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ID PMID Title PublicationDate abstract
11842821 Functional disability in relation to radiological damage and disease activity in patients 2002 Feb OBJECTIVE: To investigate the relationship between functional disability, disease activity and radiological damage in patients with rheumatoid arthritis (RA) in remission. METHODS: One hundred and eighty-six patients with RA in remission or with low disease activity were studied. The following variables were assessed at one time point: joint count, visual analog scale for pain, functional disability, i.e., health assessment questionnaire (HAQ) score, radiological joint damage as assessed by radiographs of hands and feet and scored according the Sharp-van der Heijde method, and presence of comorbidity. Disease activity was expressed as the disease activity score (DAS). Correlations were calculated by Spearman's rho coefficient of correlation. In addition, variables associated with the score were analyzed by logistic regression. RESULTS: The median HAQ score was 0.25 [interquartile (IQR) range 0-0.75] and the median DAS was 1.0 (IQR 0.7-1.5). Of the 186 RA patients included, 82% were in remission according to the DAS. The median joint damage as assessed by the Sharp-van der Heijde score was 21 (IQR 9-74). Functional disability was significantly correlated with pain (rho 0.48, p < 0.001), disease activity (rho 0.42; p < 0.001), disease duration (rho 0.39; p < 0.001), radiographic joint damage (rho 0.37; p < 0.001), and age (rho 0.19; p = 0.01). In a logistic regression model functional disability was independently related to presence of pain, disease activity, radiographic joint damage and disease duration in decreasing order of strength, but not to age. sex and co-morbidity. CONCLUSION: Patients with RA who are in remission might experience minimal functional disability and radiographic joint damage. Functional disability in RA patients in remission is most strongly related to the presence of pain and in lesser extent to disease activity, radiographic joint damage, and disease duration.
15124246 Relative sensitivity to change of the erythrocyte sedimentation rate and serum C-reactive 2004 May OBJECTIVE: To compare the sensitivity to change of the erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) concentration used as measures of rheumatoid arthritis (RA) activity. METHODS: A literature search was conducted to identify all clinical trials and observational studies of disease-modifying medications and corticosteroids in RA that reported results for both ESR and CRP before treatment and 4 weeks to 24 weeks after treatment in the same patients. For each test, effect sizes were computed as the change in the test with treatment divided by the pretreatment standard deviation. A pooled analysis was performed on the paired differences in effect sizes for ESR and CRP within each study. RESULTS: One hundred twenty-three studies with 184 active treatment arms were identified that included measurements of both ESR and CRP. Sixty-three studies with 90 active treatment arms provided sufficient data to permit calculation of effect sizes, and were included in the analysis. In the 36 treatment arms that reported results at 12 weeks, the ESR was more sensitive to change than the CRP, with a paired difference in effect sizes of 0.09 units (95% confidence interval 0.03, 0.15; p = 0.005). In the 76 treatment arms that reported results at 24 weeks, the ESR was also more sensitive to change than the CRP, with a paired difference in effect sizes of 0.11 units (95% CI 0.05, 0.17; p = 0.0004). CONCLUSION: In these studies of disease-modifying medications in RA, the ESR was more sensitive to change than the CRP at 12 weeks and 24 weeks of treatment. Few studies examined changes in these measures at times earlier than 12 weeks.
12124853 Atherosclerosis in rheumatoid arthritis: morphologic evidence obtained by carotid ultrasou 2002 Jul OBJECTIVE: Recent studies have suggested increased cardiovascular disease among patients with rheumatoid arthritis (RA). We undertook this study to obtain morphologic evidence of subclinical atherosclerosis in RA patients. METHODS: We used high-resolution B-mode ultrasound to compare carotid artery intima-media wall thickness (IMT) between 53 postmenopausal women with RA and 53 controls matched by age, sex, and menopause status. No subject in either group had a history of atherosclerosis or its complications. We investigated the association between IMT and relevant clinical and therapeutic variables, including the impact of low-dose corticosteroid therapy (< or = 10 mg/day prednisolone). RESULTS: The mean +/- SD IMT of the left and right common carotid arteries in RA patients was significantly greater than that in controls (0.77 +/- 0.09 mm versus 0.68 +/- 0.14 mm; P < 0.001). Early RA (duration < or = 1 year) was associated with lesser IMT than was RA of longer duration (0.72 +/- 0.03 mm versus 0.78 +/- 0.01 mm; P < 0.04). Prednisolone use was not associated with increased IMT (0.78 +/- 0.02 mm in nonusers versus 0.76 +/- 0.01 mm in users; P = 0.38). CONCLUSION: Our data indicate that RA patients have an ultrasonic marker of early atherosclerosis consistent with an increased risk for atherosclerosis.
