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ID PMID Title PublicationDate abstract
12473325 Concepts of arthritis in India's medical traditions: Ayurvedic and Unani perspectives. 2003 Jan Anthropology and other social sciences have not given detailed attention to cultural constructions of arthritic disorders and their place in traditional medical systems. Humoral medicine and its numerous crosscultural variants offer an important perspective on the conceptualization and treatment of arthritis. The present paper provides a descriptive account of rheumatic disorders in India's Ayurvedic and Unani medical traditions. Data derive from anthropological fieldwork in the New Delhi metropolitan area and from Ayurvedic and Unani texts and secondary sources. The discussion explores these two traditions together as a polysynthetic field of ideas, practices, and materials, and it highlights their congruent concepts of arthritis and related somatic concepts, etiologies, and treatments. It reveals parallels in the clinical practices of Ayurvedic and Unani practitioners and identifies a broadly shared model of arthritis that circulates between these practitioners and their ethnically diverse patient-clienteles. The paper suggests that this South Asian humoral model provides a framework that may be useful in anthropological studies of arthritis in other humoral traditions.
15296376 Anterior scleritis: three case reports and a review of the literature. 2004 Jul BACKGROUND: Scleritis is a rare ocular condition involving vasculitis. It can result in severe ocular morbidity and has a high association with underlying systemic disease and mortality. Management can be challenging and under-diagnosis is a concern. Treatment usually requires systemic medications and co-management with a medical specialist in the appropriate field to manage any underlying systemic etiology. METHODS: Three cases are presented: idiopathic nodular scleritis with complete recovery; bilateral, diffuse anterior scleritis with rheumatoid arthritis; and scleromalacia perforans treated with chemotherapeutic agents and co-managed with a rheumatologist. A search of the English language literature is reported, also. RESULTS: The reported cases exemplify much of our knowledge regarding scleritis. The literature review focuses on the challenges of an accurate diagnosis and management. Management is challenging and, although standards exist, controversy remains. The literature discusses the relationship of scleritis to underlying systemic disease and the significant implication of this association. CONCLUSION: Knowledge of scleritis may aid in determining a timely and accurate diagnosis and treatment of both the ocular and any underlying systemic conditions, thus decreasing morbidity and mortality.
12700593 Discovery of distinctive gene expression profiles in rheumatoid synovium using cDNA microa 2003 Apr Rheumatoid arthritis (RA) is a heterogeneous disease. We used cDNA microarray technology to subclassify RA patients and disclose disease pathways in rheumatoid synovium. Hierarchical clustering of gene expression data identified two main groups of tissues (RA-I and RA-II). A total of 121 genes were significantly higher expressed in the RA-I tissues, whereas 39 genes were overexpressed in the RA-II tissues. Among the 121 genes overexpressed in RA-I tissues, a relative majority of nine genes are located on chromosome 6p21.3. An interpretation of biological processes that take place revealed that the gene expression profile in RA-I tissues is indicative for an adaptive immune response. The RA-II group showed expression of genes suggestive for fibroblast dedifferentiation. Within the RA-I group, two subgroups could be distinguished; the RA-Ia group showed predominantly immune-related gene activity, while the RA-Ib group showed an additional higher activity of genes indicative for the classical pathway of complement activation. All tissues except the RA-Ia subgroup showed elevated expression of genes involved in tissue remodeling. These results confirm the heterogeneous nature of RA and suggest the existence of distinct pathogenic mechanisms that contribute to RA. The differences in expression profiles provide opportunities to stratify patients based on molecular criteria.
12491125 [Expert assessment of patients with rheumatoid arthritis]. 2002 Dec Rheumatoid arthritis (RA) is the most common inflammatory disease of the locomotor system associated with early loss of function and joint destruction. A relevant number of patients with RA withdraw from employment within the first years. To give a medical opinion on patients with RA regarding ability for work requires thorough knowledge of the disease, its characteristic deformities and prognostic indicators as well as knowledge of the essential examinations and instruments for the estimation of functioning and disability.
