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ID PMID Title PublicationDate abstract
14507540 Illness perceptions and levels of disability in patients with chronic fatigue syndrome and 2003 Oct OBJECTIVE: To investigate the strength of chronic fatigue syndrome (CFS) patients' negative illness perceptions by comparing illness perceptions and self-reported disability in patients with CFS and rheumatoid arthritis (RA). METHODS: Seventy-four RA patients and 49 CFS patients completed the Illness Perception Questionnaire-Revised and the 36-item Short-Form Health Survey. RESULTS: When compared to the RA group, the CFS group attributed a wider range of everyday somatic symptoms to their illness, perceived the consequences of their illness to be more profound and were more likely to attribute their illness to a virus or immune system dysfunction. Both groups reported equivalent levels of physical disability but the CFS group reported significantly higher levels of role and social disability. CONCLUSION: Although the symptoms of CFS are largely medically unexplained, CFS patients have more negative views about their symptoms and the impact that these have had on their lives than do patients with a clearly defined and potentially disabling medical condition. The data support the cognitive behavioural models of CFS that emphasise the importance of patients' illness perceptions in perpetuating this disorder.
11866351 An alternative splinting and rehabilitation protocol for metacarpophalangeal joint arthrop 2002 Jan This prospective study was completed to establish results obtained using a static splinting regimen as an alternative to the dynamic extension splint. Fifteen patients with rheumatoid arthritis, who had undergone metacarpophalangeal (MCP) joint arthroplasties and a postoperative rehabilitation program of alternating MCP joint flexion and extension static splints, were assessed pre-operatively and reviewed postoperatively. Total active arc of MCP joint motion and ulnar deviation were measured, and an activities-of-daily-living questionnaire was completed by each patient at 19 months (mean) postoperatively. Mean total active arc of MCP joint motion showed statistical improvement from 21.6 degrees (range, 5 degrees-60 degrees) pre-operatively to 47.2 degrees (range, 15 degrees-84 degrees) postoperatively. The little finger gained the most improvement, with a 50.2 degree arc, showing that this regimen does not compromise flexion gains at this joint. Ulnar deviation improved from a mean of 30.4 degrees (range, 5 degrees-65 degrees) pre-operatively to 9.7 degrees (range, 0 degrees-30 degrees) postoperatively. These initial results reinforce the clinical impression that this alternating static splint regimen can be used as an effective alternative to the dynamic extension splint.
11805935 A comparison of postoperative C-reactive protein changes in primary and revision hip arthr 2002 Jan C-reactive protein (CRP) response was studied in 40 consecutive patients with rheumatoid arthritis undergoing primary (n = 20) or revision (n = 20) total hip arthroplasty (THA). In patients with primary THA, the median preoperative CRP concentration was 10 mg/L (interquartile range [IQR], 6-17 mg/L), and the median change in CRP was 69 mg/L (IQR, 43-69 mg/L) at the 1st or 2nd postoperative day (P< .001). In the patients with revision THA, the results were 8 mg/L (IQR, 0-32 mg/L) and 48 mg/L (IQR, 21-78 mg/L) (P< .001). Median change in CRP from preoperative to postoperative values did not differ significantly among the patients with primary and revision THA. No correlation was found between the preoperative and perioperative background variables and the change in CRP compared with patients with primary and revision THA. It seems that the revision operation has no significant additional influence on the postoperative CRP response. More detailed analyses are needed to evaluate the significance of endocrine, metabolic, and inflammatory responses in these patients.
