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ID PMID Title PublicationDate abstract
14674011 The genetic control of rheumatoid factor production in a rat model of rheumatoid arthritis 2003 Dec OBJECTIVE: To investigate the genetic regulation of rheumatoid factor (RF) in a rat model of rheumatoid arthritis, in order to gain understanding of the enigmatic role of RF in the disease. METHODS: IgM-RF and IgG-RF, as well as total levels of immunoglobulins of different subclasses, were measured in sera from rats with pristane-induced arthritis (PIA). The major gene regions were identified by linkage analysis of genetically segregating crosses. RESULTS: The production of RF was found to correlate with development of arthritis and to be higher in females than in males. Surprisingly, the relatively arthritis-resistant E3 strain had higher levels of RF than the arthritis-susceptible DA strain. In an (E3 x DA)F(2) cohort a major locus controlling the levels of IgM-RF in serum was identified on chromosome 11 (Rf1) and another on chromosome 16 (Rf3), and these were not related to arthritis susceptibility. However, the Rf2 locus on chromosome 4 controlled IgG-RF levels, IgG2a levels, and chronic arthritis in males (Pia5). Some previously defined arthritis loci (Pia4, Pia6, Pia7, and Pia8) were found to also control immunoglobulin levels in serum. CONCLUSION: RFs are produced in the rat PIA model and correlate with development of arthritis. Gene regions controlling RF and serum immunoglobulin levels were identified, of which some cosegregated with arthritis. This suggests a new focus of study to elucidate the role of RF in the pathogenesis of arthritis.
14598655 [Alignment of lower extremity in rheumatoid arthritis patients with a history of both tota 2003 Oct OBJECTIVE: The following is a retrospective study on lower extremity alignment of rheumatoid arthritis (RA) patients with a history of both Total Hip Replacement (THR) and Total Knee Replacement (TKR). METHODS: From 1992 to 2000, our department had 26 rheumatoid arthritis patients who underwent both THR and TKR. We classified these patients into three groups based on radiographic alignment of the lower extremities in the standing position: Knock-knee (valgus deformity of the knees), Bowleg (varus deformity of the knees) and Windswept Deformity (one knee in severe varus alignment with the other in severe valgus alignment). Furthermore, we identified dominant weight bearing points of the hip as classified by the following new criteria: Central Shift, Lateral Shift, and Upward Shift. Mal-alignment was then evaluated based on these two classification systems. RESULTS: Of the 26 patients, 22 patients met our criteria and 4 did not. In mal-alignment, we had 11 cases in the knock-knee group, 5 cases in the bowleg group, and 6 cases in the Windswept deformity. Using the new criteria, central shift had 6 cases; lateral shift had 6 cases; and upward shift had 10 cases. The groups of Lateral shift and Central shift demonstrated deformities of the lower extremities were influenced by moving weight bearing points, pelvis obliquity, and adduction contractures of the hip joint. In upward shift, weight bearing lines did not change. Consequently, destruction of the joint in this group progressed symmetrically. Windswept deformity was asymmetric and had severe destruction on the other side of the knee and forefoot. DISCUSSION: Moving of weight bearing point, pelvis obliquity, and adduction contractures of the hip joint affected the severity of mal-alignment of the lower extremities.
14969055 Early arthritis clinic: a USA perspective. 2003 Sep An early arthritis clinic (EAC) was established to identify early rheumatoid arthritis (RA) patients for clinical trials and to create a facile method of early patient referral from the practitioner to the rheumatologist. With minimal advertising and promotion, patients with less than 12 months of symptoms were easily referred if the primary care physician suspected a rheumatic condition. Of those patients who were appropriately referred one-third had synovitis, 20% had diagnostic cutaneous findings, 20% were diagnosed with lupus (or lupus-like disease), 12.5% had RA, and 10% were diagnosed with a spondyloarthropathy. An EAC was easily established, implemented and staffed and resulted in the prompt diagnosis and early treatment of many patients who may have otherwise waited months for appropriate rheumatologic diagnosis and treatment.
