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ID PMID Title PublicationDate abstract
14969063 The French early arthritis registry. 2003 Sep This report is focused on two French multicenter cohorts of patients with early rheumatoid arthritis (RA). The first one is a community-based study which was started in 1993. It was mainly designed to identify prognostic factors of joint destruction, disability and remission in patients with early RA. The 3-year and 5-year results have been recently reported. Briefly, progression of joint damage was best predicted at baseline by radiographic scores, ESR, CRP, rheumatoid factor and DRB1*04 genes, and disability by disease activity including the HAQ score. Recently, the French Society of Rheumatology initiated a large national multicenter registry (800 patients), the "ESPOIR cohort study", that could serve as a database to allow investigations not only on diagnostic and prognostic markers, but also on etiologic, pathogenic and medico-economic factors among patients with early inflammatory arthritis who could later develop RA. The objectives, design and organization of this early arthritis registry are described.
12955194 [Joint-preserving procedures for the rheumatoid elbow joint. Medium-term results]. 2003 Aug The follow-up of 42 patients with 50 symptomatic elbow joints [average age at operation: 66.1 years (46-79 years)] with rheumatoid arthritis at an average of 6.8 years (SD: 3.5 years) after joint-preserving open operation is presented in this study. Synovectomy was mandatory. Open synovectomy with facultative additional soft tissue techniques (AS) was performed on 17 elbows, while in 33 elbows joint surface remodeling (SR)-radial head excision included-was performed. There was only a slight progression in the overall Larsen staging from 3.70 to 4.02 in the operated joints, while the non-operated joints were nearly unchanged (3.43 vs 3.56). Especially in the SR group a nearly significant ( p=0.06) increase of 31.0 degrees for the total elbow ROM as a sum of extension/ flexion and pronation/supination could be detected, while the AS group slightly decreased with -1.1 degrees. Both groups gained a comparable average Morrey score result (AS 77.6 points vs SR 75.6 points). Poor results were not noticed at all. A mild collateral instability was seen in 40% of the AS and in 20% of the SR cases, respectively. Moderate instability was found in 10% in the AS vs 5% in the SR group. Both groups showed an excellent benefit in terms of pain relief, function, and satisfaction according to the patients' self-assessment on a visual analog scale.Joint-preserving operations on the rheumatoid elbow proved to be safe and efficient methods on a medium term even at late stages. Especially joint surface remodeling guarantees a noticeable increase for the elbow ROM without provoking marked collateral instability. The patients' expectations for pain relief and functionality can be fulfilled completely with these methods.
15513677 Aetiological factors of importance for the development of rheumatoid arthritis. 2004 OBJECTIVE: To evaluate exposure to external factors associated with risk or prevention of rheumatoid arthritis (RA). METHODS: Two hundred and ninety-three incident cases of RA and 1346 population-based referents were included in a case-referent study, in which previous exposure experiences were collected through a postal questionnaire. RESULTS: An inverse association between RA and additional schooling after compulsory school was seen for men. Current smoking was associated with significantly increased risks of RA for men and women [odds ratio (OR) 2.9, 95% confidence interval (CI) 1.4-6.4, and OR 1.8, 95% CI 1.1-2.9, respectively], as was previous smoking for men (OR 2.3, 95% CI 1.2-4.4). There were also indications of relationships between previous use of a private well and RA in both men and women. CONCLUSION: Several previously published associations have been reproduced in the present study, which also generates some new hypotheses that suggest further research.
