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ID PMID Title PublicationDate abstract
15238643 Remission in rheumatoid arthritis: agreement of the disease activity score (DAS28) with th 2004 Oct OBJECTIVE: To determine which cut-off point in the RA disease activity score (DAS28) corresponds to fulfilment of the ARA criteria for clinical remission. METHODS: The disease activity of patients included in the Nijmegen RA inception cohort was systematically assessed every 3 months. For all visits, a modification of the ARA preliminary criteria for clinical remission was applied and the DAS28 was calculated. Receiver operating characteristic analysis was used to determine the cut-off point with maximum sensitivity and specificity in DAS28 corresponding with fulfilment of the modified ARA criteria. RESULTS: Three hundred and seventy-eight patients contributed 4378 visits. In 6.5% of the visits four of the five items and in 1.5% all five items of the modified ARA criteria were fulfilled. The optimal cut-off point for the DAS28 that corresponds to fulfilment of the modified ARA criteria was determined to be 2.66. CONCLUSION: DAS28 <2.6 corresponds to fulfilment of the preliminary ARA criteria for clinical remission in RA.
12498493 Craniocervical fusion for rheumatoid arthritis: comparison of sublaminar wires and the lat 2002 Oct The majority of rheumatoid arthritis patients with C1/2 instability causing neck pain and neurological compromise can be treated with unisegmental fusion. However, a minority will require decompression and more extensive craniocervical fusion. Two cohorts of patients with rheumatoid arthritis requiring decompression and craniocervical fusion were included in a retrospective study comparing sublaminar wiring (Ransford Loop, n = 10, follow-up = 36 +/- 9.5 months) and lateral mass screws (Cervifix system, n = 11; follow-up = 39.7 +/- 7.9 months). Both cohorts of patients experienced significant improvements in high cervical pain scores [McGill 5-point score; preop = 4.5 +/- 0.75 for Cervifix and 4.5 +/- 0.75 for Ransford loop; postop = 1.17 +/- 0.9 (p = 0.003) for Cervifix (at 39.7 months +/-7.9) and 2.8 +/- 1.6 (p = 0.011) for Ransford loop (at 36 +/- 9.5 months)]. Lateral mass screws for craniocervical fusion (seven out of 11 pain free) appear to produce better early results for rheumatoid arthritis patients suffering high cervical neck pain than sublaminar wire techniques (three out of 10 pain free).
12180721 Effectiveness profiles and dose dependent retention of traditional disease modifying antir 2002 Aug OBJECTIVE: To determine the fate of traditional disease modifying antirheumatic drugs (DMARD) in the longer term, with special respect to dose related effects on drug retention rates, efficacy, and toxicity. METHODS: Historical analysis of DMARD therapies in 593 patients, comprising a total of 1319 courses of DMARD over a period of 2378 patient-years of therapy. DMARD dosages, treatment durations, and reasons for discontinuation, and measures of C-reactive protein and erythrocyte sedimentation rate were analyzed. Drug retention rates were estimated by Kaplan-Meier analysis. RESULTS: Methotrexate (MTX), chloroquine, and sulfasalazine (SSZ) emerged as the drugs most commonly applied during the past 15 years, whereas gold salts and D-penicillamine became less frequently used during the past decade. Therapies had to be terminated mostly for adverse events (42%) or inefficacy (37%). Patients taking high dose therapy had significantly longer median retention rates than those taking low doses (SSZ 34 vs 7 mo; MTX 73 vs 39 mo). Toxicity, ratherthan inefficacy, was the main reason for discontinuation of MTX and SSZ at low doses (p < 0.001). Median retention rates lasted < 24 mo for most DMARD, except for high dose MTX (> 36 mo). CONCLUSION: MTX, SSZ, and antimalarials have become the most commonly used traditional DMARD for rheumatoid arthritis. Their use is more often limited by toxicity than by inefficacy. If tolerated, they can be retained for long periods of time.