12595625 Rheumatoid arthritis and macrovascular disease. 2003 Feb OBJECTIVE: To measure the extent of subclinical atherosclerosis in patients with rheumatoid arthritis (RA) compared with controls, and to evaluate any potential vascular risk factors. METHODS: Forty RA patients were compared with an age- and sex-matched control group. Non-invasive vascular tests, i.e. carotid duplex scanning [measuring common carotid artery intima-media thickness (IMT)], ankle-brachial blood pressure index (ABPI) and QT dispersion on ECG (QTD), were performed. Traditional risk factors such as high blood pressure, blood sugar, lipids and steroid usage were assessed. RESULTS: The average IMT (S.E.) in RA patients was 0.73 (0.03) mm, compared with 0.62 (0.03) mm in the control group (P=0.01, Mann-Whitney). Ten out of 40 RA patients (25%) had an ABPI < 1.0 compared with 1/40 (2.5%) in the control group (P=0.007, Fisher's). QTD was higher in RA patients; mean (S.E.) 55 (2.70) ms compared with 40 (2.50) ms in the control group (P < 0.001, t-test). There were no significant differences in the prevalence of high blood pressure, diabetes or lipid profiles. However, patients on steroids had a higher mean QTD (S.E.): 63.5 (4) compared with 48 (2.7) ms in those patients who had not received long-term steroids (P=0.003, t-test). CONCLUSION: RA patients have an increased risk of subclinical vascular disease as was shown by a higher prevalence of carotid disease, peripheral arterial disease and increased QTD. Among traditional risk factors we found a history of steroid usage to be one of the potential risk factors.
14639053 Population pharmacokinetics of hydroxychloroquine in patients with rheumatoid arthritis. 2003 Dec Hydroxychloroquine (HCQ) is an antimalarial drug that is also used as a second-line treatment of rheumatoid arthritis (RA). Clinically, the use of HCQ is characterized by a long delay in the onset of action, and withdrawal of treatment is often a result of inefficacy rather than from toxicity. The slow onset of action can be attributed to the pharmacokinetics (PK) of HCQ, and wide interpatient variability is evident. Tentative relationships between concentration and effect have been made, but to date, no population PK model has been developed for HCQ. This study aimed to develop a population PK model including an estimation of the oral bioavailability of HCQ. In addition, the effects of the coadministration of methotrexate on the PK of HCQ were examined. Hydroxychloroquine blood concentration data were combined from previous pharmacokinetic studies in patients with rheumatoid arthritis. A total of 123 patients were studied, giving the data cohort from four previously published studies. Two groups of patients were included: 74 received hydroxychloroquine (HCQ) alone, and 49 received HCQ and methotrexate (MTX). All data analyses were carried out using the NONMEM program. A one-compartment PK model was supported, rather than a three-compartment model as previously published, probably because of the clustering of concentrations taken at the end of a dosing interval. The population estimate of bioavailability of 0.75 (0.07), n = 9, was consistent with literature values. The parameter values from the final model were: Cl = 9.9 +/- 0.4 L/h, V = 605 +/- 91 L, ka = 0.77 +/- 0.22 hours(-1), t(tag) = 0.44 +/- 0.02 hours. Clearance was not affected by the presence of MTX, and, hence, steady-state drug concentrations and maintenance dosage requirements were similar. A population PK model was successfully developed for HCQ.
12195254 Results of elbow endoprostheses in patients with rheumatoid arthritis in correlation with 2002 Jul Fifty-nine patients with rheumatic destruction of the elbow received 20 St Georg, 20 GSB III, 13 Souter-Strathclyde, and 13 Kudo endoprostheses. Among the various prosthetic categories, 43.9% of the joints had had preceding rheumatoid surgery (a previous synovectomy had been performed in 10 joints at a mean of 4.1 +/- 3.7 years and a resection interposition arthroplasty had been performed in 19 cases 4.2 +/- 1.8 years before endoprosthetic replacement). We examined 51 patients with 54 prostheses after a mean follow-up of 5.7 +/- 4.1 years using the Inglis score and analyzing all radiographs. Complications occurred in 20% of the St Georg prostheses, 25% of the GSB III prostheses, and 23% of the Souter-Strathclyde prostheses. Of the St Georg prostheses, 6 (30%) had to be exchanged, as well as 4 (20%) of the GSB III prostheses and 4 (30.7%) of the Souter-Strathclyde prostheses. Of the primarily implanted joints, the St Georg prostheses measured 77.7 +/- 7.7 on the Inglis score, GSB III 89.6 +/- 7.2, Souter-Strathclyde 88.4 +/- 6.5, and Kudo 89.7 +/- 4.4. Radiolucent lines greater than 1 mm were observed in 26% of the St Georg prostheses, 23% of the GSB III prostheses, 27% of the Souter-Strathclyde prostheses, and 9% of the Kudo prostheses. In contrast to the clinical results, the intraoperative and postoperative complications, as well as the rate of failure and radiolucent lines, showed a statistically significant relationship to previous operations of the joints, especially with the resection interposition arthroplasty. We conclude that resection interposition arthroplasty seems to be associated with complications and failures when a subsequent endoprosthesis is used.
