Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
12577851 [Radiation-modifying effect of oxygen barotherapy in complex treatment of patients with rh 2002 AIM: To evaluate the efficiency of radiotherapy (RT) in combination with oxygen barotherapy (OBT) versus PT used in the complex therapy for rheumatoid arthritis (RA) and osteoarthrosis (OA). MATERIALS AND METHODS: 46 patients with RA and 18 patients with OA were examined, of them 24 patients with RA and 10 with OA received complex therapy involving a course of OBT. The groups of patients had no statistically significant differences in the characteristics of their disease and in the nature of the therapy performed. All the patients received RT as radiation therapy. The patients were followed up for 2 years by assessing basic clinical (the Richi articular index, total pain index, local articular index, pain index for knee and hand joints, circumference of knee and wrist joints) and ultrasound (the magnitude of exudate, an erosive process, osteophytes, articular fissure stenosis, the thickness of the synovial membrane and cartilage) indices. RESULTS: Use of OBT in patients with RA and OA just before articular radiation therapy brought about a more pronounced positive effect of complex therapy. In addition to significant positive changes in clinical parameters, there was a slow progression of a pathological process, as evidenced by ultrasound study. CONCLUSION: By reducing needs for drug therapy, for nonsteroidal antiflammatory drugs in particular, OBT produces a pharmacoeconomic effect.
11874831 Effect of pregnancy and obstructive jaundice on inflammatory diseases: the work of P S Hen 2002 Apr Hench considered that cortisone improved inflammatory joint symptoms during pregnancy and obstructive jaundice. However, the improved symptoms are probably due to changes in the proportions of fatty acids in plasma and inflammatory cell phospholipids. These changes decrease the superoxide anions and eicosanoids produced and also reduce tumour necrosis factor alpha production.
12804998 Interstitial granulomatous dermatitis with plaques and arthritis. 2003 May Interstitial granulomatous dermatitis (IGD) is a histopathological disorder characterised by an infiltration of the reticular dermis with a predominance of interstitial and palisadic histiocytes with a few areas of degenerating collagen bundles associated with a variable number of polynuclear neutrophils and eosinophils. There are several clinical conditions with a pattern of IGD. The linear form associated with arthritis was the first variety described. There is also a second form, which presents with plaques. This variety may be associated with arthritis, use of certain drugs or the presence of different systemic disorders. We report a case of IGD with plaques and arthritis. We discuss the differential clinical and histological diagnosis with other inflammatory skin lesions, which may be associated with joint disorders and collagen degeneration. We believe that it should be considered in patients presenting with arthritis and skin lesions.
15074176 [The practice guideline 'Rheumatoid arthritis' (first revision) from the Dutch College of 2004 Mar 20 The guideline from the Dutch College of General Practitioners regarding the early diagnosis and treatment of rheumatoid arthritis is in agreement with present concepts in rheumatology that emphasise a small window of opportunity for the effective treatment of (early) rheumatoid arthritis. Aggressive treatment of early rheumatoid arthritis is indicated, including early referral from the general practitioner to the rheumatologist.
12747271 Atlantoaxial disorders in rheumatoid arthritis associate with the destruction of periphera 2003 Mar OBJECTIVE: To evaluate whether cervical spine changes are associated with the destruction of shoulder or peripheral joints and with bone mineral density (BMD) in patients with long-term RA. METHODS: An inception cohort of 67 patients with seropositive and erosive RA were followed up for 20 years. Cervical spine, shoulder, hand and foot radiographs, and the BMD of the lumbar spine and femoral neck were evaluated. RESULTS: A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the severity of anterior atlantoaxial subluxation and atlantoaxial impaction positively correlated with the grade of destruction in the evaluated joints. Furthermore, patients with atlantoaxial disorders presented decreased BMD of the femoral neck (p = 0.019). The occurrences of subaxial subluxations (SAS) and subaxial disc space narrowings only associated with higher onset age of RA. CONCLUSIONS: Patients with severe RA and osteoporosis have an increased risk for atlantoaxial disorders. The co-existence of shoulder destruction and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging.
15488699 Health services research in rheumatology: a great deal accomplished, a great deal left to 2004 Nov Although rheumatology has been on the cutting edge of health services research for decades, there are many unresolved issues for patients, clinicians, insurers, and policy makers. This article explore three areas in which methodologic controversies present tradeoffs to a health care system that is grappling with larger issues around cost and access to care. Specifically, we examine issues around the use of large databases, the appropriate instruments for measuring patient-centered outcomes, and the questions that are raised from cost effectiveness studies of new treatments for rheumatoid arthritis. The issues are presented in the context of a need to provide better information to those who are providing care and those who are paying for it.
