypes of JRA in this population. METHODS: All patients were children from Manitoba and Northwestern Ontario seen in a single pediatric rheumatology clinic between 1975 and 1996. Patients were identified from a clinic registry. Controls were adults of Algonkian Cree and Ojibway heritage. Class I and II major histocompatibility (HLA) typing was performed for First Nations patients and controls. RESULTS: There were a total of 74 First Nations patients with JRA. The relative frequency of rheumatoid factor (RF) positive polyarticular JRA was higher and that of pauciarticular JRA was lower in First Nations compared with Caucasian patients (42 versus 3% and 22 versus 58%, respectively; p = 0.00000). HLA-DRB1*04 (63%), 08 (43%), and 1402 (25%) were the most common DRB1 antigens among controls. The main subtypes of DRB1*04 were 0404 (33% of controls) and 0407 (23%). HLA typing was performed for 39 First Nations patients; 27 were Cree or Ojibway, 4 were from other tribes, and 8 were part First Nations. Among Cree and Ojibway, 59% of controls and 63% of patients with RF positive polyarticular JRA (n = 16) had HLA-DRB1 antigens bearing the rheumatoid arthritis (RA) shared epitope (OR 1.16, 95% CI: 0.38, 3.48). The OR for polyarticular RF positive JRA in those with DRB1*0802 and 0901 were 0.15, 95% CI: 0.02; and 1.24 and 5.83, 95% CI: 1.58, 28.38, respectively. CONCLUSION: There was a high frequency of the RA shared epitope represented by both HLA-DRB1*0404 and 1402 in this Algonkian population. This high frequency may explain the high frequency of RF positive polyarticular JRA. DRB1*0802 may be protective, whereas DRB1*0901 may increase the risk for this subtype of JRA.
9543367 Systemic juvenile rheumatoid arthritis complicated by two different renal lesions. 1998 Feb Systemic-onset juvenile rheumatoid arthritis (JRA) is a complex disease which affects many organ systems. Associated renal lesions are unusual, with the possible exception of amyloidosis. We describe a girl with systemic-onset JRA who developed first membranous nephropathy and then, 3.5 years later, a severe crescentic glomerulonephritis. The membranous lesion followed therapy with intravenous immune globulin, and the possibility that this intervention caused the renal disease must be considered. It appears that both of these lesions should be added to the list of possible complications of systemic-onset JRA.
10990178 Juvenile rheumatoid arthritis. 2000 Sep A satisfactory classification of arthritis in childhood has still to be defined, and a system that can facilitate communication among physicians has been proposed by an international committee. The immunopathogenesis of the diseases that are encompassed by the term juvenile rheumatoid arthritis is complex, and many studies have investigated the role of genetic and cytokine balance abnormalities. HLA associations have been confirmed in multiple series, and there is evidence that non-major histocompatibility complex genes might also contribute to disease pathogenesis. Recent studies have added knowledge to the diverse clinical features of the disease, including joint distribution at presentation, association with Turner syndrome, presence of arthritis mutilans, and alterations in mandibulofacial development. Medical treatment remains a challenge. For cases recalcitrant to conventional therapy autologous hemopoietic stem-cell transplantation has been attempted; the risks of this procedure must however be carefully balanced in individual patients.
11560655 General practitioners' knowledge of functional and social factors in patients with rheumat 1999 Nov The care of people with chronic physical disease is an important part of the work of general practitioners (GPs). Knowledge of social and functional factors, and good teamwork with other health and social care professionals, are necessary to provide high quality general practice care. This study investigated functional disability, social situation and the involvement of health and social care professionals in patients with rheumatoid arthritis, and their GPs' knowledge of these factors. Questionnaires were sent to all patients aged 15-74 with rheumatoid arthritis in two general practices, and similar questionnaires were given to their GPs. Functional disability was assessed using the health assessment questionnaire (HAQ), on a scale of 0-3. The GP consultation rate for patients with rheumatoid arthritis in the previous year was 6.9 compared to 3.7 for all patients in the practices, and increased with increasing disability. Sixty-five per cent of patients had a moderate (HAQ > 1 but 2) disabiltiy. There was an average difference between patient and GP scores for functional disability on the HAQ of 0.49 (95% confidence interval 0.36-0.62), with GPs scoring lower than patients and the difference increased with increasing disability. Seventy-one per cent of patients had seen a rheumatologist or orthopaedic surgeon in the previous year, but there was little involvement by other members of the primary health care team (PHCT). General practitioners had good levels of knowledge of their patients' employment status and who they lived with, but poor knowledge of most of the welfare benefits they were receiving, and of other health and social care professionals involved. It is concluded that GPs see their patients with rheumatoid arthritis frequently, but are often lacking the knowledge about their patients to provide high quality care. They often only know about aspects of their patients' care in which they are directly involved. Ways are suggested for how this situation could be improved.