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ID PMID Title PublicationDate abstract
12723987 Smoking-gender interaction and risk for rheumatoid arthritis. 2003 The present case-control study was conducted to investigate the relationship between smoking and rheumatoid arthritis, and to investigate formally the interaction between sex, smoking, and risk for developing rheumatoid arthritis. The study was performed in the Central District of Finland. Cases were patients with rheumatoid arthritis and the control group was a random sample of the general population. Logistic regression models were used to evaluate the effect of smoking on risk for rheumatoid arthritis, after adjusting for the effects of age, education, body mass index, and indices of general health and pain. Overall, 1095 patients with rheumatoid arthritis and 1530 control individuals were included. Patients were older, less well educated, more disabled, and had poorer levels of general health as compared with control individuals (all P < 0.01). Preliminary analyses revealed the presence of substantial statistical interaction between smoking and sex (P < 0.001). In separate multivariable analyses, past history of smoking was associated with increased risk for rheumatoid arthritis overall in men (odds ratio 2.0, 95% confidence interval 1.2-3.2) but not in women. Among men, this effect was seen only for rheumatoid factor-positive rheumatoid arthritis. There were significant interactions between smoking and age among women but not among men. We conclude that sex is a biologic effect modifier in the association between smoking and rheumatoid arthritis. The role of menopause in the etiology of rheumatoid arthritis merits further research.
11818586 Depression in rheumatoid arthritis: a systematic review of the literature with meta-analys 2002 Jan OBJECTIVE: This systematic review and meta-analysis examined the strength of association between rheumatoid arthritis and depression. In addition, we investigated the extent to which sociodemographic characteristics, level of pain, and method of assessing depression might affect the degree of depression. METHODS: CD-ROM databases and bibliographies were searched to identify all studies comparing depression in patients with rheumatoid arthritis and control subjects using standardized assessments. Effect sizes (Pearson's r) and probabilities were combined across studies. We examined the extent to which the association between rheumatoid arthritis and depression could be attributed to level of pain (using contrasts), sociodemographic differences between groups (combining methodologically restricted studies), and methods of assessing depression (examining heterogeneity across studies). RESULTS: Twelve independent studies comparing depression in patients with rheumatoid arthritis with depression in healthy control subjects were found. Effect sizes for depression were small to moderate (r =.21, p <.0001; heterogeneous). This effect was not reduced in studies controlling for sociodemographic characteristics (r =.27, p <.0001). The effect sizes did vary in a linear manner in proportion to the effect size for pain (z = 2.67, p =.0064). The effect sizes produced by different measures of depression were heterogeneous (chi(2) for Fisher's Z = 24.6, p =.0002), with the Hospital Anxiety and Depression Scale giving effect sizes most dissimilar to those of other measures. CONCLUSIONS: Depression is more common in patients with rheumatoid arthritis than in healthy individuals. This difference is not due to sociodemographic differences between groups, but it may be attributable, in part, to the levels of pain experienced. Variation in the methods of assessing depression partly accounts for the differences among studies examining the levels of depression in patients with rheumatoid arthritis.
12638224 [Osteoporosis associated with rheumatoid arthritis]. 2003 Feb Patients with rheumatoid arthritis(RA) develop both generalized and periarticular osteoporosis. Both of them are believed to be associated with increased production of inflammatory cytokines(TNF alpha, IL-1 beta, IL-6) and increased formation and activation of osteoclasts. Whether glucocorticoids work positively or negatively on generalized/periarticular osteoporosis is still controversial. RANKL has been shown to be expressed on T cells and fibroblast-like cells in the synovium, thus 'RANKL-RANK' pathway is likely to play an important role in periarticular osteoporosis and bone erosion as well as generalized osteoporosis. Among various therapies for generalized/periarticular osteoporosis in RA, anti-cytokine antibodies/antagonists and osteoclast inhibitors including bisphosphonates are promising.
