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ID PMID Title PublicationDate abstract
15470527 [Thumb troubles in rheumatoid arthritis]. 2004 Jul Thumb involvement may play a relevant role in inducing a severe functional impairment in rheumatoid arthritis. The aim of this sonographic vignette is to show the value of sonography in detailing anatomic changes involving the thumb during a phase of active synovitis. The patient was a 50-year old man who presented with a 3-year history of rheumatoid arthritis. He complained of a 4-week history of a marked recrudescence inflammatory thumb involvement associated with clinical signs of carpal tunnel syndrome. Sonographic images were obtained with a real-time ultrasound system equipped with a 13 MHz linear transducer. Sonographic examination on longitudinal dorsal scan of the metacarpophalangeal joint of the thumb showed a moderate joint cavity widening with two evident bone erosions, one at the metacarpal head and the other one at the basis of the proximal phalanx. The longitudinal volar scan of the first metacarpophalangeal joint confirmed the presence of synovitis detecting a marked joint cavity widening, with aspect of synovial proliferation. The flexor pollicis longus tendon was severely involved (marked tendon sheath widening, synovial proliferation, loss of the normal homogeneous fibrillar echotexture, and a large intratendinous tear). Sonography allowed the depiction of a wide range of otherwise undetectable pathologic changes in the standard clinical setting.
12474739 [Changes in bone mineral density in rheumatoid arthritis]. 2002 Rheumatoid arthritis (RA) is one of the causes of secondary osteoporosis. One hundred eighty eight patients with RA (27 males and 161 females) were examined; the historical, clinical data and bone mineral mass of the spine and of the hip were evaluated. Osteoporosis was found more frequently in the spine than in the hip (27.7% and 17.9% respectively, p = 0.04). Bone mineral density (BMD) in the spine was less in women than in men (p = 0.04). The number of swollen joints, the mean of erythrocyte sedimentation rate (ESR) and rheumatoid factor (as indicators of inflammation) are correlated significantly with BMD of the hip. The age, hypogonadism and RA specific factors such as the duration and stage of the disease, and the long use of glucocorticosteroids were associated with osteoporosis. The relation between osteoporosis and history of a prior fracture in patients or in closest relatives, low weight, smoking, and RA specific factor such as the mean daily dose of glucocorticosteroids was not significant.
14528521 Rates of serious gastrointestinal events from low dose use of acetylsalicylic acid, acetam 2003 Oct OBJECTIVE: The frequency of serious gastrointestinal (GI) complications has been quantitated with chronic high doses of nonsteroidal antiinflammatory drugs (NSAID), but risk at lower dosages remains unknown. We examined the prevalence of serious GI events in patients taking aspirin (ASA), acetaminophen (APAP), or ibuprofen (IBU), focusing on low or intermittent use. METHODS: We studied 5692 patients with rheumatoid arthritis (RA) and 3124 patients with osteoarthritis (OA) from 12 databank centers, with 36,262 patient-years of observation, who had taken one of 3 study analgesics, and examined the frequency of serious GI events requiring hospitalization. RESULTS: Treatment groups were of similar ages and severity. As lower doses of study analgesics were taken, serious GI events tended to be less prevalent. In patients taking a study drug alone, without other analgesics or corticosteroids, only one event occurred in over 900 patient-years of exposure, roughly equivalent to background. Rates of GI events while taking APAP with other concurrent therapy or corticosteroids were higher (p < 0.05) than for the other 2 analgesics. In over-the-counter (OTC) doses, there were no significant differences in GI toxicity among analgesics. RA patients tended to have higher rates than OA patients. The rate of GI events was highly dependent on concurrent therapy, increasing 2 to 6-fold in patients taking other analgesics or corticosteroids. Propensity scores for serious GI events were similar across drugs. CONCLUSION: OTC use of ASA, IBU, or APAP carries little risk of serious GI toxicity for most persons. Most serious problems encountered were in higher-risk patients. Given the low rates of events, at low or intermittent dosage without concurrent treatment, these 3 analgesics cannot be distinguished from each other or from background rates of serious GI toxicity.
