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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
12176807 Living with rheumatoid arthritis: expenditures, health status, and social impact on patien 2002 Sep OBJECTIVE: To determine costs related to living with rheumatoid arthritis (RA), and to identify the association between health status-as measured by the Health Status Questionnaire short form-36 (SF-36) and the disease specific index Health Assessment Questionnaire (HAQ)-and the social impact of RA. METHODS: A prospective cohort study was carried out on 81 patients with RA who completed four consecutive three month cost diaries. The SF-36, HAQ, and social impact at baseline and one year follow up were also assessed. RESULTS: Women reported worse SF-36 physical function and HAQ scores than men and received more assistance from family and friends. Women spent more on non-prescription medication and devices to assist them than men. Older patients had higher expenditure on visits to health professionals, whereas younger patients spent more on prescription medication and tests. Pension status and membership of private health insurance schemes were important determinants in these differences in expenditure. CONCLUSION: Costs increased with duration of disease, those with private health insurance had greater out of pocket costs (excluding membership fees), and those with pension support had fewer costs. Women were more affected by RA than men in health status, social impact, and out of pocket costs.
15022313 Clustering of disease features within 512 multicase rheumatoid arthritis families. 2004 Mar OBJECTIVE: To determine whether specific rheumatoid arthritis (RA) disease features demonstrate the presence of significant familial clustering. METHODS: We studied 1,097 individuals with RA from 512 multicase families enrolled in the North American Rheumatoid Arthritis Consortium. All patients were interviewed and examined to collect standardized information about demographic and clinical characteristics. Affected individuals also underwent radiography of the hands and wrists and were genotyped for the HLA-DRB1 shared epitope. Familial clustering of disease features was assessed using contingency table analysis and Pearson correlation coefficients. Multivariate logistic and linear regression analyses were used to account for other characteristics that might influence familial clustering, such as disease duration, sex, and age at diagnosis. RESULTS: Several disease characteristics exhibited significant familial clustering, including seropositivity (multivariate odds ratio [OR] 4.3, P < 0.0001), nodules (OR 2.3, P < 0.0001), and age at RA diagnosis (multivariate regression coefficient [beta] 0.44, P < 0.0001). Other characteristics demonstrated statistically significant but modest degrees of familial clustering (Joint Alignment and Motion score, Health Assessment Questionnaire score, and year of RA diagnosis) or modest but nonsignificant familial clustering (other extraarticular manifestations, other autoimmune diseases). CONCLUSION: The clustering of certain disease characteristics implicates specific genetic or nongenetic causes. These results highlight the importance of considering disease phenotype in future genetic and epidemiologic studies of RA.
12150360 Autoimmune rheumatic diseases in women. 2002 Jul OBJECTIVE: To review the presenting symptoms, possible complications, treatment options, and reproductive considerations for rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and Sjogren's syndrome. DATA SOURCES: Articles retrieved from MEDLINE and OVID using the search terms women and female in combination with autoimmune disease, rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and Sjogren's syndrome. References identified from citations in these articles were also reviewed. DATA SYNTHESIS: Autoimmune rheumatic diseases are more common in women than in men and are most likely to manifest during the reproductive years. The reasons for this incidence pattern remain unclear but appear to be related to sex hormones and microchimerism. These diseases have varied clinical presentations that may be local or systemic and range from mild to severe. There is no cure for these autoimmune rheumatic diseases; treatments focus on managing symptoms. Many of the agents used for treating these diseases are contraindicated in pregnancy, posing special considerations for women who develop these diseases during their childbearing years. CONCLUSION: Knowledge of the presenting symptoms of, treatment options for, and reproductive considerations with these diseases is important for pharmacists who counsel women with them.
12056291 [Synovial membrane diagnostic assessment in rheumatoid arthritis]. 2002 Apr Rheumatoid arthritis (RA) is the most frequent inflammatory rheumatic disease. At the beginning of the disease, where, based on today's knowledge the therapeutic possibilities are largest, the diagnostic methods do not permit a differentiated estimation of the prognosis. Conventional x-rays are mostly normal and serum markers unspecific. So far--in contrast to other diseases--only little information had been drawn from the pathomorphologic substrate "synovialis" itself to assess the prognosis. Reasons therefor were found in difficulties in obtaining synovial tissue besides surgical interventions, particularly in patients with early arthritis. By minimalizing the diagnostic instruments and improvement of the technique, synovial tissue sampling in RA has become minimally invasive and it is even possible to perform on the smallest joints, such as finger joints. Hereby, synovial analysis is open for detecting pathways of inflammation and joint destruction, which might support the advancement of new therapeutic strategies, followed by a better prognosis and outcome of RA.
