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ID PMID Title PublicationDate abstract
12166112 [Depressive tendency in patients with RA]. 2002 Jun OBJECTIVES: To determine if depression scores are higher in patients with RA and to identify risk factors for depression. METHOD: The subjects were 287 RA in-patients and outpatients. We investigated the tendency of depression by SDS of Zung and whether SDS is correlated with age, face scale, VAS (visual analog scale), MHAQ, class, BSG and CRP. We compared the frequency of depression tendency between those who took steroid and those who did not. Among 238 cases that we studied, 131 patients took steroid hormone and the rest did not. RESULTS: It was found that 113 out of 287 patients (about 39%) showed depression tendency. SDS was correlated with face scale (r = 0.55198 P = 0.0001) followed by VAS (r = 0.40772 P = 0.0001). However, SDS was not correlated with BSG, CRP, age and duration range. For the group who took steroid hormone, the average score of SDS was 38.63 (+/- 8.37). The average score for the other group who did not take steroid was 35.98 (+/- 7.97). As a result, it was measured by T-value that the group who took steroid hormone had higher SDS than the other group who did not take steroid.
15230128 [Changes in indices of inflammatory activity in patients with rheumatoid arthritis during 2004 AIM: To assess leflunomide efficacy and tolerance in patients with rheumatoid arthritis (RA) during the first four months of the treatment. MATERIAL AND METHODS: The study included 200 RA patients treated in four Moscow clinical centers. Leflunomide was given in a dose of 100 mg/day for 3 days, then 20 mg/day for 16 weeks. The activity of the disease according to the criterion DAS 28 was assessed before the treatment and 4, 8, 12 and 16 weeks after the treatment start. RESULTS: RA activity diminished considerably after one month of leflunomide treatment. Later, the articular syndrome continued to improve. A significant improvement by DAS 28 was observed after 16 weeks of the treatment in 65% (129 of 200) patients, high RA activity persisted only in 17 of 90 patients. CONCLUSION: Leflunomide reduces articular inflammation and raises RA patients' quality of life at early stages of the treatment. This reduction continued for 4 months of the study. Therefore, adequate assessment of leflunomide efficacy should be made only after 4-6 months of therapy.
12737330 Physiotherapy in subtropic climate improves functional capacity and health-related quality 2003 OBJECTIVE: The objective was to prospectively evaluate the short as well as the long-term effects of intensive physiotherapy in a stable, sunny and warm climate on physical function and health related quality of life in patients with rheumatoid arthritis (RA) and spondylarthropathies (SpA). METHODS: Ninety-three Swedish patients with RA and SpA receiving physiotherapy for 4 weeks in Israel or Tenerife were followed for 6 months. Physical function was evaluated by the Swedish version of Stanford Health Assessment Questionnaire (HAQ) and quality of life by the Nottingham Health Profile (NHP) questionnaire. RESULTS: There were significant improvements in HAQ-scores and global NHP-scores as well as all subcategories of NHP immediately after the treatment abroad, effects that were still measurable after six months. At that time point nearly half of the patients had clinically meaningful reduction of HAQ-scores (> or = 0.25). CONCLUSION: Physiotherapy in a warm and stable climate, with many hours of daily sunshine, is a valuable treatment complement for Swedish patients with RA and SpA.
12665969 Current drug therapy for rheumatoid arthritis. 2003 The etiology of rheumatoid arthritis (RA) remains unclear at present, but advances have been made in the drug therapy for RA. Recent attention has been focused on selective cyclooxygenase-2 (COX-2) inhibitors, nonsteroidal antiinflammatory drugs (NSAIDs) that inhibit a subtype of cyclooxygenase. Various clinical studies have confirmed that the selective COX-2 inhibitors cause fewer severe gastrointestinal complications, although an increased incidence of myocardial infarction was suggested. Terminal enzymes of the arachidonic acid cascade, such as membrane-associated prostaglandin E synthase, might be a target for new NSAIDs in the near future. Low-dose glucocorticoid treatment for RA has been reconsidered possibly to prevent articular destruction of RA. Special attention for glucocorticoid-induced osteoporosis by concomitant administration of bisphosphonates might be necessary. Disease-modifying antirheumatic drugs should be effective in delaying the progression of joint destruction and physical disability. Methotrexate, sulfasalazine, and leflunomide have shown such an effect. Inhibition of articular destruction was also proven by administration of the biologic agents etanercept and infliximab plus methotrexate. Tuberculosis complicated with infliximab therapy is one of the most important concerns in Japan. Agents that improve the quality of life of patients with RA are still needed.
