Browse

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

ID PMID Title PublicationDate abstract
9256033 [A case of macrophage activation syndrome developed with systemic juvenile rheumatoid arth 1997 Jun We reported a child of macrophage activation syndrome (MAS) associated with the course of systemic juvenile rheumatoid arthritis (sJRA). The clinical and laboratory findings in our case was ascribed to the overproduced inflammatory cytokines especially TNF-alpha by activated macrophages. Moreover, macrophage-colony stimulating factor (M-CSF) was also elevated in the active phase of the disease, and decreased in the convalescent phase, indicating that M-CSF can be the most potent stimulator of macrophages to produce inflammatory cytokines. Cyclosporine A along with plasmaexchange and corticosteroid, instead of VP16 or other immunosuppresive agents, was effecting in the management of this severe, life-threatening MAS.
15094851 Clinical diagnosis of rheumatoid arthritis. 1998 Mar Rheumatoid arthritis is a common disease that is now known to progress to irreversible erosive changes in the joints much more quickly than previously recognized. Physicians thus need to identify the early symptoms and signs to make a prompt clinical diagnosis and then start earlier aggressive treatment. Critical features are morning stiffness and symmetrical inflammation involving usually small joints of the hands and feet. Soft tissue swelling is the most important sign of inflammation and begins most often at the metacarpal phalangeal or proximal interphalangeal joints. Joints are tender and warm but often not hot and red. Elevation of erythrocyte sedimentation rate can help confirm the presence of inflammation but the most important laboratory test is synovial fluid analysis which further confirms inflammation but can also help exclude many of the other potentially confusing causes of arthritis. Rheumatoid factor is present in 75% of patients but can also be seen with some other diseases.
28246818 [Surgical procedures on the cervical spine in polyarthritis. : Indication and operation st 1998 Mar Patients with rheumatoid arthritis suffer frequently from instabilities and deformities of the cervical spine which require surgical treatment. The most frequent indication for surgery represents the transverse atlantoaxial instability. As long the atlantoaxial instability remains reducible in extension a limited posterior exposure and screw fixation is adequate. Only situations with fixed dislocations and signs of myelopathy require anterior transoral decompression with simultaneous occipitocervical fusion. In the lower cervical spine, kyphotic deformities require anterior decompression and posterior stabilization in the case of electrophysiologically confirmed neurological deficits. A combined procedure with anterior vertebrectomy and decompression and posterior plate fixation is indicated since the poor bone quality rarely allows anterior stable fixation.
17657438 Mast cells as a target in the treatment of rheumatoid arthritis. 1999 Mast cells represent a unique cell population, which is involved in a number of immune responses in our body. Mast cells (MCs) release an array of potent pro-inflammatory mediators and cytokines upon activation that are either pre-stored in the granules or synthesised de novo. These mediators can make a substantial contribution to the initiation and perpetuation of the inflammatory processes. This review provides an insight for the potential role of MCs in rheumatoid arthritis (RA). The data on mast cell distribution in the rheumatoid joint along with the information obtained from in vitro experiments and observations in animal models suggest that these cells may be involved in RA. The encouraging results of MC inactivating therapy in animal models of arthritis indicate that MC stabilizers may prove beneficial as a supplementary therapy in RA.
10959321 [Ferritin levels in adult Still's disease]. 1999 Sep Adult-onset Still's disease (AOSD) is characterized by a spiking fever and diverse clinical findings; the diagnosis is often delayed for months or even years. The only positive laboratory finding is neutrophilic leukocytosis. Since 1987, the diagnostic importance of elevated serum ferritin levels has been discussed in numerous papers, but is not yet among the diagnostic criteria for AOSD. We describe a case in which the finding of extreme hyperferritinemia enabled prompt diagnosis and treatment.
9646759 3- to 11-year followup of occipitocervical fusion for rheumatoid arthritis. 1998 Jun The relief of myelopathy usually is unsatisfactory by a conventional Gallie type atlantoaxial fusion for patients with rheumatoid arthritis who have irreducible atlantoaxial dislocation. To accomplish a decompressive laminectomy of the atlas in the treatment of myelopathy, the authors have been performing a new surgical procedure since 1985 for occipitocervical fusion using a rectangular rod. The postoperative outcomes for 25 patients with rheumatoid arthritis were evaluated clinically and radiographically with a 3- to 11-year (mean, 6.5 years) followup. A decompressive laminectomy of the atlas accompanied the fusion in 21 of the 25 patients. The incidence of occipital or nuchal pains improved notably in most cases, and myelopathy was relieved in 12 of 18 (67%) cases, showing an improvement of more than one level based on Ranawat's criteria. No serious postoperative complications were seen, except for one case of a failed bone union. The cumulative survival in patients with myelopathy was 79.4% in the first 5 years after operation and 27.5% at 10 years. Occipitocervical fusion using a rectangular rod accompanied by a decompressive laminectomy of the atlas can contribute to the relief of a neurologic deficit in an irreducible atlantoaxial dislocation in rheumatoid arthritis.