12734920 MCID/Low Disease Activity State Workshop: summary, recommendations, and research agenda. 2003 May The OMERACT 6 Minimal Clinically Important Difference/Low Disease Activity Workshop was organized with the aim of meeting the many challenges that exist in determining a low disease activity in rheumatoid arthritis (RA). This article presents an overview of that workshop, including results of the voting, a summary of associated discussions, recommendations, and a proposed research agenda.
12810432 Comparison between women and men with recent onset rheumatoid arthritis of disease activit 2003 Jul OBJECTIVE: To describe the course of recent onset rheumatoid arthritis (RA) and to compare consequences of the disease in men and women. METHODS: 284 patients with recent onset RA were followed up prospectively for two years from the time of diagnosis. Measures of disease activity (for example, 28 joint disease activity score (DAS28), C reactive protein, morning stiffness, physician's global assessment) and function outcome (for example, range of movement, hand function, walking time) were determined. The patients' self reported assessment of functional capacity (Health Assessment Questionnaire (HAQ)) and grading of wellbeing and pain (visual analogue scale) were registered. Changes over time and differences between men and women were evaluated. RESULTS: Improvements were seen for all variables within the first three months. Disease activity then remained unchanged. Function variables followed the same pattern during the first year, but then tended to worsen. HAQ scores were similar at baseline, but significantly worse in women than in men at the one and two year follow ups. CONCLUSIONS: Disease activity was well managed and had improved substantially after two years, whereas function seemed slowly to deteriorate. Although disease variables were similar for men and women, functional ability (HAQ) had a less favourable course in women.
12209485 Preferences for improved health examined in 1,024 patients with rheumatoid arthritis: pain 2002 Aug OBJECTIVE: To examine preferences for improved health in patients with rheumatoid arthritis (RA). METHODS: A survey was mailed to patients with RA enrolled in a county-based register. The questionnaire comprised a variety of health status measures (Medical Outcome Study Short Form-36, Arthritis Impact Measurement Scales 2 [AIMS2], Modified Health Assessment Questionnaire, and visual analog scale for pain and fatigue). The patients were asked to check 3 of 12 areas in which they would most like to see improvement (item 60 AIMS2). The number of respondents was 1,024 (mean age/disease duration 63.4/12.7 years, 78.7% female). RESULTS: Pain was the preferred area for improvement in all subgroups of patients. Preference for improvement in pain was associated with lower age, higher levels of perceived pain, and lower scores for self efficacy related to pain. One-third of the patients with this preference did not report use of pain-relieving medication. CONCLUSION: Pain is the area of health in which almost 70% of the patients would like to see improvement. This study suggests that more attention should be paid to the examination of patient preferences for improvement in health.
12516006 Inflammatory arthritis in the elderly. 2003 Jan The three most common inflammatory arthritic conditions affecting the elderly are reviewed, along with current information about the various treatments.
15530301 Multiple cutaneous reticulohistiocytomas in a patient with rheumatoid arthritis. 2004 Oct 15 A 64-year-old woman with a long-standing peripheral symmetric polyarthritis with positive rheumatoid serology was evaluated for multiple asymptotic papulonodules of fingers, mentum, lower lip, ears, and eyelids. Histopathologic examination showed a dermal infiltrate composed of histiocytes, multinucleate giant cells with ground-glass cytoplasm, and lymphocytes, suggestive of reticulohistiocytoma. The possibilities of multicentric reticulohistiocytosis with positive rheumatoid serology or coexistence of multiple cutaneous reticulohistiocytomas and rheumatoid arthritis are discussed.
