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ID PMID Title PublicationDate abstract
24387021 What is the factor that most influences QOL among rheumatoid arthritis patients? 2001 Mar Abstract We attempted to elucidate the factors which affect the quality of life (QOL) among patients with rheumatoid arthritis (RA). Ninety-five patients who satisfied the American Rheumatism Association criteria for RA were asked to fill in a modified arthritis impact measurement scale, version 2 (AIMS2) and complete a Lorish's face scale (FS) test. The same questionnaire and FS test were completed by 75 healthy persons as controls. We used Lorish's FS for our assessment of QOL. The investigation was undertaken to analyze the relationship between FS and each item on the questionnaire. For average FS score, there was no significant difference between the RA group and the controls. However, RA group scores covered a wider range than those of the controls. From the correlation analysis, physical stress, pain factors, and some of the activities of daily living (ADL) factors showed a strong correlation with FS. ADL factors which strongly correlated with FS were those related to activities of the lower limbs. Other ADL factors were moderately correlated with FS. Socioeconomic factors were not significantly correlated with FS. There was no significant difference between the QOL of RA patients and that of healthy controls. The QOL was correlated with pain and stress factors rather than with ADL factors among patients with RA.
10101823 Spontaneous regression of periodontoid pannus mass in psoriatic atlantoaxial subluxation. 1999 Mar 15 STUDY DESIGN: A case report of a 41-year-old man with psoriasis who had cervical myelopathy caused by atlantoaxial subluxation and periodontoid pannus mass. OBJECTIVE: To describe the possible mechanism underlying the periodontoid pannus formation and the optimal treatment for such cases. SUMMARY OF BACKGROUND DATA: Atlantoaxial subluxation causing spinal cord compression at the craniocervical junction may develop in patients with rheumatoid or psoriatic arthritis. Periodontoid pannus formation plays an important role in compromising the anteroposterior diameter of the spinal canal and in causing neurologic deficits. Transoral transpharyngeal excision of the pannus is sometimes thought necessary for anterior decompression of the spinal cord. Spontaneous resolution of the periodontoid pannus after posterior atlantoaxial fusion and fixation has been documented in rheumatoid arthritis, but not in psoriatic arthritis. METHODS: The patient underwent posterior atlantoaxial fusion and Halifax fixation. RESULTS: The patient experienced clinical improvement. Regression of the periodontoid pannus mass was observed on magnetic resonance imaging. CONCLUSIONS: Posterior fusion and instrumentation resulted in spontaneous regression of the pannus mass and symptomatic relief. This report provides evidence that atlantoaxial instability may be the sine qua non for the formation of periodontoid pannus, and that amelioration of such instability leads to spontaneous resolution of the pannus mass.
12973437 What we have learned from trials of immunomodulatory agents in rheumatoid arthritis: Futur 1999 Apr In recent years substantial progress has been made in understanding the mechanisms of inflammation and autoimmunity. In an attempt to interfere with selected stages of the immune response, a variety of biological agents has been designed that specifically targets elements of the immune system. In rheumatoid arthritis (RA), a number of open-labeled clinical trials with immunomodulatory agents, such as monoclonal antibodies or recombinant proteins, has provided encouraging initial clinical results. However, with the recent exceptions of biologics inhibiting the activity of proinflammatory cytokines, randomized, controlled studies have largely failed to demonstrate a significant benefit of these agents over placebo. Nevertheless, the clinical trials have provided an excellent opportunity to test the consequences of interfering with specific interactions involved in immunity. Moreover, from the results and experiences from these studies new therapeutic strategies are constantly emerging. Some new approaches, including the application of agents that target a diverse array of substances such as cytokines, chemokines, enzymes, cell surface molecules involved in adhesion or signaling, and nitric oxide, are currently tested in animal models of human rheumatic diseases. In this article, trials of immunomodulatory agents in RA are reviewed, with an emphasis on what we have learned so far and what we have yet to learn. We will discuss recent advantages in the understanding of the pathogenesis of the disease and delineate new therapeutic approaches for chronic arthritis.
