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ID PMID Title PublicationDate abstract
15121039 Tissue repair in rheumatoid arthritis: challenges and opportunities in the face of a syste 2004 Apr Rheumatoid arthritis (RA) is a systemic inflammatory disease that can elicit a variable disease course, can influence a variable number of joints, and can exhibit a variable response to treatment. All of these factors contribute to the degree and extent of damage to joint components, as well as the potential for repair of other injured joint tissues/components. Furthermore, some of the RA treatments/drugs themselves can influence repair and injury responses, as well as the outcome of surgical interventions for advanced disease. However, as treatments and interventions become more sophisticated and successful in patient populations, the opportunity to initiate the repair/replacement of the damaged joint tissues also becomes more of a reality. This review will address the current clinical findings in the literature, and then discuss the issues and opportunities to initiate repair of damaged or injured joint tissues in order to restore joint function. These include growth factors, gene therapy, and bioengineered tissues, alone or in combination to augment endogenous repair or replace tissue damaged beyond such repair capabilities.
14693349 Rheumatoid arthritis and schizophrenia: a negative association at a dimensional level. 2004 Jan 1 There is wide evidence for a decreased risk of rheumatoid arthritis in patients with schizophrenia. Nevertheless, very few studies have looked at the risk of schizophrenia in a group of patients with rheumatoid arthritis. We prospectively investigated, with the SCL-90R, 220 consecutive outpatients with rheumatoid arthritis and 196 consecutive outpatients with various medical conditions, half of them suffering from psoriatic arthritis (a medical condition close to rheumatoid arthritis). The SCL-90R appears to be a valuable tool to distinguish patients with schizophrenia from the outpatients of our sample, the former having more "paranoid ideation" (p = 0.004) and more "psychoticism" (p < 0.001) than the latter. The "paranoid ideation" dimension was significantly lower (25% decrease) in the sample of patients with rheumatoid arthritis compared to the combined control group (p = 0.005), ratings under the median value being more frequent in the former group (p = 0.025). Confounding factors might not explain this difference according to the regression logistic analysis performed. As patients with rheumatoid arthritis have a lower score of paranoid ideation than controls in our sample, even after controlling for age, gender and severity of the disease, these data represent further evidence for a decreased risk of schizophrenia in individuals with rheumatoid arthritis.
15222600 Valerian use for sleep disturbances related to rheumatoid arthritis. 2004 May Complementary therapies are becoming increasingly popular, particularly for symptoms such as sleep disturbance. The herb valerian may be useful as a mild sleep aid in clinical populations, such as persons with rheumatoid arthritis. This article reviews valerian to inform healthcare providers of potential uses and safety considerations.
12396022 Mast cells as a target of rheumatoid arthritis treatment. 2002 Sep Rheumatoid arthritis (RA) is a chronic inflammatory disease and its exact cause and pathophysiological process remain unclear. Fibroblast-like synoviocytes, macrophages and T lymphocytes are considered to be the major contributors in the pathophysiological process of RA; however, an increasing number of papers have drawn attention to the potential role of mast cells (MCs) in the process. In an animal model of RA, we reported an increase in MC numbers in the arthritic region, which agreed with the observation in human RA. In addition, a good correlation between the number of MCs and the development of disease was observed. However, there has been little experimental or clinical evidence of the beneficial effects of the modification of MC activity on the pathogenesis of RA and this is the weak point of the hypothesis. We therefore studied the effects of a MC-stabilizing compound, cromoglicate lisetil (CL), which is an orally deliverable prodrug of cromolyn sodium, on the RA disease model. The MC-stabilizer had efficacy in a mouse model. The beneficial effects of CL in this animal model further suggested the contribution of MCs in the pathophysiological process of RA. Concerning the contributive mechanism of MC on the pathogenesis of RA, our results using a disease model suggested that activation of MC chymase and matrix metalloproteinases might be involved. MC is now considered to be one of the targets of RA treatment.
11879544 Autoantibody systems in rheumatoid arthritis: specificity, sensitivity and diagnostic valu 2002 The diagnosis of rheumatoid arthritis (RA) is primarily based on clinical symptoms, so it is often difficult to diagnose RA in very early stages of the disease. A disease-specific autoantibody that could be used as a serological marker would therefore be very useful. Most autoimmune diseases are characterized by a polyclonal B-cell response targeting multiple autoantigens. These immune responses are often not specific for a single disease. In this review, the most important autoantibody/autoantigen systems associated with RA are described and their utility as a diagnostic and prognostic tool, including their specificity, sensitivity and practical application, is discussed. We conclude that, at present, the antibody response directed to citrullinated antigens has the most valuable diagnostic and prognostic potential for RA.