14579028 [Treatment of knee joint arthritis in the middle-aged patient]. 2003 Oct Degenerative arthritis of the knee joint is a common problem of the middle-aged patient. Primary arthritis has to be distinguished from secondary disease caused by malalignment, instability or trauma. The key symptom is pain at the jointline on weight-bearing. Diagnosis is established from history, clinical and radiological examination. Treatment options are chosen depending on the severity of symptoms and the demands of the patient. They range from modification of sports- and recreational activities, nonoperative therapy to operative options such as resecting arthroscopic procedures, repair of damaged articular cartilage, osteotomy and unicompartmental knee arthroplasty. However, the patient has to be made aware that a cure for this disease remains to be found.
15259593 [On the involvement of the temporomandibular joint in rheumatoid arthritis]. 2004 Feb 64 patients with rheumatoid arthritis (RA) were examined for temporomandibular joint (TMJ) symptoms as well as for the severity and incidence of their symptoms. In detailed interviews, a total of 34 patients (53.1%) reported TMJ symptoms, the main complaints being problems during opening and closing of the mouth (45.2%). RA patients with TMJ symptoms differed significantly from those without TMJ symptoms (p < 0.01) in the duration (121.7 +/- 100.5 months vs. 37.1 +/- 27.6 months) and the state of activity of the basic disease. The patients subjectively evaluated the severity of the TMJ symptoms as mild to moderate (grade: 2-3; severity: 241 +/- 1.01). Almost 70% reported occasional symptoms, 22.5% frequent symptoms and 10.6% permanent symptoms (p < 0.01). 61.8% (21/34) of the patients showed no radiographic change in the shape of the TMJ condyle, whereas 11.8% (4/34) demonstrated a change on one side an 26.4% (9/34) a change on both sides. There was no difference in the severity of the TMJ symptoms between patients with an unchanged condyle (n = 21; severity: 2.33 +/- 0.96) and patients with changes in condylar shape (n = 13; severity: 2.5 +/- 1.12). A frequent involvement of the temporomandibular joint in RA can be considered certain. The symptoms, which were generally moderate, can cause a marked impairment of daily used functions, such as chewing and speaking.
12486544 [A comparison of total knee replacement in patients with rheumatoid arthritis and those wi 2002 Dec This article aims at determining the differences in resources needed for the treatment of patients with rheumatoid arthritis as opposed to osteoarthritis. Data on ten patients for each of these diagnoses, all of whom had been subject to the implantation of a knee arthroplasty,were compared. We looked at parameters such as the duration of surgery, further diagnoses, costs of radiological measures and medical treatment, simultaneous operations, need of nursing care,physical and occupational therapy and complications. Patients presenting with rheumatoid arthritis in many respects required substantially more clinical and/or financial resources than osteoarthritis patients. This statement holds true at least for the period of hospital care during which the knee-prosthesis was implanted.
15196621 The Sharp/van der Heijde method out-performed the Larsen/Scott method on the individual pa 2004 May OBJECTIVE: To test the reliability of two radiologic scoring methods in rheumatoid arthritis (RA)--the Sharp/van der Heijde (SvH) and the Larsen/Scott (LS)--with generalizability analyses. STUDY DESIGN AND SETTING: Films of 51 patients representing the spectrum of early RA were read by two raters for each method. The discriminative ability and responsiveness were expressed as: intraclass correlation coefficients (ICCs), two types of smallest detectable difference (SDD), and two types of smallest detectable change (SDC); reflecting measurement error when discriminating between or detecting changes within (1) individuals or (2) groups. They were calculated for (average) scores of one to three raters. RESULTS: The discriminative capacity (0.85-0.97) and responsiveness (0.91-0.97) were good when expressed by ICC. On the group level the SDDs and SDCs ranged between 0.6-3.3% of the max. obtainable score. On the individual level, the scores showed better reliability measured with the SvH (SDDs 2.0-3.4%) than with the LS (SDDs 5.3-9.2%). The SvH also assessed changes in scores in individuals with less measurement error (SDCs 1.3-2.2%) than the LS (SDCs 2.3-3.9%). CONCLUSION: For early RA patients, the SvH seems preferable if analyses on individual level are included.