9438550 The role of T lymphocytes in Sjögren's syndrome. 1997 Sep The exact role of T cells in the immunopathogenesis of Sjögren's syndrome (SS) is not well understood and is discussed herein. It seems plausible that this autoimmune disorder is associated strongly with the functions of autoantigen-specific CD4 cells. T cell receptor Vbeta gene usage appears to be unrestricted. Furthermore, elevated gene expression of T cell-derived cytokines such as IFN-gamma, IL-1, IL-6, IL-10 and IL-13 seen in salivary glands of SS patients and the animal models of this disorder suggests that the course of SS may be mediated by Th1 and Th2 cells. Defining the precise role of these CD4 cells subsets in SS would certainly provide insights into the establishment of immunotherapeutic bimodal.
11561300 [Sinusoidal modulated currents alone and in combination with carbon dioxide-hydrogen sulfi 2001 Jul The exposure of the thymus and articular fissure of the most affected joint to sinusoidal modulated currents proved more effective than only joint exposure. Adjuvant carbon dioxide-sulfurated hydrogen baths add to therapeutic effect of the currents.
10681639 Growth-suppressive effect of intra-articular glucocorticoids detected by knemometry. 1999 After one intra-articular injection of 20 mg triamcinolone hexacetonide in the knee, the length of the contralateral lower leg was found to be reduced in 2 boys with juvenile rheumatoid arthritis.
9926177 Pulmonary edema as a result of chronic upper airway obstruction. 1998 Sep This is the first case of an adult who developed recurrent pulmonary edema as a result of unrecognized chronic upper airway obstruction due to polyarticular juvenile rheumatoid arthritis. The case highlights the importance of considering upper airway involvement in the differential diagnosis of sedentary patients with arthritic joint disease and breathing difficulties.
10515642 Microvascular abnormalities in Sjögren's syndrome: nailfold capillaroscopy. 1999 Sep OBJECTIVE: To describe microvascular abnormalities by nailfold capillaroscopy in patients with primary Sjögren's syndrome (SS) with or without Raynaud's phenomenon (RP) and those with anticentromere antibodies (ACA). METHODS: Forty patients with SS (14 without RP, 16 with RP, 10 with ACA), 20 patients with scleroderma (SSc) (10 with limited and 10 with diffuse disease) (disease control group) and 40 healthy controls (control group) were evaluated by nailfold capillaroscopy. RESULTS: Capillaroscopic abnormalities in SS ranged from non-specific findings (crossed capillaries) to more specific findings (confluent haemorrhages and pericapillary haemorrhages) or scleroderma-type findings. SS patients with RP presented capillary abnormalities in higher frequency than patients without RP. The majority of SS patients with ACA (80%) presented scleroderma-type findings. CONCLUSION: Nailfold capillaroscopy can be used as a simple non-invasive method to evaluate the microvascular abnormalities in SS patients, especially in those with RP and those with ACA.
9301145 Scaling lichenoid eruptions and Sjögren-like syndrome: manifestations of nonfatal postope 1997 Aug We report a case of an 81-year-old woman in whom lichenoid eruptions and Sjögren-like sicca syndrome developed 45 days after cholecystectomy. During surgery, one unit (130 ml) of unirradiated packed red blood cells from a male donor was transfused. The lichenoid eruptions cleared up with exfoliation: however, sicca symptoms remained during the follow-up period of four years. Histological examinations of both skin and lip biopsy specimens were in agreement with those of graft-versus-host disease (GVHD). A Y-chromosomal body was identified in the lymphocytes in the skin lesion by staining with quinacrine dihydrochloride and in the lip lesion by a method with in situ hybridization. The findings suggest that this case demonstrated the manifestations of non-fatal transfusion-associated GVHD.
11714390 High frequency of association of rheumatic/autoimmune diseases and untreated male hypogona 2001 Our goal in the present work was to determine whether male patients with untreated hypogonadism have an increased risk of developing rheumatic/autoimmune disease (RAD), and, if so, whether there is a relation to the type of hypogonadism. We carried out neuroendocrine, genetic, and rheumatologic investigations in 13 such patients and 10 healthy male 46,XY normogonadic control subjects. Age and body mass index were similar in the two groups. Nine of the 13 patients had hypergonadotropic hypogonadism (five of whom had Klinefelter's syndrome [karyotype 47,XXY]) and 4 of the 13 had hypogonadotropic hypogonadism (46,XY). Of these last four, two had Kallmann's syndrome and two had idiopathic cryptorchidism. Eight (61%) of the 13 patients studied had RADs unrelated to the etiology of their hypogonadism. Of these, four had ankylosing spondylitis and histocompatibility B27 antigen, two had systemic lupus erythematosus (in one case associated with antiphospholipids), one had juvenile rheumatoid arthritis, and one had juvenile dermatomyositis. In comparison with the low frequencies of RADs in the general population (about 0.83%, including systemic lupus erythematosus, 0.03%; dermatomyositis, 0.04%; juvenile rheumatoid arthritis, 0.03%; ankylosing spondylitis, 0.01%; rheumatoid arthritis, 0.62%; and other RAD, 0.1%), there were surprisingly high frequencies of such disorders in this small group of patients with untreated hypogonadism (P < 0.001) and very low serum testosterone levels (P = 0.0005). The presence of RADs in these patients was independent of the etiology of their hypogonadism and was associated with marked gonadal failure with very low testosterone levels.