12548438 Adaptation and validation of the Turkish version of the Rheumatoid Arthritis Quality of Li 2003 Jan OBJECTIVE: The aim of this study was to adapt the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Turkey and to test its reliability and validity. METHODS: The translation process included the recent guidelines for cross-cultural adaptation. Reliability of the Turkish RAQoL was assessed by internal consistency and test-retest reliability, internal construct validity by Rasch analysis, and external construct validity by associations with impairments, disability, and general health status. Cross-cultural validity was tested through analysis of differential item functioning (DIF) by comparison with data from the UK version of the RAQoL. RESULTS: Reliability of the adapted version was good, with high internal consistency (Cronbach's alpha 0.95 and 0.96 at times 1 and 2, respectively) and test-retest reliability (Spearman's rho 0.874). Internal construct validity was confirmed by excellent fit to the Rasch model (mean item fit 0.236, SD 1.113) and external construct validity by expected associations. The DIF for culture was found in four items. CONCLUSIONS: Adaptation of the RAQoL for use in Turkey was successful. The instrument can be used in both national and international studies for cross-cultural comparison with the UK, as long as adjustments are made for the few items displaying DIF for culture.
11950007 Comparison of the Rau method and the Larsen method in the evaluation of radiographic progr 2002 Apr OBJECTIVE: To investigate the usefulness of the radiographic scoring method proposed by Rau, et al for evaluation of joint damage in patients with early rheumatoid arthritis (RA). METHODS: Radiographs of hands and feet of 30 prospectively observed patients with early RA were assessed by the Rau method, the Larsen method, and count of erosive joints. The standardized response mean (SRM) was used to estimate the sensitivity to change of each method of assessment. RESULTS: Although the Rau method evaluates only the amount of bony erosion, nearly equivalent radiographic progression was observed with the Rau and the Larsen methods. Radiographic changes in the first year were sensitively identified by all 3 methods (SRM for Rau method 0.83, Larsen method 0.88, and count of erosive joints 0.84). However, in the period from 2 to 6 years after entry into the study, sensitivity to change was maintained with use of the Rau (SRM 1.38) and Larsen (SRM 0.95) methods, but not by count of erosive joints (SRM 0.49). While an apparent ceiling effect was observed after 2 years in count of erosive joints, no ceiling effects were noted for the Rau and Larsen methods. CONCLUSION: Our study showed that the usefulness of the Rau method is equivalent to the Larsen method in clinical assessment of radiographic progression in early RA.
