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ID PMID Title PublicationDate abstract
12380141 [Symptomatic therapy of rheumatic diseases. How they reduce pain and thereby safe costs]. 2002 Aug 22 The leading symptom of rheumatic diseases is pain. Further common symptoms are swelling, restricted mobility and joint deformation. The aim of treatment is freedom from pain and unrestricted function of the affected parts, together with improved quality of life. Amelioration of pain usually succeeds with the so-called non-steroidal antiinflammatory drugs (NSAIDs). In 10% of the cases, however, these can lead to gastric bleeding and perforation necessitating emergency hospitalization. Approximately 10% of patients with complicated ulcers die. COX-2-inhibitors have an analgesic action equal to that of conventional NSAIDs, but cause appreciably fewer gastrointestinal complications. Comedication of NSAIDs and misoprostol or omeprazole also has a gastric protective effect. Concomitant treatments, provision of aids and relevant information about the disease and its course, help to secure a good outcome. In the last resort, when conservative treatment fails, surgical intervention becomes necessary.
12720535 Effect of cyclical intermittent etidronate therapy on circulating osteoprotegerin levels i 2003 May OBJECTIVE: To evaluate the role of serum osteoprotegerin (OPG) as a biochemical marker for disease activity assessment and drug monitoring in patients with rheumatoid arthritis (RA) treated with cyclical etidronate. DESIGN: Forty patients (35 women and 5 men) with RA of <5 years duration were randomized to receive intermittent cyclical etidronate therapy in conjunction with anti-rheumatic therapy or anti-rheumatic therapy alone (without etidronate) in a 2-year, open-label protocol. METHODS: Radiographs of hands and feet and serum samples for the determination of OPG, amino terminal propeptide (PINP), cross-linked C-telopeptide (ICTP) and amino terminal telopeptid of type I collagen were obtained at baseline and at 24 months. RESULTS: Etidronate treatment had no effect on circulating OPG levels, although the significant decline in PINP and ICTP (P=0.001 and P=0.04 respectively) reflected the efficacy of the anti-resorptive therapy. At baseline and at study termination, serum OPG correlated significantly with age (r=0.45; P=0.003 and r=0.56; P=0.0002 respectively). OPG was not related to biochemical markers of bone metabolism, indices of disease activity or radiographic disease progression. At baseline, the mean serum OPG was higher in patients receiving 5-10 mg/day prednisone (82.8+/-4.0 pg/ml, n=16) compared with those receiving <5 mg/day or with no prednisone (69.7+/-4.7 pg/ml, n=23) (P=0.05). CONCLUSIONS: Our results suggested that serum OPG measurement, perhaps because of the complexity of the regulation of the OPG, may be difficult to utilize in the evaluation of anti-resorptive therapy. Moreover, low dose corticosteroid-associated osteoporosis is probably not mediated by inhibition of OPG.
15048003 Unusual haematological alterations in rheumatoid arthritis. 2004 Jan Three cases of rheumatoid arthritis (RA), presenting with refractory anaemia, thrombocytopenia and peripheral lymphocytosis respectively, were observed. In all the cases haematological manifestations were unrelated to disease activity or drug toxicity. These patients were detected to have pure red cell aplasia (PRCA) (normocytic normochromic anaemia, reticulocytopenia and absence of erythroid precursors in the bone marrow), immune thrombocytopenia (IT) (absence of splenomegaly and presence of increased megakaryocytes in the bone marrow) and multiple myeloma (MM) (lytic lesions on skull, paraproteinaemia and bone marrow plasmacytosis) respectively. PRCA and IT responded to glucocorticoids. Association with these three haematological alterations has rarely been reported. Our report highlights the need to regularly monitor blood counts in patients with RA.
15024603 Biaxial total wrist arthroplasty in rheumatoid arthritis. Satisfactory functional results. 2005 Apr We reviewed 16 uncemented biaxial total wrist arthroplasties (TWA) in 14 patients with rheumatoid or juvenile arthritis. The mean follow-up was 25 months (range 5-60). According to the Hospital for Special Surgery scoring system (HSS), good-to-excellent results were accomplished in 69%, moderate in 19%, and poor in 12%. The mean pain score was 0.4 on a visual analog scale from 0-10 (0=no pain). The Wrightington activities of daily life assessment chart showed a 63% improvement, and we found a threefold increase in range of motion at follow-up. Four TWAs showed early dislocation, one of which was revised. Biaxial TWA yields good short-term results in rheumatoid patients, although instability is a frequent complication.