12110141 High-efficiency gene transfer into nontransformed cells: utility for studying gene regulat 2002 The elucidation of the signalling pathways involved in inflammatory diseases, such as rheumatoid arthritis, could provide long sought after targets for therapeutic intervention. Gene regulation is complex and varies depending on the cell type, as well as the signal eliciting gene activation. However, cells from certain lineages, such as macrophages, are specialised to degrade exogenous material and consequently do not easily transfect. Methods for high-efficiency gene transfer into primary cells of various lineages and disease states are desirable, as they remove the uncertainties associated with using transformed cell lines. Significant research has been undertaken into the development of nonviral and viral vectors for basic research, and as vehicles for gene therapy. We briefly review the current methods of gene delivery and the difficulties associated with each system. Adenoviruses have been used extensively to examine the role of various cytokines and signal transduction molecules in the pathogenesis of rheumatoid arthritis. This review will focus on the involvement of different signalling molecules in the production of tumour necrosis factor alpha by macrophages and in rheumatoid synovium. While the NF-kappaB pathway has proven to be a major mediator of tumour necrosis factor alpha production, it is not exclusive and work evaluating the involvement of other pathways is ongoing.
12727018 Management of a patient with active rheumatoid arthritis and suspected tuberculosis causin 2003 May In the following case report we present a patient who has been admitted for pericardial effusion causing cardiac compression with active rheumatoid arthritis and suspected tuberculosis. The patient was successfully treated with intravenous pulse steroid for active rheumatoid arthritis, with prophylactic anti-tuberculosis agents for suspected tuberculosis and with surgical pericardiectomy for the thickened pericardium as well as recurrent pericardial effusion.
11928787 Synovial cyst of the hip joint: an unusual cause of a pulsating groin mass. 2002 Jan Synovial cysts of the hip joint occur most frequently in patients with rheumatoid arthritis (1). Despite the increasing frequency of arthroplasty of rheumatoid hips, case reports documenting synovial cysts remain extremely rare. This case report emphasizes the need for the surgeon to include a synovial cyst in the differential diagnosis of a painless groin mass, particularly in patients with rheumatoid arthritis.
12233878 The impact of functional status and change in functional status on mortality over 18 years 2002 Sep OBJECTIVE: To calculate mortality rate associated with rheumatoid arthritis (RA), to estimate the effect of initial functional status and of change in functional status on mortality among persons with RA, and to compare the mortality experience of such persons to that of the US population. METHODS: The study used a prospective panel of 1269 persons followed for a mean of 8.4 years (median 7 yrs, interquartile range 3-12, maximum 18). Mortality status was ascertained from contacts with next of kin, study physicians, and search of the National Death Index. The Kaplan-Meier method was used to calculate the proportion dying in each time interval, with and without stratification for initial functional status [Health Assessment Questionnaire (HAQ) score] or average change in functional status. Cox proportional hazards regression was used to establish the effect of functional status, demographic characteristics, and health status on mortality risk. RESULTS: There were 270 deaths among the 1269 persons with RA. After 18 years of followup the overall death rate was 39%. The death rates in the best through worst initial quartiles of HAQ score were 29, 33, 44, and 54%. The death rate was 51% among persons with declining HAQ score versus 31 and 32% among those with no change or improvement in this measure, respectively. Demographic and health status did not reduce the effect of HAQ or average change in HAQ on mortality risk. Compared to the US population, the persons with RA had a standardized mortality rate of 1.32. CONCLUSION: The persons with RA in this study had elevated mortality rates. Poor initial functional status and declining functional status significantly increased mortality risk among these persons with RA.
12739427 [Osteoarticular scintigraphy in comparison with clinical evidence]. 2003 Jan Bone scintigraphy is a technique which is often resorted to in diagnostic rheumatology. There are few data on the effective relevance of bone scintigraphy in the evaluation of chronic inflammatory diseases of the joints. The aim of this study was to compare the results of bone scintigraphy with clinical evidence in patients with rheumatoid arthritis or osteoarthritis. Seventy-five patients were submitted to total body bone scintigraphy (44 rheumatoid arthritis, 31 osteoarthritis). The nuclear medicine specialist indicated the list of joints showing uptake. For the same patients a rheumatologist indicated the number of affected joints. The laboratory and clinical data were recorded. The patients were first stratified according to the prevalence of the clinical evidence and scintigraphic uptake. The distribution was found to be not significant. Only 5.3% of patients showed no uptake. Thirty-three patients had no clinical evidence of disease; among these, 30 showed joint uptake. Considering only the patients with clinical evidence, 97.6% showed joint uptake. These results were confirmed even when the data were analyzed by sex, disease and therapy. Considering the patients with clinical evidence, the uptake/clinical ratio did not show any significant correlation. The number of joints with clinical evidence correlated with the erythrocyte sedimentation rate. The number of joints showing uptake correlated only with age. In conclusion, on average, scintigraphy, performed in patients with rheumatoid arthritis and osteoarthritis, highlights a significantly higher number of joints involved as compared to what would be expected on the basis of clinical evaluation. It remains to be defined whether this is an overestimation related to the characteristics of the scan or whether it is sign of a higher sensitivity in highlighting the site of inflammation. Against the latter hypothesis is the absence of correlation with the inflammatory indexes.