12429540 Clinical decision rules in rheumatoid arthritis: do they identify patients at high risk fo 2002 Dec BACKGROUND: Preliminary clinical criteria based on age, inflammation, and immobility have been proposed to identify which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) to diagnose osteoporosis. The three item criteria have not been evaluated in male patients with RA or in the entire female RA population. OBJECTIVES: (1) To test the proposed criteria in a cohort of men and women thought to be representative of the entire underlying RA population. (2) To develop clinical decision rules, which could be applied to all patients with RA irrespective of corticosteroid use. METHODS: Clinical and demographic data were collected from a total of 287 representative patients with RA (235 (82%) women, 52 (18%) men, age range 25.3-73.1 years) from the Oslo RA register (completeness 85%). Bone mineral density (BMD) was measured in spine L2-4 (anterior-posterior view) and femoral neck by DXA. The criteria were applied and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: Mean age (SD) for the women and men with RA was 56.8 (11.0) years and 61.5 (10.2) years; disease duration was 15.5 (9.5) years and 14.7 (8.6) years. Of the women 163 (69%) were postmenopausal. One hundred and seventeen (50%) women and 28 (54%) men fulfilled the three item criteria. For the diagnosis of osteoporosis (T score
11840698 The shared epitope and severity of rheumatoid arthritis. 2002 Feb After two decades of research involving thousands of RA patients, it is still not possible to precisely define the relation of HLA-DRB1 SE alleles to RA severity. Improvements in our understanding require more careful consideration of several factors such as ethnicity, gender, and the specific SE allele and genotype inherited. Large studies of heterogeneous groups of patients are required and indicate the need for collaborative efforts among researchers. In the interim, meta-analysis of the existing literature may provide some insight, because it allows utilization of the tremendous amount of research already completed. A preliminary meta-analysis highlighted the significant heterogeneity among the existing literature, and a more ambitious meta-analysis that uses individual patient-level data is currently ongoing. Profound implications exist for determination of the precise relationship between the SE and RA severity. This information could be valuable in identifying patients at greater risk of severe complications or as a stratification variable for clinical trials. Moreover, patients genetically predisposed to severe disease may benefit from early initiation of more aggressive therapy. Ultimately, clarification of the role of the SE may be valuable for the development of specific therapies directed toward DRB1 and related targets.
12662400 Why do general practitioners request rheumatoid factor? A study of symptoms, requesting pa 2003 Mar BACKGROUND: To investigate the reasons why general practitioners (GPs) request rheumatoid factor (RF) assays, we studied 200 consecutive requests for RF from general practice in 1995. METHOD: By means of an audit questionnaire, we studied 100 negative, 50 positive and 50 borderline RF results and compared these with the presenting symptoms that prompted the request, the GPs' understanding of the significance of the result, the referral intention and behaviour of the GP, and finally, the patient outcome after 5 years. RESULTS: There was an 80% response rate. The presenting symptoms closely matched the American Rheumatism Association revised criteria for the classification of rheumatoid arthritis, indicating that the requests were made on valid clinical grounds, with polyarthralgia, morning stiffness and joint pain being the most common. Most GPs considered a negative or positive result to be meaningful, in that a positive RF meant that a referral was more likely than with a negative or borderline result, even in the presence of appropriate symptoms in all three groups. Seventeen to thirty per cent felt that the test excluded or confirmed RA. The result appeared to influence this decision to a greater extent than it should. A 5-year follow-up on these patients showed that 26/40 patients with positive RF were referred, and that 25 of them developed a rheumatic disease of some kind, with 17 patients eventually being diagnosed with RA. Only 17/80 patients with negative RF were referred, the remainder having no autoimmune problem evident after 5 years, 11 of them developing a rheumatic disease, and only three being diagnosed with RA. CONCLUSIONS: Although this is a locally based study, we believe the conclusions would be applicable to all laboratories and GPs undertaking these tests. RF requests are made on valid clinical grounds by GPs, but there may be an over-reliance on the results as regards referral behaviour. If patients were referred on clinical grounds, this would significantly lengthen consultants' waiting lists.
15526504 Chronic hepatitis C virus infection mimicking rheumatoid arthritis. 2003 We present the case of a young female patient diagnosed two years ago with rheumatoid arthritis (AR) for which she is taking methotrexate (MTX), who develops cutaneous lesions highly suggestive of porphyria cutanea tarda, diagnosis confirmed by biochemical means. It is noteworthy that she was regularly taking oral contraceptives until the moment of appearance of the skin lesions. The association of those two illnesses, particularly in the case of MTX treatment can raise some problems regarding the potential direct causality relationship. This is why we tried a new diagnostic hypothesis: is chronic hepatitis C virus infection, hypothesis that we verified by means of the presence of anti-VHC and of RNA-VHC. It is well known now the association between chronic viral C infection, rheumatoid syndrome and porphyria cutanea tarda (PCT). The latter are extrahepatic manifestations of that viral infection, thus representing a major indication for antiviral treatment. Our patient received that treatment and she had a very good outcome of the skin lesions. We suggest that the differential diagnosis of any arthritis should always comprise chronic hepatitis C viral infection.
