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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
14991281 [Development and/or increase of rheumatoid nodules in RA patients following leflunomide th 2004 Feb This is the first description of the development of rheumatoid nodules in 3 rheumatoid arthritis patients following leflunomide therapy. The nodules were localized at typical sites with preference of the extensor side of hands and elbow. One nodule examined histologically revealed the typical architecture of RA nodules. In all 3 patients the time of onset of nodulosis was about 6 months after initiating the leflunomide therapy. In all 3 patients leflunomide was clinically efficacious concerning RA: remission or near remission was achieved. Due to the extent of nodulosis, the leflunomide therapy had to be stopped in 2 patients. Progression and acceleration of nodulosis is well known following MTX therapy in RA patients. It is caused by adenosine A1 receptor promotion of multinucleated giant cell formation by human monocytes. Leflunomide has no known influence on adenosine metabolism, so different pathogenetic mechanisms must be assumed for the induction of nodulosis by leflunomide.
12699275 Transcendence and transformation in the life patterns of women living with rheumatoid arth 2002 Jun Considering personal life stories as the context for health transitions can enhance understanding of what is meaningful in living with chronic illness. Informed by Margaret Newman's theory of Health as Expanding Consciousness, this interpretive study described the life patterns of three women with rheumatoid arthritis as a process of expanding consciousness. The women's stories revealed transcendence of self-boundaries and personal transformation as new ways of living, including "simple pleasures" and "being positive." Through understanding life patterns within caring nursing partnerships, transitions in an entire life story can be appreciated as complex processes involving transcendence and transformation.
14611110 Does being easily moved to tears as a response to psychological stress reflect response to 2003 Sep OBJECTIVE: Psychological stress affects the condition of patients with rheumatoid arthritis (RA). We evaluated the neuroendocrine and immune responses (NEIRs) in the peripheral blood to psychological stress induced by deep emotion with tears in patients with RA. METHODS: We compared the levels of plasma cortisol and interleukin-6 (IL-6), the CD4/CD8 ratio, and natural killer (NK) cell activity in peripheral blood between the patients with easily controlled RA (CRP < 1.0 mg/dl) and those with difficult-to-control RA (CRP > or = 1.0 mg/dl) before and after the stress session. RESULTS: Psychological stress induced by deep emotion with tears had a greater influence on NEIRs in patients with difficult-to-control RA (CRP > or = 1.0 mg/dl) than in those with easily controlled RA (CRP < 1.0 mg/dl). The levels of plasma cortisol, IL-6, and the CD4/CD8 ratio were lower, while NK cell activity in the peripheral blood was higher in those who were not moved to tears than in those who were moved to tears. Patients who were moved to tears were apt to obtain good control of RA (CRP < 1.0 mg/dl) within one year. CONCLUSION: The patients with better RA control are easily moved to tears as an emotional expression; shedding tears is considered to suppress the influence of stress on the NEIRs, thus preventing the buildup of stress. Patients who were moved to tears had a more easily controlled RA compared with those who were emotionally affected but not moved to tears.
14969062 The Oslo experience with arthritis registries. 2003 Sep The Oslo experience with early rheumatoid arthritis (RA) is based on studies performed within the setting of a register of RA patients and of the longitudinal follow-up of patients with early RA. This article discusses some relevant issues for research on early arthritis: whether the current RA classification criteria are appropriate, the shift in incidence toward elderly patients, and the heterogeneity of the disease. Our data clearly show that 3 of the items of the classification criteria are infrequently fulfilled early in the disease and that RA most frequently starts after the age of 60. Our data also suggest that disease onset may be defined either as symptom onset or as when the classification criteria are fulfilled. The choice between these 2 options does not seem to influence the longitudinal results.
