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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
9609058 [Hepatitis C virus infection presenting as a polyarthritis: report of 2 cases]. 1997 Nov Several disease have been associated with hepatitis C virus infections, including rheumatologic, hematologic and neoplastic disorders. We report two women, aged 57 and 39 years old whom the initial presentation of hepatitis C virus infection was an arthritis resembling rheumatoid arthritis. Laboratory work up revealed abnormal liver function tests, stimulating the search for hepatitis C virus infection, having both patients positive ELISA tests. Detection of this agent is extremely important when selecting a therapy for the articular disease, since several drugs used in the treatment of rheumatic disorders are potentially hepatotoxic and immunosuppression is risky in the setting of a viral hepatitis.
9082929 Juvenile rheumatoid arthritis-like polyarthritis in chromosome 22q11.2 deletion syndrome ( 1997 Mar OBJECTIVE: To investigate the association of polyarthritis and chromosome 22q11.2 deletions. METHODS: Eighty patients with chromosome 22q11.2 deletion syndrome followed up at The Children's Hospital of Philadelphia were examined for evidence of arthropathy or arthritis. Patients with chromosome 22q11.2 deletion syndrome and polyarthritis underwent laboratory evaluations of immunologic function to determine the relationship of their immunodeficiency to the polyarthritis. RESULTS: The prevalence of polyarthritis in patients with chromosome 22q11.2 deletion syndrome was markedly increased over the prevalence of polyarticular juvenile rheumatoid arthritis (JRA) in the general population. All 3 patients with polyarthritis had evidence of impaired T cell function. Two of the patients with polyarthritis also had IgA deficiency. CONCLUSION: The chromosome 22q11.2 deletion syndrome represents a primary T cell disorder which can be associated with a JRA-like polyarthritis. All 3 patients with polyarthritis had evidence of more extensive immunoregulatory derangements than those typically seen in patients with chromosome 22q11.2 deletion, and these derangements may have predisposed to the development of polyarthritis.
11246667 Uveitis as a cause of visual loss in arthritides and comparable conditions. 2001 Feb OBJECTIVE: To examine the role of inflammatory rheumatic diseases and comparable conditions in the etiology of severe uveitis leading to visual impairment and blindness. METHODS: A retrospective study based on the Finnish Register of Visual Impairment. At the end of 1996, the Finnish Register of Visual Impairment included 296 uveitis patients in whom uveitis was the main cause of visual impairment. The patient records were examined retrospectively to investigate the etiology of severe uveitis. Due to the incompleteness of data obtained of the patients blinded a long time ago, we included only 174 uveitis patients whose visual handicap (best corrected visual acuity in the better eye < 20/60 or severe visual field loss) was stated during 1980-1996. RESULTS: A total of 174 uveitis patients were found, 72 male and 102 female. A diagnosed or presumed inflammatory rheumatic disease or comparable condition was found in 38/174 (22%) patients: juvenile rheumatoid arthritis in 14 (8%), spondyloarthropathy (ankylosing spondylitis or reactive arthritis) in 10 (6%), sarcoidosis in 5 (3%), seronegative rheumatoid arthritis in 4 (2%); Behçet's disease was diagnosed in 2 (1%), 1 patient had polymyositis, 1 polyarteritis nodosa, and 1 juvenile systemic lupus erythematosus. In addition to the above, 10 (6%) patients had chronic back pain and 5 (3%) patients various noninflammatory joint problems. Diverse other ophthalmologic or systemic disease was detected in 38 (22%) cases. Trauma or surgery caused uveitis in 9 (5%) patients. For 74/174 (43%) uveitis patients no specific associating condition could be shown. Legal blindness was documented in 65/174 (37%) patients, including 8 totally blind persons. CONCLUSION: This study provides first data on the relative importance of inflammatory rheumatic diseases and comparable conditions in the etiology of severe uveitis leading to visual handicap and blindness.