14527529 Pain coping and social support as predictors of long-term functional disability and pain i 2003 Nov Pain-related avoidance factors and social resources, as assessed by pain coping and social support, are supposed to have lasting effects on functional disability and pain in chronic pain disorders. As a follow-up to a prospective study demonstrating short-term effects after one year (Behaviour Research and Therapy, 36, 179-193, 1998), the role of pain coping and social support at the time of diagnosis was investigated in relationship to the long-term course of functional disability and pain after three and five years in 78 patients with rheumatoid arthritis (RA), taking into account personality characteristics of neuroticism and extraversion, clinical status and use of medication. In line with findings at the one-year follow-up, results showed that more passive pain coping predicted functional disability at the three-year, but not the five-year follow-up. In addition, low levels of social support at the time of diagnosis consistently predicted both functional disability and pain at the three and five-year follow-ups. Results indicate that pain coping and social support, assessed very early in the disease process, can affect long-term functional disability and pain in RA, and suggest that early interventions focusing on pain-related avoidance factors and social resources for patients at risk may beneficially influence long-term outcomes in RA.
12096223 Illiteracy in rheumatoid arthritis patients as determined by the Rapid Estimate of Adult L 2002 Jul OBJECTIVES: To determine the prevalence of illiteracy in a cohort of rheumatoid arthritis (RA) patients and the impact of illiteracy on disease severity and function. METHODS: We performed a prospective cross-sectional study with case record review of 127 consecutive patients with RA attending one centre. All patients completed the Rapid Estimate of Adult Literacy in Medicine (REALM) screening test. This 66-word recognition test provides an estimate of reading level in less than 3 min. Demographic data were collected by interview and case record review. Function was assessed with the Health Assessment Questionnaire (HAQ) and depression with the Hospital Anxiety and Depression (HAD) scale, both sent prior to clinic attendance. Social deprivation was assessed with the Carstairs index. RESULTS: Four patients refused to participate. Of these, three stated they were unable to read. Ninety-seven women and 26 men agreed to be interviewed. All but two were Caucasian. Median age was 56 yr (range 19-77 yr) and median disease duration was 10 yr (range 1-60 yr). Median number of previous disease-modifying anti-rheumatic drugs (DMARDs) was two. Eighteen (15%) patients were functionally illiterate, with a REALM score of less than 60. Sex, age, disease duration and numbers of joint replacements and previous DMARDs were not influenced by illiteracy. Illiteracy led to more anxiety (P=0.011), but did not affect HAQ score (P>0.5). Illiteracy was more common in the deprived (P=0.0064). Illiterate patients had three times more hospital visits compared with age- and sex-matched RA controls over the previous 12 months. CONCLUSIONS: One in six of our patient population are illiterate and would struggle to cope with patient education materials and prescription labels. These patients had significantly more hospital visits but equal function, suggesting that additional resources be directed towards these individuals. The REALM test is quick and easy to administer and allows us to identify patients who may require more appropriate literature.
14505216 QT dispersion in rheumatoid arthritis patients with and without Sjögren's syndrome. 2003 Sep The aim of this study was to assess the effect of secondary Sjögren's syndrome (SjS) on QT dispersion and corrected QT dispersion in patients with rheumatoid arthritis (RA). We performed electrocardiography and Doppler echocardiography on 58 patients with RA whom we divided into two groups according to the presence of secondary SjS, and on 29 healthy controls. All patients revealed significantly longer QT dispersion and corrected QT dispersion values ( P< 0.05). Diastolic function variables were significantly different in all patients compared to controls. QT dispersion and corrected QT dispersion values were significantly longer in RA patients with secondary SjS than in those without. We concluded that secondary SjS could be a cardiovascular risk factor contributing to the well documented cardiovascular disease in RA patients.