12187841 The role of endothelial cell dysfunction in the cardiovascular mortality of RA. 2002 Jan Rheumatoid patients present clinically with chronic inflammatory immune arthritis but die of the same cardiovascular (CVS) disease as the normal population. Recent studies emphasize the increased frequency and earlier development of CVS involvement in RA. The mechanisms of this accelerated atherosclerosis are the subject of active research. The hypothesis that rheumatoid vasculitis is a major factor has been pursued through studies in primary systemic vasculitis. These reveal diffuse endothelial dysfunction occurring across a spectrum of vasculitis and involving more than one vascular bed. This may relate to cytokines such as TNF alpha that are both prominent in rheumatoid inflammation and important in the upregulation of endothelium in innate immune responses. Endothelial injury or dysfunction is widely accepted as the initial factor in atheroma. Its occurrence in vasculitis leads us to propose a model for RA where this dysfunction is the essential first step on which other factors, ranging from adverse lipid profiles to specific T-cell subsets, may build accelerated atherogenesis related to the rheumatoid inflammation.
15293101 Giant geode at the olecranon in the rheumatoid elbow--two case reports. 2004 Aug A single giant geode at the olecranon in a patient with rheumatoid arthritis (RA) is relatively rare, and may cause diagnostic difficulties or cause a spontaneous pathological fracture owing to weakness of the cortical bone associated with osteoporosis. We report two cases of patients presenting with single giant geodes at the olecranon. In one case we performed an open reduction and internal fixation with bone grafting for a pathological fracture due to the geode. In the other case we performed curettage of the geode with bone grafting to prevent a pathological fracture, and a synovectomy of the elbow. We suggest that the presence of a giant geode at the olecranon may necessitate surgical intervention to prevent the occurrence of a spontaneous pathological fracture.
11892018 Fine-needle aspiration cytology of pulmonary rheumatoid nodule: case report and review of 2002 Mar Patients with rheumatoid disease may develop extra-articular lesions, affecting viscera and soft tissues. Pulmonary rheumatoid nodules show morphologic features reminiscent of a necrotizing inflammation of rheumatoid synovitis and differ from subcutaneous rheumatoid nodules only by their location, extension, and size. Although cytologic studies on pleural effusions in rheumatoid disease have long been performed, there are no more than three reports concerning the fine-needle aspiration (FNA) diagnosis of pulmonary rheumatoid nodules. The authors report on a case of a 62-yr-old woman with rheumatoid disease in whom a FNA diagnosis of pulmonary rheumatoid nodule was successfully performed. The authors highlight the main cytologic features of the entity and emphasise the high index of clinical and pathologic suspicions needed to be able to diagnose this lesion.
15083890 Association between urokinase gene 3'-UTR T/C polymorphism and Chinese patients with rheum 2004 Mar OBJECTIVES: The purpose of this study was to investigate whether the urokinase gene 3'-UTR C/T polymorphism is a marker of susceptibility to or severity of rheumatoid arthritis (RA) in Chinese patients. METHODS: A total of 145 RA patients and 134 healthy control subjects were enrolled in this study. We identified the C/T polymorphism of the urokinase gene, which is mapped on the 3'-untranslated region (3'-UTR) on chromosome 10 by polymerase chain reaction (PCR). RESULTS: There were significant differences in the distribution of the urokinase gene 3'-UTR C/T polymorphism frequency between RA patients and subjects in the control group. However, we did not detect an, association between the urokinase gene 3'-UTR C/T polymorphism and rheumatoid factor (RF), extraarticular involvement or bone erosion in RA patients. CONCLUSION: The urokinase gene 3'-UTR "T" allele was associated with RA in Chinese patients in Taiwan.