18034561 Juvenile idiopathic arthritis: will etanercept be an improvement over current therapies? 2000 Aug Overexpression of cytokines in inflamed joints plays an important role in joint inflammation and in damage to articular tissue. Biological agents aimed at specifically antagonising tumour necrosis factor (TNF) are effective in the treatment of adult rheumatoid arthritis. A recent trial of etanercept, a genetically engineered fusion protein consisting of the Fc domain of human IgG1 and the TNF receptor p75, has demonstrated that this agent is also well tolerated and effective in patients with juvenile idiopathic arthritis (JIA). Etanercept offers a promising new alternative for patients with JIA who have persistently active arthritis despite treatment with methotrexate. Further studies are needed to clarify whether etanercept is equally effective in the various onset types of JIA (oligoarthritis, polyarthritis and systemic arthritis), whether it can modify disease progression and whether it can be administered safely for long periods of time to children.
10517078 Treatment of juvenile rheumatoid arthritis. 1999 Sep Advances in pediatric rheumatology have closely paralleled those in adult rheumatology, but several unique features of JRA have led to some prominent differences. Methotrexate has clearly become the gold standard for use in moderate to severe disease. A variety of the second-line agents and newer methods of corticosteroid dosing can be used in milder disease or in patients who fail or refuse methotrexate. Biologic agents and newer immunosuppressive agents hold out significant promise for those with the most severe disease. As for adult disease, a cure for arthritis is far away, but the lives of these patients have truly been revolutionized by the wide array of newer therapies.
10231009 Immunity to heat shock proteins and arthritic disorders. 1999 Adjuvant arthritis (AA) is a frequently used model of experimental arthritis. Because of its histopathology, which is reminiscent of rheumatoid arthritis in humans, AA is used as a model for the development of novel anti-inflammatory drugs. Recently, it has become evident that AA is a typical T-cell-mediated autoimmune condition. Therefore, novel immunotherapies targeted to T cells can be developed in this model. Analysis of responding T cells in AA have now led to the definition of various antigens with potential relevance to arthritis, including human arthritic conditions. One such antigen defined in AA is the 60kD heat shock protein. Both T-cell vaccination approaches and active antigen immunizations and antigen toleration approaches have turned out to be effective in suppressing AA.
24387023 Predictors of rheumatoid arthritis in patients who have monoarthritis in a knee joint. 2001 Mar Abstract To determine the predictive factors for rheumatoid arthritis (RA), 79 patients (11 men, 68 women; average age at onset of symptoms 37.1 years) with fixed joint effusion of one knee joint, of minimum 6 months' duration, were divided into three groups: group I, 11 patients (14%) who progressed to RA; group II, 8 patients (10%) with the correct diagnosis, except that RA became apparent during the subsequent follow-up; group III, 60 patients (76%) whose joint effusion resolved. In group I, the degree of joint effusion and the serological values of interleukin (IL)-1β, IgG-RF, and rheumatoid factor (RF) tended to be higher than those in the other groups at the time of our initial examination. The synovial fluid concentrations of IL-1β and IgG-RF in group I were significantly higher than those in the other groups. Magnetic resonance imaging (MRI)-determined stage and histological assessment of synovial inflammation also tended to be higher in group I than in the other groups. This study revealed that it might be possible to predict the outcome of cases of monoarthritis by examining IL-1β and IgG-RF levels in the synovial fluid, in addition to various elevated inflammation signs in the knee joint.