15172048 B lymphocyte depletion therapy with rituximab in rheumatoid arthritis. 2004 May B lymphocyte depletion therapy in rheumatoid arthritis can provide major clinical benefits. Widespread use in the future will depend on continued evidence of safety, particularly in the context of long term use. Rituximab is a highly effective agent, but it may be best used in combination with other agents. Substantial improvement following a single course of therapy has been found to last up to 42 months, and it is reasonable to hope that further development of strategies targeting B cells will extend this toward the original aim of truly long-term remission.
14566029 Relevance of thiopurine methyltransferase status in rheumatology patients receiving azathi 2004 Jan Azathioprine (AZA) is widely used in the management of rheumatological diseases. Despite its efficacy, AZA can often cause bone marrow suppression, notably leucopenia, which has been recorded in up to 17% of patients taking AZA for rheumatoid arthritis, though this can be considered clinically significant in about 3% overall. Severe myelosuppression, associated with abnormal AZA metabolism, is linked to the thiopurine methyltransferase (TPMT) genetic polymorphism. TPMT status can be assessed prior to AZA treatment by measuring enzyme activity or genotyping techniques. Analysis of recent data suggests that by optimizing the AZA dose on the basis of TPMT status testing (with a substantial reduction in dose for patients homozygous for mutant TPMT alleles), a reduction in drug-induced morbidity and cost savings can be made by avoiding hospitalization and rescue therapy for leucopenic events. In this article we review the pharmacogenetic and clinical implications of the TPMT polymorphism, emphasizing its relevance to rheumatologists managing diseases with AZA.
12810418 Interpreting radiographic data in rheumatoid arthritis. 2003 Jul Plain film radiography is the preferred method for evaluating disease progression in rheumatoid arthritis and for establishing the efficacy of new disease modifying antirheumatic agents. However, the relative efficacy of these agents cannot be determined by comparing radiographic data from different studies, and a standardised system is needed.
12762142 Spontaneous pneumoperitoneum: an unusual complication of systemic reactive AA amyloidosis 2003 Mar We report a 71-year-old man with reactive AA amyloidosis secondary to rheumatoid arthritis who developed spontaneous pneumoperitoneum with intestinal pseudo-obstruction as an initial symptom. Severe deposition of amyloid in the intestinal wall was considered to play an important role in the pathogenesis of this unusual symptom. The patient has been successfully treated with total parenteral alimentation and intermediate-dose prednisolone (30 mg/day). Although pneumoperitoneum usually suggests gastrointestinal perforation requiring emergency surgery, conservative therapy should be seriously considered in amyloidosis-related cases with no associated peritonitis, since multiple vital organs are probably involved by severe amyloid deposition, thus increasing the risks of surgery.
15155116 Etanercept: a clinical review of current and emerging indications. 2004 May The recent development of inhibitors of TNF-alpha has provided the opportunity for a more targeted and highly effective approach to the treatment of chronic inflammatory illnesses such as rheumatoid arthritis. Since the initial approval of etanercept as a treatment for rheumatoid arthritis, additional indications, including psoriatic arthritis, juvenile rheumatoid arthritis and ankylosing spondylitis, have also received FDA approval. More than 220,000 patients have been treated with etanercept so far. This review summarises the body of knowledge accumulated so far on etanercept (Enbrel) since it entered the market 5 years ago.
12670381 Confronting life with rheumatoid arthritis. 2003 Apr BACKGROUND: Older people with rheumatoid arthritis are confronted with a variety of chronic stressors on a daily basis. Living with rheumatoid arthritis means learning to cope with physical limitations, fatigue, losing mobility and independence, pain, uncertainty and role changes related to periods of exacerbation and remission. There is a paucity of literature that addresses the stress and coping processes over time for older people who have had rheumatoid arthritis since midlife. AIM: The purpose of this study was to identify and describe, at three points in time and over two 6-month intervals, the illness-related stressors perceived by older people diagnosed with rheumatoid arthritis since midlife; their stress-related emotions and the coping strategies they used to manage the illness-related stressors. METHODS: A longitudinal, descriptive design was used to assess older people's perceptions of illness-related stress, their stress emotions and the coping strategies used to manage the illness-related stressors. Findings. The majority of participants most frequently identified physical limitations as their illness-related stressors, harm as the stress emotion they experienced, and use of confrontive coping strategies to manage the stress associated with rheumatoid arthritis. CONCLUSIONS: The findings provide nurses with a better understanding of the experiences, emotions and coping strategies used by older people to manage the adversity of rheumatoid arthritis in daily living.