12955198 [The significance of immunology in orthopaedics today]. 2003 Aug Within the last years, basic science in immunology has been able to extensively increase the knowledge about the pathogenesis of many diseases. Although much hesitation persists, it has been possible to develop new immunomodulatory strategies which have proven their efficiency and safety in a number of clinical studies. Prior to that, a large number of in vitro and in vivo investigations have established a knowledge base for the development of drugs used in clinical settings. In orthopedic diseases, these immunomodulatory strategies are directed mainly towards the treatment of rheumatoid arthritis and osteoarthritis. Furthermore, immunotherapeutic approaches to bone and soft tissue tumor/metastasis has been improved and we expect first clinical results soon. Moreover, improvement of our understanding of the pathogenesis of inflammation occurring in various diseases, such as aseptic loosening of endoprostheses might help identify a whole field of orthopedic problems as a target for immunomodulatory therapies. In this review, recent developments and applications of immunomodulation in orthopedics will be discussed and a view into the future of such therapies will be given.
12915156 Quantitative measures for assessing rheumatoid arthritis in clinical trials and clinical c 2003 Oct There is no single 'gold standard' quantitative measure to assess and monitor the clinical status in patients with rheumatoid arthritis (RA). Therefore, a variety of measures have been used in clinical research and clinical care, including laboratory tests, radiographic scores, formal joint counts, physical measures of functional status, global measures and patient self-report questionnaires. These measures may address disease activity, joint damage, both activity and damage, or long-term outcomes. Measures of disease activity, such as joint swelling, are reversible and are emphasized in clinical trials. However, activity measures may be improved over 5 years while measures of damage, such as radiographic score, indicate disease progression. Two quantitative indices which are widely used in clinical trials are the (1) American College of Rheumatology (ACR) Core Data Set, which includes swollen joint count, tender joint count, physician assessment of global status, acute-phase reactant-erythrocyte sedimentation rate or C-reactive protein, functional status, pain, patient estimate of global status, a radiograph in studies over 1 year or longer, and (2) the disease activity score(DAs), which includes a swollen joint count, tender joint count, acute-phase reactant, and patient assessment of global status. Randomized controlled clinical trials provide the optimal method to evaluate new therapies, by comparing a therapy with a placebo or another therapy without selecting patients for specific therapies. However, randomized trials in chronic diseases have important limitations, including a relatively short observation period, patient selection for inclusion and exclusion criteria, inflexible dosage schedules, influence of the design on results despite a control group, emphasis on group data while ignoring individual variation in treatment responses, non-standardized interpretation of adverse effects, and others. Therefore, clinical trials in RA must be supplemented by long-term observational studies to assess results of therapy in regard to long-term outcomes such as work disability, joint replacement surgery and premature mortality. The most simple and effective method of collecting important long-term data from patients in routine clinical care is through patient self-report questionnaires.
14532158 Signal transduction networks in rheumatoid arthritis. 2003 Nov Signal transduction pathways regulate cellular responses to stress and play a critical role in inflammation. The complexity and specificity of signalling mechanisms represent major hurdles for developing effective, safe therapeutic interventions that target specific molecules. One approach is to dissect the pathways methodically to determine their hierarchy in various cell types and diseases. This approach contributed to the identification and prioritisation of specific kinases that regulate NF-kappa B and the mitogen activated protein (MAP) kinase cascade as especially attractive targets. Although significant issues remain with regard to the discovery of truly selective kinase inhibitors, the risks that accompany inhibition of fundamental signal transduction mechanisms can potentially be decreased by careful dissection of the pathways and rational target selection.
15082477 Tumour necrosis factor alpha independent disease mechanisms in rheumatoid arthritis: a his 2004 May BACKGROUND: It has been suggested that the immunopathology of rheumatoid nodules parallels that of inflamed synovium in rheumatoid arthritis (RA). OBJECTIVE: To analyse the effect of infliximab on the immunopathology of rheumatoid nodules in order to provide new insights into the relationship between synovial inflammation and rheumatoid nodules. MATERIALS AND METHODS: Nodules were present at baseline in six patients with RA and after infliximab treatment in five patients, including paired nodules before and after treatment in three patients. In one patient, the nodule appeared during treatment. Paraffin sections were used for histological analysis. Frozen sections were stained by immunohistochemistry for cellular markers (CD3, CD4, CD8, CD16, CD20, CD68), blood vessels (CD146, vWF, alphavbeta3), and adhesion molecules (E-selectin, VCAM-1, ICAM-1). RESULTS: No manifest immunopathological differences were found between the nodules before and after infliximab treatment. All nodules depicted the classical structure with a central necrotic zone, surrounding the palisade layer, and an outer connective tissue zone. Immunohistochemistry showed the presence of CD68+ and CD16+ macrophages in the palisade and the connective tissue zone, as well as a small number of CD3+, CD4+ T lymphocytes in the perivascular areas. Small vessels were seen in the connective tissue and were sometimes positive for the neovascularisation marker alphavbeta3. They expressed no VCAM-1, E-selectin weakly, but ICAM-1 strongly. ICAM-1 was also strongly expressed on palisade cells. CONCLUSIONS: Despite an improvement of articular symptoms, infliximab treatment had no distinct effect on the histopathology of rheumatoid nodules, suggesting that different pathogenetic mechanisms mediate the two disease manifestations in RA.