18034543 Are there differences in methotrexate kinetics between responding and nonresponding patien 2000 May OBJECTIVE AND STUDY DESIGN: The purpose of this study was to investigate the presence of a correlation between methotrexate pharmacokinetics and clinical efficacy in patients with rheumatoid arthritis. PATIENTS AND METHODS: The study was carried out in 29 patients with rheumatoid arthritis. The patients received intramuscular methotrexate (MTX) 7.5mg once a week for 8 weeks. Before and 0.5, 1, 2, 3, 4, 6, 9, 12 and 24 hours after the first administration, MTX serum concentrations were measured and pharmacokinetic investigations were carried out. The clinical status of the disease was evaluated before and after 8 weeks of therapy. In addition, before and after 2 and 8 weeks of treatment, the patients were monitored for a complete biochemical profile. After 8 weeks of treatment, on the basis of improvement in clinical parameters, the patients were designated responders or nonresponders. RESULTS: A clinical response was obtained in 62% of patients (18 patients responded and 11 did not) and was associated with a low incidence of adverse effects. There were no differences in the pharmacokinetic parameters of MTX between the 2 groups of patients (responders vs nonresponders), except that t(max) was significantly higher in nonresponders than in responders (p < 0.05). CONCLUSIONS: These data confirm the efficacy and tolerability of low dose MTX in patients with rheumatoid arthritis in the short term, but appear to exclude a relationship between MTX kinetics and clinical response.
10806901 [Symptoms in women with Sjogren's syndrome]. 2000 Mar 10 More knowledge about symptom experience is needed for diagnosing Sjögren's disease at an early stage of disease development. We have performed a qualitative study based on group interview with eight women with Sjögren's disease. The women presented with several different symptoms. They all described weariness, fatigue, sicca symptoms, various pains, hypersensitivity and organ manifestations in the same manner. Some of the symptoms had a dramatic impact on their life activities. The study revealed new descriptions of previously known symptoms and descriptions of previously unfamiliar symptoms. The results of the study may supplement the existing criteria of Sjögren's disease and provide new hypotheses about pathogenetic mechanisms related to chest pain, abdominal pain and facial pain in patients with Sjögren's disease.
11120858 Adenoviral transfer of cyclin-dependent kinase inhibitor genes suppresses collagen-induced 2000 Dec 15 In rheumatoid synovial tissues, synovial fibroblasts are activated by proinflammatory cytokines and proliferate to develop hyperplastic pannus tissues, which irreversibly damage the affected joints. We recently reported that the cyclin-dependent kinase inhibitors p16(INK4a) and p21(Cip1) are not expressed in vivo in rheumatoid synovial fibroblasts, but are readily inducible in vitro. This observation was followed by the successful treatment of rat adjuvant arthritis by local p16(INK4a) gene transfer, showing that the inhibition of the cell cycle of the synovial cells ameliorates the arthritis. In this study, we show that another animal model of rheumatoid arthritis, murine collagen-induced arthritis, can be effectively treated by local gene transfer of p21(Cip1) as well as that of p16(INK4a). The anti-arthritic effects were observed even when the treatment was conducted after the arthritis had developed. Furthermore, the effects included suppression of the expression of proinflammatory cytokines such as IL-1ss, IL-6, and TNF-alpha. Our results demonstrate that the ectopic expression of cyclin-dependent kinase inhibitors not only prevents synovial overgrowth but also ameliorates the proinflammatory milieu in the affected joints. The induction of p21(Cip1) in rheumatoid synovial tissues by pharmacological agents may also be an effective strategy to treat rheumatoid arthritis.
10685820 Prominent expression of mRNA for proinflammatory cytokines in synovium in patients with ju 2000 Feb OBJECTIVE: To examine the cytokine profiles in synovium of patients with juvenile rheumatoid arthritis (JRA) or Lyme arthritis, 2 chronic inflammatory arthritides that affect children. METHODS: We used in situ hybridization with specific riboprobes to determine the expression of mRNA for proinflammatory or antiinflammatory cytokines in synovial samples from 5 patients with early, untreated JRA, 15 patients with late, treated JRA, and 9 patients with chronic Lyme arthritis. For comparison, synovia were examined from 6 patients with rheumatoid or psoriatic arthritis, and from 9 patients with various orthopedic conditions. RESULTS: Among the children with early, untreated JRA, a median of 3 to 8% of inflammatory cells in synovial samples expressed mRNA for the proinflammatory cytokines interleukin 1beta (IL-1beta), tumor necrosis factor-alpha(TNF-alpha), or interferon-gamma (IFN-gamma). Although a median of 3.9% of the cells expressed mRNA for the antiinflammatory cytokine IL-10, none had IL-4 mRNA. Most of the patients with late, treated JRA, chronic Lyme arthritis, rheumatoid, or psoriatic arthritis had mRNA for each of these proinflammatory cytokines in about 1% of the cells, whereas mRNA for the antiinflammatory cytokines was less frequent. The inflammatory cell density was much less in the synovium of patients with various orthopedic conditions, but about 1% of the infiltrating cells expressed mRNA for at least one of the proinflammatory cytokines. CONCLUSION: Patients with early or late JRA or chronic Lyme arthritis have expression of mRNA in synovial tissue primarily for proinflammatory cytokines, with less expression of antiinflammatory cytokines.