12959625 Quality of life in patients with rheumatoid arthritis : which drugs might make a differenc 2003 Rheumatoid arthritis (RA) is a chronic, disabling, inflammatory polyarthritis that affects patient well-being and QOL. Many disease-modifying antirheumatic drugs (DMARDs) are available for treating RA but patients are often refractory to treatment. The goal of treatment is to improve both general health and health-related QOL. Generic and disease-specific instruments exist to measure QOL. Using these instruments, one can determine if QOL improves with treatment. If the minimal clinically important difference (MCID) for the instrument is known, one can determine if the change is clinically significant. The literature was reviewed in a systematic manner to determine which drugs could affect QOL in patients with refractory RA. Refractory RA is poorly defined but we used the definition of failing at least two DMARDs. Methotrexate, leflunomide, cyclosporin, glucocorticoids, etanercept and infliximab clinically and statistically significantly improved QOL in patients with RA. Gold and epoetin-alpha (erythropoietin) statistically improved QOL in patients with RA but the clinical significance of the improvements could not be determined. These studies were either in non-refractory populations or the refractoriness could not be determined. Further study is required to determine the response of QOL to treatment in patients with refractory RA and instruments with known MCIDs should be used so that the clinical significance of the improvement can be determined.
15495436 Mortality in rheumatoid disease. 2004 This paper provides an overview of rheumatoid disease from the perspective of its impact on mortality. The term, rheumatoid arthritis, may promote the misconception that this disease is relatively trivial and easily managed; therefore, "rheumatoid disease" is preferred. Numerous long-term studies in many settings have established that significant excess mortality is associated with rheumatoid disease, and that this excess mortality is related to cardiovascular disease deaths. Inflammation in rheumatoid and cardiovascular diseases shares the same biologic mechanisms. Severity of extraarticular disease, decline in functional level, and level of inflammatory activity are associated with increased risk of mortality. Detection and measurement of novel inflammatory biomarkers may provide tools to assess prognosis and to monitor therapy. Close attention to the management of traditional cardiovascular risk factors is essential in these patients. Whether disease modifying antirheumatic drug (DMARD) therapy will reduce all-cause and cardiovascular disease mortality in rheumatoid disease is the subject of ongoing studies.
12802127 The role of complementary and alternative therapies in managing rheumatoid arthritis. 2003 Jan Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease that is characterized by joint stiffness in the morning, symmetric joint swelling, and generalized fatigue. Given the limitations of medical treatment and the ongoing problems with symptom management, it is not at all surprising that many individuals with RA turn to complementary and alternative medicine (CAM) therapies. This article provides a brief overview of what is known about CAM use in RA, presents information on a few of the most popular therapies, and recommends further resources for nurses who work with individuals with RA.
15564308 X linked agammaglobulinaemia and rheumatoid arthritis. 2005 Jul BACKGROUND: Much interest has been shown recently in the pathogenic role of B cells in rheumatoid arthritis (RA) owing to the marked clinical responses to anti-CD20 treatment in RA. CASE REPORT: A patient with X linked agammaglobulinaemia (XLA) presented with an erosive symmetric polyarthritis with histological features of RA, including formation of a destructive pannus. Furthermore, the patient developed subcutaneous nodules that were histologically indistinguishable from rheumatoid nodules. Surprisingly, lymphocytic infiltrates in both the synovium and nodule consisted almost exclusively of CD8+ T cells. DISCUSSION: Although some peculiar B cell subsets have been described in patients with XLA, no B cell subsets could be demonstrated in synovial tissue or the subcutaneous nodule. This case illustrates that classical RA can develop in the absence of mature B cells.
12110152 The determination and measurement of functional disability in rheumatoid arthritis. 2002 Although functional outcome is frequently discussed and written about, it is often not clear what functional outcome is and how it can be measured. This paper introduces the concept of latent and observed measures of functional disability, and distinguishes between disability as a process measure and disability as an outcome measure. Using the Health Assessment Questionnaire as the main functional outcome measure in rheumatoid arthritis, we propose and discuss several methods for determining disability, and describe the implications of altering the disability course.