12579596 Effects of dynamic strength training on physical function, Valpar 9 work sample test, and 2003 Feb 15 OBJECTIVE: To study the impact of 24 months of strength training on the physical function of patients with early rheumatoid arthritis (RA). METHODS: Seventy patients were assigned to either the strength training (experimental) group (n = 35) or the control group (n = 35). Patients in the experimental group performed strength training for 24 months, and control patients were instructed to perform range of motion exercises. Maximal strength of the knee extensors, trunk flexors, and extensors, as well as grip strength were recorded with dynamometers. Disease activity was assessed by the erythrocyte sedimentation rate and Ritchie's articular index, joint damage was determined by the Larsen x-ray index, and functional capacity was assessed using the Valpar 9 test and the Stanford Health Assessment Questionnaire (HAQ). The employment status of each patient was recorded. RESULTS: In the experimental group, strength training led to significant increases (19-59%) in maximal strength of the trained muscles. Such increases in the control group varied from 1% to 31%. There was a clear training effect on muscular strength in favor of the experimental group, but significant improvements in the HAQ indices as well as in the Valpar 9 test were seen also in control patients. Results of the Valpar 9 and the HAQ were statistically significantly better in patients who remained gainfully employed compared with patients who retired preterm during followup. However, compared with patients who remained in the work force, patients who retired were older, and their work was physically more demanding. CONCLUSION: As expected, strength training led to increased muscle strength, but this increase did not correlate with improved physical function as assessed by the Valpar 9 work sample test. The increased muscle performance did not prevent a substantial proportion of patients from retiring preterm. The 2 items from the Valpar 9 test that were applied were not sensitive enough to differentiate the patients according to their working status.
12672187 Correlation of single time-point damage scores with observed progression of radiographic d 2003 Apr OBJECTIVE: Aggressive treatment of early rheumatoid arthritis (RA) is recommended to prevent irreversible joint damage. We evaluated the usefulness of single time-point joint radiographs for deciding whether early RA is erosive or nonerosive. METHODS: In an observational study, 179 patients with recent onset of RA symptoms (median 5.1 mo), positive rheumatoid factor, and active polyarthritis had 2 to 8 radiographic observations of hands, wrists, and forefeet during 6 to 60 months of followup. Linear regression lines for all available radiographs were used to determine progression rates of total Sharp score (TSS), erosion score (ES), and joint space narrowing score (JSNS) of each patient. RESULTS: Using the average of 2 readers' scores, intraclass correlation coefficient was 0.97 and smallest detectable difference was 3.07 for ES, 0.93 and 7.52 for JSNS, and 0.90 and 12.71 for TSS. Mean progression rates per year were 1.20 (ES), 0.67 (JSNS), and 1.85 (TSS). Single time-point radiographs taken within 6 months of symptom onset did not correlate with progression rates (r = 0.01 to 0.07); between 7 and 18 months correlations were weak (r = 0.23 to 0.35), but were better for ES between 19 and 72 months (r = 0.60 to 0.81). Among 53 patients (31%) with no progression of TSS, only 10 of them had zero scores at baseline. Among all 630 radiographs with TSS > or = 1, 25% were associated with progression rates < or = 0. CONCLUSION: Erosion scores of single radiographic examinations done > 18 months after onset of RA symptoms correlated with progression rates, but earlier radiographs did not sufficiently predict erosive or nonerosive status to guide disease modifying antirheumatic drug treatment decisions.
14690139 High proliferative potential colony-forming cells (HPP-CFCs) in the peripheral blood of rh 2003 OBJECTIVE: To examine the presence of high proliferative potential colony-forming cells (HPP-CFCs) in the peripheral blood of rheumatoid arthritis (RA) patients with and without interstitial lung disease (ILD). METHODS: Peripheral blood mononuclear cells from 35 RA patients with and without ILD, 12 patients with infectious pulmonary diseases, 10 patients with idiopathic pulmonary fibrosis (IPF), and 20 healthy volunteers, were assayed for in vitro colony formation. RESULTS: HPP-CFCs were detected significantly more frequently in the peripheral blood of patients with ILD (11/14: 78%, p<0.05) than in that of patients without ILD (4/21: 19%). HPP-CFCs were not detected in the peripheral blood of patients with infectious pulmonary diseases, those with IPF or healthy volunteers. CONCLUSIONS: HPP-CFCs were frequently found in the peripheral blood of RA patients with ILD compared with those without ILD, suggesting the mobilization of HPP-CFCs from the bone marrow into the peripheral blood in association with ILD in RA.