9177924 Does serum rheumatoid factor have an influence on the clinical picture of ankylosing spond 1997 May OBJECTIVE: To describe the influence of serum rheumatoid factor (RF) on the clinical and radiological picture of definite ankylosing spondylitis (AS). METHODS: In a retrospective chart review of 281 AS patients typed for RF, the clinical picture of RF positive patients (Group 1) was compared with RF negative patients (Group 2); mode of onset, disease duration, and treatment were recorded. All patients were examined to determine their clinical status; the blood cell count. HLA-B27, serum IgG, IgM, IgA, and erythrocyte sedimentation rate (ESR) were determined, and radiological studies of the entire spine, pelvis and affected peripheral joints were carried out. In patients from Group 1 the HLA-DR was also determined. RESULTS: Fifteen of 281 patients (8 men, 7 women) with AS were RF+ (1:64 to 1:1024) (5.3%) and 11 were HLA-B27+. Seven patients in Group 1 had spine involvement and chronic arthritis of the knees. Four out of these 7 were tested for DR, and none was positive; in 6, AS and rheumatoid arthritis (RA) coexisted, 2 were DR1 and 2 were DR4 (test not carried out in 2). In two others we found spinal involvement only, and one of them had both DR1 and DR4. The onset of AS was similar in both groups. Group 1 was characterized by a chronic disease of moderate intensity with chronic arthritis of the metacarpophalangeal and proximal interphalangeal joints (p = 0.0008 and p = 0.04, respectively), no valvulopathy (p = 0.04) and fewer uveitis sequelae (p = 0.007) than Group 2. The ESR (p = 0.01), IgG (p = 0.008) and IgM (p = 0.0001) were higher in Group 1 than in Group 2. CONCLUSIONS: The presence of RF in AS is associated with a chronic disease of moderate intensity with chronic peripheral arthritis and fewer extra-articular manifestations. The presence of RF, not always associated with HLA-DR, seems to affect the course of AS and does not necessarily indicate an association with RA.
10468414 Rheumatic syndromes: clues to occult neoplasia. 1999 Aug OBJECTIVES: Rheumatic disorders associated with cancer include a variety of conditions, most of which have no features distinguishing them from idiopathic rheumatic disorders. It is generally held that an extensive search for occult malignancy in most rheumatic syndromes is not recommended unless accompanied by specific findings suggestive of malignancy. The objective of this review are to identify rheumatic syndromes associated with cancer, to call attention to features that may suggest the presence of a hidden cancer, and to examine the role to additional clinical and laboratory data as clues to the possible neoplastic cause of those syndromes. METHODS: A MEDLINE search of the literature dealing with cancer-associated rheumatic syndromes was conducted. RESULTS: Review of the literature identified significant progress in this area. First, the association of malignancy with certain rheumatic syndromes was convincingly established, such as asymmetric polyarthritis presenting in the elderly with an explosive onset, rheumatoid arthritis with monoclonal gammopathy, Sjögren's syndrome with monoclonality, hypertrophic osteoarthropathy, dermatomyositis, polymyalgia rheumatica with atypical features, Lambert-Eaton myasthenic syndrome, palmar fasciitis and arthritis, eosinophilic fasciitis poorly responsive to corticosteroid therapy, erythema nodosum lasting more than 6 months, and onset of Raynaud's phenomenon or cutaneous leukocytoclastic vasculitis after age 50 years. Second, the list of cancer-associated rheumatic syndromes was extended by including additional entities such as benign edematous polysynovitis, sacroiliitis, adult-onset Still's disease, dermatomyositis sine myositis, systemic sclerosis, Sweet's syndrome, osteomalacia, skeletal hyperostosis, antiphospholipid syndrome, and essential mixed cryoglobulinemia. Third, evidence was provided substantiating that certain long-standing rheumatic syndromes, in particular rheumatoid arthritis, Felty's syndrome, Sjögren's syndrome, dermatomyositis, systemic sclerosis, systemic lupus erythematosus, and temporal arteritis behave like "premalignant conditions." Fourth, it was shown that the recognized tumor markers alpha-fetoprotein, prostate-specific antigen, CA-125, CA 19-9, and CA-3 have low sensitivity and specificity in screening for occult cancer in a population of rheumatic patients, whereas the presence of a monoclonal gammopathy in rheumatoid arthritis and the monoclonal antibody 17-109 in Sjögren's syndrome are reliable signs of malignant transformation. CONCLUSIONS: The presence of specific rheumatic syndromes and certain clinical and laboratory findings may justify a workup for hidden cancer. Studies of the epidemiology of the cancer-associated rheumatic syndromes and evaluation of the validity of aforementioned clues in prospective studies are goals for future investigations.