12123517 Synovial ablation in a rabbit rheumatoid arthritis model using photodynamic therapy. 2002 Jul BACKGROUND: At present there is no ideal minimally invasive method for ablating inflamed synovium in joints that has been unresponsive to optimal medical management in patients with rheumatoid arthritis. The aim of this study was to determine whether photo-dynamic therapy could be used for this purpose. METHODS: In a rabbit knee model of rheumatoid arthritis the pharmacokinetics of the photosensitizer Haematoporphyrin Derivative (HpD) into periarticular tissues and blood was measured following intravenous injection of HpD. The second phase of the study was to determine the histological effect of HpD activation by 63 nm light delivered via an intra-articular optic fibre using a dye pumped KTP-YAG laser. The light dose was varied from 0-200 joule/cm2. RESULTS: Pharmacokinetic studies determined that inflamed synovium rapidly accumulated HpD, with peak levels being reached 12 h following intravenous injection. The ratio of HpD uptake into inflamed synovium versus peri-articular quadriceps muscle was found to be 22.8. Histological examination of the treated knees indicated that selective destruction of inflamed synovium was achieved at light doses 100 joules/cm2 and above. No significant effect was observed on normal intra-articular tissues. CONCLUSION: We have demonstrated that the first generation photosensitizer HpD selectively accumulates within inflamed -synovium. Activation of HpD by intra-articular light administration resulted in selective ablation of the inflamed synovium. These findings indicate that PDT offers potential as a new selective, minimally invasive synovectomy technique.
12000666 Assessment of pain, depression, and anxiety by visual analogue scale in Japanese women wit 2002 Jun Assessment of pain, depression, and anxiety by visual analogue scale in Japanese women with rheumatoid arthritis Visual analogue scales (VAS) of depression and anxiety were compared with standard full-length measures of these variables and with VAS of pain (VAS Pain). This was a good way to develop a practical methodology for the routine assessment of pain and affect in rheumatoid arthritis (RA) patients. The reliability of VAS Pain was studied by test-retest. The validity of VAS Pain in our sample was proved by correlations with the results of other tests. We also investigated the relationship between VAS Pain and C-reactive protein (CRP). In 145 female RA patients, VAS of depression and anxiety were significantly correlated with full-length measures of these variables, and accounted for the majority of the explained variance in VAS Pain, while the full-length standard measures contributed little more. In conclusion, VAS measurements of pain and affect were comprehensible, easily filled-out, and reliable in a sample of Japanese women with RA, and could capture some aspect of affective distress unique to RA patients.
12794373 [Rheumatoid arthritis: the usefulness of power Doppler sonography]. 2003 The purpose of this study was to investigate the intra-articular vascularization of the synovial pannus of patients with rheumatoid arthritis with power Doppler sonography and to correlate these findings with clinical findings and laboratory measures of disease activity. Seventy-four different joints of 23 patients with diagnosis of rheumatoid arthritis were studied. Clinical and functional assessment (number of swollen joints, visual analogue scale) and laboratory evaluation were made for all patients. Disease activity was evaluated using the disease activity score (DAS28) for each patient. The power Doppler sonography vascularity of the synovial membrane was classified semiquantatively. The strong correlation was found between qualitative power Doppler sonography results with joints with clinically active arthritis (Spearman's correlation coefficient was 0.67, p=0.0001). The power Doppler sonography was weakly correlated with disease activity score. No correlation was found with age, disease duration, and other laboratory and clinical variables. Power Doppler sonography may be a valuable tool to detect synovial vascularity and to assist clinicians in distinguishing between inflammatory and non-inflammatory pannus.