15476991 Evaluation of a community rehabilitation service for people with rheumatoid arthritis. 2004 Oct This study aims to evaluate the outcomes of a community rehabilitation service for people with rheumatoid arthritis, provided by the Community Rehabilitation Network (CRN) in Hong Kong. The three-phase community rehabilitation service consists of a number of standardized program elements, including orientation meeting, self-help course, stress management program, water exercises class, as well as informal social and recreational activities. Using a pre-, post-test non-equivalent groups design, the outcomes of 29 clients of the treatment group were compared with 16 clients of the comparison group at baseline and at the end of 9 months, using an 86-item self-completed questionnaire. The treatment group achieved significant more increases in self-efficacy of managing the illness, more increases in self-management behaviors, but no significant increases in the overall health status or health care utilization patterns, when compared with the comparison group.
15301983 What is the role of the occupational therapist? 2004 Aug Occupational therapy (OT) is widely provided for people with chronic musculoskeletal conditions. The aims are to improve their ability to perform daily occupations (i.e. activities and valued life roles at work, in the home, at leisure and socially), facilitate successful adaptations to disruptions in lifestyle, prevent losses of function and improve or maintain psychological status. This chapter reviews the evidence for the effectiveness of OT interventions, suggests who is relevant for referral and indicates the appropriate timing for referral. The main emphasis is on OT for people with rheumatoid arthritis-primarily because most evidence to date is for this condition. Comprehensive OT is effective in improving function in people with moderate-severe arthritis. Some interventions (e.g. joint protection and hand exercises) are effective. People are increasingly being referred sooner after diagnosis for interventions to help prevent progression of functional, physical and psychological problems. Little is known of the effectiveness of therapy at this early stage.
15454630 Working status among Dutch patients with rheumatoid arthritis: work disability and working 2005 Feb OBJECTIVES: To assess work disability and variables associated with work disability among Dutch patients with rheumatoid arthritis (RA). METHODS: A questionnaire on working status was filled out by 296 patients of working age. Employment and work disability rates adjusted for age and sex from the Dutch population were determined using indirect standardization. Cox proportional hazard analysis was used to assess baseline predictors of work disability in a subgroup of patients (n = 195). RESULTS: After a mean disease duration of 4.3 yr, patients had a 0.78 (95% CI 0.67-0.88) chance of being employed and a 2.14 (95% CI 1.75-2.54) risk of being work disabled when compared with the Dutch population. Functional disability and job type at the start of the disease were predictors of future work disability. In total, 48 (37%) currently employed patients had changed their working conditions, of which reduced working hours (46%), reduced pacing of work (42%) and help from colleagues (49%) were the most important alterations. Of the 60 work disabled patients without a paid job, only 11 patients (18%) would be willing to work again. CONCLUSION: This study shows that the adjusted employment rates were lower and that work disability rates were higher in patients with RA when compared with the general Dutch population. In addition, a substantial number of employed patients had to change their working conditions due to RA. Only a minority of work disabled RA patients was willing to return to the paid labour force.
15071755 The effect of interleukin-1 blockade on fatigue in rheumatoid arthritis--a pilot study. 2005 Aug Fatigue occurs in many patients with rheumatoid arthritis (RA) and other chronic inflammatory diseases and may be defined as an overwhelming sense of tiredness, lack of energy, and feeling of exhaustion. It can be restrictive and severely disabling. We recently found more than 3/4 of systemic lupus erythematosus patients to be significantly affected by this phenomenon. We hypothesized that fatigue in patients with RA might be comparable to sickness behavior in animals possibly caused by disturbances in interleukin-1 beta signaling pathways and thus accessible to blockade by biologic agents. This study compared measures of disease behavior and fatigue symptoms in eight RA patients before and at three time points during treatment with daily administration of anakinra.
12890858 Salivary gland involvement in rheumatoid arthritis and its relationship to induced oxidati 2003 Oct OBJECTIVES: The objective of the present study was to analyse salivary gland and free radical involvement in rheumatoid arthritis (RA). METHODS: Thirty-four consenting RA patients (rheumatoid factor-positive) and 18 healthy controls, matched in age and gender, participated in the study. Plasma and saliva samples were harvested and subjected to compositional analysis and various free radical-related tests. RESULTS: The mean salivary flow rate was lower in the RA patients than in the control group, whereas all plasma and salivary antioxidants were increased. Mean values of plasma malondialdehyde and ceruloplasmin were higher in the RA patients. CONCLUSIONS: The effects of RA on salivary gland flow rates and antioxidant compositional parameters may be of great importance for the further elucidation of the role of free radicals in RA pathogenesis and for its general diagnosis and evaluation. The demonstrated correlation between the altered salivary parameters and the severity of the disease may indicate that evaluation of the salivary status of RA patients is warranted.
