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ID PMID Title PublicationDate abstract
12905469 Synovial fluid exoglycosidases are predictors of rheumatoid arthritis and are effective in 2003 Aug OBJECTIVE: To analyze enzymes involved in joint damage by simultaneous investigation of glycosidases and matrix metalloproteinases (MMPs) in patients with various joint diseases. METHODS: Activities of glycosidases (beta-D-glucuronidase, beta-D-N-acetyl-glucosaminidase, beta-D-N-acetyl-galactosaminidase, beta-D-galactosidase, and alpha-D-mannosidase) were tested at an acidic pH as well as at the original pH of the synovial fluid (SF) samples in parallel with activities of MMP-1 and MMP-9. RESULTS: Patients with rheumatoid arthritis (RA) were characterized by significantly elevated activities of beta-D-glucuronidase and beta-D-N-acetyl-glucosaminidase in SF compared with patients with osteoarthritis, seronegative spondylarthritis, or acute sports injury. To select the best predictor for distinguishing among patient groups, a stepwise logistic regression analysis was performed; the strongest association was found to be between RA and beta-D-glucuronidase/beta-D-N-acetyl-glucosaminidase activities (measured at the pH of the SF). Further, a significant correlation was observed between the activity of SF beta-D-N-acetyl-glucosaminidase and the level of rheumatoid factor. In vitro digestion of human hyaline cartilage samples revealed that the dominant glycosidases, alone or in combination with MMPs, proved to be effective in depleting glycosaminoglycans (GAGs) from cartilage. CONCLUSION: These results suggest that exoglycosidases, which are present in the SF of RA patients, may contribute to the depletion of GAGs from cartilage and thereby facilitate the invasion of synovial cells and their attachment to cartilage in RA.
12823854 Upregulated hypoxia inducible factor-1alpha and -2alpha pathway in rheumatoid arthritis an 2003 The pathogenesis of rheumatoid arthritis (RA) and osteoarthritis (OA) remains obscure, although angiogenesis appears to play an important role. We recently confirmed an overexpression of two angiogenic factors, namely vascular endothelial growth factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF), by the lining and stromal cells of the synovium in both conditions. Because hypoxia inducible factor (HIF)-1alpha and HIF-2alpha are essential in regulating transcription of the VEGF gene, active participation of HIF-alpha molecules in the pathogenesis of these arthritides is anticipated. We investigated the immunohistochemical expression of HIF-1alpha and HIF-2alpha in the synovium of 22 patients with RA, 34 patients with OA and 22 'normal' nonarthritic individuals, in relation to VEGF, VEGF/KDR (kinase insert domain protein receptor) vascular activation, PD-ECGF and bcl-2. A significant cytoplasmic and nuclear overexpression of HIF-1alpha and HIF-2alpha was noted in the synovial lining and stromal cells of both diseases relative to normal. Overexpression of HIF-alphas was related to high microvessel density, high PD-ECGF expression and high VEGF/KDR receptor activation, suggesting HIF-alpha-dependent synovial angiogenesis in OA. By contrast, the activation of the angiogenic VEGF/KDR pathway was persistently increased in RA, as indeed was microvessel density and the expression of PD-ECGF, irrespective of the extent of HIF-alpha expression, indicating a cytokine-dependent angiogenesis. In all cases, the VEGF/KDR vascular activation was significantly lower in OA than in RA, suggesting a relative failure of the HIF-alpha pathway to effectively produce a viable vasculature for OA, which is consistent with the degenerative nature of the disease. The activation of the HIF-alpha pathway occurs in both RA and OA, although for unrelated reasons.
