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ID PMID Title PublicationDate abstract
12910964 [The relationship between prognosis after one-day arthroscopic partial synovectomy on rheu 2003 Jun Forty four rheumatoid arthritis (RA) patients with hydrops of the knee joint had partial synovectomy of the knee joint performed under arthrosopy and subsequent irrigation of the joint with 3,000 ml physiological salile solution. Seventeen out of these 44 cases demonstrated recurring hydrops at one year after the procedures (the recurrence group). The remaider (n = 27) was regarded as the non-recurrence group. The histological features consistent with RA (proliferation of surface cells, palisade fasion, multi-nucleated giant cells, lymphocytes, plasma cells and granulation tissue; and the occurrence of fibrinoid necrosis and ferritin depotits) were graded depending on the severity of each feature, according to Koizumi's criteria. The rate of heavy lymphocyte and plasma cell infiltration in the non-recurrence group was significantly higher than that in the recurrence group (P = 0.00 and 0.001, respectively). Therefore, we concluded that the prognosis for one-day arthroscopic partial synovectomy on rheumatoid knee joints is related to the pathological features of the synovial membrane.
15082109 Molecular method to test if Parvovirus B19 is a new virus to the Old World. 2004 Parvovirus B19 (PVB19) is a non-trivial cause of morbidity and mortality in young individuals from diseases such as aplastic anemia and hydrops fetalis. Curiously, given this significant disease burden, the one genetic phenotype known to protect against PVB19 infection--the p red-cell phenotype characterized by the lack on any P group antigens on erythrocytes--is extremely rare with a prevalence of only approximately 1/200,000. One explanation is that PVB19 is a new virus to the Old World. It is pointed out in this paper that recently developed powerful genetic methods can be used to test this proposal. Confirmation that PVB19 is a new virus could shed light on the etiology of rheumatoid arthritis.
15238646 Influence of previous open synovectomy on the outcome of Souter-Strathclyde total elbow pr 2004 Oct OBJECTIVES: Open synovectomy of the elbow joint is often performed in early stages of rheumatoid arthritis. Because of poor long-term results after synovectomy, insertion of a total elbow prosthesis is commonly used as a secondary procedure. The aim of this study is to evaluate the influence of previous synovectomy on the outcome after placement of a total elbow prosthesis. METHODS: We inserted 204 primary Souter-Strathclyde total elbow prostheses for rheumatoid arthritis. Two groups could be distinguished: group A with previous synovectomy 3.9 yr (mean) before the elbow replacement (n = 33) and group B without previous synovectomy (n = 171). The mean follow-up was 5.8 yr for group A and 6.3 yr for group B. All patients were assessed clinically and radiologically before the operation, 1 and 2 years later and then at regular intervals. The effect of previous synovectomy was analysed via a Cox model and a generalized linear mixed model for binomial data with multivariate normal random effects. RESULTS: No statistically significant effect of previous synovectomy on pain, function or complaints of the ulnar nerve could be found post-operatively. The post-operative flexion was significantly higher in group B than in group A. The complication-rates were similar for both groups. The overall survival rate for respectively group A and B with revision as endpoint was 66.9% (s.e. 13.4) versus 79.6 (s.e. 4.3) after 10 yr. CONCLUSIONS: Previous synovectomy does not diminish the outcome after total elbow prosthesis in this series and could therefore be considered in early, painful stages of rheumatoid destruction of the elbow joint.
15306969 [Treatment of refractory anterior diffuse scleritis with infliximab]. 2004 Aug CASE REPORT: A 48-year old woman diagnosed with rheumatoid arthritis 10 years previously, developed severe anterior scleritis in the right eye (RE) refractory to conventional treatment. The patient was treated with 3 intravenous doses of Infliximab achieving complete remission of the scleral inflammation within four weeks. DISCUSSION: The use of Infliximab, a blocker of tumour necrosis factor (TNFalpha) could be an alternative approach to the management of refractory scleritis, but further long-term investigations would be necessary to evaluate their safety and efficacy.