12890861 Modelling the cost-effectiveness of etanercept in adults with rheumatoid arthritis in the 2004 Jan OBJECTIVES: This model examines the cost-effectiveness of etanercept monotherapy under British Society for Rheumatology guidelines, i.e. adults previously failing two disease-modifying anti-rheumatic drugs (DMARDs). It compares a DMARD sequence with etanercept third line against the same sequence excluding etanercept. METHOD: The 6-monthly trend in Health Assessment Questionnaire (HAQ) disability score is simulated for 10 000 patients' lifetimes using clinical trial data and published literature. Switching to the next treatment is triggered by lack of response, loss of efficacy or adverse events. Patient mortality depends on rheumatoid arthritis life-tables and on epidemiological evidence relating reduced risk to HAQ improvement. Regression of HAQ/EuroQol (EQ-5D) utility provides quality-adjusted life years (QALY) gained. Primary analysis includes drug costs, monitoring and hospitalizations. RESULTS: The central estimate cost per QALY is pound 16 330. Sensitivity analyses ( pound 7800 to pound 42 000) showed long-term HAQ progression (etanercept, DMARDs, non-responders) as most sensitive variables. The inclusion of potential avoided nursing home admissions and indirect costs/lost employment further improves the cost-effectiveness. CONCLUSIONS: For adults in the UK, the results suggest that etanercept is cost-effective when compared with non-biologic agents. The National Institute for Clinical Excellence has accepted that etanercept is cost-effective and recommended its availability for use in patients who have failed at least two DMARDs. This model was an important component of that decision. The model is further suitable for use for a wide range of other cost-effectiveness questions in rheumatoid arthritis.
12747269 Seasonal distribution of relapse onset in rheumatoid arthritis and spondyloarthropathy: th 2003 Mar BACKGROUND AND OBJECTIVE: The seasonal effect on the relapse of rheumatoid arthritis and spondyloarthropathies is still unclear. To assess the seasonal distribution of relapse onset in rheumatoid arthritis (RA) and spondyloarthropathy (SpA) and its association with solar factors. METHODS: The monthly distribution of relapse onsets during the years 1998-2000 was retrospectively chart reviewed in 364 patients. In 1998 a total of 131 patients were studied; 60 with seropositive (sp) RA, 30 with seronegative (sn) RA and 41 with SpA; 113 patients in 1999: 44 with spRA, 38 with snRA and 31 with SpA; 120 patients in 2000: 56 with spRA, 38 with snRA and 26 with SpA. All of them were treated in the Department of Rheumatology, which serves the population of northwestern Israel. Solar activity was analyzed according to the "Solar Terrestrial Activity Report Charts 1998-2000". The Central Israel Bureau of Statistics provided the sun global radiation data. Data was assessed during the summer (April-September) and winter (January-March, October-December). The correlation between the monthly distribution of disease relapses and solar factors was measured (SPSS-10 for WIN). RESULTS: Relapses in spRA patients occurred mostly during the summer months with peak activity during the month of July 2000. Single monthly peaks of spRA relapse onset were noted in January 1998-1999 and April 1998 and for snRA in January 1998 and June 2000, but there were no seasonal differences for spRA, snRA and SpA in 1998-1999 and for snRA and SpA in 2000. Relapses in spRA patients were associated with a summer bias of increased solar activity and global solar radiation in 2000 compared with lower peak solar activity in 1998-1999. Furthermore, in 2000 we found a significant correlation of the spRA monthly relapse count to solar activity (p = 0.005) and global sun radiation (p = 0.048) unlike snRA and SpA. No above-mentioned association and correlation was noted in 1998-1999. We revealed mild negative correlation (p = 0.046) of SpA relapse count only to peak solar flux (PSF) by analysis of data for 1998-2000 as one united group. CONCLUSIONS: Relapses were more frequent during the summer of 2000 (May-June-July) in spRA but not in snRA and SpA. The reasons are still unclear. No seasonal differences were observed in 1998-1999. Enhanced solar activity in summer-2000 compared with 1998-1999 may be inferred to be the proposed cause but coincidence may occur as well. Outbreak in RA and SpA was not registered despite increased peak solar activity in 2000. We observed mild evidence of reciprocal relation between SpA relapsing and solar activity during 1998-2000. Solar and any other possible contributory factors remain still to be elucidated.