15552517 Cost-effectiveness of anti-tumor necrosis factor agents. 2004 Sep Rheumatoid arthritis can lead to substantial morbidity, disability and mortality. The development of anti-tumor necrosis factor antibodies from the bench to the bedside over the past 15 years has ushered in the new era of biologic therapies for rheumatic diseases. Etanercept, infliximab and adalimumab have all been approved for the treatment of rheumatoid arthritis on the basis of improved clinical outcomes. Because these treatments, however, are expensive and not uniformly effective, concerns have arisen regarding their cost-effectiveness. This paper reviews the disease burden of rheumatoid arthritis, costs of drug therapy, costs of rheumatoid arthritis and the economics and cost-effectiveness of anti-tumor necrosis factor antibody agents.
15293486 The long-term outcomes from a randomized controlled trial of an educational-behavioural jo 2004 Aug OBJECTIVE: To evaluate the long-term effects of joint protection on health status of people with early rheumatoid arthritis (RA). DESIGN: A four-year follow-up of a randomized, controlled, assessor-blinded trial was conducted. SETTING: Two rheumatology outpatient departments. PARTICIPANTS: People with rheumatoid arthritis less than five years since diagnosis. INTERVENTIONS: Two 8-hour interventions were originally compared: a standard arthritis education programme, including 2(1/2) hours of joint protection based on typical UK occupational therapy practice (plus 5(1/2) hours on RA, exercise, pain management, diet and foot care); and a joint protection programme, using educational-behavioural training. MAIN MEASURES: Adherence to joint protection, pain, hand pain on activity, Arthritis Impact Measurement Scales 2 and Arthritis Self-efficacy were recorded at 0 and 4 years. RESULTS: Sixty-five people attended the joint protection and 62 the standard programmes. Groups at entry were similar in age (51 years; 49 years), disease duration (21 months: 17.5 months) and use of nonsteroidal anti-inflammatory and disease-modifying drugs. At four years, the joint protection group continued to have significantly better: joint protection adherence (p=0.001); early morning stiffness (p=0.01); AIMS2 activities of daily living (ADL) scores (p=0.04) compared with the standard group. The joint protection group also had significantly fewer hand deformities: metacarpophalangeal (MCP) (p =0.02) and wrist joints (p=0.04). CONCLUSION: Attending an educational-behavioural joint protection programme significantly improves joint protection adherence and maintains functional ability long term. This approach is more effective than standard methods of training and should be more widely adopted.
12687535 Development of an instrument to measure disability in parenting activity among women with 2003 Apr OBJECTIVE: To develop a method of assessing and summarizing parenting function and disability, and to use that method to describe parenting disability among a group of women with rheumatoid arthritis (RA). METHODS: The study group comprised 231 women with RA who are members of the University of California, San Francisco RA Panel Study. Parenting disability scales were developed by first asking open-ended questions and then, based on the responses, constructing closed-ended questions. Separate sets of questions were asked concerning young (ages 0-5 years) and older (ages 6-18 years) children. Parenting disability indices (PDIs), scored in a manner similar to that for the Health Assessment Questionnaire (HAQ) (range 0-3), were developed (total, and for young and older children). Associations of PDIs with demographic, health, and symptom measures were assessed. RESULTS: Substantial proportions of women with RA experienced disability in parenting activities. Greater disability was reported for activities related to parenting young children. Doing less of parenting functions because of RA was commonly reported. The mean total PDI of women who currently had children under age 18 years, taking into account "doing less" of activities because of RA, was 0.76 (range 0-2.08). Greater parenting disability was associated with poorer general function (HAQ; P < 0.0001), more severe pain (P = 0.002), greater fatigue (P = 0.0005), greater parenting stress (P = 0.005), and greater psychological distress (depressive symptoms; P < 0.0001). DISCUSSION: The PDI appears to be valid. This method can provide the means of assessing parenting disability, its risk factors, and its effects, which may assist in identifying ways of helping individuals with RA cope more effectively with parenting.