15508553 Inflammatory arthropathy: a review of rheumatoid arthritis in older patients. 2004 Oct Rheumatoid arthritis (RA) is the most common inflammatory synovitis in older adults. The primary care physician may see its presentatiion as the late stage of a long-term disorder, or alternatively as an elderly-onset disease. These two presentations of RA may differ significantly with respect to mode of onset, prevalence of associated systemic symptoms (eg, fatigue, weight loss, depression), criteria for diagnosis (eg, rheumatoid factor or rheumatoid nodules), progression of diseases and functional outcomes. Because RA is responsive to treatmentt, and new treatments are available, diagnosis of this disorder is imperative. Differential diagnostic possibilities and therapies are reviewed, with particular emphasis on the cause and effect of comorbid disease such as infection, osteoporosis, and cardiovascular disease.
12086173 The problem of empyematous pleural effusion in rheumatoid arthritis: report of two cases a 2002 May Two patients with rheumatoid arthritis and empyematous pleural effusion were treated with repeated drainage and intrapleural corticosteroids. One patient with active joint disease improved within 3 months without sequelae, probably because of the systemic therapy. The other patient, with non-active joint disease, had persistent pleural effusion which resulted in pleural thickening and symptomatic restrictive disturbance. It appears that early intervention intended to prevent the accumulation of empyematous pleural effusion could also prevent pleural thickening and fibrosis. Therapeutic options are discussed.
15482571 Rheumatoid arthritis with diffuse pulmonary rheumatoid nodules. 2004 Oct Rheumatoid nodules in dermal or subcutaneous tissues, while indicative of rheumatoid arthritis, are very rare. It is even less common to identify these rheumatoid nodules by biopsy as well as in autopsy materials from lung tissue. These nodules may be single or multiple, which seldom cause respiratory symptoms. Here, a patient with diffuse pulmonary rheumatoid nodules and interstitial fibrosis throughout both lungs, is described. The patient, with articular symptoms and seropositivity, exhibited a rapid clinical course and died of respiratory failure 3 months after the appearance of dyspnea. Chest radiography indicated interstitial pneumonitis with bilateral diffuse peripheral shadows. At autopsy, numerous rheumatoid nodules and interstitial fibrosis had destroyed both lungs, such that no residual normal pulmonary tissue remained. It is believed that this was an extremely rare case exhibiting large numbers of rheumatoid nodules throughout the lungs. Findings with this patient indicate that, in patients with rheumatoid arthritis, clinical interstitial pneumonitis confirmed radiologically does not exclude the existence of rheumatoid lung nodules.
12819627 Clinical and radiological manifestations of the rheumatoid wrist. A comprehensive review. 2003 Jun OBJECTIVE: The intent of this review article is to present the common clinical and radiological features of the rheumatoid wrist as seen in everyday practice. Imaging of the rheumatoid wrist is discussed with emphasis on magnetic resonance imaging (MRI) and its current and future role in the diagnosis and treatment follow-up of the disease. DATA SOURCE: A search of the current medical literature from 1990 to present through PubMed was performed without constraints. Search terms used included: MRI, rheumatoid arthritis, wrist, treatment, diagnosis, radiology, clinical manifestations, and incidence. STUDY SELECTION: The articles included in this review were selected by historical significance, date of publication, pertinent review information, and, most specifically, those articles studying the current uses for imaging the rheumatoid wrist. DATA SYNTHESIS: This review demonstrated an overall agreement between numerous studies that the usefulness of MRI evaluation of the rheumatoid wrist is in its early stages of development. Many of the features of this examination of the wrist are discussed and contrasted with plain film radiographic examination. RESULTS: The role of the clinician in the diagnosis and treatment, including complementary care, as well as the follow-up of rheumatoid arthritis in the wrist is unquestionable. The role of plain film examination as a diagnostic tool is excellent. The current and future role of MRI of rheumatoid arthritis is becoming obvious and will likely become the diagnostic imaging tool of choice in the near future. CONCLUSION: MRI provides more specific information on rheumatoid lesions in the wrist than plain film imaging. This is especially true when intravenous contrast is utilized. The clinician's use of physical examination, laboratory examination, radiography, and MRI will provide for early diagnosis, treatment, and follow-up of RA in the wrist.