15228186 Radiological progression of joint damage in a longitudinal cohort of early DMARD-treated r 2004 OBJECTIVE: The efficacy of DMARD therapy in rheumatoid arthritis (RA) can be judged by radiological analysis. This study aimed to determine the time-dependent progression of joint damage, acute-phase response, and rates of radiologic progression in early DMARD-treated RA patients over 10 years. PATIENTS AND METHODS: We evaluated outpatient records, and radiographs of hands and feet of 54 early RA patients on DMARDs for 10 years. Radiographs were quantified by the Larsen method using recently developed quantification software. RESULTS: Radiological damage attenuated, with disease progression from baseline to Year 10 [correlation coefficient (r)=0.95, probability (p)<0.001]. Radiographic scores progressed more rapidly during the first 5 years than thereafter. Cumulative erythrocyte sedimentation rate (ESR) was strongly correlated with radiological progression (p<0.001, r=0.88). CONCLUSION: Our findings reveal a higher amount of radiographic RA progression during the first years of DMARD treatment. Thus, our data provide strong evidence for the importance of both early DMARD therapy and continuous radiographic assessments in RA.
15134616 Rheumatoid necroses in the forefoot. 2004 May BACKGROUND: The incidence and morphological features of rheumatoid necroses (RN) in the forefoot are unknown. METHODS: Biopsy material from 223 patients with seropositive rheumatoid arthritis (RA) was examined morphologically. The incidence and morphological features of RN in the forefoot were evaluated. RESULTS: RN was found in 65% of cases, which had not been suspected clinically. It was correlated with pain in 69% of cases. CONCLUSIONS: Rheumatoid necrosis contributes to the development of pain and foot deformation. It can be a significant factor worsening the clinical behavior in seropositive RA patients.
12635943 The assessment of fatigue in primary Sjögren's syndrome. 2003 OBJECTIVE: Disabling fatigue is a prominent feature of primary Sjögren's syndrome (PSS). We evaluated a number of questionnaires for their ability to discriminate fatigue in PSS from that in other rheumatic disorders and healthy controls. METHODS: 33 female caucasian patients with PSS, 45 with rheumatoid arthritis (RA), 16 with systemic lupus erythematosus (SLE) and 30 controls completed self-administered questionnaires including; Visual Analogue Scales (VAS), the Chalder Fatigue Scale (CFS), the Nottingham Health Profile (NHP) and the Medical Outcomes Short Form 36 Questionnaire (SF-36). RESULTS: All patient groups scored significantly worse than controls on the 'Energy' dimension of the NHP, the fatigue VAS and the 'Vitality' domain of the SF-36. No significant differences were observed between PSS patients and controls using the CFS. CONCLUSIONS: The NHP. VAS and SF-36 are useful in identifying fatigue in these rheumatic disorders. Further work is required to identify the characteristic features of fatigue in these conditions.
12463064 DNA-transfer approaches in treatment of chronic inflammatory joint disease. 2002 Chronic inflammatory joint diseases (CIJDs), including rheumatoid arthritis, are complex inflammatory processes that result in joint damage, pain, deformity, and disability. Established therapies of pain control and anti-inflammatory medications fail to control the disease processes themselves. Gene-therapy strategies may offer therapies that can modify or abort the inflammatory processes attaching joint tissue, and may deliver biologically active DNA to critical morphological and biochemical points in these diseases. Such techniques as cell-mediated transport may allow highly selective treatments for these diseases.
11922195 Abnormal sonographic findings in the asymptomatic arthritic shoulder. 2002 OBJECTIVE: To assess the diagnostic value of ultrasonography (US) in the evaluation of arthritic shoulder joints, especially in painless shoulders. METHODS: US examinations were performed in 57 consecutive patients with rheumatoid arthritis (114 shoulders) and in 32 controls (32 shoulders), using a 7.5 MHz linear probe and a standardized study protocol. US findings were compared with clinical, laboratory, and radiological data to find any relationship. RESULTS: Abnormal sonographic findings were found in 80 shoulders (70%); the most common were lesions in the supraspinatus tendon (38%), subacromial-subdeltoid bursitis (29%), bone erosions of the humeral head (20%), glenohumeral joint ellusion (19%), and biceps tendinitis (13%). Although US abnormalities were most frequent in patients with painful shoulders or abnormal findings on physical examination or radiography, a high rate of alterations was found in asymptomatic shoulders (51%), in normal shoulders on physical examination (44%) and in normal shoulders on radiographic assessment (61%). Differences of US findings in relation to time of evolution of rheumatoid arthritis, patient's age, and radiographic stage in hand and/or wrist joints were not found. CONCLUSION: US abnormalities in the shoulder joint are frequent in rheumatoid arthritis, both in patients with and without shoulder complaints as well as in patients with normal findings on physical examination.