15229949 The role of diet in susceptibility to rheumatoid arthritis: a systematic review. 2004 Jul OBJECTIVE: Many studies have examined the role of diet in the management of established rheumatoid arthritis (RA), warranting several recent reviews. However, none have considered the possible link between diet and the onset of RA in detail. Studies investigated a possible effect of individual components of diet and the development of RA, but the lack of a systematic review means there is no unbiased assessment of the evidence. METHODS: We systematically reviewed studies with comparison groups that examined dietary intake or biological markers prior to the onset of RA. Four electronic databases were searched to identify relevant reports. Six quality criteria were agreed, against which the studies were assessed. The main outcome measure was a diagnosis of RA according to the ARA 1958 or revised ACR 1987 classification criteria. RESULTS: Fourteen reports were included in the review. There was evidence of a protective effect of higher consumption of olive oil, oil-rich fish, fruit, vegetables and beta-cryptoxanthin. Lower serum concentrations of antioxidants were associated with an increased risk of RA in 3 studies. Due to the heterogeneity of study designs and analyses, the results could not be pooled. CONCLUSION: Evidence exists that diet may play a role in the etiology of RA, but it is inconclusive due to the small number of studies available and variation in study design.
14969050 The evaluation of bone damage in rheumatoid arthritis with magnetic resonance imaging. 2003 Sep Magnetic resonance imaging (MRA) greatly improves the early detection and visualization of osseous and non-osseous joint changes over conventional x-rays of involved joints in patients with rheumatoid arthritis (RA). However, the "pathophysiological correlate" of these MR imaging changes remains poorly defined. Careful validation of MRI findings and the evaluation of MRI as a tool to follow the effect of therapy remain to be performed before MRI may be used as a clinical tool to follow therapy or as a surrogate for evaluating osseous changes over time.
12435467 Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: 2002 Nov Recent developments in chronic pain research suggest that effectiveness of cognitive-behavioral therapy (CBT) may be optimized when applying early, customized treatments to patients at risk. For this purpose, a randomized, controlled trial with tailor-made treatment modules was conducted among patients with relatively early rheumatoid arthritis (RA disease duration of <8 years), who had been screened for psychosocial risk profiles. All participants received standard medical care from a rheumatologist and rheumatology nurse consultant. Patients in the CBT condition additionally received an individual CBT treatment with two out of four possible treatment modules. Choice of treatment modules was determined on the basis of patient priorities, which resulted in most frequent application of the fatigue module, followed by the negative mood, social relationships and pain and functional disability modules. Analyses of completers and of intention-to-treat revealed beneficial effects of CBT on physical, psychological and social functioning. Specifically, fatigue and depression were significantly reduced at post-treatment and at the 6-month follow-up in the CBT condition in comparison to the control condition, while perceived support increased at follow-up assessment. In addition, helplessness decreased at post-treatment and follow-up assessment, active coping with stress increased at post-treatment, and compliance with medication increased at follow-up assessment in the CBT condition in comparison to the control condition. Results indicate the effectiveness of tailor-made CBT for patients at risk in relatively early RA, and supply preliminary support for the idea that customizing treatments to patient characteristics may be a way to optimize CBT effectiveness in RA patients.
12509626 Control perceptions in patients with rheumatoid arthritis: the impact of the medical consu 2003 Jan OBJECTIVE: To identify factors that patients perceive as influencing control in living with the symptoms of rheumatoid arthritis (RA). METHOD: A sample of 40 patients with RA were recruited randomly from an out-patient population. The participants of the sample were interviewed in depth by one researcher to identify perceptions of control. They also completed two self-administered questionnaires, the Health Assessment Questionnaire and the Rheumatology Attitude Index. RESULTS: Four major categories were identified that positively influenced perceptions of control in patients living with the consequences of RA. These included: (i) the reduction of physical symptoms; (ii) social support matching perceived need; (iii) the provision of information; and (iv) the medical consultation. Components of the consultation included patient involvement, provision of information, feedback and reassurance, empathy and access to an expert. CONCLUSION: The categories identified can be influenced by health-care professionals in the management of the patient, and if the medical consultation is utilized to its full potential it can play a major role in enabling patients with RA to manage the daily symptoms of their condition.