12709825 Production of adrenomedullin from synovial cells in rheumatoid arthritis patients. 2004 Jan It was recently reported that plasma levels of adrenomedullin (AM), identified as a vasorelaxant peptide, are significantly higher in rheumatoid arthritis (RA) patients than in osteoarthritis (OA) patients. The objective of the present study was to elucidate AM production in synovial cells from patients with RA. Adrenomedullin mRNA was detected in cultured synovial cells from RA patients by reverse transcription polymerase chain reaction (RT-PCR). Immunohistochemical analysis demonstrated the presence of AM in synovial cells from RA patients. In addition, we investigated AM levels in knee joint fluids from RA and OA patients. Those from RA patients were elevated approximately threefold over those of OA patients. In this study, we demonstrated for the first time AM expression in synovial cells from RA patients and high levels of AM production in RA joint fluid.
12115160 Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized contro 2002 Jun 15 OBJECTIVE: To carry out a systematic review of the literature examining the efficacy of psychological interventions (e.g., relaxation, biofeedback, cognitive-behavioral therapy) in the treatment of rheumatoid arthritis (RA). METHODS: Studies that met the following criteria were included: random assignment, wait-list or usual care control condition; publication in peer-reviewed journals; treatment that included some psychological component beyond simply providing education information; and separate data provided for patients with RA if subjects with conditions other than RA were included. Two investigators independently extracted data on study design, sample size and characteristics, type of intervention, type of control, direction and nature of the outcome(s). RESULTS: Twenty-five trials met the inclusion criteria. Methodologic quality was assessed, and effect sizes were calculated for 6 outcomes. Significant pooled effect sizes were found postintervention for pain (0.22), functional disability (0.27), psychological status (0.15), coping (0.46), and self efficacy (0.35). At followup (averaging 8.5 months), significant pooled effect sizes were observed for tender joints (0.33), psychological status (0.30), and coping (0.52). No clear or consistent patterns emerged when effect sizes for different types of treatment and control conditions were compared, or when higher quality trials were compared to lower quality ones. Findings do, however, suggest that these psychological interventions may be more effective for patients who have had the illness for shorter duration. CONCLUSIONS: Despite some methodologic flaws in the literature, psychological interventions may be important adjunctive therapies in the medical management of RA.
15449023 Pedobarography and its relation to radiologic erosion scores in rheumatoid arthritis. 2005 Nov OBJECTIVE: The aim of this study was to assess probable plantar pressure alterations in rheumatoid arthritis (RA) patients by comparison with normal subjects and to investigate the probable relation between pressure distribution under the foot and radiologic foot erosion score. METHODS: Two hundred feet of 50 chronic RA patients and 50 healthy controls were evaluated. Static and dynamic pedobarographic evaluations were used to define the plantar pressure distribution. Also, the modified Larsen scoring system was used to detect the staging of erosions on feet radiograms of the RA patients. RESULTS: Static pedobarography revealed higher pressure and contact areas in the forefoot. All dynamic pedobarographic parameters except for plantar contact area were significantly different between the RA patients and control subjects. Patients with high erosion scores had higher static forefoot and dynamic phalanx peak pressure values. CONCLUSION: Pedobarographic investigation can be useful to evaluate pressure distribution disorders in RA feet and may provide suitable guidelines for the design of various plantar supports.
15249321 Quantitative ultrasound and bone mineral density: discriminatory ability in patients with 2004 Aug BACKGROUND: Quantitative ultrasound (QUS) is a reliable tool for discriminating between subjects with and without vertebral deformities in postmenopausal osteoporosis. Less is known about osteoporosis caused by inflammatory diseases or corticosteroid use. OBJECTIVES: (1). To compare in patients with rheumatoid arthritis the ability of QUS and dual energy x ray absorptiometry (DXA) to discriminate between those with and without vertebral deformities; (2). to explore whether the results are similar in population based controls. METHODS: Standardised lateral radiographs of the spine were obtained from 210 patients with rheumatoid arthritis aged over 50 years and 210 individually matched controls. Vertebral deformities were assessed morphometrically and semiquantitatively. All participants underwent bone measurements by DXA (Lunar Expert) and QUS (Lunar Achilles+). Receiver operating curve (ROC) analysis was used to compare the discriminating ability of BMD and QUS measurements in patients and controls with and without vertebral deformities. Analyses were repeated in patients stratified according to corticosteroid use. RESULTS: For all bone measurements except lumbar spine in the rheumatoid arthritis group, BMD discriminated significantly between the patients with and without vertebral deformities, and the results were similar to those obtained in controls. Among current corticosteroid users, neither QUS nor DXA could discriminate between subjects with and without vertebral deformities. CONCLUSIONS: These findings support QUS as an alternative tool for identifying patients at risk of having vertebral deformities in rheumatoid arthritis, although results should be interpreted with caution in current users of corticosteroids.