12465141 Adverse effects of sulfasalazine in patients with rheumatoid arthritis are associated with 2002 Dec OBJECTIVE: N-acetyltransferase 2 (NAT2) is a key enzyme for the acetylation of sulfasalazine (SSZ). We examine whether there was a correlation between diplotype configurations (combinations of 2 haplotypes for a subject) at the NAT2 gene and the adverse effects of SSZ used for the treatment of rheumatoid arthritis (RA). METHODS: The findings from 144 patients with RA who had been treated with SSZ were collected from our outpatient department and used for a retrospective study. Haplotype analysis was performed by the maximum-likelihood estimation based on the EM algorithm using the obtained polymorphism data. RESULTS: Sixteen patients (11.1%) had experienced adverse effects from SSZ, the most common being allergic reactions including rash and fever. The slow acetylators who had no NAT2*4 haplotype had experienced adverse effects more frequently (62.5%) than the fast acetylators who had at least one NAT2*4 haplotype (8.1%) (p < 0.001, OR 7.73, 95% CI 3.54-16.86). In 25% of the slow acetylators, the adverse effects were so severe that they were hospitalized. CONCLUSION: Genotyping the NAT2 gene followed by estimation of diplotype configuration before administration of SSZ is likely to reduce the frequency of adverse effects in Japanese patients with RA.
12492256 Subacute cutaneous lupus erythematosus in a patient with rheumatoid arthritis. 2002 A 51-year woman with a seropositive rheumatoid arthritis (RA) developed antiLa/SSB antibodies and erythematosquamous lesions on her upper back. The histological diagnosis was subacute cutaneous lupus erythematosus (SCLE) (papulosquamous form). There was no indication or a drug-induced SCLE. The concurrence of RA and SCLE seems to be rare. We review the clinical, serologic and immunogenetic features in these patients with coexistent RA and SCLE.
12688237 [Analysis of quality of life among patients with bronchial asthma or rheumatoid arthritis] 2003 Mar 2 AIMS: The authors have analysed the quality of life of 228 asthmatic patients and of 81 patients suffering from rheumatoid arthritis with a general and a disease specific instrument. RESULTS: Their results indicate that the subjects experience a lower level of quality of life. Despite the availability the valid clinical tests they can not predict how the patients feel, what is their health status like. CONCLUSIONS: In every day clinical practice it is necessary to quantify the patients quality of life especially in chronically ill patients. To do so it is important to use reliable instruments which are easy to use. They have found strong correlation between the Euro-QoL and the disease specific instruments both in asthma and rheumatoid arthritis, so they could conclude that the Euro-QoL questionnaire is an easy and reliable instrument in daily practice to assess the quality of life of asthmatics and patients suffering from rheumatoid arthritis.
12832140 [Development of rheumatoid arthritis functional handicap assessment questionnaire: prelimi 2003 Jun OBJECTIVE: To construct a handicap assessment questionnaire for rheumatoid arthritis and to determine if the concept of "participation" can replace the one of "handicap". METHODS: Selection of daily life domains and items was based on the International Classification of Impairment Disability and Handicap "ICIDH" and on some others handicap epidemiological studies. The questionnaire was tested among rheumatoid arthritis patients. The relation between handicap and participation was investigated. Statistics analysis was performed with Systat.9 program. Spearman's correlation coefficient between 2 quantitative variables was examined. RESULTS: Six among the 7 "ICIDH" domains were included in the questionnaire. Each of them was explored with many items. Forty-six items were included; each item was explored in 4 chapters:participation assessment with VAS (Visual Analogical Scale) before rheumatoid arthritis and during the study; difficulties: need of help, environment accessibility, patient's satisfaction, feeling of devalorization; patient's propositions;handicap assessment with VAS; other questions were added in some particular items. Thirty patients were included in the study (23 women), the average age was 51 years. Five patients didn't understand the meaning of "Handicap".This study allows us to eliminate 2 items, to add 2 others and to ameliorate 1 of them. Correlation between handicap and participation was moderate to bad. CONCLUSION: This questionnaire allows to explore rheumatoid arthritis handicap. Each domain of the daily life can be assessed separately. The main difficulties are the length and the impossibility to be self-administered. Handicap and participation probably assess different concepts or are differently understood by patients.