15221051 Rheumatoid pachymeningitis. 2004 Jul Symptomatic rheumatoid pachymeningitis is a rare extra-articular manifestation of rheumatoid arthritis. Clinical symptoms are non-specific and diagnosis is frequently made by exclusion. We present a 61-year-old woman with a 9-year history of rheumatoid arthritis presenting with deafness and progressive disability over a two month duration. She was diagnosed as having rheumatoid pachymeningitis based on the cerebral magnetic resonance imaging findings.
15547080 Atorvastatin reduces arterial stiffness in patients with rheumatoid arthritis. 2004 Dec BACKGROUND: Chronic systemic inflammation may contribute to accelerated atherosclerosis and increased arterial stiffness in patients with rheumatoid arthritis (RA). In addition to lowering cholesterol, statins have immunomodulatory effects which may be especially beneficial in patients with RA who have systemic immune activation. OBJECTIVE: To investigate the effect of atorvastatin on the augmentation index (AIx: a measure of arterial stiffness) and systemic inflammation in RA. METHODS: 29 patients with RA (mean (SD) age 55 (13) years) with moderately active disease of long duration were studied. AIx, lipid levels, serum inflammatory markers, and disease activity score were measured before and after 12 weeks of atorvastatin 20 mg daily. RESULTS: AIx improved significantly from 34.1 (11.6)% to 29.9 (11)% (p = 0.0002), with the greatest improvements in AIx occurring in those subjects with the highest disease activity scores (r = -0.5, p = 0.007). Total and LDL cholesterol were reduced from 5.5 (0.9) to 3.9 (0.7) mmol/l and 3.3 (0.8) to 1.9 (0.6) mmol/l, respectively (p = 0.0001). Serum inflammatory markers remained unchanged during the study. CONCLUSIONS: Atorvastatin significantly reduced arterial stiffness in patients with RA. The greatest improvements were seen in patients with more active disease, suggesting that, in addition to the beneficial effects of cholesterol reduction, immune modulation may contribute to the cardioprotective effect of statins.
12898305 Changes in anteroposterior stability following total knee arthroplasty. 2003 This study evaluated the changes in anteroposterior stability at flexion and extension following posterior cruciate ligament (PCL)-retaining and PCL-substituting total knee arthroplasty (TKA), in comparison with normal knees. Altogether, 29 knees of 24 patients underwent either PCL-retaining ( n = 19) or PCL-substituting ( n = 10) TKA. Anteroposterior displacement was measured with a KT-2000 arthrometer preoperatively, 1 month after surgery, and again an average of 3 years after surgery. Anteroposterior stability at flexion and extension did not change following PCL-retaining TKA and was not significantly different from that of normal subjects, whereas anteroposterior stability increased following PCL-substituting TKA and was significantly greater than that of normal subjects an average of 3 years after surgery.
11955559 Research in complex diseases. 2002 Apr 6 Many diseases that have a substantial effect on health have a complex pathogenesis. Examples are atherosclerosis, diabetes mellitus, and rheumatoid arthritis. Here, we discuss a hierarchy of goals of research in complex diseases, and introduce a stepwise approach for the development of disease models, paying specific attention to the position of genetic factors and stochastic variables in these models.