12426848 [Long-term follow-up and prognosis of work capacity in the early stage of chronic polyarth 2002 Aug OBJECTIVES: Work disability (WD) in early rheumatoid arthritis (RA) has not been extensively evaluated in Germany. Therefore, the occurrence of WD pension within the first seven years of RA and prognostic indicators of the first year including the duration of sick leave (SL) were analyzed. PATIENTS AND METHODS: Within the first year of RA according to the ACR 1987 criteria, 141 gainfully employed patients were entered into a prospective multicenter study (61% females, mean age 47 +/- 9 years, mean disease duration 6 +/- 3.5 months). One hundred and ten patients (78%) participated in a reevaluation (postal questionnaire) after a mean follow-up of 6.1 +/- 0.4 years. Predictors of WD pension were identified in univariate analyses and in backward multivariate Cox regression analyses (p < 0.05) with Hazard-ratios [H-R] as measures of WD risk. RESULTS: Of 110 patients 53 (48%) were still employed at reexamination. WD due to RA occurred in 5% after one year disease duration, in 15% after 2 years, in 20% after 3 years, and in 28% after 6.5 years. Other reasons for leaving the labor force were found in 24%. High pain intensity, radiographic erosions, comorbidity and the pain behavior of avoidance were associated with WD only in univariate analyses. Age > 45 years [H-R 6.3] and the following job-related prognostic indicators were identified in the multivariate analyses: working under pressure of time [H-R 9.0], limited joint motion interferring with job tasks [H-R 5.9], feeling overworked [H-R 3.8] and work status (unskilled blue-collar workers vs white-collar professionals and self-employed persons) [H-R 3.4]. In an alternative final Cox-regression model the variables feeling overworked and work status were replaced by SL duration > 8 weeks within the first year of RA [H-R 7.1]. CONCLUSIONS: Since WD frequently occurs already within the first 3 years (20%) adequate interventions resulting from the prognostic indicators have to begin early in the course of RA. Apart from the rheumatological treatment and rehabilitation focusing on the reduction of pain, improved coping with pain, reduced joint destruction and improved mobility particularly working under pressure of time should be avoided and the work place has to be adjusted in case of limited joint motion interferring with job tasks. SL of several weeks duration already within the first year of RA is a red flag for impending WD.
14974037 Paracetamol versus nonsteroidal anti-inflammatory drugs for rheumatoid arthritis. 2004 BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually preferred for simple analgesics such as paracetamol for rheumatoid arthritis. It is not clear, however, whether the trade-offs between benefits and harms of NSAIDs are preferable to those of paracetamol (paracetamol is also called acetaminophen). OBJECTIVES: To compare the benefits and harms of paracetamol with NSAIDs in patients with rheumatoid arthritis. SEARCH STRATEGY: Medline Silverplatter, Embase databases were searched up until Sept 2002. Reference lists of identified articles were also searched. SELECTION CRITERIA: Randomised double-blind studies comparing paracetamol with an NSAID. DATA COLLECTION AND ANALYSIS: Decisions on inclusion of trials and data extraction were performed by the two authors independently. MAIN RESULTS: Four cross-over studies, published between 1968 and 1982, involving 121 patients, and four different NSAIDs were included. The generation of the allocation sequence and the use of methods to conceal the allocation were not described in any of the studies. The studies were double-blind but it was not clear whether the blinding was effective. Methods for collecting adverse effects were not described. The NSAIDs were preferred more often than paracetamol by the patients or the investigator. In the largest trial, 20 out of 54 patients (37%) preferred ibuprofen and 7 out of 54 (13%) paracetamol. Investigators preference (as established by joint tenderness, grip strength and joint circumference) was 17 out of 35 for diclofenac versus 5 out of 35 for paracetamol in another trial. However, because of the weaknessess in the trials, no firm conclusion can be drawn. REVIEWER'S CONCLUSIONS: When considering the trade off between the benefits and harms of non-steroidal anti-inflammatory drugs and paracetamol/acetaminophen, it is not known whether one is better than the other for rheumatoid arthritis. But people with rheumatoid arthritis and the researchers in the study did prefer non-steroidal anti-inflammatory drugs more than acetaminophen/paracetamol. There is a need for a large trial, with appropriate randomisation, double-blinding, test of the success of the blinding, and with explicit methods to measure and analyse pain and adverse effects.