12491116 [Evidence-based guidelines--what is the present situation?]. 2002 Guidelines have proven to be an important tool for improving quality of health care. Evidence-based guidelines are particularly well accepted and have a high degree of credibility based on the transparent process of their development and the explicit use of clinical patient-oriented research, on which the recommendations are based. The goal of the guidelines "Management of early rheumatoid arthritis", currently developed by an interdisciplinary working group, is to minimize out existing deficiencies in the provision of health care.
15015249 [Diagnostic image (176). A man with a black thumb. Necrosis of the thumb as a symptom of r 2004 Feb 14 A 72-year-old man presented with necrosis of the thumb as a symptom of rheumatoid vasculitis.
15366667 Minor and major complications of arthroscopic synovectomy of the knee joint performed by r 2003 The aim of the study was to analyze the type and incidence of major and minor complications resulting from arthroscopy with arthroscopic synovectomy of the knee joint performed by rheumatologist in different rheumatological diseases. METHODS: In a prospective study the incidence of complications in arthroscopic subtotal synovectomy with subsequent tidal flow lavage was analyzed in 201 rheumatic patients. The arthroscopic synovectomies were performed by one team of rheumatologists in the operation room of the University Clinic of Rheumatology in the town of Plovdiv for a period of 8-9 years. RESULTS: The major complications related to the arthroscopic synovectomy included septic arthritis (0.5%) and rupture of the joint capsule with edema of the thigh and leg (1.5%). The minor postarthroscopic complications were infection of the operative skin incision (2.0%), hemarthrosis (3.5%), severe postoperative pain (1.5%) and gout relapse (0.5%). Complete recovery was achieved after complications were treated and the result of the synovectomy was not compromised. CONCLUSION: Arthroscopic synovectomy of the knee joint performed by rheumatologist in in-patients involves low risk of complications among which minor operative and postoperative ones are prevalent. These do not compromise near and late results of the arthroscopic synovectomy.
12154208 Surgical treatment of the rheumatoid cervical spine in patients aged 70 years or older. 2002 Aug OBJECTIVE: To investigate whether surgery is appropriate for elderly rheumatoid arthritis patients who are already approaching their statistical life expectancy. PATIENTS AND METHODS: The subjects were 10 patients who underwent cervical spine surgery for rheumatoid arthritis at an age of over 70 yr. The pain grade and neurological deficit class according to Ranawat, peri-operative complications, causes of death and pre-operative cardiopulmonary function were assessed. RESULTS: Good pain relief was achieved. Relief of pain enabled the patients, who could not sit up even in bed because of intolerable neck pain, to ride in a wheel chair without using a neck collar. Only one death was related to surgery. Pre-operative cardiopulmonary function was not significantly different compared with that of elderly patients undergoing other surgical procedures. CONCLUSION: Surgery is a valuable option for the management of elderly patients with rheumatoid cervical spine since it can improve the quality of life.
12598797 Genetic epidemiology: disease susceptibility and severity. 2003 Mar Genetic factors are increasingly recognized to have an important contribution to the occurrence of both inflammatory and noninflammatory rheumatic disease. Although identifying the specific genetic mechanisms involved in the rheumatic diseases continues to present considerable challenges, the prospect of identifying individual gene action has been brought closer by a number of recent developments. These include newer approaches to phenotype definition, refinements in statistical tools for analysis, and the advent of newer technologies, including the use of microarrays. In this article, we review some of these developments together with the recent literature on the contribution of both broad and specific genetic factors to the spectrum of rheumatic disease. We also consider contemporary opinions on the potential impact of genetic discoveries to human health.
15028795 Rheumatologic conditions of the foot. 2004 Mar Podiatric physicians are frequently the first clinicians with the opportunity to diagnose a rheumatologic disease. Awareness of the multisystem nature of the more common rheumatologic conditions will assist podiatrists in making the appropriate diagnosis. The specific joints affected, the temporal pattern of joint involvement, and the distribution of affected joints give clues to the diagnosis. Knowledge of the current treatment for rheumatic diseases as well as early referral for evaluation by a medical physician is essential for the appropriate care of patients with systemic arthritis.