15775564 [Drug therapy for osteoporosis associated with reumatoid arthritis (bisphosphonates)]. 2001 May Rheumatoid arthritis (RA) causes local and systemic bone loss due the increased bone resorption. Because the bisphosphonates are potent inhibitors for bone resorption, these drugs will be the major regimen to treat RA-associated osteoporosis. In addition, some reports suggest that bisphosphonates may modulate the pathogenesis of RA itself. Further study of bisphosphonates may help improve the treatment of RA.
9287813 The spondyloarthropathies. 1997 Jul The spondyloarthropathies represent a heterogeneous group of arthropathies including ankylosing spondylitis, reactive arthritis with Reiter syndrome as one subtype, arthritis associated with inflammatory bowel disease, arthritis associated with psoriasis, and juvenile spondyloarthritis. These conditions are linked by several common features: inflammatory arthritis involving the back, a high prevalence of HLA-B27, frequent tendon/ligament insertion inflammation, and several common extra-articular manifestations (iritis, skin lesions). Although not uncommon, these types of arthritis are more difficult to recognize than other types of arthritis such as osteoarthritis and rheumatoid arthritis.
9336421 Trial of intravenous pulse cyclophosphamide and methylprednisolone in the treatment of sev 1997 Oct OBJECTIVE: Not uncommonly, some children with systemic-onset juvenile rheumatoid arthritis (JRA) have persistently active disease with joint destruction and profound growth delay despite maximum treatment with known medications. Based on previous observations of improvement in synovitis following intravenous (I.V.) cyclophosphamide (CYC) and methylprednisolone (MP) treatments, a group of children with severe systemic-onset JRA was treated in an attempt to control active synovitis and to allow tapering of corticosteroids. METHODS: Four patients with systemic-onset JRA were continued on a daily regimen of nonsteroidal antiinflammatory agents and prednisone, with a weekly subcutaneous dose of methotrexate (1 mg/kg). In addition, 1 patient continued receiving sulfasalazine and 1 patient remained on a regimen of sulfasalazine and hydroxychloroquine. Patients received 6-10 monthly treatments of I.V. CYC (500-1,000 mg/m2) and MP (30 mg/kg; 1 gm maximum) accompanied by I.V. mesna and large amounts of I.V. fluids. Subsequent treatments were given once every 2-3 months. RESULTS: After 12-20 I.V. pulses of CYC, all patients showed improvement, and 3 achieved remission of disease. All were able to discontinue corticosteroid use and all had an increase in linear growth. CONCLUSION: Monthly I.V. pulse CYC treatments can be useful to control disease in selected children with severe, destructive JRA.
16464188 The direct cost of rheumatoid arthritis. 2000 Jul OBJECTIVES: This analysis estimated the direct cost of rheumatoid arthritis (RA) from a societal perspective. METHODS: Primary and secondary data sets were used to determine the rate of medical resource utilization. National average Medicare or Medicaid reimbursement rates were used to value direct costs (in 1994 dollars). RESULTS: Persons with RA have, on average, dollar 1702 in direct costs for treating RA annually. More than half of the total cost is for medications. Nursing home care accounts for nearly one fifth of the cost and hospitalizations and ambulatory care (combined) comprise another fifth of the total cost. Travel to medical appointments and medical supplies make up the remaining 10%. The projected annual US direct costs are dollar 3.6 billion for treating RA. CONCLUSIONS: The health care utilization in persons with RA is frequent and includes a number of components leading to high annual direct cost.