14563791 Metacarpophalangeal joint arthroplasty in rheumatoid arthritis. A long-term assessment. 2003 Oct BACKGROUND: The long-term results of silicone metacarpophalangeal arthroplasty in patients with rheumatoid arthritis are uncertain. The purpose of this investigation was to evaluate the subjective, objective, and radiographic outcomes at the time of long-term follow-up. METHODS: Patients with rheumatoid arthritis who underwent simultaneous silicone metacarpophalangeal joint arthroplasties of all four fingers by one surgeon were eligible for inclusion in the study. The results of a total of 208 arthroplasties in fifty-two hands of thirty-six patients were evaluated at an average of fourteen years postoperatively. Active metacarpophalangeal joint motion, ulnar drift, and radiographs were assessed. The radiographs were reviewed for changes in bone length, erosions, and implant fractures. The Michigan Hand Outcomes Questionnaire (MHQ) was administered to the patients. RESULTS: The mean arc of motion of the metacarpophalangeal joints improved from 30 degrees preoperatively to 46 degrees immediately after the surgery but decreased to 36 degrees at the time of final follow-up. The mean extension deficit of the metacarpophalangeal joints improved from 57 degrees preoperatively to 11 degrees immediately after the surgery but worsened to 23 degrees at the time of final follow-up. The mean ulnar drift improved from 26 degrees preoperatively to <5 degrees in the immediate postoperative period and then recurred to an average of 16 degrees at the time of final follow-up. Implant fractures were associated with increased ulnar drift (p < 0.001). Bone reaction adjacent to the implant was demonstrated by bone-shortening in most patients and by erosions in 29% of the patients. One hundred and thirty implants (63%) were broken and forty-five (22%) more were deformed at the time of final follow-up. The MHQ score averaged 48 of 100 points. The patients expressed satisfaction with the function of only 38% of the hands, and only 27% of the hands were pain-free at the time of final follow-up. A greater degree of ulnar drift was associated with decreased patient satisfaction and a decreased score for the cosmetic appearance (p
12509606 The effect of treatment on radiological progression in rheumatoid arthritis: a systematic 2003 Jan OBJECTIVE: To undertake a systematic review of randomized placebo-controlled trials to assess and rank the efficacy of pharmacological interventions in preventing radiological progression of rheumatoid arthritis. METHODS: The two outcome measures were the weighted standardized mean difference and the odds of progression of X-ray scores pooled as close to 12 months as possible to minimize heterogeneity. RESULTS: A total of 38 trials were identified. Of these, 13 were excluded, leaving data on 3907 subjects. Infliximab, cyclosporin, sulphasalazine, leflunomide, methotrexate, parenteral gold, corticosteroids, auranofin and interleukin 1 receptor antagonist were statistically better than placebo in terms of change in erosion scores. All agents were equivalent statistically, with the exception of infliximab (which was superior to the last five agents). There were similar findings for the odds of progression, with the exception of auranofin (P=0.06) and the infliximab-methotrexate comparison (P=0.07). Other agents did not reach statistical significance in either outcome measure. With the exception of the antimalarials, the magnitude of the effect was consistent with the effect seen in short-term disease activity trials. CONCLUSION: There is published evidence which supports the efficacy of nine agents in decreasing radiological progression in rheumatoid arthritis.
12594104 An experimental study of a Mediterranean diet intervention for patients with rheumatoid ar 2003 Mar OBJECTIVE: To investigate the efficacy of a Mediterranean diet (MD) versus an ordinary Western diet for suppression of disease activity in patients with rheumatoid arthritis (RA). METHODS: Patients with well controlled, although active RA of at least two years' duration, who were receiving stable pharmacological treatment, were invited to participate. All patients were randomly allocated to the MD or the control diet (CD). To achieve good compliance with prescribed diets all patients were for the first three weeks served the MD or the CD, respectively, for lunch and dinner at the outpatient clinic's canteen. Clinical examinations were performed at baseline, and again in the 3rd, 6th, and 12th week. A composite disease activity index (DAS28), a physical function index (Health Assessment Questionnaire (HAQ)), a health survey of quality of life (Short Form-36 (SF-36)), and the daily consumption of non-steroidal anti-inflammatory drugs were used as primary efficacy variables. RESULTS: From baseline to the end of the study the patients in the MD group (n=26) showed a decrease in DAS28 of 0.56 (p<0.001), in HAQ of 0.15 (p=0.020), and in two dimensions of the SF-36 Health Survey: an increase in "vitality" of 11.3 (p=0.018) and a decrease in "compared with one year earlier" of 0.6 (p=0.016). For the control patients (n=25) no significant change was seen at the end of the study. This difference between the two treatment groups was notable only in the second half of the trial. CONCLUSION: The results indicate that patients with RA, by adjusting to a Mediterranean diet, did obtain a reduction in inflammatory activity, an increase in physical function, and improved vitality.