15539412 Depletion of synovial macrophages in rheumatoid arthritis by an anti-FcgammaRI-calicheamic 2005 Jun BACKGROUND: Monocytes/macrophages have an important and versatile role in joint inflammation and destruction in rheumatoid arthritis (RA). OBJECTIVE: To determine the efficiency of monocyte/macrophage elimination by a new drug conjugated antibody (CD64-calicheamicin (CD64-CaMi)) directed to the high affinity receptor for IgG (FcgammaRI). METHODS: Mononuclear cells from peripheral blood and synovial fluid of patients with RA were cultured in the presence of CD64-CaMi. Cell death of monocytes/macrophages was measured by analysis of phenotypic changes (light scatter patterns, CD14 expression, and FcgammaRI expression) and nuclear DNA fragmentation. The selectivity of CD64-CaMi was checked by using FcgammaRI deficient and FcgammaRI transfected cell lines. In addition, the indirect effect of CD64-CaMi-induced macrophage cell death on arthritogenic T(h1) cell activity was determined. RESULTS: Inflammatory macrophages from RA synovial fluid, expressing increased FcgammaRI levels, were efficiently killed by CD64-CaMi through induction of DNA fragmentation. CD64-CaMi-induced cell death of monocytes/macrophages from peripheral blood of patients with RA proved less efficient. Induction of synovial macrophage death by CD64-CaMi was accompanied by efficient inhibition of proinflammatory T(h1) cytokine production. CONCLUSION: Together, the presented data suggest that elimination of macrophages through a new FcgammaRI directed CD64-CaMi is feasible. Because monocytes from peripheral blood are also eliminated by this immunoconjugate, additional experimental studies should validate its potential for local (intra-articular) application in the treatment of RA.
14628150 Serum oxidized low-density lipoproteins in rheumatoid arthritis. 2004 Jul OBJECTIVE: The aim of this study was to measure serum oxidized low-density lipoprotein (Ox-LDL) levels in patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) and to identify any association with clinical variables. METHODS: We studied 126 female patients (27 with active RA, 27 with inactive RA, 72 with SLE). One hundred fifteen age-matched healthy women (76 for RA, 39 for SLE) with no clinical or laboratory evidence of disease served as normal controls. Serum Ox-LDL levels were measured with a commercial enzyme-linked immunosorbent assay kit (Mercodia, Sweden). RESULTS: The serum Ox-LDL levels were significantly higher in patients with active RA (P<0.05) or SLE (P<0.01) than age-matched controls and significantly higher in patients with active RA than with inactive RA (P<0.01). The levels of serum total cholesterol and LDL were significantly lower in patients with RA than in age-matched controls (P<0.01). There was no correlation among serum Ox-LDL levels and inflammatory markers (erythrocyte sedimentation rate, C-reactive protein) or rheumatoid factors in patients with RA. CONCLUSIONS: Compared with healthy women, those with SLE or active RA had increased serum Ox-LDL levels, which may contribute to the increased risk of cardiovascular disease in this patient group.
15381644 Declines in mortality from acute myocardial infarction in successive incidence and birth c 2004 Sep 28 BACKGROUND: Patients with rheumatoid arthritis are at high risk for acute myocardial infarction (AMI). The treatment of rheumatoid arthritis has become more intensive over the past 2 decades, resulting in tighter control of inflammation and lower levels of disability. The impact of this on atherosclerotic cardiovascular diseases is not known. METHODS AND RESULTS: Death rates from AMI in a cohort of 3862 patients with rheumatoid arthritis followed up from 1980 to 1997 were studied. Time trends in AMI mortality among successive incidence and birth cohorts were examined by use of multivariable Poisson regression models and by comparing standardized mortality ratios. The mean age was 56 years in this predominantly female cohort (76%), and median disease duration was 6.5 years. During the period of observation, the use of methotrexate increased substantially, whereas that of prednisone was relatively stable. Over the 22,209 person-years of observation, there were 157 deaths as a result of AMI, with a death rate of 7.06 per 1000 person-years. Mortality rates were higher in older age groups and in men. After adjustment for age, sex, race, and disease duration, the risk of AMI declined in successive incidence years (relative risk, 0.94; 95% CI, 0.92 to 0.96). Patients with rheumatoid arthritis incident after 1990 did not have excess AMI mortality compared with general population. Declines in mortality trends were observed in successive birth cohorts as well. CONCLUSIONS: Mortality as a result of AMI among patients with rheumatoid arthritis has declined over time.
15031666 Serum concentrations of soluble 4-1BB and 4-1BB ligand correlated with the disease severit 2004 Feb 29 Rheumatoid arthritis (RA) is a multifactorial autoimmune disease whose etiopathogenesis is not well understood. Although soluble (s) forms of 4-1BB (s4-1BB) and 4-1BB legand (s4-1BBL) have been detected in the sera of RA patients, their significance is not known. We compared the serum levels of s4-1BB and s4-1BBL in RA patients with those in systemic lupus erythematosus (SLE) and Behcet's disease (BD) patients. Serum levels of s4-1BB and s4-1BBL were significantly higher in RA patients compared with healthy controls, SLE or BD patients, and the abundance was correlated with disease severity in patients with RA. The serum levels of s4-1BB in RA patients were inversely corroborated with 4-1BB expression levels on activated T lymphocytes. In addition, there was a correlation between serum levels of s4-1BB and s4-1BBL. The augmented secretion of s4-1BB and s4-1BBL levels into the serum may reflect the clinical symptoms of RA and levels of s4-1BB and s4-1BBL in sera at the time of diagnosis may be indicative of the severity and outcome of RA.