12914123 [Genetic investigation of human leukocyte antigens in rheumatoid arthritis patients with a 2003 Jul 13 Two rheumatoid arthritis patients with antiphospholipid antibody syndrome were observed. The diagnosis was established by the clinical signs and the measurement of anticardiolipin antibodies. As a result of the genetic investigations, typical HLA markers of the rheumatoid arthritis and those of the antiphospholipid antibody syndrome were found in both patients. In connection with rheumatoid arthritis they were the HLA-DRB1*0101 allele in the female and the HLA-DRB1*0401 in the male patient. With regards to antiphospholipid antibody syndrome, the HLA alleles were the HLA DQB1*0602 in both patients and the HLA DQB1*0302 in the male patient.
14504915 The effect of low-dose methotrexate on bone mineral density in patients with early rheumat 2003 Sep OBJECTIVE: The intent of this study was to assess the effect of low-dose methotrexate treatment on bone mineral density (BMD) in patients with early rheumatoid arthritis (RA). METHODS: Forty-six premenopausal women with early RA not previously treated with disease-modifying antirheumatic drugs or corticosteroid were randomized to 7.5 mg/week of methotrexate or 2 g/day of sulphasalazine for 18 months. Bone mineral density of the lumbar spine, femoral neck, and trochanter was measured using dual-energy X-ray absorptiometry (DEXA). Biochemical studies included serum calcium, phosphorus, total alkaline phosphatase, beta-2 microglobulin, parathyroid hormone and 25-hydroxyvitamin D(3) concentrations, spot urinary calcium, and 24-h urinary calcium excretion. Disease activity was assessed by modified disease activity score (DAS 28), and functional impairment was estimated by the Health Assessment Questionnaire. RESULTS: No significant difference in BMD of the lumbar spine, femur neck, or trochanter was observed at 18 months in either group. There was also no significant change in the biochemical parameters of both groups. CONCLUSION: Our findings suggest that low-dose methotrexate has no negative effect on BMD in premenopausal RA patients.
12176808 Infliximab treatment in combination with cyclosporin A in patients with severe refractory 2002 Sep OBJECTIVE: To investigate whether infliximab can be used in combination with cyclosporin A (CsA) in patients with refractory rheumatoid arthritis (RA) who cannot tolerate methotrexate (MTX). MATERIALS AND METHODS: Eighteen patients with refractory RA receiving low dose CsA (2 mg/kg/day) and prednisone (5 mg/day) were treated with intravenous infliximab. The patients were given infliximab (3 mg/kg weight) at 0, two, six, and every eight weeks thereafter for a total period of 12 months. Clinical improvement was evaluated according to the American College of Rheumatology (ACR) 20% response criteria. RESULTS: Eighty per cent of patients receiving the combination treatment with CsA and infliximab achieved the 20% ACR criteria for response to treatment, whereas 39% satisfied the 50% response criteria. In addition, a 76% reduction in swollen and tender joint count was found. Finally, a reduction in C reactive protein and erythrocyte sedimentation rate was maintained throughout the study. In general, treatment was well tolerated, with minimal adverse drug reactions. Two patients dropped out; one because of an immediate hypersensitivity reaction and the other because of the development of pulmonary tuberculosis. CONCLUSION: Multiple infusions of infliximab and low doses of CsA improve patients with refractory RA. It seems that CsA may be an alternative disease modifying drug to be used in combination with infliximab in patients with refractory RA who cannot tolerate MTX.