11229462 The association of cigarette smoking with disease outcome in patients with early inflammat 2001 Feb OBJECTIVE: Cigarette smoking is known to increase rheumatoid factor (RF) and nodule formation in patients with rheumatoid arthritis (RA). In this study, we examined the influence of smoking on disease outcome at 3 years among patients newly presenting with inflammatory polyarthritis (IP). METHODS: We studied 486 patients with IP who were referred to the Norfolk Arthritis Register, of whom 323 (67%) satisfied the American College of Rheumatology 1987 criteria for RA. Smoking status was assessed at baseline. Disease outcome was assessed at 3 years, using measures of joint inflammation, functional disability, and radiologic damage. The influence of smoking on disease outcome was explored using logistic regression techniques, with patients who had never smoked as the referent group. Results are expressed as odds ratios (ORs), with their 95% confidence intervals (95% CIs). RESULTS: Current smokers were significantly more likely to be RF positive at baseline (47%) than were ex-smokers (34%) and never smokers (31%). After 3 years, rheumatoid nodules were significantly more common in smokers (13%) compared with ex-smokers/never smokers (4%), a relationship which persisted after adjusting for age and sex (OR 4.07, 95% CI 1.38-12). In contrast, after adjusting for age and sex, current smokers had significantly fewer swollen joints (OR 0.61, 95% CI 0.37-0.98). However, smoking status had no influence on the development of erosions or functional disability. CONCLUSION: Despite smokers being more likely to develop nodules and to be RF positive, current smokers did not have higher levels of radiologic damage, and had fewer swollen joints. We hypothesize that this could be due to either the effect of cigarette smoking on the inflammatory response or other factors (e.g., reduced physical activity in smokers) which may limit joint inflammation and damage.
10439526 Pyoderma gangrenosum with secondary pyarthrosis following propylthiouracil. 1999 Aug The association of pyoderma gangrenosum and arthritic symptoms is well documented. We present a rarely reported variant of this in a 44-year-old woman with pyoderma gangrenosum and bilateral large purulent effusions of her knees. She had no evidence of underlying rheumatoid arthritis or a specific seronegative spondyloarthropathy. Of note she had a history of Graves' disease for which she had been treated with propylthiouracil for 3 years and on investigation at this presentation had a markedly elevated perinuclear antineutrophil cytoplasm antibody (P-ANCA) level with specificities for IgM myeloperoxidase, IgG elastase and IgG lactoferrin. We believe this patient had pyoderma gangrenosum with secondary sterile pyarthrosis and a P-ANCA precipitated by propylthiouracil.
12167972 [Stress response system and personality in rheumatoid arthritis patients]. 2001 Various factors such as immunogenetic determinants, sex, age and stress play an important role in the pathogenesis of rheumatoid arthritis (RA). The relationship between stress and RA is still unclear and undefined; however, various lines of research are developing in order to evaluate environmental, psychologic, and biologic stressors as predisposing factors. The aim of our study was to evaluate whether stress-related psychologic factors and personality disorders might be involved in the development of RA, by using a psychometric investigation-methodology in a series of patients. Twenty-three patients underwent a clinical interview and other specific psychometric tests. Macro and microstressful life-events preceded RA in 83% of the cases. Sixty percent of the patients showed a correlation between flare-ups of the disease and appearance of microevents. An obsessive-compulsive personality was found in 26% of the patients. Anxia was detected in 40% of the patients. Among the group of patients with borderline disorder's was also detected alexithymia. The high prevalence of major life-events preceding the onset of RA and the presence of personality disorders support the role of the altered stress response system as an important pathogenetic factor in the disease.