12478511 Cemented ceramic YMCK total knee arthroplasty in patients with severe rheumatoid arthritis 2002 Dec Total knee arthroplasty (cemented) using a ceramic Yokohama Medical Ceramic Knee (YMCK) (Kyocera Corp; Kyoto, Japan) prosthesis was evaluated in 90 knees of 64 patients with severe rheumatoid arthritis, with a mean age of 59 +/- 11 years. The mean follow-up period was 56 +/- 20 months (range, 27 to 97 months). Larsen's grading of rheumatoid arthritis revealed grade 2 in 3, grade 3 in 36, grade 4 in 36, and grade 5 in 15 of 90 knees. Of 64 patients, 9 were judged to have class 1, 30 were judged to have class 2, and 25 were judged to have class 3 functional disability. The American Knee Society knee score and function score improved from 41 +/- 16 and 29 +/- 22 preoperatively to 83 +/- 14 and 50 +/- 29 at the final follow-up (P <.0001) even in patients with multiple joint involvement. Radiographs at the final follow-up showed satisfactory insertion of all prostheses, with no osteolysis. A radiolucent line measuring <1 mm was observed around the tip of the pegs of the patellar dome in 3 knees. Complications consisted of infection (1 case) and femoral fractures (3 cases). There were no cases of ceramic fractures.
12070674 A 7-day oral treatment of patients with active rheumatoid arthritis using the prostacyclin 2002 Jun OBJECTIVE: The purpose of this study was to investigate the plasma levels of tumor necrosis factor (TNF)-alpha, its soluble p55 and p75 receptors, ex vivo lipopolysaccharide (LPS)-stimulated TNF-alpha production, and plasma levels of interleukin 6, interleukin 1, and interleukin 10 during a 7-day oral administration of iloprost in patients with active rheumatoid arthritis. METHODS: During oral 7-day administration of the prostacyclin analog iloprost, the plasma levels of TNF-alpha, soluble p55, and p75 TNF-alpha receptors, IL-1, IL-6, and IL-10 and C-reactive protein (CRP) in serum were determined on days -1, 1, 3, 4, 6, and 8 and after a treatment-free follow-up on day 15. In addition, the ex vivo TNF-alpha production in whole blood under LPS-stimulated and -unstimulated conditions were measured. Fifteen patients with active rheumatoid arthritis and baseline TNF-alpha plasma levels of > or =2 pg/ml were included in independent groups receiving 50 microg, 100 microg, or 150 microg iloprost per day in addition to their conventional antirheumatic therapy. The respective dose was given once daily from days 1 to 3 and doubled from days 4 to 7. The tender and swollen joint count (28 joints) and the patients' assessments of pain severity and general feeling (10-cm visual analog scale) were performed on days -1, 4, and 8 (end of treatment) and after a 7-day follow-up. RESULTS: The patients showed decreased TNF-alpha levels during iloprost administration. The decrease in the ex vivo LPS-stimulated TNF-alpha production and plasma levels of the p75 TNF receptor were found to be associated with a decrease in the number of tender joints. Additionally, IL-6 was downregulated. CONCLUSION: A 7-day oral administration of iloprost resulted in a change of in vivo and ex vivo cellular cytokine production, with reductions in TNF-alpha and p75 TNF receptor plasma levels. These changes were associated with clinical improvements in active rheumatoid arthritis.