19078160 Cytokines and the pathophysiology of bone erosions in rheumatoid arthritis. 1997 Apr Rheumatoid arthritis is an inflammatory joint disease in which the chronic synovitis leads to bone and cartilage degradation. Proinflammatory cytokines such as interleukin-1 (IL-1) and tumor necrosis factor alpha are key factors in this process. The specific control of the action of these cytokines can be obtained with blocking antibodies, soluble receptors and receptor antagonists. Many of these products are now in clinical investigation. Some of the anti-inflammatory cytokines such as IL-4, IL-13 and IL-10 appear to affect more directly the consequences of inflammation, reducing destruction and inducing repair. Modulation of cytokine production by the rheumatoid synovitis appears to represent a potential way to control local bone degradation.
9200936 [Pathomechanism of HTLV-I associated arthropathy and the role of tax gene]. 1997 Jun HTLV-I is known to be a causative agent for adult T cell leukemia. Recent studies revealed this virus is also related to several autoimmune disorders, such as arthropathy, myelopathy and Sjögren's syndrome. We studied etiology of HTLV-I associated arthropathy (HAAP), and found that tax is a causative gene for synovial proliferation and induction of immunogenicity. HTLV-I transgenic mice supported the etiopathological role of tax gene. Our results suggested that HAAP is considered to be a prototype of rheumatoid arthritis, and tax is a best tool for recognizing pathomechanism of rheumatoid arthritis.
9890097 Systemic onset juvenile rheumatoid arthritis. 1998 May Systemic onset juvenile rheumatoid arthritis (SoJRA) accounts for 10-20% of all JRA, affecting males and females equally and occurring most frequently under the age of 5 years. It is characterized by arthritis, daily spiking fever, an evanescent rash, serositis and a variety of other extra-articular features. Exclusion of systemic infections, malignancies and connective tissue diseases is most important in establishing the diagnosis. The disease has a wide range of severity from a short monocyclic course to a prolonged chronic course with severe destructive arthritis in approximately one third of patients. Destructive arthritis, secondary amyloidosis and treatment complications including infections, osteoporosis, growth retardation and the macrophage activation syndrome account for the significant morbidity and mortality associated with the disease. Pharmacological management includes non-steroidal anti-inflammatory drugs, corticosteroids, methotrexate and an emerging role for cyclosporine A and cytotoxic drug therapy. Elucidation of the immunopathogenetic mechanisms may lead to new targeted therapy.
19078465 Mycobacterium avium/Mycobacterium intracellulare Complex-Associated Arthritis Masquerading 2000 Jun Mycobacterium avium/Mycobacterium intracellulare[cf1] complex (MAC) is a rare cause of tenosynovitis. We describe a case in which a previously healthy patient developed bilaterally symmetric synovitis and was treated with disease modifying anti rheumatic drugs (DMARDs); the synovitis progressed into a bilaterally symmetric chronic granulomatous tenosynovitis that was uncontrollable despite a synovectomy and DMARD therapy. Three years after developing symptoms, and 2 1/2 years after her diagnosis of rheumatoid arthritis, MAC was cultured from synovial fluid. All DMARDS were stopped, and the patient received a total of 24 months of triple antibiotic therapy. All swelling and stiffness resolved after 7 months of therapy. The patient remains asymptomatic two months after completion of antibiotic therapy. Rheumatologists and other arthritis specialists need to include MAC in their differential diagnosis of seronegative symmetrical inflammatory arthritis.
11252944 [Sicca syndromes in the elderly]. 2001 Jan 31 Sicca syndromes, especially salivary sicca syndromes, are prevalent in the elderly. Even, in the absence of local complications, they can impair the quality of life and lead to denutrition. Drugs are essentially responsible for these sicca syndromes. Paraclinic investigations (tests for autoimmunity, biopsy of minor salivary glands) are useful when uncommon Sjögren syndrome is hypothesized. This autoimmune disease, probably rare in the elderly, has to be suspected when general manifestations are present. The treatment of sicca syndromes is based on the reduction of drug prescriptions and on local care.
