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ID PMID Title PublicationDate abstract
12846059 Seropositive rheumatoid arthritis associated with Crohn's disease. 2003 May In the present study we report a patient with long-standing seropositive rheumatoid arthritis, who developed Crohn's disease. We discuss the possible pathophysiologic mechanisms and their associations between these two entities.
15517624 Thoracic surgical procedures in patients with rheumatoid arthritis. 2004 Nov OBJECTIVE: Rheumatoid arthritis (RA) is associated with a variety of pleuropulmonary manifestations, some of which require surgical intervention. We investigated the spectrum of indications and results, as well as outcome associated with thoracic surgical procedures in rheumatoid patients. METHODS: Identification and retrospective review of medical records of 100 patients with RA at a tertiary-referral medical center undergoing thoracic surgical procedures over a 24-year period from January 1, 1976, to December 31, 1999. RESULTS: Sixty-four patients underwent surgical lung biopsy for localized lung lesions, 57 of which were nodules or masses; 24 lesions proved to be malignant. Surgical lung biopsy was undertaken in 40 patients for diffuse interstitial lung disease, 4 cases of which were found to be infectious. Five other patients underwent surgery for pleural disease, 3 of which proved to be benign pleuritis. CONCLUSION: Patients with rheumatoid disease undergo thoracic surgical procedures for a variety of indications, including benign and malignant localized lesions and pleural disease as well as diffuse parenchymal lung disease. The overall in-hospital mortality rate was low. However, the subgroup with diffuse interstitial lung disease was found to have a 20% in-hospital death rate following surgical lung biopsy.
15326999 Phenomenological lived experience of patients with rheumatoid arthritis. 2004 Jul This phenomenological study explored (a) the lived experience of rheumatoid arthritis (RA), (b) the patient's view of the nurse's role, and (c) the patient as comanager of RA. The purposive sample consisted of 6 Caucasian women living in West Virginia. Using Colaizzi's methodology, a rich, exhaustive description of living with RA emerged. Recommendations for nursing care quality focus on providing personalized, holistic, and humanistic care, which may ultimately improve the patient's quality of life.
12910564 Group education for patients with rheumatoid arthritis and their partners. 2003 Aug 15 OBJECTIVE: To determine the effects of group education followed by booster sessions for people with rheumatoid arthritis (RA), and to determine whether participation of a significant other influenced the effects. METHODS: A total of 218 RA patients, each of them with a partner, took part in the study. Two-thirds of the patients received a 5-week group self-management education program, with booster sessions after 3, 6, and 9 months; half of them received the intervention with a partner, and half without. One-third of the patients received the same educational materials without group sessions. Data were collected 1 week before the group sessions began and 2, 6, and 12 months later. The assessments included health behavior, arthritis self-efficacy, health status, and social interactions. RESULTS: After 12 months, self-efficacy scores for coping with other symptoms were significantly higher for patients participating in the group education without a partner and significantly lower for patients participating in the group education with a partner. Fatigue increased in patients participating in the group education with a significant other and decreased in patients participating in the group education without a significant other. No other effects were found on health status, health behavior, or social interactions. CONCLUSION: Our findings suggest that participation of a significant other in psychoeducational programs does not have only positive effects. Instead of stimulating patients to adopt beneficial health behaviors and increase their self-efficacy expectations, participation of a significant other led in our program to decreases in self-efficacy and increased fatigue, whereas patients participating in group education without partners showed increases in self-efficacy and decreased fatigue. Booster sessions did not seem to influence results.
15053447 The Nijmegen inception cohort of early rheumatoid arthritis. 2004 Mar Rheumatoid arthritis is a heterogeneous chronic disease with an unpredictable disease course. To study such a disease, longterm observational studies are needed, with regular assessment of patients using valid and reproducible measures. This article describes the purpose and design of such a study at the Department of Rheumatology, University Medical Centre Nijmegen. Within this inception cohort, several instruments to assess RA were developed and validated, such as the Disease Activity Score, the European League Against Rheumatism response criteria, and a Dutch version of the Health Assessment Questionnaire disability index. These instruments are described and results of studies are discussed concerning prognostic and predictive factors, disease course, and the relationship between the different process and outcome measures.