12077707 Influence of human leukocyte antigen-DRB1 on the susceptibility and severity of rheumatoid 2002 Jun BACKGROUND AND OBJECTIVES: All human leukocyte antigen (HLA)-DRB1 alleles associated with rheumatoid arthritis (RA) encode a conserved amino acid sequence (QKRAA, QRRAA, or RRRAA) at position 70-74 in the third hypervariable region (HVR3) of the DRbeta(1) chain, which is commonly called the shared epitope (SE). Several studies, however, have associated the HLA-DRB1 gene in RA severity and progression rather than with susceptibility. Moreover, the association with disease severity and presence of the SE varies among different ethnic populations. HLA-DRB1 alleles also influence the disease onset. In this manuscript, the role of the HLA genes in RA was examined. METHODS: A retrospective review of the literature was conducted to analyze the influence of the HLA-class II genes on the susceptibility, severity and protection against RA. RESULTS: The HLA-DRB1*0401/*0404 genotype was associated with a higher risk for early disease onset in more severe forms in patients from the United Kingdom (UK). In northwest Spain, RA onset under 40 years is strongly associated with HLA-DRB1*0401 and *0404. In contrast, RA onset above 60 years is associated with HLA-DRB1*01. The protection against RA linked to some HLA-DRB1 alleles encoding a DERAA sequence of amino acids at position 70-74 in the HVR3 of the DRbeta1 chain, and specifically aspartic acid (D) at position 70 of this chain, recently was confirmed in both UK and northwest Spanish populations. Besides HLA-class II, other genes may be implicated in RA. Polymorphism in the tumor necrosis factor (TNF) region seems to be associated with RA, even in patients without the HLA-DRB1 SE. However, other genes such as interleukin-1 (IL-1) and corticotropin-releasing hormone may play a role in susceptibility to RA. CONCLUSIONS: The additive effect of various genes may account for the development of RA and its clinical severity.
15116488 Rheumatoid arthritis of TMJ--a diagnostic dilemma? 2004 Apr Rheumatoid arthritis is a chronic disease affecting the musculo-skeletal connective tissue of the body with a strong predilection for the joints. The temporomandibular joint (TMJ) is commonly affected with rheumatoid arthritis in adults and children, but it is usually among the last joints to be affected. A case report is presented of a patient undergoing orthodontic treatment who developed unilateral condylar changes and whose serum was also positive for rheumatoid factor. The involvement of TMJ in several systemic disorders is a well established fact. When such disorders manifest in an atypical manner, it poses a diagnostic dilemma. This article aims to discuss various disorders causing condylar erosions.
12605320 Silica-related rheumatoid arthritis without lung involvement. 2003 Feb We report a young male with recent onset of rheumatoid arthritis (RA) in whom the remarkable severity of the disease led to additional investigations. The only significant finding was mediastinal lymphadenopathy, without lung involvement. Biopsy of the mediastinal lymph node revealed pathological findings typical of silicosis. To our knowledge, this is the first report of silicosis apparent solely in the mediastinal lymph node of an RA patient. This suggests that lung involvement is not crucial for the development of silica-related arthritis.
14969069 Disease-modifying anti-rheumatic drug therapy and structural damage in early rheumatoid ar 2003 Sep The appearance of measurable structural damage in rheumatoid arthritis (RA) is an indicator of disease severity and future disability. Disease-modifying anti-rheumatic drugs (DMARDs) used in combination appear to be more effective than monotherapies at reducing the rate of progressive joint damage during randomized controlled trials. In clinical practice, however, combination DMARD therapy is still largely reserved for patients who have failed to respond to monotherapy. High dose corticosteroid, when given in early disease with combination DMARD therapy, may continue to ameliorate disease severity and progression for years after discontinuation of the high dose. To date, no DMARD combination has totally arrested joint damage in all patients with early RA. Future randomised controlled trials should always include prospective radiographic data as a primary outcome measure.