12672186 Patterns of disease modifying antirheumatic drug use in a Spanish cohort of patients with 2003 Apr OBJECTIVE: To determine the adequacy of disease modifying antirheumatic drug (DMARD) prescription to disease activity in patients with rheumatoid arthritis (RA) and to assess whether the reasons for DMARD discontinuation agree with published evidence. METHODS: Cross-sectional analysis of the baseline year of a RA cohort (n = 788) randomly selected from the clinical registries of 34 centers. Data about current and previous DMARD use was collected from medical records and confirmed by the patient. Disease activity score (DAS), Health Assessment Questionnaire (HAQ) and Larsen scores, and other clinical data were obtained during the study visit. RESULTS: At baseline visit, 607 patients (77%) were receiving one or more DMARD. Mean DAS, HAQ, and Larsen scores (+/- SD) were: 3.40 +/- 1.22, 1.6 +/- 0.4, and 54.68 +/- 26.37, respectively. Methotrexate (MTX) was the most frequently prescribed DMARD and parenteral gold salts (GS) showed the highest rate of discontinuation. MTX was used as single therapy in a significantly higher proportion (64.3%) than other DMARD (< 50%) and treatment discontinuation due to inefficacy was significantly less frequent (25.5%) than with other DMARD (> 40%). However, the DAS28 was significantly worse in the group treated with MTX in single therapy than in the group treated with GS alone (4.13 vs 3.43; p = 0.032). CONCLUSION: Despite the high use of DMARD among Spanish patients with RA, a significant number of them still have poor control of the disease. In addition, our data show a different perception of ineffectiveness depending on the DMARD used. A non-systematic use of objective quantitative tools for assessment of RA activity and some non-evidence based decisions on the management of DMARD may account for these findings.
15365781 The sesamoid index in psoriatic arthropathy. 2005 Apr OBJECTIVE: The sesamoid index was originally described as an aid to the diagnosis of acromegaly. We performed this study to assess the value of the thumb sesamoid index in the diagnosis of psoriatic arthropathy. DESIGN: Retrospective measurement of the sesamoid index (length x width of the medial thumb sesamoid), along with the age and sex were recorded for patients as described below. Patients with psoriasis were subdivided into those with or without radiographic evidence of hand arthropathy. PATIENTS: Fifty-nine consecutive patients attending rheumatology clinics with arthralgia and psoriasis were studied. Comparison groups with radiographic evidence of rheumatoid arthritis (52 patients), osteoarthritis (44) or normal hands (55) were also recorded. RESULTS: Twenty-one of 59 patients with psoriasis and arthropathy had a sesamoid index>40, compared with two of 52 with rheumatoid arthritis, none of 44 with osteoarthritis and none of 55 normals. CONCLUSIONS: Psoriatic arthropathy is a recognised cause of bone enlargement, usually in the phalanges due to periostitis and proliferative enthesopathy. We have confirmed that psoriatic hand arthropathy can cause significant enlargement of the thumb sesamoids, a feature which is easily quantified and may assist diagnosis.
12520821 Immunotherapy in autoimmune diseases. 2002 Nov Immunotherapy has the potential to modify or re-balance the immune system and hence useful in the management of autoimmune conditions. This article aims to review clinically useful immunotherapies available for treatment of autoimmune conditions, with particular emphasis on Type I diabetes mellitus, multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus. A Medline search for the period 1992 to 2002 (10 years) using the unrestricted keywords "immunotherapy AND autoimmune" was done. Full-length articles were selected for reviews based on the contents of their published abstracts. Additional Medline searches were focussed on the keywords "immunotherapy AND diabetes mellitus", "immunotherapy AND multiple sclerosis", "immunotherapy AND rheumatoid arthritis", and "immunotherapy AND systemic lupus erythematosus". Relevant publications referenced in the reviewed literature were further included for review, if not present in the original Medline search. Immunotherapy in Type I diabetes mellitus has focussed on the induction of tolerance to beta cell antigens, and in multiple sclerosis trials of anti-alpha 4 integrins and altered peptide ligand of myelin basic protein (MBP 83-99) showed initial promising results. The use of anti-cytokine therapy (anti-TNF alpha and IL-1Ra) in rheumatoid arthritis has improved the quality of life of patients with refractory disease. The use of anti-CD20 monoclonal antibody for in vivo B cells depletion and early trials of autologous peripheral stem cell transplants represent additional immunomodulatory treatment modalities for systemic lupus erythematosus patients. Better understanding of autoimmune conditions and advances in the production of humanized monoclonal antibodies, promises better immunotherapy in the near future.