9850691 [Pneumatosis cystoides intestinalis in systemic diseases: 3 cases]. 1998 Nov 14 BACKGROUND: Pneumatosis cystoides intestinalis (PCI) is usually a complication of digestive tract or respiratory tract diseases, but rare cases have been described in systemic diseases, mainly systemic sclerosis. CASE REPORTS: Three patients, one with temporal arteritis and two with polyarteritis nodosa (complicating rheumatoid arthritis in one case) were treated by prednisone. All three developed PCI, complicated in one case by a retropneumoperitoneum. Medical treatment led to a favorable outcome in all cases. DISCUSSION: Sixty-two cases of PCI have been reported in patients with various systemic diseases (systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease, dermatopolymyositis, polyarteritis nodosa, rheumatoid arthritis, Sjögren's syndrome, amyloidosis). Systemic sclerosis is the most frequent condition (45%). In the other cases, corticosteroid therapy or digestive tract vasculitis are the main causal factors. Outcome is usually favorable with medical treatment. Laparotomy is rarely needed.
18465576 Bisphosphonates: a review of their novel anti-inflammatory properties and potential for th 1998 Aug Bisphosphonates (BP) are synthetic pyrophosphates with a stable P-C-P bond replacing the more labile P-O-P bond. This structural class has been used extensively for the treatment of bone diseases, such as osteoporosis and hypercalcemia due to the propensity of BP to bind mineralized tissues and prevent bone resorption. Rheumatoid arthritis (RA) is characterized by chronic inflammatory synovitis, pannus tissue formation and erosion of bone and cartilage, which is a major, disabling, pathogenic feature poorly managed with existing disease modifying anti-rheumatic drugs (DMARDs). A few investigators have used BP in combination with anti-arthritic therapy to treat the bone erosion component of RA, reports of which are mainly anecdotal. We review data suggesting that BP possess novel anti-inflammatory properties which may also be of benefit for the treatment of the chronic inflammatory component of RA, thus modifying the subsequent destructive disease process by mechanisms unrelated to direct inhibition of bone resorption. The rationale for pursuing this therapeutic approach to demonstrate BP anti-inflammatory activity will be reviewed. The subsequent design and synthesis of new BP chemical entities and their altered pharmacokinetic properties will also be discussed.
11681098 [100 years shoulder and elbow surgery]. 2001 Oct Within the past 100 years, shoulder and elbow surgery has developed into a highly sophisticated specialty. Technical advancements now allow operative treatment of most shoulder and elbow disorders. Shoulder arthroplasty is able to accurately reproduce normal anatomy and function. It is used in degenerative omarthrosis, humeral head fractures, rheumatoid arthritis, and rotator cuff arthropathy. After 10 years, survival of 93% can be expected and in omarthrosis an outcome score of 85 of 100 points. In recurrent shoulder instability, open surgery is still the gold standard. It allows to accurately adjust capsular tension. Modern arthroscopic techniques shorten the capsule with sutures or by capsular shrinkage, but sufficient follow-up is not yet available. Arthroscopic subacromial decompression is the standard procedure for subacromial disorders. The indication for operative rotator cuff closure must be adjusted to the age and functional expectations of the patient. Smaller defects can be closed arthroscopically. The operative technique in proximal humerus fractures is particularly demanding, due to osteoporosis and the risk of avascular necrosis. Magnetic resonance imaging is the preferred imaging technique at the shoulder, often combined with intravenous or intra-articular contrast injection. Elbow joint replacement is mostly used in rheumatoid arthritis and has achieved a high technical standard.
16196481 IL-6 and arthritis: a detrimental or beneficial mediator? 1998 Dec Acute inflammation is accompanied by changes in the concentrations of several plasma proteins. Cytokines play a crucial role in the regulation of inflammatory events. Inflammatory disorders such as rheumatoid arthritis are characterized by an overproduction of several cytokines including interleukin-6 (IL-6). Recent data suggest that IL-6 and other members of the IL-6-cytokine family have anti-inflammatory and immunosuppressive properties, and therefore may negatively regulate inflammatory processes.