12211537 Elderly onset rheumatoid arthritis complicated by polymyalgia rheumatica. 2002 Aug We report herein the case of a 70-year-old patient with elderly onset rheumatoid arthritis associated with severe muscle pain in shoulder and pelvic girdle. The patient revealed erosive polyarthritis with high titers of rheumatoid factor. Muscle pain started one month after the onset of rheumatoid arthritis followed by muscle weakness and muscle atrophy. Synovial effusion and edema in the soft tissue outside of the articular capsule in the knee joint were confirmed ultrasonographically. Administration of prednisolone at 20 mg/day dramatically abolished the muscular manifestations. The coexistence of an early stage of elderly onset rheumatoid arthritis and polymyalgia rheumatica was considered due to the presence of seropositive erosive arthritis and severe muscle manifestations at the same time.
12143412 Management of inflammatory arthritis around the elbow. 2002 Feb There are multiple causes of elbow swelling, with RA being the most common. Crystalline disease such as gout is also frequently seen. Oral medication or intra-articular steroid injection can be extremely effective in controlling symptoms. Synovectomy in conjunction with radial head excision continues to have a role. Fascial arthroplasty can be beneficial in younger patients in isolated disease. In more advanced cases, total elbow arthroplasty is an attractive alternative.
12435164 Key randomized trials of single agents in early rheumatoid arthritis. 2002 Nov Disease modifying antirheumatic drugs (DMARD) for treatment of rheumatoid arthritis (RA) are well established. As evidence has shown, considerable damage to the joints occurs early in the disease: thus DMARD therapy is being initiated earlier. Clinical trials with DMARD monotherapy in early RA are reviewed with consideration given to efficacy, onset of therapeutic effect, and the toxicity profile of currently available drugs.
14657620 The expression of rheumatoid arthritis in Kuwaiti patients in an outpatient hospital-based 2004 Jan OBJECTIVE: To describe the characteristic clinical, serologic and radiological features of rheumatoid arthritis (RA) in Kuwaiti patients in a tertiary outpatient hospital-based practice. SUBJECTS AND METHODS: An outpatient hospital-based study on 100 consecutive consenting Kuwaiti patients with RA was done at the Rheumatology Unit, Al-Amiri Hospital, one of the main teaching hospitals in Kuwait. The study group included 11 men and 89 women. The duration of their disease ranged from 2 to 30 years with a mean duration of 10.7 (SD 7.5) years. The age at disease onset ranged from 21 to 71 years with a mean age of 39.1 (SD 11.2) years. RESULTS: Joints most commonly involved in RA were metacarpophalangeal, wrist, knee, and proximal interphalangeal joints. Extra-articular manifestations were present in 24 patients; the most common was the sicca complex in 14 individuals. Rheumatoid factor seropositivity was found in 60 patients and erosive arthropathy in 42 patients. CONCLUSION: The findings indicate a low incidence of radiological erosive arthropathy in Kuwaiti patients. The sicca complex was the most common extra-articular manifestation of RA in these patients.
12734919 Deriving an operational definition of low disease activity state in rheumatoid arthritis. 2003 May This article summarizes the process proposed to come to a definition of low disease activity in rheumatoid arthritis (RA). The purpose of this definition is to aid the interpretation of trial and longitudinal study results. A conceptual proposal is "a disease activity state that is deemed a useful treatment target by both physicians and patients." An operant definition can be derived by judgmental (opinion-based) or statistical (data-based) approaches, but the first seems more appropriate. Once a few candidate definitions have been selected, their usefulness and prognostic validity can be tested in longitudinal datasets.