15570637 Folate, homocysteine, and cobalamin status in patients with rheumatoid arthritis treated w 2004 Dec OBJECTIVE: To investigate the effect of methotrexate (MTX) treatment of rheumatoid arthritis (RA) on folate metabolism, and to determine the effect of low dose folic acid on toxicity, efficacy, and folate status. METHODS: A 52-week prospective study of 81 patients with RA treated with MTX and self-administered low dose folic acid; 38 patients were included prior to MTX therapy, 33 patients continued established MTX therapy, and 10 patients were excluded. Drug efficacy and side effects were monitored with biochemical and clinical indicators. RESULTS: MTX treatment resulted in decreased concentrations of red blood cell (RBC) folate and a rise in plasma homocysteine. Intracellular concentrations of MTX were inversely correlated to RBC folate levels after treatment for a longer period (mean 41 months). Supplement with low dose folic acid prevented or diminished the influence of MTX on folate status and had a protective effect on MTX induced liver toxicity without changing the efficacy of MTX. CONCLUSION: MTX interferes with folate and homocysteine metabolism, and the intracellular concentration of MTX may play a role. Our results indicate low dose folic acid supplementation has a beneficial effect on MTX toxicity.
12114281 Serum prolactin concentrations in male patients with rheumatoid arthritis. 2002 Jun Altered serum prolactin (PRL) levels have been reported in autoimmune diseases; however, data of serum PRL concentrations in rheumatoid arthritis (RA) are contradictory. We evaluated the PRL status in men affected by RA and the possible relationships among serum PRL levels, bone mass, and disease activity. We investigated 29 men affected by RA and 30 age- and sex-matched controls. All patients were evaluated for serum PRL levels, parameters of disease activity, and bone mineral density (BMD) at L2-L4 and the femoral neck. Serum PRL levels were found significantly higher in men with RA than in controls (p = 0.001). High serum PRL levels were significantly correlated with duration of RA and some laboratory parameters of RA disease activity. A negative correlation between femoral BMD and serum PRL levels were found (r = -0.821, p = 0.001). Male patients affected by RA showed high serum PRL levels. The serum PRL concentration was found to be increased in relation to the duration and the activity of the disease. Serum PRL levels do not seem to have any relationship with the BMD, at least in RA.
12522838 Attentional functioning in fibromyalgia, rheumatoid arthritis, and musculoskeletal pain pa 2002 Dec 15 OBJECTIVES: To investigate whether chronic pain patients have deficits in attentional functioning compared with pain-free controls, and whether fibromyalgia patients have larger deficits in attentional functioning compared with rheumatoid arthritis and musculoskeletal pain patients. METHODS: Sixty patients (20 in each of 3 patient groups) and 20 pain-free controls completed measures assessing pain intensity, mood, pain-related disability, somatic awareness, and catastrophic thinking about pain. Attentional functioning was assessed using an age-standardized, ecologically valid test battery. Analyses were made of between-group differences. RESULTS: Sixty percent of patients had at least one score in the clinical range of neuropsychological impairment, independent of demography and mood. Fibromyalgia patients were more anxious and somatically aware than rheumatoid arthritis or musculoskeletal pain patients, but did not show larger attentional deficits than other patient groups. CONCLUSION: All 3 groups of chronic pain patients, regardless of diagnosis, had impaired cognitive functioning on an ecologically sensitive neuropsychological test of everyday attention.