12665422 The therapeutic potential of costimulatory blockade with CTLA4Ig in rheumatoid arthritis. 2003 Apr Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder characterised by joint inflammation and destruction. Controversy exists regarding the significance and exact role of activated T cells in RA. CTLA4Ig is a soluble fusion protein (cytotoxic T lymphocyte-associated antigen 4 fused to the heavy chain constant region of human IgG1), which represents the first in a new class of agents called costimulation blockers. By blocking the second signal required for optimal T-cell activation, CTLA4Ig has demonstrated efficacy in a variety of spontaneous and induced animal models of autoimmunity. A Phase II clinical study in RA showed CTLA4Ig was efficacious with an acceptable safety profile. These results suggest that activated T cells may be important in RA pathogenesis and that costimulation blockade may be a novel therapeutic approach for this disorder.
12621836 [Computer-assisted radiologic quantification of hand and foot changes in rheumatoid arthri 2002 Driven by the increasing implementation of electronical picture archiving and communications system (PACS) into every days practice a fully operative Java application software was developed to support the efficacy of the scoring process in rheumatoid arthritis. This software, namely the "Rheuma-Coach" offers the possibility to use the Larsen- or the Ratingen-Score. We measured time savings of approximately 20% per case if this computer assistance was used. The lack of a standard for the positioning of limbs was confirmed.
12598805 Psychoeducational interventions in rheumatic diseases: a review of papers published from S 2003 Mar A large number of psychoeducational intervention studies have been developed for use with patients with rheumatic disease. The interventions vary considerably in the components they include and in the extent of the benefits they find. Recent meta-analyses of studies in rheumatoid arthritis (RA) report moderate short-term benefits, but it remains necessary to further examine which components are most important in bringing about change. A significant recent development in psychoeducational interventions is the move toward a generic intervention-the Chronic Disease Self-Management Program (CDSMP). A randomized controlled trial of this program has been performed, but statistical analysis for arthritis have not been reported separately.
15045628 Antibacterial and antipeptide antibodies in Japanese and Finnish patients with rheumatoid 2004 Apr It has been suggested that Proteus infection may be involved in the pathogenesis of rheumatoid arthritis (RA). Bacterial and peptide immune responses in patients with RA and other control subjects were investigated in two geographically different populations. Serum samples from Finnish patients with early ( n=72) and advanced ( n=27) RA and 30 Finnish healthy controls, as well as from Japanese RA patients from two different locations: Tokyo ( n=30) and Otsu ( n=30), 18 patients with systemic lupus erythematosus (SLE) and 23 Japanese healthy controls were all screened for the total, and class-specific (IgG, IgA and IgM) antibodies against Proteus mirabilis, Escherichia coli and Serratia marcescens by indirect immunofluorescence assay. These samples were also tested for the determination of levels of isotypic antibodies against the shared epitope involving 16-mer synthetic peptides containing the EQRRAA or ESSRAL sequences and compared to scrambled control peptide by using an enzyme-labeled immunosorbent assay method. Significantly elevated levels of IgG and IgM antibodies to P. mirabilis and antibodies against both EQRRAA and ESSRAL peptides were detected in sera of Finnish patients with early and advanced RA, and in Japanese patients from Otsu or Tokyo compared to their corresponding control groups. In contrast, no difference either in the total or in any of the isotypic antibodies were observed between these groups when serum samples were screened against each of E. coli and S. marcescens or against the control peptide. Furthermore, there was a significant correlation between the antibody levels against Proteus bacteria only and both EQRRAA and ESRRAL peptides. Our findings support the possibility for specific involvement of P. mirabilis in the etiopathogenesis of RA even in early cases.
12166002 Major spine surgery. 2002 Jun Current operative approaches to the spine range from "band aid" lumbar discectomy and foraminotomy to extensive anterior/posterior resections for spinal tumors. In this chapter, perioperative and intraoperative pathophysiologic conditions and procedures relevant to the anesthesiologist are discussed including rheumatoid arthritis, management of metastatic spinal tumors, posterior lumbar inter body fusion procedures and laparoscopic approaches to the spine. Considerations and new findings related to perioperative visual loss following spine surgery are also highlighted.