15338256 [Adaptive patterns of the rheumatoid wrist after radiolunate arthrodesis]. 2004 Aug OBJECTIVE: The aim of this study was the analysis of long-term carpal changes after radiolunate arthrodesis. METHODS: Pre- and postoperative X-rays of 91 wrists in 78 patients with rheumatoid arthritis, who were treated for carpal instability with a radiolunate arthrodesis, were examined concerning the midcarpal joint and the Larsen grade. The mean follow-up was 60 months. RESULTS: After radiolunate arthrodesis the midcarpal joint space remained unchanged in 28%. In 35% secondary arthritis and in 37% further arthritic destruction occurred. The mean Larsen grade increased from 3.2 to 3.8. Six wrists needed complete arthrodesis 25 to 87 months after the primary procedure and one was treated by total wrist replacement. Adaptive changes of the carpus during progressive disease and in secondary arthritis were recognized. Three types of joint lines could be identified: in 35% of the wrists a "perilunar", in 22% a "radio-midcarpal" and in 3% a purely "midcarpal" joint line. In 40% no specific joint line could be identified. CONCLUSION: After radiolunate arthrodesis the carpus remains unchanged in the long run in nearly a third of cases. But even if secondary arthritis or further arthritic destruction occurs as in the remaining cases, the carpus shows an amazing capacity for adaptation. A new intracarpal joint line may develop or the midcarpal joint re-establishes itself.
15121035 Different approaches to understanding autoimmune rheumatic diseases: the neuroimmunoendocr 2004 Apr Rheumatic autoimmune diseases are characterized by dysregulation of the immune response that leads to inflammation, pain, disease and stiffness and have been shown to have differences in disease pattern, depending on the gender and age of an individual. The majority of these conditions predominantly affect females of all species and also show increased severity of disease in female animal models. In addition to the gender differences in disease development, persons are often more susceptible at specific stages of life. This review will discuss some of the data indicating age and gender differences in development of these diseases and will review hormonal and other factors that may contribute to disease expression and severity.
11934960 Unwillingness of rheumatoid arthritis patients to risk adverse effects. 2002 Mar OBJECTIVE: To evaluate patient willingness to accept the risk of adverse effects (AEs) commonly associated with arthritis medications. METHODS: Rheumatoid arthritis patients were asked to rate their willingness to take a medication associated with 17 specific AEs using a visual analogue scale. RESULTS: We interviewed 100 patients. Eighty-one were currently using one or more disease-modifying anti-rheumatic drugs (DMARDs) and 29 had previously experienced AEs related to DMARDs. Seventy-five stated that they were doing very well or well with respect to their arthritis compared with other people their age. Thirty-five per cent of those interviewed were unwilling to accept the risk of cosmetic changes, 38% were unwilling to accept the risk of temporary discomfort and 45% were unwilling to accept the risk of major toxicity. Patients who had previously experienced AEs were more willing to accept the risk of cosmetic changes (83 vs. 58%, P=0.02), temporary discomfort (79 vs. 55%, P=0.02) and major toxicity (83 vs. 44%, P=0.001) compared with those who had not previously experienced AEs. CONCLUSIONS: Many rheumatoid arthritis patients are very concerned about potential drug toxicity. However, risk adversity appeared to be attenuated by past experience with AEs. Our results suggest that certain patients, especially those with milder disease activity, might be reluctant to accept commonly used arthritis medications if they are fully informed of their potential toxicity.
12561579 [Determination of serum type III procollagen in patients with rheumatoid arthritis and int 2002 Feb Type III serum procollagen (Pc III) was measured by radio-immunossay in 30 rheumatoid arthritis(RA) patients with or without intestitial lung disease(ILD) and in 15 normal control subjects. The results showed that Pc III of RA patients were significantly higher than that of normal controls. Pc III levels is higher in RA patients with ILD than that in RA patients without ILD. The results suggested that RA patients with higher serum Pc III is more vulnerable to ILD, and the determination of Pc III might be valuable to show the complicated ILD.