14626628 The costs of early inflammatory joint disease: a population-based study in southern Sweden 2003 OBJECTIVE: To study the costs and use of healthcare for patients during the first months with early joint inflammation, in a population-based prospective referral study in Southern Sweden. METHODS: Adult patients with arthritis for < 3 months and with onset of symptoms between 1 May 1999 and 1 May 2000 were referred from primary health centres to rheumatologists. Four clinical assessments were performed during a 6-month follow-up period. The direct medical costs for inpatient stays, outpatient visits, visits to general practitioners, and visits to health professionals, as well as costs for medication, radiographs, and laboratory tests were recorded from the onset of the disease up to 6 months of follow-up. Indirect costs for sick leave were also recorded. RESULTS: Fifty-six of 71 referred patients agreed to participate. Thirteen (23%) had RA, 21 (38%) had reactive arthritis (ReA), 14 (25%) had undifferentiated arthritis, and eight (14%) had other arthritides. The median cost per patient in the entire group was USD 3362. The median cost per patient in the RA group was USD 4385, and USD 4085 in the ReA group. There was no statistically significant difference in the median costs per patient in the different diagnostic groups. Sick leave accounted for 44% of the total costs in the entire group, and 46% and 47%, respectively, in the RA and ReA groups. CONCLUSION: The costs of early arthritis are already considerable during the first months of the disease following the onset of the symptoms. The indirect costs due to sick leave accounted for nearly half of the costs.
12228157 Clinical outcome in 22 patients with rheumatoid arthritis treated with B lymphocyte deplet 2002 Oct OBJECTIVES: To obtain evidence for dose response and to extend evidence of safety and efficacy for B lymphocyte depletion in rheumatoid arthritis. METHODS: Twenty two patients with rheumatoid arthritis received a total of 29 treatments with five different combinations of rituximab (RTX), cyclophosphamide (CP), and/or high dose prednisolone (PR) on an open basis as follows; cohort I: RTX 1400 mg/m(2), CP 750x2+PR; cohort II: RTX 300-700 mg/m(2), -CP+/-PR); cohort III: RTX 600-700 mg/m(2), CP 750x2+PR; cohort IV: RTX 1200 mg/m(2), CP 750x2-PR; cohort V: RTX 500 mg/m(2), CP 750x2+PR. American College of Rheumatology (ACR) criteria of improvement at six months were chosen as the primary outcome measure. Disease activity scores and total duration of improvement and of B cytopenia were also recorded. RESULTS: No major adverse events attributable to treatment were seen. ACR grades of improvement at six months were as follows: cohort I: ACR70x3, ACR50x2; cohort II: ACR20x1, ACR0x3; cohort III: ACR70x6, ACR50x2, ACR20x2; cohort IV: ACR70x2, ACR50x2, ACR20x1, ACR0x1; cohort V: ACR0x4. CONCLUSIONS: B lymphocyte depletion in rheumatoid arthritis has so far proved to be safe and associated with major improvement with protocols including RTX 600 mg/m(2) or more and CP, but not with more limited protocols. These observations provide an initial basis for the design of formal trials of B cell depletion and other B cell directed treatments, including a phase II controlled trial now in progress.
15517298 [The role of utilities in economic evaluations of healthcare interventions-an introduction 2004 Oct Assessment of strength of preference values (utilities) for patients' own health, or disease states from a societal perspective, is an essential element to economic evaluations of healthcare interventions. This review provides an overview of the different methods used to directly elicit strength of preference values: the standard gamble, time trade-off and rating scale methods. Methods used to derive utilities for patients' health states indirectly, and from a societal perspective are described. Three commonly used questionnaires: Health Utilities Index 3, EQ-5D and SF-6D are briefly commented upon. We also discuss the usefulness of utilities and advantages and disadvantages to be considered when choosing direct or indirect utility elicitation methods.
11744304 Kalopanaxsaponin A from Kalopanax pictus, a potent antioxidant in the rheumatoidal rat tre 2002 Jan The stem bark of Kalopanax pictus is an anti-rheumatoidal arthritis drug in Oriental medicine. In the rheumatoidal rat, induced by Freund's complete adjuvant (FCA) reagent, we investigated the effects of hederagenin monodesmosides of K. pictus on oxidative stress and hepatic drug-metabolizing enzymes. Kalopanaxsaponin-A (KPS-A) significantly decreased malondialdehyde formation and the activities of xanthine oxidase and aldehyde oxidase of hepatic non-microsomal systems in FCA reagent-treated rats. In addition, increased activity levels of superoxide dismutase, catalase and glutathione peroxidase were also observed. The effects of KPS-A were more potent than the effects of KPS-I. These results suggested that KPS-A, extracted from K. pictus, could reduce rheumatoidal syndromes through antioxidative mechanisms.