15108069 Bone mineral density and urolithiasis interaction in rheumatoid arthritis. 2004 Rheumatoid arthritis (RA) is a systemic inflammatory disease with extraarticular manifestations involving many organs. Both urinary stone formation and bone mineral density (BMD) can be affected by calcium (Ca) metabolism changes in RA. We aimed, in our study, to investigate the incidence of urolithiasis in adult RA patients and to identify the BMD characteristics of stone-forming RA patients. Seventy-nine RA patients and 35 control subjects participated in our study. None had a known renal disease, except for urolithiasis. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and C-reactive protein (CRP) were recorded. Twenty-four-hour urinalysis, as well as plain X-ray, ultrasound imaging, and BMD measurements with dual-energy X-ray absorptiometry (DEXA) were performed. T scores more than 1 SD below the mean value were accepted as low BMD. There was no statistically significant difference between urinary stone incidence in RA patients and controls. There was a significant difference between BMD values in RA patients with and without urinary stone disease. The low T scores of stone-forming RA patients may be explained by the additive effect of two coexisting diseases, both shown to be related to low bone mass. From another point of view, both BMD loss and urolithiasis can be consequences of altered Ca metabolism in RA. So we suggest that RA patients with urolithiasis should be evaluated for BMD, and that RA patients with low BMD be evaluated for urolithiasis.
12734916 Repair of erosions in rheumatoid arthritis does occur. Results from 2 studies by the OMERA 2003 May The committee was charged with determining whether healing of erosions in rheumatoid arthritis (RA) occurs. Two exercises were performed: The first asked the committee members, as a panel of experts, to express agreement or disagreement with the presence of improvement and features of bone reaction to injury in images submitted by members as examples of healing. The second presented panel members with 28 pairs of serial images, 14 chosen to illustrate progression and 14 chosen to illustrate repair. Agreement was tested on 8 items: global judgment on which image in the pair was better, relative size of the erosion in the 2 images, judgment on which image was first, presence and extent of sclerosis, cortication, filling-in, remodeling, and reconstituting normal structure. Our results showed good agreement, among the 15 respondents, on global assessment of which image was better and which image showed the smaller erosion. Correct assignment of sequence was only slightly better than expected by chance (in 65% of the cases). Agreement was poor regarding the presence of morphologic features of bone repair. A majority of a panel of experts agreed on which 2nd images in a set of paired, serial images represented improvement and which showed progression based on global assessment of which was better and on size of erosion. Features of bone repair were not distinctive and did not enable the panel to deduce the correct sequence of the serial images. This study provides evidence that repair of bone damage in RA does occur, resulting in some degree of improvement, which was recognized by a majority of a panel of experts.
14532139 Imaging: do erosions heal? 2003 Nov It was shown previously that reparative changes in erosions can be seen in individual joints and individual patients. Whether repair may occur at a group level, and can be induced by treatment, is not known. This manuscript describes a means of visualising data obtained in a clinical trial by the use of probability plots to better understand the results. These probability plots give a good insight into the coherence of the data. They can also be used to make the interpretation of repair at a group level easier. Probability plots also explain the hazard of using binomial cut off points to compare treatment effects. The interference of true repair with measurement error is demonstrated. Repair at a group level is suggested if the mean progression score is statistically significantly different from zero, which can be visualised by a 95% confidence interval of this mean change score below zero. Application of this technique may give us better information on the effects of new drugs on the induction of repair.