16133582 Pulmonary involvement in rheumatoid arthritis. 2005 Aug The primary objective of this investigation was to assess the relationships between clinical characteristics, lung involvement, and frequency of pulmonary involvement in rheumatoid arthritis (RA). Using high-resolution computed tomography (HRCT) and pulmonary function tests (PFT), we prospectively evaluated 52 patients with RA (eight males and 44 females, mean age 53.6 years). The HRCT was abnormal in 35 patients (67.3%), the most frequent abnormalities being reticulonodular patterns, which were found in 22 patients (62.9%), ground-glass attenuation (20%), and bronchiectasis (17%). In this group of patients, PFT results were normal in 13 patients (37%). Titers of rheumatoid factor and erythrocyte sedimentation rate were significantly higher in abnormal HRCT presence. Higher Larsen's score, advanced age, and severe disease were significant risk factors for lung involvement (p<0.001, p<0.01, and p<0.01, respectively) and are suggested by our data to be statistically significant predictors of lung involvement in RA.
14989426 Effects of DMARDs on IL-1Ra levels in rheumatoid arthritis: is there any evidence? 2002 Sep Recent research has shown that in the processes of rheumatoid arthritis (RA), interleukin-1 (IL-1) is one of the pivotal cytokines in initiating and driving the disease, and the body's natural response, IL-1 receptor antagonist (IL-1Ra), has been shown conclusively to block its effects. Several agents used to treat RA such as disease modifying antirheumatic drugs (DMARDs), as well as glucocorticoids (GC), affect the transcription, synthesis, release, and/or activity of cytokines, including the IL-1Ra. A higher ratio of IL-1Ra:IL-1 production by the peripheral blood mononuclear cells (PBMC) of RA patients successfully treated with methotrexate (MTX) is observed when compared with the PBMC of untreated patients or healthy controls. Recent studies have also shown a significant increase in IL-1Ra with low-dose MTX treatment of cultured monocytic cells. Antimalarials (hydroxychloroquine and chloroquine) have been found to increase the monocyte production of IL-1Ra and these changes might explain at least some of their mechanisms of action. Various studies have shown that leflunomide (LF) tends to favor the inhibition of pro-inflammatory and matrix-destructive factors over that of anti-inflammatory factors (i.e. IL-1Ra) and metalloproteinase inhibitors, thus interfering with both inflammation and tissue destruction. Further studies should investigate the effects of LF on synovial tissue/fluid expression of the IL-1Ra in treated RA patients. Regarding cyclosporin A (CyA), considerable evidence shows that the treatment of RA patients induces a decrease in IL-1Ra levels. Similar results with the inhibition of IL-1Ra mRNA and protein have been observed following RA treatment with glucocorticoids. In addition, the oral administration of cortisol to normal subjects also decreased LPS-induced IL-1Ra synthesis in cultured monocytes. The effects of different DMARDs and GC on IL-1Ra levels in RA patients, as reviewed in this paper, support the important role that selected anticytokine treatments might exert in the pathophysiology of the disease.
12110121 Genes and environment in arthritis: can RA be prevented? 2002 Understanding of how interactions between genes and environment contribute to the development of arthritis is a central issue in understanding the etiology of rheumatoid arthritis (RA), as well as for eventual subsequent efforts to prevent the disease. In this paper, we review current published data on genes and environment in RA as well as in certain induced animal models of disease, mainly those in which adjuvants only or adjuvants plus organ-specific autoantigens are used to induce arthritis. We refer to some new data on environmental and genetic factors of importance for RA generated from a large case-control study in Sweden (1200 patients, 1200 matched controls). We found an increased risk of seropositive but not of seronegative RA in smokers, and there are indications that this effect may be due to a gene-environment interaction involving MHC class II genes. We also found an increased risk of RA in individuals heavily exposed to mineral oils. This was of particular interest because mineral oils are strong inducers of arthritis in certain rodent strains and because polymorphisms in human genetic regions syntenic with genes predisposing for oil-induced arthritis in rats have now been shown to associate with RA in humans. Taken together, our data support the notion that concepts and data on gene-environment interactions in arthritis can now be taken from induced animal models of arthritis to generate new etiological hypotheses for RA.