11892712 Rheumatoid arthritis and B-cell chronic lymphocytic leukemia. 2002 Jan The association between lymphoproliferate malignancies, especially lymphoma, and rheumatoid arthritis (RA) has been confirmed by several studies. However; there are few reports of RA patients who developed B-cell chronic lymphocytic leukemia (B-CLL) and vice versa. We report a patient with B-CLL who developed RA and another with RA who presented with B-CLL during follow-up. We discuss the incidence of B-CLL among the RA population and the possible interaction of the pathogenetic mechanisms of these two entities.
15552515 Relative versus absolute goals of therapies for RA: ACR 20 or ACR 50 responses versus targ 2004 Sep Therapies for rheumatoid arthritis (RA) may be assessed according to relative levels of measures to compare efficacy to another therapy or to a placebo, as in the American College of Rheumatology (ACR) 20%, 50%, or 70% (ACR 20 ACR 50 and ACR 70) responses, or by absolute levels of measures, as in disease activity scores (DAS), ACR criteria for remission, or "target values" of specific measures. Regulatory considerations have emphasized primarily relative comparisons to a placebo or standard therapy, derived in part from the weak efficacy of traditional disease modifying anti-rheumatic drugs (DMARDs). While improvement compared to placebo certainly indicates efficacy, it is of concern that measures of inflammatory activity, such as swollen joints and the erythrocyte sedimentation rate (ESR), may be stable or improved over periods of 5-10 years, while measures of damage, such as joint deformity and radiographic changes, may progress over the same period in the same patients. These findings suggest that improvement at a level of 20% or 50% may deter but not prevent severe long-term outcomes of radiographic progression, functional declines, work disability, and premature mortality, seen in most patients until the middle 1990s. Outcomes appear to be improved at this time, associated with aggressive treatment strategies and more powerful therapies, including biologic agents. In the Finnish Rheumatoid Arthritis Combination Therapy Trial (FinRACo), no patient who was in remission after 6 months was receiving work disability payments 4 1/2 years later, compared to 22% of patients who had ACR 20 or 50 responses and 54% of patients who did not have ACR 20 responses after 6 months who were all receiving work disability payments after 5 years. These findings suggest that absolute targets, including remission, may be realistic contemporary goals, with aggressive treatment strategies and more effective DMARDs and biologic agents.
11850603 Autologous stem cell transplantation in the treatment of refractory rheumatoid arthritis. 2002 Feb The concept of using high-dose immunosuppressive treatment (HDIT) with autologous stem cell transplantation (ASCT) to treat patients with refractory rheumatoid arthritis has been provided by animal studies and anecdotal case reports. Over the past five years, an increasing number of patients with refractory rheumatoid arthritis have received HDIT with ASCT as an adjunct to intense immunosuppression. Here, we present a case of refractory rheumatoid arthritis in a 54-yr-old woman using HDIT with ASCT. Peripheral blood stem cells were mobilized with cyclophosphamide (4 g/m(2)) followed by G-CSF (5 microg/kg/day). Leukapheresis continued daily until the number of harvested progenitor cells reached 2 x 10(6) CD34+ cells/kg after CliniMax CD34+ positive selection. For HDIT, high-dose cyclophosphamide (total dose 200 mg/kg) and antithymocyte globulin (total dose 90 mg/kg) were administered and CD34+ cells were infused 24 hr after HDIT. The patient tolerated the treatment well but experienced an episode of neutropenic fever. She achieved an early dramatic improvement of joint symptoms during therapy. Fifty percent of improvement of rheumatoid arthritis by the American College of Rheumatology (ACR 50) preliminary definition was fulfilled during the 6 months following ASCT. Although further long-term follow-up is required, the patient's activity of arthritis has been stable since receiving HDIT with ASCT.