12759465 Validity of the Nottingham Health Profile in a Finnish out-patient population with rheumat 2003 Jul OBJECTIVE: To assess the quality of life of 122 rheumatoid arthritis (RA) patients using the Nottingham Health Profile (NHP), which is a generic quality-of-life instrument, and to compare the results with those of 99 healthy local control subjects. METHODS: Our patient group represented consecutive out-patients from a central hospital. The NHP contains 38 items, each with a weighted score, that assess subjective distress on six dimensions: mobility, pain, energy, sleep, emotional reactions and social isolation. RESULTS: The median (age-adjusted) NHP scores for mobility, pain and energy showed statistically highly significant differences (P < 0.001) between the RA patients and the control group, indicating a poorer quality of life among the RA patients on all these dimensions. These NHP dimensions were also closely related to patients' experience of their overall health status. The NHP scores for sleep, emotional reaction and social isolation did not differ between the patients and the controls. CONCLUSION: The NHP, an instrument for assessing health-related quality of life, differentiated RA patients from local healthy individuals on the dimensions of mobility, energy and pain.
12928223 Indications for requesting laboratory tests for concurrent diseases in patients with carpa 2003 Sep BACKGROUND: Carpal tunnel syndrome (CTS) is known as a repetitive motion disorder, but the role of other diseases in the development or prognosis of CTS is uncertain. We reviewed the literature to determine whether there is evidence for an increased prevalence of specific conditions in CTS patients and whether this evidence would support laboratory screening for these conditions. METHODS: Medline, Embase, and Cochrane Controlled Trial Register were searched for key words related to CTS and associated diseases. Relevant articles were selected according to specific criteria. Sources of bias and heterogeneity attributable to differences in study design and in patient selection were investigated by subgroup analysis. RESULTS: After an initial search, we limited ourselves to three potentially important conditions: diabetes mellitus (DM), hypothyroidism (HT), and rheumatoid arthritis (RA). We identified nine articles with a total of 4908 CTS patients and 7671 controls that met our selection criteria. The nine studies were heterogeneous with respect to clinical and methodologic factors. In general, the prevalence of concurrent diseases was higher in CTS patients than in controls: the pooled odds ratios were 2.2 (95% confidence interval, 1.5-3.1) for DM, 1.4 (1.0-2.0) for HT, and 2.2 (1.4-3.4) for RA. Studies of lower methodologic quality reported, on average, higher odds ratios. Only one study provided information about whether the diagnosis of the concurrent condition was already made at the time of the CTS diagnosis. CONCLUSIONS: We found evidence that the prevalences of DM, HT, and RA are higher in CTS patients, but only one study specifically addressed the issue of the prevalence of nonmanifest cases of the concurrent condition. At present, there is insufficient evidence for routine laboratory screening for concurrent conditions in all newly diagnosed CTS patients.
12022317 Increase in lifetime adverse drug reactions, service utilization, and disease severity amo 2002 May OBJECTIVE: Nonrandom assignment of therapy in observational studies and clinical practice can be accompanied by channeling bias and confounding by indication. This in turn can lead to unreliable conclusions about treatment effectiveness. Although widely acknowledged as important, no studies in rheumatology have measured the extent of these biases. We identified variables contributing to confounding and investigated the strength of the confounding effect. Analytical methods (propensity scores) are available to mitigate the effect of nonrandom assignment if the full extent of confounding can be understood. METHODS: A population of 6637 patients with rheumatoid arthritis (RA) and osteoarthritis (OA) from the practices of 433 US rheumatologists completed 2 sets of detailed questionnaires concerning (1) the last 6 months in 1998 and (2) the first 6 months of 1999, generally prior to and after the release of celecoxib and rofecoxib. Patients who received the COX-2 specific inhibitors in period 2 were identified (n = 1517), and their characteristics were compared to the 5120 who did not start a new COX-2 specific inhibitor during Period 1. RESULTS: Patients starting a new COX-2 specific inhibitor had a greater lifetime history of adverse reactions of all kinds, but particularly gastrointestinal adverse drug reactions. They also had more severe scores for pain, functional disability, fatigue, helplessness, and global severity, and they used more inpatient and outpatients services than patients who would not switch to COX-2 specific inhibitors. CONCLUSION: Confounding by indication and channeling bias result in an overall increase in severity of about 25% for the above measures. Observational studies should account for these biases by a broadly defined propensity score that includes the variables identified in this report. These observations are germane to observational studies of disease modifying antirheumatic drugs and biologics, as well, and suggest the need for careful control of confounders when assessing treatment effects in rheumatic disease observational studies.