12049692 [Variations in the drug treatment of rheumatoid arthritis in Spain]. 2002 Jun 1 BACKGROUND: Variations in the use of healthcare resources can result in differences in the outcome of rheumatoid arthritis (RA). The emAR study was developed to determine variations in the management of socio-sanitary resources, including drugs use, in patients with this disorder. PATIENTS AND METHOD: The clinical records of 1,379 patients, randomly selected among all RA patients attended in Spanish hospitals, were reviewed. Information about prescription of disease modifying anti-rheumatic drugs (DMARD), non-steroidal anti-inflammatory drugs (NSAID), corticosteroids, analgesics, gastric protectors and drugs for osteoporosis was collected. In addition, socio-demographic- and disease-related information, as well as data from hospitals, medical units and responsible physicians were also obtained in each patient. RESULTS: There was a high level of DMARD and NSAID prescription that was associated with patient or disease characteristics. Treatment with corticosteroids, as well as with the remaining drugs, showed a substantial regional variability, which may be related to physician-associated variables as well as to patient- and disease-associated characteristics. CONCLUSIONS: Variability in the management of therapeutic resources in RA patients mainly depends on the characteristics of the patient or the disease. There is also a variation that is influenced by physician's characteristics; in some cases, the available scientific evidence may not support this variability.
15082487 MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome a 2004 May OBJECTIVES: To determine whether magnetic resonance (MR) scans of the dominant wrist of patients with early rheumatoid arthritis (RA) can be used to predict functional outcome at 6 years' follow up. METHODS: Dominant wrist MR scans were obtained in 42 patients with criteria for RA at first presentation. Patients were followed up prospectively for 6 years, and further scans obtained at 1 year (42 patients) and 6 years (31 patients). Two radiologists scored scans for synovitis, tendonitis, bone oedema, and erosions. The Stanford Health Assessment Questionnaire (HAQ) score, indicating functional outcome, and standard measures of disease activity were assessed at 0, 1, 2, and 6 years. The physical function component of the SF-36 score (PF-SF36) was also used as a functional outcome measure at 6 years. RESULTS: Baseline MR parameters, including bone oedema score and the total baseline MR score, were predictive of the PF-SF36 at 6 years (R2 = 0.22, p = 0.005 and R2 = 0.16, p = 0.02, respectively). The PF-SF36 score correlated strongly with the HAQ score at 6 years (rs = -0.725, p<0.0001); none of the baseline MR parameters predicted the 6 year HAQ score. The total MR score obtained at 1 year was predictive of the 6 year HAQ (R2 = 0.04, p = 0.01). Standard clinical and radiographic measures at baseline were not predictive of the 6 year PF-SF36, but when combined in a model with baseline MR oedema score, prediction increased from 0.09 to 0.23, or 23% of the 6 year variance. CONCLUSION: MR imaging of the wrist in patients with early RA can help to predict function at 6 years and could be used to plan aggressive management at an earlier stage.
15053445 Outcome after 40 years with rheumatoid arthritis: a prospective study of function, disease 2004 Mar In an inception cohort of 100 patients with rheumatoid arthritis (RA) we studied course and outcome after 40 years, regarding function, disease activity, cause and age of death, and prognostic factors. Function, joint count, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), rheumatoid factor (RF), and the number of orthopedic operations were measured in 100 consecutive referrals between 1957 and 1963 with either definite or classical RA at one year after onset of symptoms. Subjects have been followed for a mean of 40 years, or until death. In May 1999, 84 subjects had died. Of the 16 survivors, 8 (50%) were severely disabled from RA while 5 (31%) had normal function. The mean joint score had gradually increased over 40 years. Death was directly attributable to RA in 13, while RA or its treatment contributed to death in 11 subjects. In the other 60 deceased subjects, cardiovascular causes accounted for 28 deaths (33% of total deaths). Features at one year that were associated with mortality up to 40 years after onset by regression analysis were: older age (p < 0.0001), lower Hb (p = 0.0461), and worse function (p < 0.0001). The standardized mortality ratio of the cohort at 40 years was 2.13 (confidence interval 1.26-3.60), and median survival was reduced by 10 years for men and 11 years for women compared to the general population. In conclusion, RA is a progressive disease impairing function up to 40 years after onset, with shortened life span. The leading cause of death was cardiovascular disease.
12475517 Arthrodesis of the wrist with bioabsorbable fixation in patients with rheumatoid arthritis 2002 Dec Twenty-four wrist arthrodeses were performed on 18 patients with rheumatoid arthritis using a bioabsorbable self-reinforced poly-L-lactide rod as the fixation device. There was one nonunion which required a re-operation and two nonunions which did not need further treatment. The position of the arthrodesis was ulnar deviation and extension in most patients, and there was high patient satisfaction with 21 of the 24 wrists and satisfactory pain relief in 22 of the 24 wrists. This method for fusing the wrist in patients with rheumatoid arthritis appears reliable and simple to perform.