11907701 Forearm bone mineral density in postmenopausal women with rheumatoid arthritis. 2002 Jan Osteoporosis in cases of rheumatoid arthritis (RA) is multifactorial, and the pathogenesis of bone loss induced by RA in postmenopausal women is not fully understood. The purpose of the present study was to determine the factors that affect forearm bone mineral density (BMD) in postmenopausal women with RA. In total, 839 postmenopausal women aged 46-90 years, were enrolled in the study; 470 patients with RA and 369 healthy controls (CON). Forearm (distal radius) BMD, measured by DXA using a DTX-200 (Osteometer, MediTech, CA, USA), was significantly lower in the RA group than in the CON group (P < 0.0001), even when adjusted for age, height, body weight, body mass index, and years since menopause (YSM) (P < 0.01). On multiple regression analysis, in the CON group, age and YSM were significantly correlated with BMD (P < 0.01 and P < 0.05, respectively). On the other hand, in the RA group, in addition to YSM, anatomic grade in the wrist, modified health assessment questionnaire (HAQ) score for the upper extremities, and erythrocyte sedimentation rate were each significantly correlated with BMD (P < 0.0001, P < 0.001, P < 0.0001, and P < 0.001, respectively), whereas functional class, duration of disease, dose of prednisolone used, modified HAQ score for the lower extremities, and the levels of c-reactive protein and rheumatoid factor were not. The present study with a large number of subjects shows that in addition to YSM, disuse (anatomic grade) of the wrist, arm function, and disease activity appear to be significant determinants of forearm BMD in postmenopausal women with RA.
12819928 Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiogra 2004 May OBJECTIVE: The aim of the present study was to evaluate cardiac involvement in patients with active rheumatoid arthritis (RA). METHODS: Forty patients with active RA participated. All were submitted to standard Doppler echocardiography and myocardial performance index (MPI) grading. RESULTS: There were left and right ventricular diastolic function abnormalities in RA patients. Left ventricular MPI was also significantly higher than in controls ( P<0.05). A relationship was found between left ventricular early diastolic (E)/atrial (A) flow velocities (E/A ratio), isovolumic relaxation time (IRT), and disease duration ( r=-0.47 and P=0.002, r=0.618 and P=0.000, respectively). CONCLUSION: Diastolic function was impaired in both ventricles in patients with active RA. There was a direct relationship between some of the parameters of left ventricular diastolic function and disease duration as well. These findings suggest a subclinical myocardial involvement in RA patients.
12089609 [Role of chemokines in the pathogenesis of chronic synovitis during rheumatoid arthritis]. 2002 Chemokines play a central role in the pathogenesis of rheumatoid arthritis (RA) synovitis which is characterised by new blood vessel formation, thickening of the lining layer and infiltration of immune cells. The inflammatory infiltrate is generated by a series of events which include the recruitment of leukocytes from the blood stream into the tissue, their local retention and activation to effector cells. All these processes are finely regulated by the interplay of different cell adhesion molecules (CAMs) and chemoattractant factors called chemokines (CK). CK are a superfamily of small proteins that play a crucial role in immune and inflammatory reactions. These chemoattractant cytokines share structural similarities including four conserved cysteine residues which form disulphide bonds in the tertiary structure of the proteins. CK mediate their effects by binding specific receptors (CK-R) characterised by a domain structure which spans the cell membrane seven times and signal through heterotrimeric GPT-binding proteins. Activation of the CK network results in an amplification of the inflammatory cascade and consequently in the progressive destruction of RA joints. The recognition of the central role of CK in inflammation has paved the way to the development of new agents capable of interfering with CK and CK-R. This review will focus in particular on the role of CK in regulating leukocyte trafficking in RA joints.
15383813 Successful outcome of the Souter-Strathclyde elbow arthroplasty. 2004 Sep This study describes a consecutive series of 68 primary Souter-Strathclyde elbow replacements performed in a predominantly rheumatoid population, compares survivorship and complication profile with published series, and analyzes factors associated with successful outcome. Survivorship at 10 years was 74%, with at least 5 years' follow-up in 25 prostheses and a satisfactory Mayo score in 92% of all 68 elbows. These results compare acceptably with those from specialized elbow units. Careful component selection with regard to joint stability and bony fixation are important factors in the successful outcome of the Souter-Strathclyde arthroplasty. Use of a long-stemmed prosthesis was associated with a significantly better outcome after intraoperative fracture, and revision to a linked articulation was the most reliable treatment for instability.