12426799 Guidelines for the management of rheumatoid arthritis: 2002 update. 2002 Oct Rheumatoid arthritis (RA) is a progressive polyarthritis that is responsible for over nine million office visits annually. It is likely that most nurse practitioners will care for one or more patients with RA because approximately 1% of the adult population is affected by this disabling disorder. The guideline reviewed in this month's column describes the recommended care of patients who have been previously diagnosed with RA.
12447626 Bloodstream thrombopoietin in rheumatoid arthritis with thrombocytosis. 2002 Nov Thrombopoietin (TPO) is the major regulator of growth and differentiation of megakaryocytes. Recent studies have shown that TPO may also act as an acute-phase reactant, and it has been suggested as a component of inflammatory reactions. In this study our objective was to investigate serum TPO levels in patients with rheumatoid arthritis, a complex chronic inflammatory disorder not uncommonly associated with thrombocytosis. Bloodstream TPO concentrations were assessed in 13 RA patients with platelet counts between 450 and 650 x 10(9)/l, 10 RA patients with platelet counts >650 x 10(9)/l, 15 RA patients with normal platelet counts and 12 healthy controls. RA patients with normal platelet counts had TPO levels comparable with healthy controls. TPO concentrations in patients with mild thrombocytosis were significantly elevated, whereas patients with markedly increased thrombocyte counts had prominently decreased TPO levels. These results indicate that TPO seems to be associated with reactive thrombocytosis in RA patients with active disease. In patients with extremely increased thrombocytosis serum TPO levels might be regulated by increased platelet mass via receptor-mediated uptake and metabolism.
12827063 A longitudinal study of rheumatoid arthritis in South Africans. 2003 Feb 5 Little is known about the functional outcome of rheumatoid arthritis (RA) in Africans treated with disease-modifying antirheumatic drugs (DMARDs). We describe our experience with 182 RA patients seen at a tertiary hospital in South Africa. During the median follow-up period of 3.3 years, the proportion of patients with severe functional disability (American College of Rheumatology [ACR] functional classes [FCs] 3 and 4) declined significantly from 48.9% at presentation to 30.8% at last visit (P =.0006). There was a significant fall in the median Westergren erythrocyte sedimentation rate (ESR) (46-28 mm/hour, P <.00001) and C-reactive protein (CRP) (19-15.5 mg/L, P =.006) over this period. Logistic regression analysis showed that the factors that negatively affected functional outcome at last visit were severe functional disability at presentation (odds ratio [OR] = 4.1, P =.0004), delay in referral for specialist care > 2 years (OR = 3.1, P =.02), and ESR at last visit > 28 mm/hour (OR = 3.2, P =.002). DMARDs and oral corticosteroids were prescribed in 93.1% of patients at presentation and 60.4% of patients at last visit. Life-table analysis showed that the survival time with methotrexate (MTX) use was significantly longer compared with the other DMARDs (P =.0002). A total of only 37 surgical procedures were performed on 21 patients. This retrospective study shows that despite the late presentation and severe disease, patients do improve on DMARD therapy in the medium term. The study highlights the need for prospective studies to assess the efficacy and safety of DMARDs, particularly in early disease, in the developing countries where biologics are unlikely to be affordable in the foreseeable future.
15201608 Noninvasive techniques for assessing skeletal changes in inflammatory arthritis: imaging t 2004 Jul New imaging techniques such as ultrasound and MRI are likely to play increasing roles in the future management of patients with inflammatory arthritis, particularly those with rheumatoid arthritis and spondyloarthropathies. Ultrasound has a number of distinct advantages including its ability to scan multiple joints, safety, and immediately availability in clinic. MRI, however, is more sensitive and has a greater field of view because of its tomographic nature. Both modalities have the added advantage over radiography in that they can image soft tissue as well as bone. Dual X-ray absorptiometry already has an established role to play in the assessment of osteoporosis, but new techniques such as digital radiogrametry, quantitative CT, and ultrasound potentially will have a more important role to play in the future.