11434473 Adult-Onset Still's disease in Saudi Arabia. 2001 We present a series of 14 Saudi patients diagnosed to have adult-onset Still's disease (AOSD). The clinical and laboratory pattern of AOSD in our series is more or less similar to that in other reported series, apart from having lower cardiac and pulmonary involvement than western series. The disease course was relatively benign, with only half the cases showing recurrences, which were controlled by alterations in the dosage of corticosteroid and NSAIDs. A comparison with other series is given.
19078456 Cranioventral Subluxation of the Odontoid Process With Accompanying Neo(pseudo)arthrosis i 2000 Apr Cervical spine involvement is a common feature in the course of long existing rheumatoid arthritis (RA).We describe a rare type of vertical subluxation with pronounced cranioventral disposition of the odontoid process and neo(pseudo)arthrosis between the skull and the tip of the odontoid processus. This 74-year-old women with RA for 40 years had progressive neck symptoms over the previous 5 years. She no longer had signs of active synovitis. Plain roentgenographs performed in a neutral position and full flexion and extension gave information about neither the osseous integrity nor the subluxation of the dens axis. Computed tomography and MR imaging techniques established the nature of the atlantoaxial and atlantooccipital joint involvement. During 2 years, this rare cranio-ventral subluxation with neo(pseudo)arthrosis seems to be rather solid, and follow up CT-images demonstrate no signs of progressive migration or suggestion of immediate fracture risk. Pronounced reduction of cervical spine mobility by long standing destructive cases of RA should always raise suspicions for cervical subluxation at the atlantoaxial level, irrespective of serological and clinical signs of rheumatoid arthritis. Vertical subluxation as seen in this patient may be missed on routine x-rays.
9606764 Rheumatic manifestations of parvovirus B19 infection. 1998 May Human parvovirus B19 is an emerging DNA virus. B19 infection is common and widespread. Major manifestations of B19 infection are transient aplastic crisis, erythema infectiosum, hydrops fetalis, acute and chronic rheumatoid-like arthropathy, and, in the immunocompromised host, chronic or recurrent bone marrow suppression. A number of less common manifestations of B19 infection include various rash illnesses, neuropathies, and acute fulminant liver failure. Of rheumatologic interest, B19 infection must be differentiated from early presentation of more classic erosive rheumatoid arthritis and, in some cases, systemic lupus erythematosus. It is unlikely that B19 plays a role in classic erosive rheumatoid arthritis, but understanding pathogenesis of B19 arthropathy may provide insights into the mechanisms by which rheumatoid arthritis develops. Evidence for persistence of B19 infection suggests that human parvovirus B19 infection may serve as a model for the study of virus-host interactions and the role of viruses in the pathogenesis of rheumatic diseases.
9638500 Time course of apoptosis in collagen-induced arthritis. 1998 Recently, apoptotic cells were discovered in the synovial cells of rheumatoid arthritis patients. Their role, however, is unknown. We thus examined the time course of apoptosis in the synovium using an animal model of rheumatoid arthritis, in which arthritis was induced by intracutaneous injection of collagen. No apoptotic cells were detected before the onset of synovitis, but they increased in parallel with the progress of arthritis in its initial period, and decreased in the later chronic stages. Apoptotic cells appear to maintain the homeostasis of a joint when synovial proliferation occurs.
11359851 Chemokine receptor CCR4 on CD4+ T cells in juvenile rheumatoid arthritis synovial fluid de 2001 Jun 1 To understand the mechanisms that promote recruitment and survival of T cells within the pediatric inflamed joint, we have studied the expression of CCR4 and CCR5 on synovial fluid T cells and matched peripheral blood samples from juvenile rheumatoid arthritis (JRA) patients using three-color flow cytometric analysis. Thymus- and activation-regulated chemokine and macrophage-derived chemokine, ligands for CCR4, were measured by ELISA in JRA synovial fluid, JRA plasma, adult rheumatoid arthritis synovial fluid, and normal plasma. IL-4 and IFN-gamma mRNA production was assessed in CD4+/CCR4+ and CD4+/CCR4(-) cell subsets. We found accumulations of both CCR4+ and CCR5+ T cells in JRA synovial fluids and a correlation for increased numbers of CCR4+ T cells in samples collected early in the disease process. Thymus- and activation-regulated chemokine was detected in JRA synovial fluid and plasma samples, but not in adult rheumatoid arthritis synovial fluid or control plasma. Macrophage-derived chemokine was present in all samples. CD4+/CCR4+ synovial lymphocytes produced more IL-4 and less IFN-gamma than CD4+/CCR4(-) cells. These findings suggest that CCR4+ T cells in the JRA joint may function early in disease in an anti-inflammatory capacity through the production of type 2 cytokines and may play a role in determining disease phenotype.