12476931 Disease activity in rheumatoid arthritis: fibrinogen is superior to the erythrocyte sedime 2002 Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are the most widely used assays to measure the laboratory aspect of the acute-phase response, being of great value in monitoring disease activity in rheumatoid arthritis (RA). The ESR is influenced by several factors, and mainly by fibrinogen. Therefore the relationships between ESR, fibrinogen and CRP and their correlations with a patient questionnaire score on activities of daily living, the Modified Stanford Health Assessment Questionnaire (MHAQ) were studied. Fifty-four consecutive patients with RA admitted to the hospital were recruited to this cross-sectional study. Strong mutual correlations were found between the studied acute-phase markers (p<0.000000001). Fibrinogen and CRP rates showed highly significant correlations with MHAQ, whereas ESR did not. We suggest that ESR could be replaced by fibrinogen in the assessment of RA in order more accurately to assess the slower component of the acute-phase response and to have a variable that shows better correlation with disability.
14961856 Hearing thresholds in patients affected by rheumatoid arthritis. 2004 Feb The aim of the study was to evaluate hearing thresholds in 38 patients with rheumatoid arthritis, divided according to disease activity into active (group A, n = 20) and non-active (group B, n = 18) patients. Pure tone audiometry, tympanometry and complete rheumatological assessment were performed. All patients presented poorer auditory thresholds compared with controls. Patients of group A had both air and bone conduction thresholds poorer than group B (although not statistically significant), and most patients of both groups presented an air-bone (a-b) gap. No significant difference in middle ear pressure was noticed between patients and controls. No correlation between hearing impairment and duration of the disease or patients' age was found. The high prevalence of hearing loss in autoimmune diseases supports the importance of audiometric evaluation in such patients. The auditory recovery through middle ear surgery before cranial nerve involvement could be considered in selected patients. Further investigations are needed for a better knowledge of the middle and inner ear involvement in patients with rheumatoid arthritis.
12875687 Impact of rheumatoid arthritis-associated HLA-DRbeta1 subtypes on protein kinase A signali 2003 May OBJECTIVE: To investigate the impact of rheumatoid arthritis (RA)-associated HLA-DRbeta1 * 0401, * 0402, * 0403, * 0404 and * 0101 subtypes on the protein kinase A (PKA) signaling pathway. METHODS: Adenylate cyclase (AC), cAMP and PKA activity in transfectants expressing RA-associated HLA-DRbeta1 subtypes and their mutants were detected. RESULTS: Compared to HLA-DRbeta1 * 0402 transfectants, the RA-associated HLA-DRbeta1 * 0401, * 0404 and * 0101 transfectants produced significantly lower levels of AC, cAMP and PKA. CONCLUSION: RA-associated HLA-DRbeta1 molecules are involved in the pathogenesis of RA through down-regulation of the PKA signaling pathway.