14749975 Reappraisal of cervical spine subluxation in Thai patients with rheumatoid arthritis. 2004 Feb Subluxation of the cervical spine is one of a number of devastating complications of rheumatoid arthritis. In spite of this, the features of cervical spine subluxation in Thai patients with rheumatoid arthritis have never previously been studied. We enrolled 134 patients with rheumatoid arthritis who were being followed at the rheumatology clinic, Ramathibodi Hospital, during 1978-2001. Radiological examinations were made in lateral neck flexion, extension and open-mouth views. Symptoms of neck pain and the results of relevant neurological examinations were recorded at the time of imaging. Other data on clinical features and treatments since diagnosis were reviewed retrospectively. The overall prevalence of cervical spine subluxation was 68.7%, which can be categorised into anterior (26.9%), posterior (14.9%), lateral (17.2%), vertical (16.4%) atlantoaxial and subaxial subluxation (28.4%). The percentages of cervical subluxation in patients who had suffered from the disease for 1, 5, 10 or more than 10 years were 77.8%, 64.9%, 70% and 64.7%, respectively. None of the patients had neurological deficits. No correlation between neck pain and cervical spine subluxation was established. The number of patients treated with corticosteroids was significantly higher in the subluxation group than in the non-subluxation group ( p=0.04). However, no difference in duration of treatment and cumulative dosages of steroids was displayed between the two groups. It was concluded that the prevalence of cervical spine subluxation in Thai patients with rheumatoid arthritis is much higher than the average, even in the early phase of the disease. Hence, radiological examination of the cervical spine should be included in the initial evaluation of Thai RA patients. Corticosteroid use was associated with cervical subluxation, regardless of dose and duration of treatment. The possible explanations are that steroids may directly cause ligament laxity, osteoporosis and decreasing muscle mass, which leads to accelerated subluxation, or that steroid treatments are used in more severe cases which have a higher tendency towards cervical subluxation.
11844948 Psychological well-being in rheumatoid arthritis: relationship to 'disease' variables and 2002 Mar BACKGROUND: Resilience is likely to be important in understanding psychological responses to chronic physical illnesses. This study aimed to examine one measure of resilience--Ryff's operationalized measure of psychological well-being (PWB)--in rheumatoid arthritis. It was hypothesized that PWB would be influenced by age and gender in the same way as in community samples, and that the absence of current mood disorder would be associated with high PWB. METHODS: Rheumatology clinic outpatients (n = 104) were assessed for pain, disease activity, disability, depression and anxiety. PWB was assessed using Ryff's six-subscale model. The measured variables were used in a logistic regression analysis to model the absence of clinically important mood disorder. RESULTS: The expected variations in PWB according to age and gender were largely absent, with the overall findings suggesting that chronic illness in general, rather than arthritis in particular, affects PWB. Significant bivariate correlations were found between depression and pain, disease activity, disability and all six PWB subscales. However, in the regression analysis, only the PWB environmental mastery subscale and self-rated disability made significant contributions to the absence of mood disturbance, and their inclusion in the regression model correctly classified 81% of the total sample. CONCLUSIONS: These results require replication in a longitudinal study, but indicate the potential value of using PWB among people with rheumatoid arthritis to screen for individuals who may be particularly vulnerable to developing depression. It might be appropriate to target such people with focused psychological interventions.
12582801 Arthroplasty of the shoulder in rheumatoid arthritis with rotator cuff dysfunction. 2003 We carried out a retrospective analysis of 17 total shoulder replacements using the reversed Delta III prosthesis in patients with rheumatoid arthritis of the glenohumeral joint complicated by rotator cuff dysfunction. Outcome was assessed using the Constant-Murley scoring system. In addition, general health status was assessed with the Short Form Health Survey and radiographical analysis of the prostheses undertaken. Mean age at the time of surgery was 64 years. Thirteen shoulders were followed up for more than 5 years (mean 87 months). Median Constant-Murley score was 59.0; median scores for general health were 33.40 and 49.36 for the physical and mental components respectively. Radiographical analysis revealed evidence of lucencies about the humeral component in all cases and about the glenoid component in five cases. Despite the good clinical results, the high incidence of radiographical lucencies is of concern.