12460723 Design considerations for a wrist implant. 2002 Dec Rheumatoid arthritis and other forms of inflammatory arthritides commonly affect the wrist leading to pain, deformity and a reduced quality of life for the patient. Joint arthroplasty is an attractive solution for improving function while relieving pain, but unfortunately, current designs of wrist arthroplasties have not met with great success. This review paper describes the anatomy and biomechanics of the normal wrist, and reviews the current and past designs of artificial wrist joints. The design considerations for a successful wrist implant are discussed, and it is concluded that future generations of wrist implants should not attempt to recreate the natural wrist, but permit a limited functional range of motion. Different materials and methods of fixation of artificial wrist joints should also be considered to improve implant durability.
15135604 Autoantibodies as predictors of disease. 2004 May 8 CONTEXT: Many human diseases are the result of autoimmune attack, presumably related to a loss of tolerance to self. Autoimmune disease can be divided into either organ-specific illnesses, such as thyroid disease, type 1 diabetes, and mysasthenia gravis, or systemic illnesses, such as rheumatoid arthritis and systemic lupus erythematosus. The pathogenesis of autoimmune damage also segregates autoimmune disease in that some diseases or manifestations are mainly induced by autoantibodies. Pathogenesis may be mainly mediated by autoimmune T lymphocytes. Notwithstanding the underlying mechanism of disease, virtually all autoimmune diseases are associated with circulating autoantibodies, which bind self-protein. Furthermore, for many diseases these autoantibodies are found in serum samples many years before disease onset. STARTING POINT: In the past several years a new autoantibody specificity has been identified in the sera of patients with rheumatoid arthritis. These autoantibodies bind citrulline, a post-translational modification of arginine. Markus Nielen and colleagues recently studied the presence of these autoantibodies and rheumatoid factor in blood donors who later developed rheumatoid arthritis (Arthritis Rheum 2004; 50: 380-86). About half the patients were positive for at least autoantibody at a median of 4.5 years before the onset of disease. The negative predictive value of these tests was high, while the positive predictive value was very high. WHERE NEXT? Autoantibodies might not be directly responsible for many of the manifestations of autoimmune disease, but they are markers of future disease in presently healthy individuals. Long-term large studies of outcome are needed to assess the use of assaying autoantibodies for prediction of disease. Such data could lead to intervention trials to prevent autoimmune disease, as are already underway in type 1 diabetes.
12810421 Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis. 2003 Jul OBJECTIVE: To investigate development of radiographic damage in hands and feet of patients with early rheumatoid arthritis (RA) monitored prospectively for 10 years, and to search for prognostic factors. PATIENTS AND METHODS: 181 patients with early RA (mean disease duration one year) were assessed annually with radiographs of hands and feet during years 0-5 and at year 10. Radiographs were evaluated according to Larsen (range 0-200). Predictive factors for progressive disease for years 0-5 and 5-10 were evaluated by logistic regression analyses. RESULTS: 82/168 (49%) patients had erosions at inclusion and almost all became erosive with time (90% after two years and 96% after 10 years). Radiographic progression was most rapid during the first two years and 75% of all damage occurred during the first five years. The median Larsen score increased from 6 at inclusion to 41 after five years and 54 after 10 years. Only 5.3% of all evaluated joints became maximally eroded, the second metacarpophalangeal joint being the most commonly affected. Mean ESR during the first three months and rheumatoid factor status were significant predictors for radiographic progressive disease, it was not possible to predict non-progressive disease. CONCLUSIONS: Joint damage in hands and feet developed early and progression was most rapid during the first years of disease. The different rates of progression at different stages should be considered in the design of trials of drugs aimed at retarding joint damage. Disease activity at study start influenced the degree of joint damage during the entire 10 years.