12531671 Fate of failed Meuli total wrist arthroplasty. 2003 Feb Sixteen Meuli wrist arthroplasties in 13 patients suffering mainly from rheumatoid arthritis were revised for failure. Causes for failure were mechanical problems with the implant in three wrists, soft tissue problems in two wrists and a combination of mechanical failure and soft tissue problems in 11 wrists. Management included 11 revision arthroplasties in ten wrists, four arthrodeses and two primary soft tissue reconstructions. Twenty-six additional soft tissue procedures were required in association with the revision arthroplasties or arthrodeses. Five of the 11 revision arthroplasties had to be converted to arthrodeses after an average of 5 (range 3-8) years. After removal of a failed wrist implant union of the salvage arthrodesis was difficult to achieve in two of the nine instances. This series demonstrates that revision arthroplasty may be a useful alternative to arthrodesis for the salvage of primary wrist arthroplasties in rheumatoid patients. However, complications and reoperations may occur after both revision arthroplasty and arthrodesis.
15112094 [Navigated implantation of total knee endoprostheses in secondary knee osteoarthritis of r 2004 Apr INTRODUCTION: The operative treatment of a secondary gonarthrosis due to RA claims high quality in soft tissue balancing and accurate alignment in total knee arthroplasty (TKA) which are essential for good long-term results. The efficiency of an imageless computer-assisted implantation in TKA was evaluated and compared with conventional technique. METHOD: The authors implanted each 40 TKA either using the imageless computer-assisted or classical surgeon-controlled technique. The quality of implantation was studied on postoperative long leg coronal and lateral x-rays. RESULTS: A postoperative leg axis between 3 degrees varus and 3 degrees valgus was obtained in 37 patients (92.5%) in the study group and 30 patients (75%) in the control group. Complications influencing the clinical outcome did not occur. CONCLUSION: The use of the imageless Vector-Vision navigation system provides the patient a good chance for longterm survival. Especially the ligament balancing tool appears to be useful. Cutting errors can be detected and intraoperatively corrected.
11795731 Shortening osteotomy for treatment of metacarpophalangeal joint deformity. 2002 Jan The results of a new subcapital shortening osteotomy for correction of metacarpophalangeal joint deformity in patients with rheumatoid arthritis of the hands are presented. Seven patients (16 joints) were followed up for a mean of 33.5 months. The mean shortening of the metacarpal bone was 4.6 mm (range, 4-8 mm), and seven joints had additional intrinsic release. Only four (25%) joints held the correction of the deformity; all other joints had recurrence of palmar subluxation with or without additional ulnar drift. The range of motion of the joints with preserved correction after surgery was 80 degrees compared with 28 degrees of the joints with recurrent deformity. The possible mechanism of failure was analyzed. The results of the current series suggest that subcapital shortening osteotomy may not be indicated for treatment of severe metacarpophalangeal joint deformity in patients with rheumatoid arthritis.
14989429 Partial control of Core Data Set measures and Disease Activity Score (DAS) measures of inf 2002 Sep Several reports concerning outcomes of rheumatoid arthritis (RA) document that measures of inflammatory activity [such as swollen joint count, tender joint count, and acute phase reactant, which are included in the Core Data Set or Disease Activity Score (DAS)] may be stable or improved over 5-10 years, while measures of damage (such as radiographic progression and joint deformity) may show contemporaneous progression. Therefore, studies which include only improvement in measures of disease activity cannot document overall improvement in patient status over 5-10 years. Studies designed to document favorable long-term effects of therapy in RA must include, at baseline and later follow-up evaluation, measures of damage, such as a radiograph, joint deformity, comorbidities, and extra-articular disease, in addition to measures of disease activity. The one prognostic measure which appears to detect both activity and damage in RA over short, intermediate, and long periods is a disability score on a patient questionnaire, which might be used by all rheumatologists at all patient encounters. The need for inclusion of accurate and relevant measures of damage appears of particular importance in the current era of biological drugs, in which the slowing or prevention of damage now appears a realistic goal in most patients with RA.
12715557 Perceptions of control in patients with rheumatoid arthritis. 2003 Apr 1 Forty patients with rheumatoid arthritis were randomly recruited from an outpatient population for an in-depth, qualitative interview. The aim was to identify factors that influence whether patients feel they have any control over their condition. The data were analysed using Colaizzi's procedural steps. Four major categories that positively influence perceptions of control were identified. These were the reduction of physical symptoms, the matching of social support with perceived need, the provision of information, and the nature of the clinical consultation.