24383774 Analysis of the levels of endotoxin and β-d-glucan in the synovial fluid of hemodialysis 2001 Dec Abstract We analyzed the levels of endotoxin and β-d-glucan, which possibly induce cytokine production, in the synovial fluid of patients on long-term hemodialysis and compared the results to those in patients with osteoarthritis and rheumatoid arthritis. We studied 42 knees in 42 hemodialysis patients, 21 in 21 osteoarthritis patients, and 26 in 26 rheumatoid arthritis patients. The mean ages were 60.7, 63.2, and 59.7 years, respectively. The duration of hemodialysis in the long-term hemodialysis group averaged 14.0 years. The concentrations of endotoxin and β-d-glucan in the synovial fluid of these three groups were measured. The concentration of endotoxin was the same in the three groups. However, the concentration of β-d-glucan was significantly higher in long-term hemodialysis patients. This finding suggests that β-d-glucan may have some relation to the pathogenesis of the synovitis which exists in the hydrarthrosis of long-term hemodialysis patients.
11590271 Distally based sural neurocutaneous flaps for ankle and heel ulcers. 2001 Sep This study assessed the use of sural neurocutaneous flaps to repair chronic ulcers in difficult-to-cover areas around the ankle and heel. Follow-up of the 14 patients included in this study ranged from 6 months to 3 years after their operation. Total flap loss occurred in two patients, both of whom had rheumatoid arthritis complicated by vasculitis. Partial flap loss occurred in three patients; all were heel ulcers. Additional skin grafting procedures were required to cover their ulcers. A lateral malleolus ulcer in a patient with rheumatoid arthritis recurred after 1 year and had to be covered with a free parascapular flap. The sural neurocutaneous flap is thus a reliable means of resurfacing ulcers in the ankle and heel region. It requires no sacrifice of major peripheral vessels and may be a useful alternative for patients with poor peripheral pulses. Its use in the presence of vasculitis, however, needs further refinement.
10795060 Rheumatoid Arthritis of the Cervical Spine. 1997 Oct Cervical involvement in patients with rheumatoid arthritis occurs primarily in the upper cervical spine. The characteristic deformities are atlantoaxial subluxation, vertical settling, and subaxial subluxation. The typical patient complaints are neck pain and occipital pain. Subtle signs of myelopathy may also be present. Useful radiologic studies include plain radiography, tomography, and functional magnetic resonance imaging. The most helpful radiographic measurements are the anterior atlantodens interval, the posterior atlantodens interval, and assessment of vertical settling. Atlantoaxial subluxation greater than 9 mm with vertical settling and a posterior atlantodens interval less than 14 mm correlate with neurologic deficit. Nonoperative management does not change the natural history of cervical disease. Traditional surgical indications include intractable pain and neurologic deficit. The author discusses more controversial indications and proposes a rationale and protocol for treatment. The primary surgical objectives are to achieve stabilization of the affected segments and to relieve neural compression by reduction of subluxations or direct decompression. Arthrodesis provides reliable pain relief. Neurologic recovery occurs more consistently in patients with lower grades of preoperative myelopathy.
9972979 Arthritis in patients with chronic hepatitis C virus infection. 1999 Feb OBJECTIVE: To describe the clinical picture of arthritis in patients with chronic infection by hepatitis C virus (HCV). METHODS: Two patient populations were studied. Patients with arthritis and evidence of serum elevation of alanine aminotransferase (ALT) at the consultation were checked for HCV infection. A second group of 303 consecutive patients with rheumatoid arthritis (RA) were also checked for the presence of HCV antibodies. All patients attended the outpatient rheumatology unit of a tertiary care teaching hospital. Chronic HCV infection was determined by the presence of viral RNA in serum. A group of 315 first-time blood donors served as controls. RESULTS: Twenty-eight patients with arthritis and chronic HCV infection were identified. Seven fulfilled criteria for RA, psoriatic arthritis was found in one patient, systemic lupus erythematosus in one, gout in 2, chondrocalcinosis in 2, osteoarthritis in 7, and tenosynovitis in one. In 7 patients with a clinical picture of intermittent arthritis, a definitive diagnosis could not be made. In these patients, mixed cryoglobulinemia was present in 6/7 (86%), whereas mixed cryoglobulinemia was found in 6/21 (28%) of the other patients. Among patients with RA, 23 (7.6%) had HCV antibodies, and active infection by HCV was found in 7 (2.3%) patients. The prevalence of HCV antibodies in a blood donor population was 0.95%, significantly different (p<0.001; 95% CI 0.03, 0.10) compared to patients with RA. The distribution of antibodies determined by recombinant immunoblot analysis was similar (p = NS) between RA patients and blood donors with HCV antibodies. CONCLUSION: There is not a single clinical picture of arthritis in patients with chronic HCV infection. There is a well defined picture of arthritis associated with the presence of mixed cryoglobulinemia that consists of an intermittent, mono or oligoarticular, nondestructive arthritis affecting large and medium size joints. Although a high prevalence of HCV antibodies is suspected in patients with RA, its occurrence may be coincidental and its interpretation is difficult to determine from the data in this study.