15643478 [Atherosclerosis and rheumatoid arthritis: relationships between intima-media thickness of 2004 Oct OBJECTIVES: To investigate the intima-media thickness of the common carotid arteries (IMT-CCA) in patients with Rheumatoid Arthritis (RA), and its relationships with classical atherosclerosis risk factors and disease features i.e. duration, activity and disability. METHODS: 48 RA patients (35 F, 13 M; age ed 26-69 years median 55; disease duration 1-18 years, median 8), and 22 controls (16 F, 6 M; age 28-66, median 50) matched for classical atherosclerosis risk factors, i.e. age, sex, smoking, blood pressure, body mass index, diabetes, familiarity, and for postmenopausal status, were studied. IMT and plaques were measured in the left and right common carotid arteries. Serum total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apoliporotein AI, apolipoprotein B, and rheumatoid factor were determined in patients and controls. The DAS28, the HAQ-DI and disease duration were considered as clinical parameters reflecting disease status. RESULTS: The IMT-CCA (mean +/- SD) was significantly greater in the 48 RA patients than in the 22 controls subjects (1.00+/-0.25 vs. 0.78+/-0.21; p=0.0007). In the 70 subjects investigated CCA-IMT resulted to be significantly correlated with diastolic blood pressure, body mass index, triglyceride and RA status. In the 48 RA patients no correlation was detected with either disease duration or activity or disability. CONCLUSION: our study confirms an increased IMT in RA patients without any clinically evident manifestation of cardiovascular disease. It supports the existence of subclinical atherosclerosis in RA.
12137706 Patient education for adults with rheumatoid arthritis. 2002 BACKGROUND: Because of the unpredictability people with arthritis face on a daily basis, patient education programmes have become an effective complement to traditional medical treatment giving people with arthritis the strategies and the tools necessary to make daily decisions to cope with the disease. OBJECTIVES: To assess the effectiveness of patient education interventions on health status in patients with rheumatoid arthritis. SEARCH STRATEGY: We searched MEDLINE, EMBASE and PsycINFO and the Cochrane Controlled Trials Register. A selection of review articles (see references) were examined to identify further relevant publications. There was no language restriction. SELECTION CRITERIA: Randomised controlled trials (RCT's) evaluating patient education interventions that included an instructional component and a non-intervention control group; pre- and post-test results available separately for RA, either in the publication or from the studies' authors; and study results presented in full, end-of-study report. MAIN RESULTS: Twenty-four studies with relevant data were included. We found significant effects of patient education at first follow-up for scores on disability, joint counts, patient global assessment and psychological status. Physician global assessment was not assessed in any of the included studies. The two separate dimensions of psychological status: anxiety and depression showed no significant effects, nor did the dimensions of pain and disease activity. At final follow up no significant effects of patient education were found. REVIEWER'S CONCLUSIONS: Patient education as provided in the studies reviewed here had moderate short-term effects on patient global assessment, and small short-term effects on disability, joint counts and psychological status. There were no long-term benefits.
14764980 [Transcutaneous electrical nerve stimulation in treatment of rheumatoid arthritis patients 2004 The aim of the study was pain management in rheumatoid arthritis patients (n=10) by applying the method of transcutaneous electrical nerve stimulation. The 10-point visual analogue scale was used before stimulation and following it. The total number of pain measurement tests in the joints was 180. The estimated average pain before stimulation was evaluated by 6.56+/-0.17 points and following it by 5.88+/-0.18 points. The average pain decrease after stimulation (Pt<0.05) was 10.4 %, compared with the control level.
12123552 T cell receptor Vbeta gene bias in rheumatoid arthritis. 2002 Jun OBJECTIVE: To explore the pathogenesis of rheumatoid arthritis (RA) by studying the expression of T cell receptors (TCRs). METHODS: T cell receptor Vbeta (TCR Vbeta) gene usage and expression were analyzed from synovial membrane and peripheral blood of 8 RA patients, 2 osteoarthritis patients and 2 accident amputees. The complementary determining region 3 (CDR3) of 25 TCR Vbeta subfamily genes in unselected T cell populations were amplified semi-quantitatively by reverse transcription-polymerase chain reaction (RT-PCR). The products were further studied by genescan for frequency of Vbeta usage. RESULTS: The numbers of Vbeta subfamilies expressed by T cells from RA peripheral blood and synovial membrane were not significantly restricted. More importantly, biased Vbeta gene expression in RA synovium was observed and Vbeta6, Vbeta17, and Vbeta22 genes were the predominant subfamilies. It was noteworthy that the expression of Vbeta17 in RA synovium was significantly increased. CONCLUSION: Our data were consistent with the hypothesis that several antigen or superantigen-driven processes may be involved in the pathogenesis of RA.