12639611 Parvovirus B19 and autoimmune diseases. 2003 Feb Parvovirus B19 (B19) causes many clinical disorders, of which the most common are erythema infectiosum, aplastic crisis complicating chronic hemolytic anemia, and hydrops fetalis. In young adults, the skin eruption caused by B19 is accompanied with polyarthritis and polyarthralgia in 60% of the cases. The joint abnormalities predominate in the hands and feet and usually resolve within a week (range 2-21 d). Serological tests show IgM antibodies against B19, confirming the diagnosis of recent infection. Protracted polyarthritis occurs in some patients and seems associated with the DR4 histocompatibility alleles. Rheumatoid factors can be produced transiently in these patients. Other autoantibodies produced in the wake of B19 infection include anti-nuclear antibodies, anti-DNA, anti-SSA/SSB, and anti-phospholipids. Acute B19 infection can simulate early rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) (lupus-like eruption over the cheeks, cytopenia, etc.). In addition, there have been a few reports of erosive RA or SLE developing shortly after a B19 infection, with positive PCR tests for B19 DNA in synovial tissue or blood cells. Studies in large series indicate that B19 is probably an extremely rare cause of RA or SLE. Vasculitides affecting the small vessels (Henoch-Schonlein purpura, Wegener's granulomatosis), medium-sized vessels (periarteritis nodosa), and large vessels (giant cell arteritis) can occur after B19 infection. Here again, the number of clinical cases is small.
15059266 Endothelial cell phenotypes in the rheumatoid synovium: activated, angiogenic, apoptotic a 2004 Endothelial cells are active participants in chronic inflammatory diseases. These cells undergo phenotypic changes that can be characterised as activated, angiogenic, apoptotic and leaky. In the present review, these phenotypes are described in the context of human rheumatoid arthritis as the disease example. Endothelial cells become activated in rheumatoid arthritis pathophysiology, expressing adhesion molecules and presenting chemokines, leading to leukocyte migration from the blood into the tissue. Endothelial cell permeability increases, leading to oedema formation and swelling of the joints. These cells proliferate as part of the angiogenic response and there is also a net increase in the turnover of endothelial cells since the number of apoptotic endothelial cells increases. The endothelium expresses various cytokines, cytokine receptors and proteases that are involved in angiogenesis, proliferation and tissue degradation. Associated with these mechanisms is a change in the spectrum of genes expressed, some of which are relatively endothelial specific and others are widely expressed by other cells in the synovium. Better knowledge of molecular and functional changes occurring in endothelial cells during chronic inflammation may lead to the development of endothelium-targeted therapies for rheumatoid arthritis and other chronic inflammatory diseases.
14730597 Progression of radiologic damage in patients with rheumatoid arthritis in clinical remissi 2004 Jan OBJECTIVE: To assess whether radiologic progression occurs during clinical remission in patients with rheumatoid arthritis (RA). METHODS: One hundred eighty-seven patients with RA in clinical remission were followed up clinically and radiologically for 2 years. Clinical remission was defined according to a modification of the American College of Rheumatology criteria (i.e., the criterion of fatigue was omitted, and patients had to fulfill 4 of the 5 remaining criteria). Radiologic joint damage was assessed by the Sharp/van der Heijde method. RESULTS: After 2 years of followup, remission persisted in 52% of patients. The median radiologic score for the total group of patients increased from 21 (interquartile range [IQR] 5, 65) at the time of entry to 25 (IQR 7, 72) after 2 years (P < 0.001). The median score for radiologic progression between baseline and 2 years was 0.5 (IQR 0, 2.5). Among patients with an exacerbation of RA (n = 86), the median score for progression over 2 years was 1.0 (IQR 0, 4.5) (P < 0.001), and in patients with a persistent remission (n = 93) it was 0 (IQR -0.5, 2.0) (P < 0.001). Clinically relevant progression of damage was more frequent in patients with exacerbation (23%) than in those with persistent remission (7%) (P = 0.001). However, in 15% of patients with persistent remission, an erosion developed in a previously unaffected joint. In the logistic regression analysis, the area under the curve of the Disease Activity Score, a continuous measure, was related to the chance of radiologic progression, regardless of the absolute disease activity level. Results were similar when other definitions of remission were used. CONCLUSION: Although rare, clinically relevant progression of joint damage does occur in patients with RA in prolonged remission. This suggests the need for markers that predict progression during periods of low disease activity and for drugs that prevent damage that is independent of disease activity.