15201606 Bone loss in inflammatory arthritis: mechanisms and treatment strategies. 2004 Jul PURPOSE OF REVIEW: Focal bone loss in inflammatory arthritis begins early in the disease process and can contribute to patient morbidity. Current treatment strategies primarily target suppression of the inflammatory cascade with varying success in limiting the progression of focal bone destruction. This review outlines the current understanding of the mechanisms mediating inflammation-induced focal bone loss in rheumatoid arthritis and other inflammatory arthritides and highlights recent studies in animal models of arthritis that have contributed to our knowledge of this process. RECENT FINDINGS: Bone-resorbing osteoclasts have been identified as important effector cells in inflammation-induced bone loss in both experimental animal models and human rheumatoid arthritis and psoriatic arthritis. The RANK/RANKL (receptor activator of nuclear factor-kappaB and RANK ligand) pathway has been shown to be essential for osteoclast differentiation in inflammatory arthritis. In addition, in vitro and in vivo studies have demonstrated that many cytokines and growth factors elaborated by inflamed synovial tissues may contribute to osteoclast differentiation and activation. SUMMARY: Elucidation of the mechanisms mediating osteoclast differentiation and function has identified new pathways for potential targeted therapeutic intervention for focal bone loss in inflammatory arthritis. Challenges in the application of this approach are that therapies targeting the osteoclast would need to be used in combination with effective anti-inflammatory agents, and that pathways mediating osteoclast differentiation and function would need to remain at least partially functional to allow for continued skeletal remodeling.
15678800 [Impact of cardiovascular illness on hospitalization costs in patients with rheumatoid art 2004 Dec The causes of admission and the distribution of direct medical costs were examined to establish the clinical predictors of high hospitalization costs in patients with rheumatoid arthritis. This retrospective study included all rheumatoid arthritis patients who were hospitalized in the Clínica Universitaria Bolivariana in Medellín, Colombia, between January 1999 and June 2003. Data were obtained from the medical records and from the hospital statistical section using a cost-analysis spreadsheet. A total of 41 patients were hospitalized 62 times (0.34 hospitalization per patient per year). Disease activity was the most important cause of admission (60%), followed by surgery (18%), and infection (10%). In 30 (48%) hospitalizations, at least one comorbidity was recorded, with cardiovascular disease being the most frequent (32%). The mean length of stay per patient was 5+/-6 days. The mean total cost was 1,277 US dollars, and the mean cost per day of hospitalization was 235 US dollars. Medications represented 54% of the total cost, whereas that representing medical care was only 3%. Variance analysis disclosed cardiovascular disease as the most important determinant of high costs (p<0.01). In conclusion, the direct costs for inpatients with rheumatoid arthritis were considerable, and arose mainly from organic complications. Prevention and treatment of cardiovascular disease are indispensable not only to reduce the economic burden of rheumatoid arthitis, but also to diminish the risk of mortality. These data assist in the estimation of health care resources and in the selection of public health policies for the improvement of patient outcomes.
15535839 Oxidation in rheumatoid arthritis. 2004 Oxygen metabolism has an important role in the pathogenesis of rheumatoid arthritis. Reactive oxygen species (ROS) produced in the course of cellular oxidative phosphorylation, and by activated phagocytic cells during oxidative bursts, exceed the physiological buffering capacity and result in oxidative stress. The excessive production of ROS can damage protein, lipids, nucleic acids, and matrix components. They also serve as important intracellular signaling molecules that amplify the synovial inflammatory-proliferative response. Repetitive cycles of hypoxia and reoxygenation associated with changes in synovial perfusion are postulated to activate hypoxia-inducible factor-1alpha and nuclear factor-kappaB, two key transcription factors that are regulated by changes in cellular oxygenation and cytokine stimulation, and that in turn orchestrate the expression of a spectrum of genes critical to the persistence of synovitis. An understanding of the complex interactions involved in these pathways might allow the development of novel therapeutic strategies for rheumatoid arthritis.