15182789 Do primary care physicians have a place in the management of rheumatoid arthritis? 2004 May OBJECTIVE: Few recommendations have been issued about the management of rheumatoid arthritis (RA), which varies widely across physicians. The primary care physician (PCP) plays a unique role as the first physician to evaluate the patient. The objective of this study was to evaluate the place of PCPs in the management of RA. METHODS: Medline was searched for articles reporting management of rheumatoid arthritis in primary care practice. RESULTS: Currently, the goal of initiating a disease modifying anti-rheumatic drug (DMARD) early is unrealistic for numerous patients. Agreement between PCPs and rheumatologists about the diagnosis of RA is only passable, but PCPs tend to overdiagnose RA. Median time from symptom onset to second-line treatment was 19 months and the best predictive factor for a longer lag time before DMARD prescription was the time from symptom onset to the first rheumatologist visit. Moreover, DMARDs are only rarely prescribed by PCPs. Some data suggest that the impact of rheumatologists care is positive on outcomes but it has to be confirmed by longitudinal, randomized studies, with valid outcomes and diagnosis criteria. Recognition of the need for timely referral is an important goal in the teaching of students and generalists. Moreover, the nature of management differences between rheumatologists and PCPs has to be explored. We should also think how to create a better coordination. This starts by knowing what are the needs of the PCP (e.g. education, access to phone advice or rapid consultation) and by defining common plan if the care should be shared. CONCLUSION: Several healthcare professionals, among whom the PCP plays a pivotal role, should share the management of RA. PCPs and rheumatologists should be encouraged to work together on optimizing the management of patients with RA.
15162104 The effectiveness of hand exercises for persons with rheumatoid arthritis: a systematic re 2004 Apr A systematic review was conducted to evaluate the efficacy of hand exercises for persons with rheumatoid arthritis. The databases Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PEDro, and Cochrane were used to search for articles on exercise and hand and rheumatoid arthritis (and their synonyms). Any articles that evaluated the effects of exercise on the hand were included in the review and evaluated for quality on a form specifically developed for the reviews in this issue. Only nine studies evaluated the effect of hand exercise or a program that included hand exercise. Quality scores ranged from 21 to 39 out of a possible 48. Few studies used psychometrically sound measures or reported on changes to everyday function. Although some significant results were obtained, they may have been due to multiple outcome measures, lack of blinding, and within-group rather than between-group comparisons. Impairment and dexterity were frequent outcomes, but measurement of self-report function was lacking. Long-term exercise may increase strength, but results on range of motion are inconsistent across studies, subjects, and joints. There is a need for randomized controlled trials with goal-specific exercise, measurement of outcomes appropriate to the goals, adequate sample size, and comparison with an appropriate control condition.
15488690 Quantitative measures and indices to assess rheumatoid arthritis in clinical trials and cl 2004 Nov Modern medical care has been advanced, in large part, by quantitative measures that provide single, easily-assessed end points for clinical trials, clinical research, or clinical care (eg, blood pressure, serum cholesterol). In rheumatoid arthritis, several types of quantitative measures are used to assess patient status, including formal joint counts; radiographic scores; laboratory tests; patient self-report questionnaire measures of physical function, pain, global status, morning stiffness, and fatigue; as well as physical measures of functional status. Each of these measures is effective to document changes of status with treatment in groups of patients; however, no single measure can serve as a "gold standard" to document changes in each individual patient. Therefore, the measures have been combined into pooled indices that can be applied to individual patients in clinical research and clinical care.
15074028 [Kidneys in rheumatoid arthritis]. 2004 Jan Kidney pathology is a common phenomenon which is revealed in patients with rheumatoid arthritis (RA). Its incidence is estimated at 50-60% of all patients. It is an important clinical problem because it directly affects the outcomes of RA. Changes in the kidneys may result directly from either the underlying illness or complications due to various, including iatrogenic causes. In the following paper we present actual views on the subject of the known up-to-date causes of renal impairment in the course of RA.
14969068 Window of opportunity in early rheumatoid arthritis: possibility of altering the disease p 2003 Sep Therapeutic strategies for the treatment of rheumatoid arthritis (RA) have changed significantly in the last decade. The emphasis is now on early intervention with the aim of preventing disability and irreversible damage. Advocates of early intervention would suggest an alteration in the disease process, not just debulking of inflammatory disease. The data would at least support attenuation of the disease process with aggressive early therapy. Further research is required to elucidate the scientific mechanisms involved and their impact on the pathological progress of RA.
12920646 Magnetic resonance imaging in early detection of rheumatoid arthritis. 2003 Jun Magnetic resonance imaging (MRI) is the modality of choice in early diagnosis and management of rheumatoid arthritis (RA). The pathologic processes in RA involve synovitis, joint effusion, proliferation of fibrovascular connective tissue, and the formation of pannus. Other imaging techniques available for imaging of RA include ultrasound, scintigraphy, computed tomography, and plain radiography (PR). MRI provides high sensitivity in detecting inflammatory changes in the joints. Several studies report high intra- and interobserver reliability and low variation for MRI. MRI allows detection and, in some cases, quantification of synovial changes. Dynamic MRI is a new technique that utilizes rate of synovial enhancement in evaluation of inflammatory changes. MRI allows visualization of erosions in three orthogonal planes. MRI has been shown in many studies to have much greater sensitivity than PR in detecting erosions. Use of a contrast agent further increases the sensitivity in detecting erosions and differentiates and outlines synovial proliferation from fluid collection. Other manifestations of RA such as intraosseous cysts, tenosynovitis, bone marrow edema, and carpal tunnel syndrome can also be visualized on magnetic resonance images. Advances in MRI include contrast-enhancement, dynamic, and quantitative techniques. MRI assists in the early detection of RA, which allows earlier initiation of treatment with disease-modifying therapies.