15074177 [Summary of the practice guideline 'Rheumatoid arthritis' (first revision) from the Dutch 2004 Mar 20 The guideline covers the evaluation of patients with one or more painful joints without previous injury and focuses on the distinction between rheumatoid arthritis and other joint complaints. In the case of rheumatoid arthritis, the arthritis is based on aseptic synovitis and is nearly always associated with tenderness, warmth, swelling, and impaired function. Redness is not present in most cases. The diagnosis is primarily made on the basis of the case history and physical examination. Laboratory tests and X-ray are only of secondary importance. NSAIDs are recommended as the initial treatment for patients with rheumatoid arthritis or serious indications for this. If the arthritis does not settle within a period of 6 to 12 weeks after the onset of the complaints, the patient should be referred to a rheumatologist to start treatment with one or more disease-modifying antirheumatic drugs (DMARDs). DMARDs suppress the activity of the disease and can prevent joint damage. However, which combination of DMARDs gives the best results is still unclear.
12673895 Correlation of serum levels of adenosine deaminase activity and its isoenzymes with diseas 2003 Jan OBJECTIVE: Adenosine deaminase (ADA) is involved in purine metabolism and plays a significant role in the mechanisms of the immune system. The aim of this study was to investigate the correlation between the activity of total ADA (tADA) and isoenzymes ADA1 and ADA2 and clinical activity in patients with rheumatoid arthritis (RA). METHODS: The study comprised 37 patients with rheumatoid arthritis and 30 healthy controls. Total serum ADA activity was measured spectrophotometrically. The isoenzyme pattern of ADA was analyzed using erytro-9-(2-hydroxy-3-nonyl) adenine (EHNA). Disease activity was assessed using DAS criterion. RESULTS: The means of tADA, ADA1 and ADA2 levels were found to be 22.7 +/- 5.9, 3.9 +/- 2.0 and 18.8 +/- 4.9 IU/L in patients with RA, and 15.1 +/- 4.4, 4.1 +/- 1.2 and 11.0 +/- 3.7 IU/L in healthy control subjects. When compared to the healthy controls, serum tADA and ADA2 levels were significantly higher (p < 0.001) in patients with RA, but the decrease of ADA1 level was not statistically significant (p > 0.05). There was a strong correlation (r = 0.527, p < 0.001) between serum tADA level and disease activity by DAS (Pearson's rank correlation), and no correlation between tADA and CRP or ESR in the patient groups (p > 0.05). CONCLUSION: Serum tADA and ADA2 activity is closely associated with RA and these non-invasive investigations can be used as biochemical markers for inflammation. These may provide additional information regarding disease activity along with the traditional indices such as ESR and CRP.
15112093 [The infected rheumatoid forefoot--how much surgery is advisable?]. 2004 Apr A biomechanically altered rheumatic forefoot with a resulting shoe conflict and an impaired immune system due to underlying disease and medical treatment are often cause for infection. Often infected bursae perforate into the corresponding joints and may consequently lead to severe infectious states of the foot. The multiplicity of possible biomechanical adjustments makes it difficult to develop an undisputed concept. Conservative versus operative therapeutic options are possible and may be individually applied. It should be questioned, if the same general rules in septic joint surgery also apply to the rheumatoid forefoot. This retrospective clinical study will evaluate a concept for possible operative treatment of the infected rheumatoid forefoot in selected cases. Our conception advocates operative procedures on a patient adapted basis in order to prevent recurrent infections. Suggestions for operative procedures are given.
12531678 Osteochondral grafting of the metacarpophalangeal joint in rheumatoid arthritis. 2003 Feb We report two cases of isolated metacarpophalangeal joint subluxation in rheumatoid patients with dorsal osteochondral defects on the base of the proximal phalanx. These were treated by open reduction, autologous osteochondral grafting and synovectomy. Stable reduction was maintained and appeared to delay the deterioration of the joint.