14528501 Unified theory of the origins of erosive arthritis: conditioning as a protective/directing 2003 Oct OBJECTIVE: To validate the western Tennessee River limits of the originally described rheumatoid arthritis (RA) catchment area and to assess the possibility that absence of tuberculosis allowed the original development of RA. The hypothesis that RA was related to tuberculosis was once a driving force in treatment approach. RA initially was very limited in geographic distribution, in contrast to tuberculosis. Classical tubercular lesions were not observed in the rheumatoid catchment area in ancient times. Similarities between clinical and radiologic manifestations of spondyloarthropathy (SpA) and adjuvant arthritis raised the possibility of a potential conditioning role for occurrence of nonrheumatoid erosive arthritis. METHODS: Skeletal samples from ancient RA catchment and non-catchment areas were compared for frequency of tubercular-relatable pathologies. RESULTS: Tubercular-relatable osseous pathologies were found only outside the rheumatoid catchment area (p < 0.0001). The original RA catchment area was confirmed not to extend beyond the western portion of the Tennessee River. CONCLUSION: There is an inverse relationship between occurrence of tuberculosis and RA in the Archaic and Early Woodland periods of North America. The virtually universal presence of tuberculosis in contiguous Amerindian populations contrasts dramatically with its absence in the ancient catchment area for RA. Conversely, SpA and tuberculosis do occur in the same populations. Tuberculosis may represent a conditioning agent for development of SpA, but at least potentially provides protection against development of RA.
12595618 A simplified disease activity index for rheumatoid arthritis for use in clinical practice. 2003 Feb OBJECTIVE: The objective of this study was to verify the usefulness of a simple disease activity index (SDAI) for rheumatoid arthritis (RA). METHODS: The SDAI is the numerical sum of five outcome parameters: tender and swollen joint count (based on a 28-joint assessment), patient and physician global assessment of disease activity [visual analogue scale (VAS) 0-10 cm] and level of C-reactive protein (mg/dl, normal <1 mg/dl). Analysis initially focused on MN301, one of the three phase III clinical trials of leflunomide, in order to assess possible correlations between the SDAI and the Health Assessment Questionnaire (HAQ) and Disease Activity Score 28 (DAS 28). Results were then compared with the other two trials, MN302 and US301. A total of 1839 patients were evaluated. At baseline, 6 and 12 months, the SDAI, DAS 28, American College of Rheumatology (ACR) response criteria and mean HAQ scores were determined for each patient and compared by linear regression for significant correlation. The SDAI was compared qualitatively to the ACR 20% at 3, 6 and 12 months. The index was further validated by comparing the SDAI with survey results obtained from rheumatologists' evaluations of disease activity in test cases. The survey results included defining categorical changes in the SDAI indicating major, minor or no improvement in disease activity in response to treatment. Changes in total Sharp score at 6 and 12 months of treatment were determined for each of these categories of the SDAI and for comparable categories of the DAS 28. RESULTS: The mean SDAI calculated for patients at baseline in study MN301 was 50.06 (range 25.10-96.10) and was, respectively, 50.55 (range 22.10-98.10) and 43.20 (range 12.90-78.20) in studies MN302 and US301. In all three trials, the SDAI was correlated with a high level of statistical significance to the DAS 28 and HAQ scores at baseline, endpoint and change at endpoint. Patients achieving the ACR 20, 50, 70 or 90% response showed proportionate changes in the SDAI. Analysis of surveyed physician responses showed a significant association between the perception of disease activity and the SDAI, as well as changes in the SDAI. Qualitative analysis of radiographic progression at 6 and 12 months for patients showing either major, minor or no improvement of the SDAI showed correspondingly larger increases of the total Sharp score at 12 months. CONCLUSION: The SDAI is a valid and sensitive assessment of disease activity and treatment response that is comparable with the DAS 28 and ACR response criteria; it is easy to calculate and therefore a viable tool for day-to-day clinical assessment of RA treatment. Overall results indicate that the SDAI has content, criterion and construct validity.