15459811 Atlanto-odontoid osteoarthritis in rheumatoid arthritis: dynamic CT findings. 2004 Oct We analyzed the CT appearances of degenerative change in the atlanto-odontoid joint (AOJ) in patients with rheumatoid arthritis (RA) and evaluated the effect of these changes on atlanto-axial joint (AAJ) rotation by dynamic CT. This revealed that 9 patients (24%) treated with methotrexate had degenerative features in the AOJ. The ratio of AAJ rotation to the total rotation of the cervical spine was significantly higher in normal subjects (54 +/- 3%) than in patients (38 +/- 12%). The degree of AAJ rotation was significantly lower in the patient group with degenerative features in the AOJ (20.9 +/- 8.4 degrees ) than in patients without degenerative features (28.5 +/- 7.4 degrees ). RA patients with a history of longstanding disease and treatment with antirheumatic drugs may develop AO OA. Although secondary OA was described as healing phenomena in the joints of RA patients, it can limit rotation in the AAJ and cause suboccipital neck pain. A regular check-up of the AAJ and AOJ by means of dynamic CT in all RA patients is proposed to avoid possible antirheumatic drug complications.
15121042 Pharmacogenetics of disease-modifying anti-rheumatic drugs. 2004 Apr The outcome of treatment with disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients is considerably variable and is also unpredictable. It would be useful clinically if physicians were able to predict responses to DMARDs prior to their administration. One possible cause of differences in efficacy and adverse drug reactions is genetic variation in how individuals metabolize drugs. Based on pharmacogenetics, tailor-made drug therapy, also called personalized drug therapy or individual drug therapy, will be possible with analysis of genetic polymorphism, such as single nucleotide polymorphism (SNP), and analysis of haplotype and diplotype configuration. Several studies of the correlation between the genetic polymorphism of enzymes metabolizing several DMARDs and efficacy or adverse drug reactions have already been reported, suggesting that pharmacogenetics will be applicable to the treatment of RA in the near future.
15572395 The patient's perspective and rheumatoid arthritis disease activity indexes. 2005 Mar BACKGROUND: Monitoring disease activity in rheumatoid arthritis (RA) patients by composite indexes is regarded as obligatory when following the recent recommendations for therapy. Whether these recommendations and the patient's perspective are in congruence is a crucial question with respect to the patient's compliance. The aim of the study was to obtain information on the patient's perspective with respect to the disease activity indexes used most often. METHODS: Two hundred and seven RA patients (157 female, 50 male; mean age 59.03 yr, 17-86 yr) were enrolled in this cross-sectional evaluation. The patients' satisfaction [PATSAT (Austrian school mark system) 1 = excellent to 5 = unsatisfactory] and the patients' attitude to therapy (PATATT 1 = reduction, 2 = no change, 3 = increase) were assessed and related to the 28-joint Disease Activity Score (DAS28), the Simplified Disease Activity Index (SDAI) and the Modified Health Assessment Questionnaire (M-HAQ). Statistical evaluation was carried out by applying the Mann-Whitney U test, calculating chi2 and ANOVA. RESULTS: According to the DAS28 and the M-HAQ, patients were at a moderately active disease stage and had low functional deficiency. PATSAT was significantly correlated to the disease activity indexes (all PS < or = 0.002). The mean DAS28 (2.56) at PATSAT 1 was within the remission range, whereas at PATSAT 5 a mean of 5.52 indicated highly active disease. PATATT was found to be related to PATSAT, but did not completely parallel it. Reduction of therapy was intended at a mean DAS28 of 2.87, whereas a request for an increase did not occur before a mean DAS28 of 4.92. CONCLUSION: The patients' therapeutic attitudes are somewhat in line with their satisfaction, which mirrors disease activity to a great extent, though not with the common therapeutic recommendations. The DAS28 proved to be superior to both other indexes taking account of the patient's perspective. These results may provide guidance in patient care and education as well as therapeutic strategies.