12670136 Surgical management of the rheumatoid elbow. 2003 Mar Many patients with rheumatoid arthritis demonstrate elbow involvement that may limit upper extremity function, usually within 5 years of disease onset. Initial management consists of nonsurgical measures that address synovitis and capsular inflammation in an effort to diminish pain and maintain elbow range of motion. Disease progression may result in articular damage and ligamentous compromise, causing increased symptoms, elbow instability, and functional debilitation. For patients unresponsive to nonsurgical management, open or arthroscopic synovectomy may provide relief of symptoms. For those with more advanced disease, elbow arthroplasty is a reasonable alternative. Advancements in prosthetic technology and surgical techniques allow elbow arthroplasty to be reliably performed in patients with severe rheumatoid arthritis of the elbow.
15017903 [Criteria for work capacity evaluation in rheumatoid arthritis]. 2004 The Rheumatoid arthritis (RA) causes early retirement and great number of working day losses. According to our investigation, retirement of patient in our country comes even earlier then in other countries. Possible causes for that are limited possibilities of application of contemporary therapy, which result in severer clinical course of the diseases as well as of the different criteria of the physicians for evaluation of the working ability. The aim of this work was to propose the criteria, which would help physicians to evaluate temporary or permanent working ability. For the purpose of forming the proposal of criteria, functional tests, parameters from our own research as well as the suggestions of the top world's institutions OMERACT, EULAR) are used. In order to assess working ability one should need: pain assessment, Ritchie articular index, the number of painful and swollen joints, morning stiffness duration, index of joint motion, functional ability measured by HAQ, ESR, CRP, Disease Activity Score (DAS), and rtg of both hands. Decision of working ability should not be made based on the current status of some parameters; it should be made by the analysis of the disease's progression. If the index of joint motion, functional status and rtg changes are severer every year, the retirement should be considered. The appropriate evaluation of current activity and follow up of its progression with the usage of the proposed criteria should help primary care physicians to evaluate temporary and permanent working disability.
14637276 Antioxidant status in rheumatoid arthritis and role of antioxidant therapy. 2003 Dec BACKGROUND: Oxygen free radicals have been implicated as mediators of tissue damage in patients of rheumatoid arthritis (RA). This study was designed to elucidate plasma oxidant/antioxidant status in rheumatoid arthritis, with the aim of evaluating the importance of antioxidant therapy in the management of this disease. METHODS: The study included 40 patients of rheumatoid arthritis who were randomly divided into two subgroups of 20 each. One group received conventional treatment for 12 weeks and in the other group conventional treatment was supplemented with antioxidants for the same duration. Twenty age- and sex-matched normal individuals constituted the control group. Blood samples of controls and patients were collected at the time of presentation and analyzed for total thiols, glutathione, vitamin C and malondialdehyde (MDA-marker of oxidative stress). The investigations were repeated in the patients after 12 weeks. RESULTS: The blood concentrations of total thiols, glutathione and vitamin C were found to be significantly lower in rheumatoid arthritis patients as compared to healthy controls, while the concentrations of MDA were much higher. There was a statistically significant increase in the posttreatment concentrations of these antioxidants, along with a decrease in the concentrations of MDA. CONCLUSIONS: The antioxidant defense system is compromised in rheumatoid arthritis patients. There is a shift in the oxidant/antioxidant balance in favor of lipid peroxidation, which could lead to the tissue damage observed in the disease. The results suggest the necessity for therapeutic co-administration of antioxidants along with conventional drugs to such patients. However, due to the limited number of cases included in this study, more studies may be required to substantiate the results and arrive at a definite conclusion, in terms of safety and efficacy of adding on antioxidant therapy for the treatment of RA.