15301244 HLA DRB1*01 and DRB1*04 phenotyping does not predict the need for joint surgery in rheumat 2004 Jul OBJECTIVE: To determine if the presence of HLA-DR disease-associated epitopes predicts the need for total joint arthroplasty or joint fusion in rheumatoid arthritis (RA). METHODS: Tertiary-referral, monocenter study. Three hundred RA patients (1987 ACR criteria) were retrospectively evaluated; outcome measure was recourse to total joint arthroplasty, joint fusion or bone resection. HLA-DR1 and DR4 were considered as the disease-associated epitopes (subtypes were not available for analysis). Analysis was performed using the lifetable method (Kaplan-Meyer technique). RESULTS: Of the 300 patients included, 78% were women, mean age: 56+/-14 years, mean RA follow-up: 12+/-9 years. Phenotyping: 73% of patients carried one (52%) or two (21%) disease-associated epitopes. Surgery was performed on 24% of the patients during follow-up. The most frequent surgery was total hip arthroplasty (13% of patients). According to lifetable analysis, 13% of patients had surgery (total joint arthroplasty or joint fusion) after 10 years of follow-up, 34% after 20 years. years of follow-up, There was no statistically significant difference in recourse to surgery according to absence or presence (single or double-dose) of disease-associated epitopes. Similar results were observed if the event was the second surgical procedure on a given patient. CONCLUSION: This study failed to demonstrate a relation between HLA phenotyping and the severity of RA defined by the requirement for surgery.
15167520 (99m)Tc-dextran scintigraphy to detect disease activity in patients with rheumatoid arthri 2004 Jun AIM: To test the applicability of Tc-dextran joint scintigraphy in the assessment of disease activity in patients with rheumatoid arthritis (RA), and to compare it with the clinical disease activity scores and laboratory parameters. METHODS: Twenty-seven patients with RA were investigated using Tc-dextran joint scintigraphy. The images were evaluated semi-quantitatively and the regional uptakes of the radiopharmaceutical were calculated for the knee, wrist and ankle joints. The clinical and laboratory parameters were collected and fully analysed. An articular Ritchie index (a tender joint score), the number of swollen joints (Sw), the number of tender joints, the morning stiffness (h), the total Ritchie articular index (R), the visual analogue scale (VAS) and the Disease Activity Score (DAS) were determined for all patients. RESULTS: Compared with controls, patients with RA had significantly higher regional Tc-dextran uptake in the knee, wrist and ankle joints (P=0.001). The regional Tc-dextran uptake showed no correlation with the patient's age, gender, duration of disease, number of swollen joints (Sw), number of tender joints, morning stiffness (h), VAS, total Ritchie articular index and DAS, or any laboratory parameters. There was a significant correlation between the regional Tc-dextran uptake for individual joints and the articular Ritchie index of the right and left wrist (r=0.42, P=0.03; r=0.45, P=0.02), right and left knee (r=0.66, P<0.0001; r=0.80, P<0.0001) and right and left ankle (r=0.47, P=0.014; r=0.76, P<0.0001), respectively. CONCLUSIONS: This study demonstrates that Tc-dextran scintigraphy is a sensitive method to detect active joint inflammation and could be useful in the management of patients with RA.
12195084 Radionuclide therapy of inflammatory joint diseases. 2002 Sep Inflammatory joint diseases as well as arthropathy are common joint diseases. Many of them may be treated by synovectomy to stop disease progression and to improve joint function. Radiosynoviorthesis as one therapeutic procedure of rheumatoid arthritis, other inflammatory joint diseases, persistent synovial perfusion, and other joint diseases is widely used in many countries in Europe. Using Y-90 for the knee joint, Re-186 for middle sized joints and Er-169 for small joints an improvement of symptoms and function may be observed in about 60-80% of patients.
12905774 [Comparison of radiographs and magnetic resonance imaging in the detection of carpal lesio 2002 Oct OBJECTIVE: To compare MR imaging with radiographs in detection of the erosions of the wrists in patients with rheumatoid arthritis (RA). METHODS: In 50 wrists of 25 patients with RA, radiographs of AP projection and MR imaging examination were performed within 1 week. The MRI sequences were SE T1-weighted image, FSE T2-weighted image, and GE T2* weighted image in coronal plane. Gd-DTPA enhanced SE T1-weighted image with same parameters of pre-contrast administration SE T1WI was performed in 25 wrists, which showed prominent lesions in each 25 patients. RESULTS: In 50 wrists of 25 patients with RA, bone erosions were found by MR images compared to radiographs in 46 versus 14 wrists, respectively. There were 170 sites of carpal erosions found by MR images, while radiographs found only 23 sites of carpal erosions. Among them triquetrum and lunate were the most frequently involved sites. Significant difference (P < 0.001) was statistically found between conventional radiography and MR imaging in detection of erosions of the wrists of RA. MR imaging also permitted demonstrating synovitis and joint effusion in the wrists. Gd-DTPA-enhanced images allowed distinguishing pannus changes from joint effusion. CONCLUSION: MRI is superior to conventional radiography with respect to detection of bone erosion in wrists. For those whose conventional radiographs show suspected RA, MRI examination should be advised for the early diagnosis.