15045633 Spontaneous bilateral humeral head fractures occurring simultaneously in a woman with rheu 2004 Apr A 67-year-old woman with a 15-year history of seropositive rheumatoid arthritis developed acute night pain in both shoulders. Examination revealed bilateral swelling and joint mobility impairment. Ultrasonography disclosed joint effusions which were hemorrhagic on aspiration. Radiographs showed the presence of a four-part fracture of both humeral heads. Bilateral humeral head fractures can occur spontaneously in patients with rheumatoid arthritis and osteoporosis. Repeated use of crutches could be a predisposing factor.
15053446 Experiences from a prospective early rheumatoid arthritis study in southern Sweden. 2004 Mar Characteristics of an ongoing longitudinal observational study of patients with established rheumatoid arthritis (RA) are described. The sample comprised 183 patients enrolled from 1985 to 1989. Disease duration at inclusion was 1 year. Patients were referred from primary care and were included in the study irrespective of disease severity, with evaluation at a team care unit every 6 to 12 months. The assessment comprised a broad spectrum of standardized measures that covered the potentially most important disease outcomes. After 10 years the dropout rate was only 3%. Results to date from this study are summarized. Findings include disease course and remission rate, physical function, radiographic progression, hip involvement, mortality, work disability, and economic consequences.
12847673 Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in 2003 Jul OBJECTIVE: To study the prevalence of cervical spine subluxations and predictive factors for atlantoaxial subluxations (including anterior atlantoaxial subluxation and atlantoaxial impaction, i.e., vertical subluxation) in patients with rheumatoid arthritis (RA) who were treated early and continuously with disease-modifying antirheumatic drugs for 8-13 years. METHODS: Radiographs of the cervical spine were obtained in 103 of 110 patients (the 110 surviving patients of the original 135-patient cohort) at their 8-13-year followup visits. The prevalence of cervical spine subluxations was determined. Demographic variables and the first 5-year serial data concerning disease course were analyzed in a logistic regression model to find predictive factors for atlantoaxial subluxations. RESULTS: Atlantoaxial subluxations were found in 14 patients (14%), and 5 patients (5%) had subaxial subluxations. Older age at baseline, greater disease activity during the first 5 years, and early erosiveness in peripheral joints predicted the development of atlantoaxial subluxations. Patients who had >or=10% of the maximum possible radiographic damage (by Larsen score) in peripheral joints at 5 years were 15.9 times more likely to develop atlantoaxial subluxations at 8-13 years than patients whose peripheral joint damage remained <10% of the maximum. CONCLUSION: Compared with historical control RA cohorts, a lower prevalence of cervical spine destruction was found in the present group of patients. Rapid erosiveness in peripheral joints was the best predictor for atlantoaxial subluxations. Extensive erosiveness in peripheral joints should alert rheumatologists to the possible development of atlantoaxial subluxations in patients with RA.
15516102 The role of outcome measures in assessing change in the at-risk rheumatoid foot. 2004 Oct In common with other outcome measures, those for the at-risk rheumatoid foot need to be sensitive, specific and patient focussed, although currently these combined features are not available within one measure. There is also the issue of cross-validation with other commonly used measures to be considered. Both government policy and clinical need predicate development of suitable measures for the rheumatoid foot. In the first part of this paper, general issues relating to outcome measures and some government policy are considered and in the second, outcome measures relating to the at-risk rheumatoid foot are introduced alongside a discussion on the implications for practitioners.
14616209 Spectral Doppler and resistive index. A promising tool in ultrasonographic evaluation of i 2003 Nov PURPOSE: To evaluate the use of spectral Doppler in the longitudinal follow-up of inflammatory joint involvement in rheumatoid arthritis (RA) by comparing resistive index (RI) findings with color fraction and pain on a visual analog scale (VAS). MATERIAL AND METHODS: Five patients on unchanged disease modifying anti-rheumatic drugs (DMARD) treatment were followed after an intra-articular corticosteroids injection and received no further injections in the observation period. They were followed clinically and by ultrasound using color Doppler pixels and the spectral Doppler RI as indicators of inflammation. At 1, 6 and 12 months the measurements were repeated on the same joint. RESULTS: At 1-month follow-up after the corticosteroids injection, a marked decrease in the color fraction was seen in 4 out of 5 patients, while the fifth patient had a moderate decrease (Wilcoxon p < 0.05). The changes in RI showed correspondingly a marked increase in 4 out of 5 patients indicating a diminished flow to the synovium (Wilcoxon p < 0.05). The effect of the corticosteroid injection could still be seen after 1 year in 4 out of 5 patients. In RI, pixel fraction and VAS there was improvement compared with the baseline values; however, only the pixel fraction was statistically significant (Wilcoxon p < 0.05). CONCLUSION: RI seems to be an objective alternative to pixel estimation of the degree of inflammation and treatment response in RA.