12410095 Scleroderma overlap syndromes. 2002 Nov Scleroderma is a connective tissue disease that causes fibrosis and vascular abnormalities, but that also has an autoimmune component. Many patients with scleroderma have a positive antinuclear antibody, and there can be family histories of other connective tissue diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis. Some patients have features of scleroderma and other autoimmune conditions. This article will review recent literature to help in the understanding of scleroderma with overlap features. Recent reports of scleroderma overlap with rheumatoid arthritis suggest distinct features of diffuse scleroderma with positive Scl-70, pulmonary fibrosis, and later seropositive erosive rheumatoid arthritis. SLE rarely occurs with scleroderma. Sjögren syndrome symptoms are common in scleroderma. In primary Sjögren syndrome, anticentromere antibody positive patients have more Raynaud phenomenon. Antibodies that occur in scleroderma that are thought to be specific are present in other connective tissue diseases. For instance, Scl-70 antibody is reported in as many as 35% of patients with scleroderma but can be present in 25% of patients with SLE. Myositis or myopathy can be features of scleroderma. Scleroderma overlap with polymyositis is frequently anti-PM Scl antibody positive, whereas anti-Jo-1 does not normally occur in the overlap of scleroderma and polymyositis but is usually exclusively positive in polymyositis with arthritis and alveolitis. A better prognosis is found with PM Scl antibody in myositis. Vasculitis is not a typical feature of scleroderma, but has been reported. Eosinophilic fasciitis is rare, and the onset could be associated with simvastatin.
15537055 Inflammation-responsive promoters for fine-tuned gene therapy in rheumatoid arthritis. 2004 Oct The inflamed joints of rheumatoid arthritis (RA) patients are ideally suited for gene therapy applications that induce local production of potent anti-inflammatory biologicals. The precise and absolute targeting needed when treating cancer is not necessary in RA. However, the challenge is to regulate transgene expression to meet variable physiological demands during the intermittent course of the disease in RA patients. Thus, a biosensing system with an inducible transcriptional switch that allows robust but adjustable transgene expression is required. Inflammation-inducible promoters are likely candidates to achieve precise control of transgene expression by physiologically driven processes. Acute-phase proteins, pro-inflammatory cytokines, heatshock proteins and hypoxia-responsive genes are all related to the pathogenesis of RA, and their promoters can be exploited for disease-inducible transgene expression. With this, gene therapy enters a new era, that of temporal control of the therapeutic transgene expression. In addition to the reversible transcriptional switch, the ideal expression system also contains an amplification loop for high transgene expression and a drug-controllable switch to allow intervention by the physician. The merging of these modalities may provide a flexible system to fine-tune transgene expression, which is a prerequisite for the implementation of gene therapy in RA.
15082117 Is rheumatoid arthritis a consequence of natural selection for enhanced tuberculosis resis 2004 Although the bubonic plague or "Black Death" is notorious for the toll it took on the population of Europe in the middle ages, another epidemic, the "White Death" of tuberculosis is responsible for millions of deaths worldwide over the past 300 years. With one in four deaths due to tuberculosis in Western Europe and the United States in the 19th century, this disease undoubtedly acted as a powerful genetic selective force. The epidemiology of modern day rheumatoid arthritis (RA) is strikingly similar to the epidemiology of tuberculosis 100-200 years ago, suggesting the possibility that genetic factors that enhanced survival in tuberculosis epidemics are now influencing susceptibility to RA. Recent advances in the analysis of genetic polymorphisms associated with disease have identified several genes linked to RA susceptibility that encode proteins involved in the immune response to Mycobacterium tuberculosis infection, including TNF-alpha, NRAMP1, PARP-1, HLA-DRB1, and PADI4. These results suggest that rheumatoid arthritis, and possibly other autoimmune diseases, are modern day manifestations of the genetic selective pressure exerted by tuberculosis epidemics of the recent past.
11833033 Hypoglossal nerve palsy from cervical spine involvement in rheumatoid arthritis: 3 case re 2002 Feb Rheumatoid arthritis (RA) involvement of the cervical spine is a well-known but perhaps underappreciated phenomenon. Neurologic complications of this involvement include pain, myelopathy, and cranial nerve (CN) palsies. However, hypoglossal nerve palsy (CN XII) is rarely diagnosed. Mechanical nerve injury, either from vertical odontoid subluxation or pannus formation, is the suspected mechanism. We present 2 cases of hypoglossal nerve palsy attributed to cervical spine involvement of RA and 1 case of postoperative tongue weakness after cervical fusion in a patient with long-standing RA. These cases show a potentially devastating complication of RA that may be underdiagnosed. Therapy involving the cervical spine must be prescribed with caution in this patient population.