14872223 [Anti-chromatin antibodies in juvenile rheumatoid arthritis]. 2003 Oct OBJECTIVE: to evaluate the prevalence and clinical significance of anti-chromatin antibodies (Abs) in juvenile rheumatoid arthritis (JRA). METHODS: IgG anti-chromatin Abs were detected by an enzyme-linked immunosorbent assay (ELISA), in sera of 94 children with JRA (10 children with systemic, 38 with polyarticular and 46 with oligoarticular disease onset). As control group, 33 age- and-sex-matched healthy children (HC) were also examined. RESULTS: Abs to chromatin were detected in 24/94 (25.5%) of children suffering from JRA. Particularly, the higher prevalence of anti-chromatin Abs has been found in children with oligoarticular (30,4%) and polyarticular (23.7%) onset JRA. In these groups Abs titers were significantly higher compared to systemic JRA and HC (p=0.003). Anti-chromatin Abs were observed more frequently in patients with oligoarticular disease and chronic uveitis (21.7%). Furthermore, higher levels of anti-chromatin Abs has been found in all the patients treated with anti-TNF-alpha therapy (p< 0.0001). CONCLUSIONS: our results confirm previous data about the prevalence of anti-chromatin Abs in JRA. These Abs were significantly higher in the group of patients with oligoarticular onset with past or present history of ocular involvement and in the group with polyarticular JRA treated with biologic therapy. A long-term follow-up study could be useful to evaluate the potential utility of these autoantibodies.
12117680 Anti-tumour necrosis factor (TNF) alpha treatment of rheumatoid arthritis (infliximab) sel 2002 Aug OBJECTIVE: To measure interleukin (IL)18 serum concentrations in patients with rheumatoid arthritis (RA) undergoing infliximab treatment (tumour necrosis factor (TNF) alpha blockade) and to evaluate the concomitant modification of IL12 and IL13 serum concentrations, two cytokines belonging to the Th1 and Th2 profile respectively and biologically related to IL18. METHODS: Ten patients with RA not responding to disease modifying antirheumatic drugs (DMARDs) received intravenous infliximab at a dose of 3 mg/kg at baseline and after two and six weeks. Serum samples were collected from all patients before each infusion and assayed for IL18, IL12, and IL13 by enzyme linked immunosorbent assay (ELISA); IL18 was also measured eight weeks after the last infusion. RESULTS: Serum concentrations of IL18 in all patients were already markedly reduced from baseline after two weeks (p<0.005). Serum IL18 was also decreased in a stable manner after six (p<0.01) and 14 weeks (p<0.01) compared with baseline concentrations. No significant modifications were found in serum concentrations of IL12 and IL13 at any time point. CONCLUSION: There was a rapid and persistent decrease in serum concentrations of IL18 in all the patients studied. This result provides evidence of an in vivo regulation of IL18 by TNFalpha and suggests that anti-TNFalpha therapy is likely to interrupt the synergistic effect between these two cytokines.
11893849 Treatment of rheumatoid arthritis by TNF-blocking agents. 2002 Jan Chimeric, humanized and fully human monoclonal antibodies directed against tumor necrosis factor-alpha as well as TNF receptor constructs can be administered relatively safely during long-term use for the treatment of rheumatoid arthritis (RA). Their therapeutic efficacy in patients refractory to treatment with conventional disease-modifying drugs was proven in large clinical trials and their ability to slow the progression of disease was demonstrated radiographically. The insights into the pathophysiology of RA provided by the beneficial effects of blocking proinflammatory cytokines will lead to further drug development for this destructive autoimmune disease.