12632413 An index of the three core data set patient questionnaire measures distinguishes efficacy 2003 Mar OBJECTIVE: To evaluate the capacity of a pooled index of only the 3 patient self-report questionnaire measures among the 7 American College of Rheumatology (ACR) core data set (Core Data Set) measures to distinguish efficacy of active treatment of rheumatoid arthritis (RA) with leflunomide or methotrexate versus placebo in a randomized, controlled clinical trial, and to compare the results with those obtained using the ACR 20% response criteria (ACR20), Disease Activity Score (DAS), and other pooled indices. METHODS: The 7 ACR Core Data Set measures of 1) joint swelling, 2) joint tenderness, 3) physician global assessment, 4) erythrocyte sedimentation rate (ESR), 5) functional disability, 6) pain, and 7) patient global assessment were combined into the following 5 pooled indices: "All Core Data Set" (all 7 measures), "Assessor Only" (measures 1-3), "Assessor + ESR" (measures 1-4), "Patient Only" (measures 5-7), and "Patient + ESR" (measures 4-7). The capacity of each of these 5 indices to detect differences between active treatment and placebo treatment was compared with that of the ACR20 and the DAS using 4 different analytic methods, each of which presented advantages and limitations. Agreement of the indices with one another and with the ACR20 and the DAS was analyzed according to pairwise kappa statistics and Z scores in multivariate logistic regression models. RESULTS: Each of the 5 indices, including "Patient Only," had a similar capacity to detect greater efficacy of leflunomide and methotrexate versus placebo in this clinical trial, according to each of 4 methods, at similar levels of statistical and clinical significance. CONCLUSION: A pooled index of patient self-report questionnaire Core Data Set measures appears to be as informative as ACR20 responses, DAS scores, and pooled indices of all and assessor-derived Core Data Set measures for distinguishing between active treatment and placebo treatment in this RA clinical trial.
15188328 Factors associated with attrition of African Americans during the recruitment phase of a c 2004 Jun 15 OBJECTIVE: To examine factors contributing to the loss of potential minority participants in a study of medication adherence among rheumatoid arthritis patients. METHODS: Chi-square statistics were used to test for differences in refusal/ineligibility by race and site at 4 screening points (initial eligibility review, initial patient contact, adherence screening, and informed consent). Differences in criteria-specific risks for exclusion at initial eligibility review were examined across 4 sites by race. Odds ratios (95% confidence intervals) were estimated if differences were significant. Multivariate logistic regression was used to examine sociodemographic factors associated with the probability for ineligibility at the initial eligibility review. Stated reasons for refusal were qualitatively quantified. RESULTS: A greater percentage of African Americans were lost at every screening point when compared with whites, but only the difference at the initial eligibility review was statistically significant. CONCLUSION: Factors associated with attrition included selection of area medical sites, research design issues, comorbid conditions, alcohol abuse, and being younger, unmarried, African American, and male.
12672219 Patient perspective in outcome assessments--perceptions or something more? 2003 Apr Health status measures constitute an essential part of outcome assessments in patients with rheumatic diseases. Currently used health status measures typically assess patient perceptions within various dimensions of health. The issue of widening patient perspective in outcome assessments was raised at OMERACT 2000 and further activities were initiated at the subsequent American College of Rheumatology meetings. Measuring patient perceptions of health is considered the standard approach in clinical practice, controlled clinical trials, and longitudinal observation studies, as well as in other types of epidemiological research. However, the traditionally used instruments also have limitations based on the relevance of the questionnaire items, sensitivity to change in longitudinal observational studies, and intraindividual variations over time. Patient priorities or preferences for improvement in health may be an alternative for the assessment of important patient outcomes. Data support that patient priorities for improvement in health are associated with their perception, but that overlap is incomplete and that complimentary information may be achieved. Expectations about future health and satisfaction with health may also represent alternative approaches. Thus, an open research agenda is required for the future, including different approaches regarding both endpoints and methodological issues.