11874838 Review of the function of a telephone helpline in the treatment of outpatients with rheuma 2002 Apr OBJECTIVES: To examine the role, acceptability, and cost effectiveness of a telephone helpline organised and run by specialist nurses in a district general hospital outpatient rheumatology department. MATERIAL AND METHODS: Patients accessed the telephone helpline by leaving a taped message on an answer phone with a 24 hour response time. Assessment included an audit of the nature and outcome of helpline calls, patient satisfaction with the helpline, and a health economic analysis of the helpline operation. A postal questionnaire was used to assess patient satisfaction; this was sent to the 87 patients who called the helpline during one month, and overall satisfaction with the helpline was assessed. The nature and outcome of all calls was analysed retrospectively using a helpline record book for February and October of one year and February of the following year. From the results of the retrospective analysis and an estimate of the number of general practitioner consultations avoided by provision of the helpline, the cost effectiveness of the helpline was calculated. RESULTS: Of those returning questionnaires, 61/63 (97%) were satisfied with the response time, 63/63 (100%) with the courtesy, and 60/63 (95%) felt that their questions were answered directly and to their satisfaction in 62 (98%) of cases. Had the helpline not been available, 38/63 (60%) patients would have made an appointment with their GP. When these figures were extrapolated to an annual estimation, a basic cost analysis showed that the helpline produced a cost saving to the NHS, largely as a result of GP consultations avoided. CONCLUSION: Clinical advice and support can be provided by a rheumatology helpline set up as an adjunct to a standard outpatient service. The results of a postal questionnaire suggested more than 95% satisfaction with all aspects of the helpline service and that 99% of callers would call the helpline again. The provision of the helpline service contributes to the quality of care provided by an outpatient department and provides benefit to the NHS.
15546398 Is targeting Toll-like receptors and their signaling pathway a useful therapeutic approach 2004 Dec Cytokine-driven inflammation and tissue destruction is a common theme of chronic inflammatory diseases such as rheumatoid arthritis, Crohn's disease, ulcerative colitis, psoriasis, chronic obstructive pulmonary disease, and atherosclerosis. Research over the last two decades demonstrated the importance of cytokines that are not only expressed chronically but also are capable of signaling at sites of chronic inflammation. Cytokines thus regulate major pathological processes that include inflammation, angiogenesis, tissue remodeling, and fibrosis. This research led to the identification of key cytokines involved in these processes, two of which, tumor necrosis factor-alpha and interleukin-1, have also been successfully targeted in the clinic. However, what triggers and maintains cytokine gene expression in chronic inflammation remains a mystery. In this article, we review current progress in the understanding of cytokine-driven inflammation and discuss current evidence implicating Toll-like receptors (TLRs), recently identified as the receptors recognizing self versus non-self molecular patterns, in the regulation of cytokine-driven inflammation. Whether targeting TLRs and their downstream signaling pathway will prove to be a successful approach for the treatment of these devastating diseases remains to be determined.
12787514 Radiography in the assessment of musculoskeletal conditions. 2003 Jun Plain film radiography is the most widely used imaging technique for diagnosing and monitoring the progression of chronic inflammatory and degenerative joint diseases. Advanced imaging techniques that are better suited for detecting soft-tissue inflammation are available, but they are more costly and some of them may expose the patient to higher doses of radiation. Plain film radiographs are inexpensive, easy to generate, can be compared with baseline and prospective films, and provide a permanent, reproducible record. Radiographs can easily detect the features that are specific to various rheumatological disorders, and serial radiography can be used to assess response to therapy by measuring erosions, joint space narrowing, and other disease-specific features. This chapter discusses the use of radiography for diagnosing and differentiating various rheumatic joint diseases, specifically rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and osteoarthritis. The most frequently used scoring systems that are used to assess and monitor the severity and progression of these disorders are briefly described.