12377742 Impaired responsiveness to NO in newly diagnosed patients with rheumatoid arthritis. 2002 Oct 1 OBJECTIVE: Cardiovascular disease is the major cause of excessive mortality in patients with rheumatoid arthritis (RA). We determined whether endothelial dysfunction characterizes patients with newly diagnosed RA (n=10) compared with normal subjects (control group, n=33) and whether it is reversible with 6 months of anti-inflammatory therapy. METHODS AND RESULTS: Endothelial function was determined by measuring vasodilatory responses to intrabrachial artery infusions of acetylcholine (ACh at 7.5 and 15 microg/min, low and high dose, respectively), an endothelium-dependent vasodilator, and to sodium nitroprusside (SNP, 3 and 10 micro g/min), an endothelium-independent vasodilator. Before treatment, blood flow responses (fold increase in flow) to low-dose SNP were 30% lower in the RA versus the control group (4.1+/-0.4-fold versus 5.9+/-0.5-fold, respectively), and responses to high-dose SNP were 34% lower in the RA group versus the control group (5.1+/-0.6-fold versus 7.7+/-0.7-fold, respectively; P<0.001). The responses to low-dose ACh were 50% lower in the RA group versus the control group (3.0+/-0.5-fold versus 6.6+/-0.7-fold, respectively), and responses to high-dose ACh were 37% lower in the RA group versus the control group (5.0+/-0.4-fold versus 7.9+/-0.8-fold, respectively; P<0.001). After therapy, clinical and laboratory markers of inflammation had significantly decreased. Blood flow responses to ACh increased significantly (P=0.02). CONCLUSIONS: We conclude that newly diagnosed patients with RA have vascular dysfunction, which is reversible with successful therapy. Therefore, early suppression of inflammatory activity may reduce long-term vascular damage.
15088293 Severe rheumatoid arthritis (RA), worse outcomes, comorbid illness, and sociodemographic d 2004 Apr OBJECTIVE: Fibromyalgia (FM) is a controversial construct. Recently suggested survey criteria identify persons with FM characteristics without physical examination or clinical diagnosis, thereby obviating many of the objections to FM. Little is known about FM among patients with rheumatoid arthritis (RAF). We used the survey definition to characterize persons with RAF and to obtain insight into possible pathogenic mechanisms. METHODS: A total of 11,866 patients with RA completed the Regional Pain Scale (RPS) and a 0-10 visual analog scale (VAS) for fatigue. FM was diagnosed in patients with an RPS score > or = 8 and a VAS fatigue score > or = 6. RESULTS: Altogether 1731 (17.1%) patients with RA fulfilled the criteria. Fewer RAF patients were married (64.9% vs 69.8%) and more were divorced (14.8% vs 10.4%); fewer were college graduates (19.7% vs 28.1%) and more did not finish high school (15.0% vs 8.9%). We found 35.8% of patients with FM but only 21.5% of those without FM had incomes less than 185% of the US poverty guidelines. Patients with RAF had higher validated hospitalization rates for major comorbid conditions and received treatment for comorbid conditions more often (expressed as odds ratios and 95% confidence interval): hypertension (1.5, 1.4-1.7), cardiovascular (1.8, 1.6-2.0), diabetes (1.9, 1.6-2.3), and depression (2.7, 1.8-4.2). RAF were 3.3 (3.0-3.7) times more likely to have been work-disabled (54.5% vs 26.4%) or to have total joint replacement (14.0% vs 11.2%; OR 1.3, 1.1-1.5), and incurred greater direct 6-month medical costs (6477 vs 4687 US dollars). RAF patients had more severe symptoms across all scales, including the Health Assessment Questionnaire (1.8 vs 1.0), pain (6.7 vs 3.4), Medical Outcomes Study Short Form-36 (SF-36) physical component score (23.5 vs 33.5), SF-36 mental component score (29.5 vs 46.1), and quality of life assessed by EuroQol mapped utilities (0.33 vs 0.65). CONCLUSION: FM exists in a substantial number of patients with RA (17.1%), who have more severe RA by subjective and objective measures, greater medical costs, worse outcomes, more comorbidities, sociodemographic disadvantage, and substantially worse quality of life. We hypothesize that illness severity and sociodemographic disadvantage both play a role in producing the clinical picture of FM.