12916876 A case of clinical indolent natural killer cell lineage large granular lymphocytic leukemi 2003 Jul We report a case of natural killer (NK) cell leukemia with unusual biological features in a 65-year-old woman with a 20-year history of rheumatoid arthritis. She presented with neutropenia, thrombocytopenia, splenomegaly and bone marrow infiltration. Immunophenotyping (CD2+ CD3- CD4- CD5- CD8- CD16+ CD56-) confirmed NK cell leukemia. Her neutropenia and thrombocytopenia resolved following splenectomy and she has remained well with stable disease for 12 months on oral low-dose methotrexate. In contrast to all previous reports, in this instance the phenotype of large granular lymphocytic (LGL) leukemia occurring in the context of rheumatoid arthritis was NK-cell rather than T-cell. Furthermore, the clinical course was indolent, whereas, all prior literature reports have described a very aggressive clinical course for this disorder with a median survival of just 3.5 months. This case illustrates previously unrecognized heterogeneity in the natural history of this disorder.
12486540 [Therapy of rheumatoid cubarthritis]. 2002 Dec With the progression of rheumatoid arthritis (RA),more than half of the patients develop an affliction of the elbow.Cub arthritis has to be regarded as a part of systemic rheumatoid disease. Thus, the indication for operative treatment depends not only on local changes but is determined by the pattern of all affected joints, the activity of the basic rheumatic disease as well as the effect of physical therapy and medication. The complexity of the rheumatic disease, which typically affects many joints, demands an individual therapeutic plan that can only be developed and accomplished successfully when rheumatologists, rheumatoid surgeons and other specialists cooperate. In cases of recurrent cub arthritis,in spite of adequate medication, synoviorthesis or synovectomy should be performed. This may relieve pain and swelling,however if lesions of the cartilage already exist,progressive joint destruction cannot be prevented. Arthroscopic surgery of the elbow provides all of the known advantages of minimal traumatisation. In RA,it is used mainly when there is ligament laxity in late synovectomies eventually combined with arthroscopically assisted resection of caput radii. In contrast to monoarticular diseases in RA,the adjoining bursa olecrani, neighbouring joints and nerve entrapment syndromes also require treatment. The treatment for advanced cub arthritis is arthroplasty. Due to progress in the development of elbow endoprotheses, the range of indications for resection (interposition) arthroplasty has increased. It is now preferred mainly in younger patients with ankylosing arthritis. Rheumatoid changes in the bone and soft tissue impede the implantation of artificial joints and require time consuming and precise preparation techniques. When choosing either an unconstrained or semi-constrained prosthesis,one has to bear in mind the actual ligament stability and its often unpredictable changes during the course of the disease.Perioperative measures, postoperative care and therapy is made even more difficult due to the involvement of several joints, often extensive permanent medication, secondary lesions such as ldquo;corticoid skin" and in most cases the multimorbidity of patients after many years of chronic disease. When comparing elbow surgery in osteoarthritis and RA,we found that patients with RA clearly required more elaborate surgery and more extensive perioperative and postoperative care.
15153584 Plantar pressures in rheumatoid arthritis using prefabricated metatarsal padding. 2004 May We sought to determine whether one of two prefabricated insole designs could better manage high forefoot plantar pressures in patients with rheumatoid arthritis. Ten subjects with rheumatoid arthritis who experienced pain with shod weightbearing were studied by using a plantar pressure measurement system. Two insole designs and a shoe-only control condition were randomly tested in repeated trials. Dome- and bar-shaped metatarsal pads made of latex foam were incorporated into full-length insoles made of urethane. Significant reductions in mean peak plantar pressures over the central metatarsals were noted when using the insole and dome pad design (12% [33 kPa]) and the insole and bar pad design (21% [58 kPa]) compared with the shoe-only condition. A prefabricated insole design incorporating a bar metatarsal pad is recommended to manage high forefoot plantar pressures in patients with rheumatoid arthritis.