15372317 Bone mineral density in patients with early rheumatoid arthritis treated with corticostero 2005 Apr The aim of this study was to evaluate the bone mineral density (BMD) in patients with early rheumatoid arthritis (RA) prior to and 6 months after adding low-dose corticosteroid (CS) treatment. Adult patients (>21 years old) with early RA (symptom duration <1 year) and severe joint pain under maximal dose of nonsteroidal anti-inflammatory drugs (NSAIDS) were started on low-dose prednisone (10 mg/day). Patients were evaluated after 1, 3, and 6 months. Disease activity measures including swollen and tender joint count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were documented, and the dose of prednisone was adjusted according to the level of pain at each visit. BMD of the femoral neck (FN) and lumbar spine (LS) was measured using dual energy X-ray absorptiometry prior to and 6 months after starting CS treatment. Calcium supplements, vitamin D, bisphosphonates, or hormonal therapy that may affect BMD were not permitted during the study. Twenty patients were eligible and 16 completed the study; 75% were female. The mean age was 47.2+/-12 years and mean duration of symptoms was 7+/-2 months. The mean BMD at the FN prior to and 6 months after starting CS treatment were 0.8080 g/cm(2)+/-0.1145 and 0.8242 g/cm(2)+/-0.1122, respectively (p=0.04). The mean BMD at the LS prior to and 6 months after starting CS treatment were 0.9429 g/cm(2)+/-0.1406 and 0.9490 g/cm(2)+/-0.1277, respectively (p=0.423). There was a significant correlation between the mean change of BMD at the FN and mean change of tender joint count (p=0.01), ESR (p=0.008), and CRP (p=0.006) but not with swollen joint count (p=0.099). However, there was no correlation between the change of BMD at the FN or LS and the change of any of the disease activity measures of every patient. Also, no correlation was seen between the cumulative dose of CS and the change in BMD. BMD increases significantly at the FN in early RA patients 6 months after adding low-dose CS to the treatment.
14680502 Are synovial biopsies of diagnostic value? 2003 Synovial tissue is readily accessible by closed needle or arthroscopic biopsy. These techniques provide adequate tissue for most diagnostic requirements. Examination of synovial tissue can assist in the diagnosis of some joint infections, and in several atypical or rare synovial disorders. Histological confirmation is not normally required for diagnosis of the common forms of inflammatory arthritis, including rheumatoid arthritis (RA). In patients with either established or early RA, immunohistological measures of inflammation in synovial tissue are associated with clinical measures of disease activity, may predict the clinical outcome, and change in response to treatment. Surrogate markers of disease activity and outcome that have been identified in synovial tissue include components of the cellular infiltrate, and several mediators of inflammation and matrix degradation. There is evidence that the very early introduction of disease-modifying therapy inhibits progressive structural damage maximally. Clinicians exploiting this 'window of opportunity' therefore require very early indicators of the diagnosis and outcome in patients who present with an undifferentiated inflammatory arthritis. Some immunohistological features have been described that distinguish patients who are likely to develop progressive RA and who might benefit most from early aggressive therapeutic intervention. In this regard, the inclusion of pharmacogenomic and proteomic techniques in the analysis of synovial tissue presents some exciting possibilities for future research.
12447631 Responsiveness of health status measures and utility-based methods in patients with rheuma 2002 Nov The aim of the study was to compare the responsiveness of disease-specific (Arthritis Impact Measurement Scale 2, AIMS2), generic (Medical Outcome Study Short Form Health Survey, SF-36) and preference-based instruments (rating scale, RS and time tradeoff, TTO) to changes in articular status and perceived health in patients with rheumatoid arthritis (RA). Seventy-eight consecutive patients with RA, attending the care facilities of the Department of Rheumatology of Ancona, were recruited in this longitudinal study. In order to assess the responsiveness three strategies were used: effect size (ES), standardised response mean (SRM) and receiver operating characteristic (ROC). There were 55 women and 23 men with a mean age of 56 years (range 19-78) and arthritis duration of 7.1 years (range 6 months to 24 years). Using three-category EULAR criteria as external indicators of improvement/response, 21 patients (27%) reported a significant improvement, 23 (29.5%) moderate improvement, and 34 (43.5%) no change over the 12-month period. The mean change scores in generic and specific health status instruments and utility measures were significantly related to response category. The AIMS2 subscales (physical function, pain, psychological function and social interaction) were slightly more responsive than those of SF-36. The physical and pain dimensions were most sensitive for measuring change over a 12-month period, followed by psychological and social dimensions. For the utility measurement, RS scores were found to be significantly more responsive in detecting changes in preferences than TTO scores. These results may have implications for the application of the health status and utility measures in clinical trials in patients with RA.