14633380 Bioreconstructive joint scaffold implant arthroplasty in metacarpophalangeal joints: short 2003 Oct Swanson silicone implant is the "gold standard" of metacarpophalangeal joint reconstruction in rheumatoid arthritis (RA) patients. However, durability problems of silicone implants have led us to develop a new technique based on bioreconstructive implants. PLA96 (poly-L,D-lactide copolymer, L:D ratio of 96:4) scaffolds were engineered. Bioabsorption and substitution of porous PLA96 scaffold with living tissue eventually produce a neojoint. In the current prospective study, 23 RA patients (80 joints) were operated on, using PLA96 implants. Fifteen patients (54 joints) have been monitored for at least 1 year. Pain alleviation was well achieved. Range of motion improvement was emphasized to extension direction of functional arc. The average ulnar deviation was preoperatively 26 degrees, and at follow-up it was 6 degrees. Volar subluxation was noticeable in 56% of joints preoperatively and in 6% at 1-year follow-up. This is the first report of the formation of a living, functional joint in situ by means of a synthetic bioreconstructive joint scaffold. Results of this preliminary short-term study are comparable with previously published data on silicone arthroplasty. However, bioreconstructive prostheses can aid in preventing problems that occur with biostable prostheses. Tissue engineering has created a new era in the reconstruction of damaged joints.
12833651 The role of IL-17 and family members in the pathogenesis of arthritis. 2003 May Interleukin (IL)-17 is a T-cell-derived cytokine that is expressed in the synovium of patients with arthritis. IL-17 contributes to the pathogenesis of arthritis, and demonstrates additive or even synergistic effects with IL-1 and tumor necrosis factor (TNF) in inducing joint pathology. It is a potent inducer of receptor activator of nuclear factor-kappa B. IL-17 also has the capacity to induce joint destruction in an IL-1-independent manner. The discovery of IL-17 family members may further elucidate the role of this cytokine family in arthritis pathology, with IL-17F a promising candidate. Anti-IL-17 cytokine therapy may be an interesting new antirheumatic approach to the prevention of joint destruction, in addition to anti-TNF and anti-IL-1 therapy.
12510374 [Chronic rheumatoid arthritis and the long-term care insurance system in Japan]. 2002 Dec The long-term care insurance system in Japan is the social support system for the elderly, mainly aged 65 or over, requiring long-term care and provides necessary welfare services and health and medical care services of the user's choice in a comprehensive and unified manner. On the other hand, chronic rheumatoid arthritis often causes various disturbance and needs of long-term care for daily life in accordance with the progression of the disease. This system shall be provided to patients aged 40 or over with chronic rheumatoid arthritis, after screened by the long-term care approval board. Combination with both services not covered by the long-term care insurance and the Government Action Plan for Persons with Disabilities, users shall be provided comprehensive and planned services.
12491115 [Diagnosis and therapy monitoring applying methods of molecular medicine]. 2002 New experimental approaches are presented which are implemented in rheumatology research. DNA microarray technology and proteome analysis are two new methods which are applied to gain a global survey over the gene expression at the RNA and protein level under various conditions. Based on these methods of molecular medicine important functional proteins in the pathogenesis of rheumatoid arthritis (RA) as well as clinical relevant genetic polymorphisms shall be identified. New insights are expected which will help in the differentiation of clinical entities and in the search for new therapeutic strategies in the treatment of RA.
15053453 Assessment of radiographs in longitudinal observational studies. 2004 Mar Radiographs are important to assess structural damage in longitudinal studies. This article describes several issues on the selection of films, frequency of followup, scoring of radiographs, and presentation of results, especially in the context of longitudinal studies.