18034549 Management of the patient with severe refractory rheumatoid arthritis: are the newer treat 2000 Jun Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease leading to joint destruction. It is the most common cause of potentially treatable disabilities. The outcome of the disease varies from very mild to a refractory, rapidly progressive type with a high mortality rate. In recent years, profound changes in the traditional paradigms of RA therapy have been introduced. Instead of a therapeutically progressive approach, aggressive therapy is recommended for aggressive forms of RA. It has forced us to remodel the traditional treatment pyramid, and to start new strategies such as saw-tooth or step-down-bridge schedules. The last 10 years have seen wide acceptance of immunosuppressive therapy. These agents hold much promise for the further treatment of RA. A few years ago it seemed that we would be unable to influence the long term outcome in RA, but today the development of new drugs and techniques has increased our chances of fighting RA, and prospects for the future are even more promising.
18020567 Biological agents in rheumatoid arthritis: which ones could be used in combination? 1998 Apr Rheumatoid arthritis is a chronic inflammatory disease. Established treatment is limited because of the clinical response or the induction of adverse effects. New biological agents evaluated for treatment of rheumatoid arthritis have shown varied clinical success. These agents target cytokines such as tumour necrosis factor-alpha (TNFalpha), interleukin (IL)-1 or IL-6, or cell surface molecules such as CD4, CD5, CD7, IL-2 receptor, CDw52 or CD54. Amongst these new drugs, only a few have shown clinical effectiveness in double-blind placebo-controlled trials. These include the primatised nondepleting anti-CD4 monoclonal antibody (mAb) CE9.1 (keliximab), the TNFalpha-blocking mAbs cA2 (infliximab) and CDP-571, the human recombinant soluble TNFalpha receptors p55 (lenercept) and p80, as well as the human recombinant IL-1 receptor antagonist protein, anakinra. Thus, only these agents qualify for evaluation of combination treatment in rheumatoid arthritis. Rationales for combination therapy include: combining drugs with different sites of action to increase efficacy or with different toxicities to minimise risk; combining drugs with different kinetics, thus improving clinical activity; using a combination of drugs for the prevention of tachyphylaxis; or using a second drug which helps to prevent or delay the development of resistance to the first one. In addition, combination therapy could help to prevent or minimise adverse effects caused by treatment with biological agents. Based on knowledge from trials with biological agents, and on the different properties attributed to the established disease-modifying antirheumatic drugs (DMARDs) in ex vivo and in vitro studies, we propose evaluation of the following combination regimens involving biological agents. First, biological agents targeting TNFalpha (such as the mAbs cA2 or CDP-571, or the TNFalpha receptor p55-IgG1 fusion protein) given as a single infusion for rapid clinical response could be followed by continuation treatment with methotrexate, possibly combined with chloroquine, azathioprine or cyclosporin. Combination of specific anti-TNFalpha strategies with sulfasalazine should be avoided because of the induction of double-stranded DNA antibodies seen after TNFalpha blockade in vivo and reports on a systemic lupus erythematosus-like syndrome as an adverse effect during treatment with biological agents directed against TNFalpha or with sulfasalazine. Alternatively, continuous inhibition of TNFalpha or IL-1 with TNFalpha receptor p80-IgG1 fusion protein or IL-1 receptor antagonist, respectively, could be combined with methotrexate, with the disadvantage of a slower initial improvement of clinical symptoms. Combination regimens with the primatised CD4 mAb could include methotrexate as concomitant medication, with chloroquine or sulfasalazine as additional medication. Importantly, combination of different biological agents might induce more severe adverse effects than seen with monotherapy. Thus, protocols involving combinations of biological agents with established DMARDs promise better acceptance than combinations of 2 new and as yet unestablished drugs with possibly synergistic adverse effects because of their antigenic properties.