15201940 [Reconstructing the pyramid as a therapeutic approach to rheumatoid arthritis]. 2004 Jan Several recent clinical studies have clearly established that rheumatoid arthritis (RA) is a disease identifiable since its early phases, a disease that can be adequately and efficaciously treated provided the therapeutic program can be started early on. To reach the aim of controlling effectively the disease and of leading the patients to live a normal life, several points must be fulfilled. The first is an early diagnosis obtained through a careful clinical examination along with an appropriate laboratory immunological work-up, followed by an adequate monotherapy within the first 4 months from symptoms onset. The second is the therapeutic re-assessment that needs to be done every three months, to start a possible combination therapy (COMBO), in order to rescue monotherapy failures. The third is the initiation of biological response modifiers (BRMs) within 6 months from monotherapy onset, within 3 months from COMBO in the most resistant cases. Having at hand several molecules with BRMs characteristics, we believe that the future appears much more favourable in most cases even in those with the severe disease.
15366664 Serologic markers of early rheumatoid arthritis. 2003 Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects symmetrically multiple joints. Recent therapeutic strategy has been focusing on the symptoms of the disease and the ways to prevent its progression as early as possible. Thus, early diagnosis is crucial since early therapy with disease-modifying anti-rheumatic drugs reduces the severity of joint damage. It is the early period of the development of the disease that a specific and sensitive serologic test is needed. The RA patient sera contains a lot of antibodies. Some of them are not specific for RA occurring also in other diseases, others are highly specific and detectable only in rheumatoid arthritis. Rheumatoid factor (RF) is a very sensitive but poorly specific marker which makes it rather an unsuitable antibody for rheumatoid arthritis. RA-specific antibodies can be very useful for early diagnosis and prognosis of the disease. Among the antibodies described in recent years the most promising candidates are the autoantibodies to antigens containing one or more than one citrulline residues (cyclic citrulline peptides, CCP) - the anti-CCP antibodies. They have been shown in recent research to play an important role in the diagnosis, prognosis and therapeutic approach to patients with RA. Their high specificity, the ability to diagnose RA early in its development and distinguish it from other nonerosive type of arthritis, make the anti-CCP a key serologic marker in the future.
15284648 Clinical skills: evidence-based nursing care of people with rheumatoid arthritis. 2004 Jul 22 Rheumatoid arthritis is a complex inflammatory disease with an unknown cause, uncertain prognosis and no known cure. The physical symptoms of this chronic disease can impact on the patient's psychological state and also affect the family unit and social/economic viability. Nursing patients with such a multifaceted illness is a skilled and complex task and it is imperative that the care provided is optimal, timely and underpinned by patient education. Evidence-based nursing care founded on an in-depth knowledge of the disease and its treatments will help to achieve optimal patient outcome.
15157001 Pursuit of optimal outcomes in rheumatoid arthritis. 2004 The aim of this review is to describe methods of quantifying disease activity and symptomatology and discuss treatment goals for rheumatoid arthritis (RA). The benefits and limitations of existing therapeutic approaches, the importance of early therapy in preventing disease progression and the place of biologicals in early therapy will be discussed. Disease activity and symptomatology in RA are often measured using a set of core endpoints that incorporate pain, patient global assessment, physical disability, swollen joints, tender joints, acute phase reactants, physician global assessment and radiographic imaging of joints. Imaging of joints is the only means by which to measure the effects of disease-modifying antirheumatic drugs (DMARDs) on the irreversible joint damage that occurs during RA. There is increasing evidence that this damage and its functional consequences occur early in the onset of disease. The consensus is that patients with RA should be treated with DMARDs earlier rather than later in the disease process. Remission, or a state of sustained response or low disease activity that is not damaging or disabling, is the ideal goal of therapy for RA, but formal criteria defining a state of remission need to be revised and, ideally, updated to include a radiographic component. Currently available DMARDs are limited in their ability to achieve early, sustained response or remission, by delayed onset of action, cumulative toxicity and lack of long-term therapeutic response. It is hoped that the emergence of novel DMARDs--targeted biological agents, such as anti-tumour necrosis factor-alpha (anti-TNF-alpha)--will help to counteract such limitations and will allow early DMARD use to be adopted as standard practice in place of their use as a last resort therapy after failure of other treatment. One such biological agent, etanercept, has been shown to reduce radiographic disease progression and induce overall clinical response during the early stages of RA. It is significantly more effective and fast-acting than methotrexate, one of the most effective, commonly used DMARDs.