12118176 Pathogenesis of bone erosions in rheumatoid arthritis. 2002 Jul Focal marginal joint erosions represent the radiographic hallmark of rheumatoid arthritis (RA). These bone changes are characteristically localized to the joint margins, but in addition, regions of focal bone resorption can be detected in the subchondral bone adjacent to the bone marrow space into which the synovial inflammatory tissues have extended. Because progressive destruction of the periarticular bone contributes significantly to joint dysfunction and disability in patients with RA, there is considerable interest in developing a better understanding of the pathologic mechanisms involved in this process and in developing therapies that can arrest these events. Previous analysis of joint tissues from patients with RA have provided morphologic evidence that osteoclasts are the cell types that mediate the focal bone resorption associated with the rheumatoid synovial lesion. Additional recent data from animal models have helped to further implicate these cells in the pathogenesis of focal bone erosions. Furthermore, analysis of RA synovium and joint tissues from animal models of inflammatory arthritis, as well as cell and tissues culture studies, have helped to define the cytokines and inflammatory mediators that are involved in the recruitment and activation of bone resorbing cells associated with focal bone erosions. These findings provide a rational framework for developing targeted therapies that can specifically inhibit or slow the progressive focal bone destruction associated with the rheumatoid synovial lesion.
12955196 [Synovectomy of the rheumatoid elbow]. 2003 Aug We present a comparative study of 120 elbow synovectomies with and without radial head resection performed between 1985 and 1993. Minimal radiological destruction according to Larsen stage 1-2 was present in 38 joints; 28 patients were followed postoperatively for an average period of 8.2 years. Synovectomy was combined with radial head resection in 70 patients (82 joints) where rheumatoid arthritis had radiologically proceeded to Larsen stage 3-4. Fifty patients were available for clinical and radiological follow-up. The follow-up period ranged from 6 to 15 years (average: 9.3 years). All patients in both groups were suffering from rheumatoid arthritis, and the proportion of females dominated. The mean age at the time of operation was 50 and 56 years, respectively. The results according to Inglis and Pellicci (16) were graded as good and excellent in 63.3% (19 joints) after elbow synovectomy. An average postoperative score result of 80.7 points (range: 43-96 points) was obtained. Synovectomy and radial head resection achieved comparable score results (75.7 points), representing 59.4% (35 joints) good and excellent ratings. Complete pain relief was obtained in 51.5%, and 27.1% complained of slight pain after elbow synovectomy. Of the patients who underwent radial head excision, 45.8% were pain free and 27.1% experienced slight pain. The range of motion of combined extension and flexion averaged 113 degrees and 110 degrees, respectively. A comparable improvement concerning pro/supination was maintained at final follow-up with an average gain of 20.4 degrees after synovectomy and 25.3 degrees for the latter group. We routinely noticed a moderate radiographic progression in both groups according to the criteria of the Larsen classification. The radiographic deterioration did not correlate with the clinical outcome. Synovectomy of the rheumatoid elbow is a valuable procedure in early as well as late stages of the disease. Our long-term results after synovectomy of the elbow prove significant pain relief and restoration of elbow function. The radiographic assessment revealed a moderate radiological deterioration. From the clinical viewpoint, the elbow function is maintained for a long time and valuable time is gained before reconstructive surgery may become necessary.
12418448 Infections in the immunocompromised rheumatologic patient. 2002 Oct Immunocompromised patients with rheumatic diseases have an increased risk of infections. A major risk factor for infection seems to be the immunosuppressive therapy used. Newer therapies for RA may lead to increased rates of infection by opportunistic pathogens such as Mycobacteria tuberculosis. Because disease manifestation may mimic signs and symptoms of infection, prompt diagnosis may be difficult. Familiarity with the likely infections and their causes should aid in obtaining the appropriate culture specimens.
15465070 Perceived importance of activities of daily living and arthritis helplessness in rheumatoi 2004 Aug OBJECTIVE: To examine the contribution of perceived importance of activities of daily living (ADL) to arthritis-specific helplessness in a sample of rheumatoid arthritis (RA) patients over a 1-year period. METHOD: Forty-two individuals from an outpatient rheumatology clinic completed measures of ADL importance, helplessness, depression, pain, and disability; the physician's assistant provided objective ratings of disability. RESULTS: Time 1 importance of ADL predicted a significant amount of variance in Time 2 arthritis helplessness after statistically controlling disease and psychological covariates. Moreover, increased perceived ADL importance predicted decreased arthritis helplessness over the 1-year period. CONCLUSIONS: Results indicate that RA patients' experience of arthritis-specific helplessness may be minimized over time when performing ADL is perceived as important. Furthermore, these findings provide preliminary evidence for one possible antecedent to increased perceptions of arthritis helplessness in individuals with RA.