11859558 Intercessory prayer and its effect on patients with rheumatoid arthritis. 2002 Jan Matthews et al's. (2000) study suggested that in person intercessory prayer was useful in the medical treatment of patients with RA, improving overall health. However, distant prayer showed no overall improvement. This study could be used to support a research utilization project to educate nurses on the potential benefits of prayer on the healthcare and health outcomes of patients with certain illnesses. An in-service could be made available for nurses to educate them on potential benefits of prayer. A feasibility issue would be cost. Religion and spiritual beliefs can influence a patient's level of health and self-care behaviors. It is essential for nurses to meet the spiritual needs of their patients. A nurse should also recognize that there are many different religions and not all patients have the same religion and beliefs.
15675264 [The influence of FcgammaRIIa polymorphism on rheumatoid arthritis]. 2004 Aug The FcgammaRIIa receptor is most widely distributed of the Fcgamma receptors and is expressed on the most types of immunocomponent cells. Polymorphism of the FcgammaRIIa receptors may modulate immune complex mediated inflammation, particularly when immune complex contains IgG. The aim of the study was to evaluate the influence the FcgammaRIIa polymorphism on disease parameters activity in patients with rheumatoid arthritis (RA). The study included 75 patients with RA diagnosed according to the American College of Rheumatology criteria. In each patient the following parameters of disease activity were evaluated during one-year period: number of swollen and tender joints, morning stiffness duration, CRP, ESR as well as the disease activity in global physical assessment. There was no correlation between disease activity parameters and FcgammaRIIa polymorphism. Our results suggest, that FcgammaRIIa polymorphism does not represent an important genetic risk factor for RA activity.
12508778 FC gamma RIIa polymorphism in patients with rheumatoid arthritis. 2002 Nov OBJECTIVE: Polymorphism of phagocyte IgG receptor Fc gamma RIIa may modulate immune complex mediated inflammation, particularly when immune complex contain IgG2. METHODS: Fc gamma RIIa genotyping in 82 patients with rheumatoid arthritis (RA) and 148 healthy subjects was performed using the polymerase chain reaction technique with allele specific primers. RESULTS: No significant relation between Fc gamma RIIa genotypes and susceptibility to RA was observed, but extraarticular complications with high frequency were revealed in patients with R/R131 genotype. CONCLUSION: The results suggest that the Fc gamma RIIa polymorphism is not a risk factor for RA.
15005011 The influence of N-acetyltransferase 2 polymorphism on rheumatoid arthritis activity. 2004 Jan OBJECTIVE: The N-acetyltransferase polymorphism is involved in the metabolism of many xenobiotics, as well as in susceptibility to some diseases such as rheumatoid arthritis (RA). The aim of this study was to investigate the influence of NAT 2 polymorphism on disease activity in RA patients. METHODS: 70 with RA were enrolled in the study. As a measure of disease activity, the number of swollen and tender joints, the duration of morning stiffness, ESR and CRP as well as disease activity based on a global physician's assessment were evaluated. The NAT2 polymorphism was determined by a polymerase chain reaction-restriction fragment length polymorphism assay (PCR-RFLP). RESULTS: The mean number of swollen and tender joints, as well as the ESR and CRP values, did not differ significantly with the acetylation genotype. Erosive RA was diagnosed in 74.5% of the slow and 40% of the fast acetylators. The risk for the development of erosive RA was 4.39 time greater in slow acetylators than in fast acetylators. CONCLUSION: NAT2 polymorphism may be a genetic risk factor for joint destruction.
14648088 [Molecular imaging in rheumatoid arthritis]. 2003 Advances in molecular biology and technical developments in the field of imaging are increasingly allowing for non-invasive visualization and quantitation of biological processes at the molecular level. Such technologies, defined as molecular imaging, promise early diagnosis and improved classification of the stage and severity of disease, objective assessment of treatment efficacy, and reliable prognosis based on so-called molecular markers. Furthermore, molecular imaging is an important tool for the evaluation of physiological and pathophysiological processes and for drug development. Various different imaging modalities are available, such as conventional radiography (CR), computed tomography (CT), nuclear imaging, magnetic resonance imaging (MRI), ultrasound (US), as well as other methods including fluorescence-based optical imaging. These methods differ with respect to resolution and their potential to gather information at the anatomical, physiological, cellular and molecular level. Therefore, the choice of the imaging modality for molecular imaging depends on the questions that need to be answered. This review discusses the potential of imaging modalities for molecular imaging in rheumatoid arthritis (RA).