12833249 Use of the leeds assessment of neuropathic symptoms and signs questionnaire in patients wi 2003 Jun OBJECTIVE: Neuropathic pain syndrome is characterized by chronic, stimulus-independent pain sensation accompanied by hyperalgesia/allodynia and paresthesia. Fibromyalgia (FM) syndrome displays such features. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale is an instrument developed and validated to recognize neuropathic pain and set it apart from nociceptive pain. METHODS: This study assessed the responses of patients with FM versus patients with rheumatoid arthritis (RA) to the LANSS Pain Scale questionnaire. Twenty patients with FM and 20 patients with RA answered the Fibromyalgia Impact Questionnaire and LANSS Pain Scale questions related to the following neuropathic sensory disturbance domains: dysesthetic, autonomic, evoked, paroxysmal, and thermal. RESULTS: Pain severity was similar in both groups according to visual analog scale values (5.3 +/- 3.0 for FM v 5.4 +/- 3.1 for RA). There were sharp differences between FM and RA groups in the percentage of affirmative responses to 4 of 5 sensory disturbance questions: dysesthetic (95 v 30), evoked (95 v 35), paroxysmal (90 v 15), and thermal (90 v 20); P <.0001 for each comparison. CONCLUSIONS: The high prevalence of associated sensory disturbances supports the notion that FM is a neuropathic pain syndrome. CLINICAL RELEVANCE: The LANSS Pain Scale items may become a useful, easily applied bedside test to differentiate FM pain from the nociceptive pain present in RA and in similar arthritic illnesses.
12118166 Immune features of seronegative and seropositive arthritis in early synovitis studies. 2002 Jul Synovitis of recent onset is a challenging problem, both from a diagnostic and a mechanistic point of view. The role of the immune system in mediating the systemic and synovial inflammatory response remains an area of active investigation. Studies in early synovitis cohorts have confirmed the relatively specific association of rheumatoid factor positive polyarthritis with a number of autoantibodies, particularly anticyclical citrullinated peptide (CCP) antibodies, antifilaggarin antibodies (AFA), and anti-Sa antibodies. Immunopathologic studies of synovial tissue samples from patients with early synovitis have generally suggested quantitative rather than qualitative differences between various forms of synovitis. In particular, Th1 cytokines appear to predominate in rheumatoid arthritis and psoriatic synovitis, while Th2 cytokines are more often detectable in the synovium of reactive arthritis patients. This latter observation is consistent with an immune response profile that favors persistence of intracellular organisms.
11947922 Tumor necrosis factor microsatellite alleles in patients with rheumatoid arthritis in Taiw 2002 May 1 OBJECTIVE: To investigate the association of tumor necrosis factor (TNF) microsatellite alleles with the pathogenesis of rheumatoid arthritis (RA) in Taiwan. METHODS: The TNF a, b, c, d, and e microsatellites were determined in 112 patients with RA and 99 healthy controls by using polymerase chain reaction (PCR) and electrophoresis with sequencing gel. All of these patients and controls had known HLA-DR genotypes and TNF-308 polymorphisms. RESULTS: The phenotypic frequency of TNFa9 was significantly higher in DR4(-) RA patients than in DR4(-) controls. However, the phenotypic frequency of TNFb6 was significantly higher in RA patients than in controls in the presence of HLA-DR4. The phenotypic frequency of TNFa3-e1 was significantly lower in DR4(+) RA patients than in DR4(+) controls, while a negative linkage disequilibrium was noted between TNFa3-e1 and HLA-DR4. TNF microsatellite alleles were not related to the prevalences of bone erosion, rheumatoid nodule, sicca syndrome, pulmonary fibrosis, and seropositivity of rheumatoid factor (RF) in patients with RA. CONCLUSION: The associations of TNF microsatellites with the susceptibility to RA in Taiwan are not completely independent of the HLA-DR associations. The association of TNFb6 with the susceptibility to RA depends on the presence of HLA-DR4, and the correlation of TNFa9 to RA depends on the absence of HLA-DR4. The negative association of TNFa3-e1 with RA may be secondary to the negative linkage disequilibrium between TNFa3-e1 and HLA-DR4. Moreover, TNFb6 and HLA-DR4 have a synergistic effect on the susceptibility to RA. TNFa3-e1 and TNF-308A have a synergistic effect on preventing from RA. The TNF microsatellite alleles are not related to the clinical manifestations and severity of RA patients in Taiwan.
14505221 Sweet's syndrome with arthritis and vasculitis. 2003 Sep Acute febrile neutrophilic dermatosis or Sweet's syndrome is a rare disease. We describe a patient with oligoarthritis, increased liver enzymes and vasculitis. One year later the patient is free of symptoms. Diseases mimicking Sweet's syndrome have been excluded.