14722207 Self reported non-vertebral fractures in rheumatoid arthritis and population based control 2004 Feb OBJECTIVE: To compare the incidence of self reported non-vertebral fractures after RA diagnosis between female patients with RA and control subjects, and to explore possible associations between non-vertebral fractures and bone mineral density (BMD), disease, and demographic factors. METHODS: 249 women (mean age 63.0 years) recruited from a county register of patients with RA and population controls (n = 249) randomly selected after matching for age, sex, and residential area were studied. Data on previous non-vertebral fractures were obtained from a detailed questionnaire, and BMD was measured at the hip and spine. RESULTS: 53 (21.3%) patients with RA had had 67 fractures after RA diagnosis, the corresponding numbers for controls were 50 (20.1%) and 60 (odds ratio (OR) for paired variables for overall fracture history 1.09, 95% CI 0.67 to 1.77). The overall fracture rates per 100 patient-years were 1.62 and 1.45, respectively, but self reported hip fractures were increased in RA (10 v 2, OR 9.0, 95% CI 1.2 to 394.5). Patients with a positive fracture history had longer disease duration, were more likely to have at least one deformed joint, and had lower age and weight adjusted BMD than those with no fracture history. In logistic regression analysis, fracture history was independently related to BMD only. CONCLUSIONS: With the probable exception of hip fractures, non-vertebral fractures do not seem to be a substantial burden in RA. Similar independent relationships between levels of BMD and fracture history were found in patients with RA and in population based controls.
15586842 Self-valuation and societal valuations of health state differ with disease severity in chr 2004 Nov OBJECTIVES: We sought to determine the relationship between self-reported ratings of health-related quality of life (HRQoL) by people with 3 chronic and disabling conditions and population estimates of those health states and to model factors that might explain the disagreement between these 2 ratings. RESEARCH DESIGN: A cross-sectional postal survey was sent in which each participant completed a set of questionnaires addressing HRQoL. Data from self-valuation on a visual analog scale (VAS) was compared with a population-based VAS-equivalent valuation, using the EQ-5D instrument. Different ways of scaling the 2 VAS scores were also explored. Data were analyzed using descriptive statistics and analysis of covariance. SUBJECTS: A community sample of 1036 people took part in the study (rheumatoid arthritis n = 142, stroke n = 585, multiple sclerosis n = 309). MEASUREMENT INSTRUMENT: The EQ-5D health state profile and accompanying visual analog scale were used. RESULTS: Self-ratings were significantly different than the population-based ratings, and agreement was poor, both on the original scale of the data and by analyses of rescaled data. On the original scales the mean difference was 0.13 (95% confidence interval 0.117-0.143). Diagnosis, health state severity, and its square explained 35.3% of the variation in the differences between self and population ratings with a curvilinear relationship suggesting that the differences increased as the health state worsened, but at a decreasing rate as health state severity increased. CONCLUSIONS: This study provides evidence that EQ-5D population valuation estimates of treatment benefit for people with disabling and chronic conditions may well be inaccurate representations of the degree of change actually experienced by the individual with the condition. The varying magnitude of difference between the 2 forms of valuation has important implications for interpreting shifts in health status valuation following interventions for these populations.
15291254 [A case of rheumatoid arthritis/Sjogren's syndrome with acute renal failure due to hyperur 2004 Jun A 64-year-old woman was diagnosed as having rheumatoid arthritis in 1999 at a nearby hospital. She had been treated with etodolac, actarit, mizoribine (MZ) and prednisolone. On May 25, 2001, she noticed fever and nausea and was treated with diclofenac sodium and clindamycin. On May 31, a nasal bleeding, tarry stool, hyperuricemia, renal dysfunction and thrombocytopenia developed and she was admitted to our hospital. Administration of drugs except prednisolone was stopped and hemodialysis was carried out on June 1. Fever and nausea improved during several days. Hyperuricemia and renal dysfunction disappeared on June 11. The platelet count became normal after platelet transfusion and she was discharged from our hospital on July 2. She was also diagnosed as having Sjogren's syndrome. In our case, a delay in MZ discharge by transient renal dysfunction might have caused a hyperuricemia, following an aggravation of renal dysfunction. So, care should be taken about latent renal dysfunction during the use of MZ. Moreover, it may be necessary to consider a discontinuation of MZ and administration of hemodialysis in the case of transient renal dysfunction.