12086029 The effect of corrective splinting on flexion contracture of rheumatoid fingers. 2002 Apr This paper reports a matched-pair experimental study to investigate the effect of corrective splinting on flexion contracture of rheumatoid fingers. Twenty-four patients with rheumatoid arthritis and finger flexion contracture participated in the study. After a 6-week baseline measurement of hand function-including measurement of grip strength and range of motion and administration of the Jebsen Hand Function Test-the patients were randomly placed into two groups. Patients in the first group were given dynamic (Capener) splints, and those in the second group were given static (belly gutter) splints. Hand function was re-assessed 6 weeks after the splinting program. Results indicated significant improvement in both groups, not only in the correction of the finger flexion contracture (p < 0.0005) but also in grip strength (p = 0.001) and hand function (p < 0.0005). Patients with dynamic finger extension splints did not differ from those with static splints in extension gains, but they did have better flexion than patients with static splints. Both types of splints can be recommended for flexion contracture of rheumatoid fingers, depending on patients' preferences and comfort.
12145893 [Effect of rarefaction process on osteoporosis in rheumatoid arthritis]. 2002 Apr In 68 patients with rheumatoid arthritis (RA) changes were analysed in the osseous tissue structural-and-functional state depending on the activity of the inflammatory process. Ascertained in RA patients were regularities in the course of rarefication processes, rate of the bone mass loss relative to stages of RA activity. With the aid of the ultrasound densitometry and echoosteometry techniques systemic disorders were studied together with structural-and-functional changes in the bone tissue.
15663536 Double filtration plasmapheresis for the treatment of a rheumatoid arthritis patient with 2004 Oct A 68-year-old-male who was diagnosed as having rheumatoid arthritis (RA) 7 years previously was admitted the Chiba Social Insurance Hospital due to general fatigue, spiking fever, and appetite loss. Blood tests showed extremely high levels of C-reactive protein (CRP, 318.5 mg/dL), and hypergammapathy (IgG 3228 mg/dL, IgA 905 mg/dL, IgM 2537 mg/dL) and high titers of rheumatoid factor (RAPA 40960X). He was diagnosed as having RA with vasculitis, according to interstitial pneumonitis, cutaneous nodules and polyneuropathy. Prednisolone (30 mg/day) was prescribed, however, myeloperoxidase-antineutrophil cytoplasmic antibody proved to be positive (86EU) and cyclophosphamide (50 mg/day) was added one week later. Additionally, IgM K-chain M-protein was revealed and the differentiation between auto-immune and hematologic diseases was required for further drug prescriptions. Therefore, double filtration plasmapheresis (DFPP) was initiated weekly. Hematologic diseases were negated and the hypergammapathy was improved. C-reactive protein and MPO-ANCA decreased to the normal level after three sessions (IgG 1064 mg/dL, IgA 331 mg/dL, IgM 94 mg/dL, CRP 0.04 mg/dL) and the patients symptoms improved. Prednisolone was tapered and he was discharged. It was suggested that the case presented here was quite rare, having an extremely high level of CRP which was successfully managed by DFPP.