14719197 Erosions develop rarely in joints without clinically detectable inflammation in patients w 2003 Dec OBJECTIVE: To study whether clinically observed tenderness and/or swelling of a wrist joint over the first 3 years after diagnosis predict the development of erosions in radiographs of the same joint at 5 years in patients with early rheumatoid arthritis (RA). METHODS: A total of 58 patients with recent onset RA were enrolled in a prospective RA study at Jyväskylä Central Hospital in 1983-85. Physical examination including joint counts was performed 6 times over 3 years (at 0, 6, 12, 18, 24, and 36 mo). Radiographs of hands and feet taken at the 5-year visit were scored according to the Larsen method (0-1 = non-erosive; 2-5 = erosive). At each visit, the wrist joints were assessed for tenderness (0/1) and swelling (0/1). A frequency (ranging from 0 to 6) was calculated for 4 inflammation categories tenderness, swelling, tenderness or swelling, and tenderness and swelling over the 3 years. Percentages of wrist joints with erosions on the 5-year radiographs were calculated for the frequency groups 0, 1, 2-3, and 4-6 of each category. Two patients died, and 5 wrists were erosive at baseline. Thus the data for 107 wrist joints of 54 patients were available for analyses. RESULTS: A statistically significant correlation was seen in the frequency of clinical inflammation and the development of erosions. Only one (3.3%) wrist with no tenderness in 6 examinations over the first 3 years developed erosions over 5 years, while 13 (59.1%) wrists that were tender 4-6 times in 6 examinations developed erosions. The corresponding percentages were 4.4% and 50.0% for wrists with swelling, 3.4% and 51.6% for wrists with tenderness or swelling, and 6.1% and 75.0% for wrists with tenderness and swelling. CONCLUSION: Radiographic erosions develop rarely without preceding clinically detectable inflammation in the joints of patients with early RA.
12847892 [Patient non-compliance in rheumatoid arthritis: the degree, frequency, types and correlat 2003 AIM: To assess the degree of non-compliance (NC) in patients with rheumatoid arthritis (RA) as well as NC frequency, types, correlations. MATERIAL AND METHODS: 34 patients with RA (the study group) and 21 patients with osteoarthrosis (the control group) have filled in an original questionnaire developed by the authors. The analysis was made of correlations between NC degree and clinico-laboratory, social-demographic and psychopathological factors. RESULTS: The degree of NC (general and type-specific) and its frequency appeared to be significantly higher in the group of RA patients. Significant positive correlations were found between the degree of NC and hormone dependence, functional decline of the joint, presence of organic and adaptation mental disorders. CONCLUSION: A high degree of RA patient NC with medical recommendations dictates the necessity of psychocorrective measures for such patients.
15083881 Long-term results of multiple synovectomy for patients with refractory rheumatoid arthriti 2004 Mar OBJECTIVES: We developed a radical multiple synovectomy (RaMS) procedure designed to reduce disease activity in refractory RA patients involving the excision of all inflamed synovial tissues. In this study we examined the long-term outcome of RaMS in terms of disease activity and articular destruction. METHODS: Forty-two patients with refractory RA underwent RaMS and were followed up for an average of 7.3 years. Clinical findings and radiological outcome were evaluated and compared to a control group. RESULTS: More than 40% of patients continued to maintain improvement up to 4 years after the operation. The number of swollen joints and painful joints, the erythrocyte sedimentation rate, CRP and rheumatoid factor quickly decreased after the operation. The beneficial effects continued for 4 years compared to patients treated with combination disease modifying anti-rheumatic drug therapy. The damage score worsened less rapidly in patients undergoing RaMS than in the control group. Articular destruction was less marked in the PIP, MP, wrist and ankle joints of patients who responded well to RaMS. CONCLUSIONS: RaMS was effective for refractory RA in the short term and seemed to offer some advantages over other therapies in terms of slowing articular destruction. However, RaMS did not radically alter the natural disease course of RA.