16118714 Ilodecakin. Schering-Plough Corp. 1999 Oct Schering-Plough's interleukin (IL)-10 (ilodecakin) is under investigation for the potential treatment of autoimmune diseases, solid tumors, ulcerative colitis, Crohn's disease and organ transplantation. In June 1996, ilodecakin entered phase II trials for Crohn's disease, ulcerative colitis and rheumatoid arthritis and, as of June 1999 was reported to be in phase III trials for Crohn's disease and rheumatoid arthritis. It has also demonstrated promising effects in the treatment of inflammatory bowel disease. In January 1997, phase I trials began in HIV-infected patients. Initial results from a pilot study, carried out by the National Institute of Allergy and Infectious Disease Control, indicated that a single dose of IL-10 decreases the blood viral load. The results, however, were transient. Early clinical studies are ongoing in acute lung injury, ischemia-reperfusion injury, multiple sclerosis and psoriasis. In February 1999, Morgan Stanley Dean Witter predicted sales of US $50 million in 2000 rising to US $325 million in 2005.
24383683 Role of HTLV-I infection in the pathogenesis of Sjögren's syndrome and rheumatoid arthrit 2001 Jun Abstract HTLV-I has been identified as a causative agent which initiates and/or perpetuates the process of Sjögren's syndrome (SS) and rheumatoid arthritis (RA). A high seroprevalence of HTLV-I infection has been determined in both SS and RA patients in the HTLV-I-endemic area of Nagasaki, Japan. HTLV-I proviral DNA and HTLV-I Tax/Rex mRNA are expressed in the salivary glands or synovial cells of HTLV-I-seropositive SS or RA patients, indicating that HTLV-I is present in the affected organs and modulates the process of the disease. Cellular functions are modulated by HTLV-I infection, showing that cell proliferation and cytokine production are upregulated in HTLV-I-infected cells, and this is in part mediated by the HTLV-I Tax-induced NF-κB activation of host cells. Furthermore, Tax-mediated NF-κB activation involves resistance toward apoptotic stimuli in HTLV-I infected cells. These modulatory effects of HTLV-I Tax are believed to be important in promoting autoimmune disorders such as SS and RA in HTLV-I-seropositive subjects.
24383637 Factors affecting emotional instability in female rheumatoid arthritis outpatients with li 2000 Dec Abstract We attempted to identify which background factors were the most important indicators of such psychological problems as emotional instability, a feeling of hopelessness, and suicidal tendencies in female rheumatoid arthritis (RA) outpatients with limited functional disorder. Among female RA patients aged 20 years and older who visited the outpatient clinic, 101 class I and II patients were selected as subjects for the present study. An original questionnaire and a psychological test (CMI) were given to those subjects who had given their written consent to such testing, and an analysis was carried out on 85 patients who returned all the written forms. Their emotional instability was related to factors such as "not being able to understand the nature of RA disease and its treatment," "sense of value had changed after developing RA," "nonuse of drugs," and "duration of disease." A feeling of hopelessness was related to "smoking," and a suicidal tendency was related to "smoking" and "class I." We identified a characteristic correlation between emotional instability and background factors in this study. Paying close attention to these factors may thus be useful in preventing the appearance of psychological problems as well as in developing effective early treatment strategies.
22175264 The effect of hypnosis therapy on the symptoms and disease activity in Rheumatoid Arthriti 2000 Nov Abstract The present study aimed to assess the effectiveness of clinical hypnosis on the symptoms and disease activity of Rheumatoid Arthritis (RA). Sixty six RA patients participated in a controlled group design. Twenty six patients learnt the hypnosis intervention, 20 patients were in a relaxation control group and 20 patients were in a waiting-list control group. During hypnosis, patients developed individual visual imagery aimed at reducing the autoimmune activity underlying the RA and at reducing the symptoms of joint pain, swelling and stiffness. Subjective assessments of symptom severity and body and joint function, using standardised questionnaires and visual analogue scales, were obtained. Objective measures of disease activity via multiple blood samples during the therapy period and at the two follow-ups were also taken. These measurements were of erythrocyte sedimentation rate. C-reactive protein, haemoglobin and leukocyte total numbers. Results indicate that the hypnosis therapy produced more significant improvements in both the subjective and objective measurements. above relaxation and medication. Improvements were also found to be of clinical significance and became even more significant when patients practised the hypnosis regularly during the follow-up periods.