12462018 [Evaluation of the burdens of rheumatoid arthritis and osteoarthritis: a questionnaire sur 2002 Oct OBJECTIVES: To evaluate the burdens of rheumatoid arthritis (RA) and osteoarthritis (OA), focusing on quality of life (QOL). METHODS: A questionnaire survey was conducted with 3407 qualified doctors of Japan Rheumatism Foundation (response rate 20%). Subjects were asked to assume three patient groups characterized by treatment status (outpatient, inpatient with inactive treatment and inpatient with active treatment) and to answer the questions about (1) percent distributions of the groups a decade ago and today and (2) QOL, including physical functions, daily living activities and social activities, of each group. RESULTS: More than 70% of patients with RA and OA were included in the outpatient group, who had problems in social activities rather than in physical functions and daily living activities. During the last decade, percentage of he outpatient group was increased, while those of the inpatient groups were decreased, and QOL of patients with RA and OA was improved. Compared with OA, RA showed lower percentages of the inpatient groups and greater losses in physical functions, daily living activities and social activities. Accordingly, the burden of RA was greater than that of OA. CONCLUSIONS: In order to improve QOL and reduce the burden of RA, not only development of effective treatment but also assistance to social activities of the patients is required.
15286006 Deciding on progression of joint damage in paired films of individual patients: smallest d 2005 Feb Progression of radiological joint damage is usually based on the simultaneous assessment of a series of films from an individual patient ("paired", with or without known sequence). In this setting the degree of progression that can be reliably detected above the measurement error is best determined by the smallest detectable change, and overestimated by the traditionally calculated smallest detectable difference. This knowledge is important for calculation of the proportion of patients showing radiographic progression in clinical trials.
15603400 [Fixation of the crico-arythenoid joints in rheumatoid arthritis--preliminary report]. 2004 Rheumatoid arthritis (RA) is a systemic disease of connective tissue which affects joints lined with synovial membrane. Laryngeal joints also have such a structure. Among all reasons leading to their inflammation rheumatoid arthritis is mentioned on the first place. In larynx RA mostly affects cricoarythenoid joints (CA). RA of the CA joints is found in 27% to 78% suffering from RA. In the acute phase of the disease patients complain of burning and foreign body sensation in the throat, hoarseness, pain on speaking, voice fatigability, problems with swallowing. Chronic RA of the CA joints can lead to their fixation and dyspnoea, requiring emergency tracheotomy. According to the literature, this state occurs in 10% to 25% patients suffering from RA. A case of 75 years old woman is presented, who was admitted to our Clinic with severe inspiratory dyspnoea requiring tracheotomy. She was suffering from RA for 26 years. She complained of effort dyspnoea, problems with swallowing and tightness sensation in the throat for 4 years. Patient complained also about cervical spine pain, upper right extremity and knee joint periodic oedema. The patient was suffering from so severe lower extremities pain and rheumatoid changes in knee joints that she had to walk on crutches. Little hands' joints were deformed with significant ulnarisation. Videolaryngostroboscopic examination showed no movement in CA joints, paramedian position of the vocal folds and narrowing of the glottic rim to 1.5 mm. Phonatory mobility of the vocal folds was preserved. Electromiographic examination of the internal laryngeal muscles made a) during phonation--showed bilateral normal bioelectrical record from thyroarythenoid muscles, b) at rest--there was no denervation activity. In computerized tomography study no degenerative changes in CA joints were found. On the basis of clinical view and examinations results, there was considered that fixation in CA joints was due to degenerative changes, which were the result of their rheumatoid inflammation. It was emphasized that this subject has been mentioned only several times in laryngological and phoniatric handbooks and in few articles.
15501352 [Hemophagocytic syndrome complicating adult's seropositive rheumatoid arthritis]. 2004 Nov INTRODUCTION: Macrophage activation syndrome (MAS) is a severe complication of chronic rheumatic diseases, particularly juvenile rheumatoid arthritis. However, MAS is rarely described in adult rheumatoid polyarthritis. EXEGESE: We report a case of MAS complicating a seropositive rheumatoid polyarthritis after 20 years of evolution. Pancytopenia with fever, renal failure and hepatic dysfunction revealed the disease that was confirmed by multiple macrophages and monocytes invading the bone marrow specimen. CONCLUSION: Outcome has been spectacular under corticosteroids.