14672898 Effect of the first infliximab infusion on sleep and alertness in patients with active rhe 2004 Jan OBJECTIVE: To assess the benefit of the first infliximab infusion on sleep disturbances in patients with RA Material and methods: Evaluation of RA activity, sleepiness (Epworth scale and multiple sleep latency test), alertness (steer clear test), and sleep structure (polysomnography) were conducted before and after the first infusion of infliximab in six female patients with RA. RESULTS: The day after the first infliximab infusion, the mean (SD) number of tender (20 (2.4)) or swollen (15.3 (2)) joints and the morning stiffness (140 (61.9) min) had not changed. There were significant improvements in the median number of total sleep stage transitions per hour (median (IR) before v after infusion: 20.5 (43) v 7.5 (6); Wilcoxon paired test, p = 0.014), median percentage of phase I+II (83.5 (8) v 54.5 (24); p = 0.023), percentage of REM stages (2 (10) v 11.5 (8); p = 0.014), median percentage sleep efficiency (44 (22) v 75 (18); p = 0.014), median sleep latency (77.5 (150) v 25.5 (23) min; p = 0.023), and median number of hits in the steer clear test (48.5 (86) v 6 (45); p = 0.023). Neither objective nor subjective daytime sleepiness was noted. One obese patient had obstructive sleep apnoea syndrome. CONCLUSIONS: Sleep and the alertness disturbances in RA improve with infliximab treatment. Improvement appears unrelated to joint discomfort amelioration but suggests a central effect through inhibition of circulating TNFalpha levels.
11817600 Genetic links between the acute-phase response and arthritis development in rats. 2002 Jan OBJECTIVE: The acute-phase inflammatory response is closely correlated with the development of rheumatoid arthritis, but the pathophysiologic role of its specific components is largely unknown. We investigated the genetic control of the acute-phase protein response in pristane-induced arthritis (PIA), which is a chronic erosive arthritis model in rats. METHODS: Plasma levels of the acute-phase proteins interleukin-6 (IL-6), alpha1-acid glycoprotein (orosomucoid), fibrinogen, and alpha1-inhibitor3 were quantified in 3 strains of rats during the development and progression of disease: DA and LEW.1F, which are susceptible to arthritis, and E3, which is resistant. Genetic linkage analysis was performed on an F2 intercross between E3 and DA to determine the genetic control of the acute-phase response in arthritis. Elevated levels of alpha1-acid glycoprotein were associated with acute inflammation, whereas levels of IL-6 were increased during the entire course of the disease. RESULTS: Using these acute-phase markers as quantitative traits in linkage analysis revealed a colocalization of loci controlling the acute-phase response and regions previously shown to control the development of arthritis in chromosomes 10, 12, and 14. In addition, 2 loci that were not associated with arthritis were found to regulate serum levels of the acute-phase protein Apr1 (acute-phase response 1) at the telomeric end of chromosome 12 and Apr2 on chromosome 5. CONCLUSION: The PIA model in rats is a useful tool for understanding some of the pathways leading to chronic erosive arthritis. The analysis of acute-phase proteins in PIA and its application as quantitative traits for studying the genetics of arthritis will promote the understanding of the genetic regulation of the acute-phase response.