12136890 Prostaglandin E2 suppresses nuclear factor-kappaB mediated interleukin 15 production in rh 2002 Jul OBJECTIVE: Prostaglandin E2 (PGE2) has a wide range of regulatory action in diverse cell types. To investigate the role of PGE2 in rheumatoid arthritis (RA), we tested the effect of exogenous PGE2 on the production of cytokines in synoviocytes. METHODS: Fibroblast-like synoviocytes (FLS) were prepared from the synovial tissue of patients with RA and cultured in the presence of PGE2. The production of interleukin 15 (IL-15) and IL-10 were measured in culture supernatant by ELISA. IL-15 mRNA expression and nuclear factor-kappaB binding activity for IL- 15 transcription were determined by reverse transcription-polymerase chain reaction and electrophoresis mobility shift assay (EMSA), respectively. The level of IL-15 production was also measured by Western blot. RESULTS: PGE2 at concentrations from 10(-11) to 10(-5) M inhibited secretion of IL-15 by FLS, while increasing IL-10 production, in a dose dependent manner. IL-15 production stimulated by interferon-gamma (IFN-gamma), IL-1beta, or lipopolysaccharide were also strongly inhibited by PGE2. This PGE2-mediated inhibition of IL-15 production appears to be dependent in part on the increase of IL-10, since neutralizing anti-IL-10 antibodies reversed this inhibition to some extent. The EMSA of the NF-kappaB site in the IL-15 promoter showed that PGE2 inhibited binding of NF-kappaB in a dose dependent manner. Experiments using inducers and an inhibitor of cyclic AMP (cAMP) suggest that a major intracellular signal mediates the regulatory effect of PGE2 on the production of IL-15 and IL-10. CONCLUSION: PGE2 differentially regulates the production of IL-15 and IL-10 in FLS. The strong inhibition of PGE2 on IL-15 production is exerted via a cAMP-dependent modulation of NF-kappaB activity. Our data suggest that overproduced PGE2 in RA joints may play an antiinflammatory role.
12730506 Exploring the reciprocal relationship between immunity and inflammation in chronic inflamm 2003 Jun Experimental models seeking to explore how susceptible individuals develop rheumatoid arthritis (RA) propose that genetic and environmental factors shape a complex series of molecular and cellular interactions leading to a chronic inflammatory response. T lymphocytes and MHC class II genes have featured prominently in these models. More recent studies have suggested that perpetuation of inflammation in a disease-susceptible host might occur through failure to down-regulate the inflammatory process. One prediction from this model is that effective mechanisms of immunoregulation might be most easily investigated in non-susceptible individuals. However, this has been difficult to study in man. Based on the observation that extended MHC haplotypes are strongly associated with RA in different ethnic groups, I have explored the function of human MHC-encoded genes in transgenic mice using two different experimental approaches. First, by comparing the molecular interactions between disease-associated or non-associated HLA-DR4 molecules and CD4+ T lymphocytes, it has been possible to gain insight into how immune responses in non-susceptible individuals might differ from T-cell responses observed in a susceptible host. This has been achieved using transgenic mice expressing RA disease-associated and non-associated human HLA class II molecules. Secondly, the effects of prolonged exposure of T cells to the proinflammatory cytokine tumour necrosis factor alpha (TNF) have been studied in vitro and in vivo, focusing on T-cell receptor (TCR) signalling and effector responses. In studies of HLA class II transgenic mice, the major differences between disease-associated and non-associated alleles in terms of T-cell responses occur at the level of presentation of antigenic peptides, and the sustained expression of inflammatory cytokines such as TNF. Chronic exposure of T cells to inflammatory cytokines such as TNF induces a phenotype which resembles RA synovial T cells, including the induction of non-deletional and reversible hyporesponsiveness to TCR ligation and uncoupling of proximal TCR signal transduction pathways. The experimental findings are consistent with a model in which HLA class II-driven inflammatory cytokine expression uncouples TCR signalling pathways in the susceptible host in such a way as to profoundly suppress proliferative and immunoregulatory cytokine responses, while at the same time promoting cell survival and effector responses.
12607301 [Acute exacerbation of interstitial pneumonia associated with active systemic lupus erythe 2002 Sep A 36-year-old woman with rheumatoid arthritis was admitted to our hospital for evaluation of newly developed active systemic lupus erythematosus (SLE). After hospitalization, she showed progressive respiratory failure. Chest CT revealed exacerbation of interstitial pneumonia, showing acute development of air-space consolidation and ground-glass opacity in addition to intensified reticular shadows. Administration of high-dose corticosteroids and cyclosporine A resulted in recovery from respiratory failure, accompanied by obvious improvement in the chest radiographs and CT, as demonstrated by the disappearance of air-space consolidation and ground-glass opacity. Clinically, the exacerbation of her interstitial pneumonia was compatible with acute lupus pneumonitis, a rare complication with active SLE.
12115177 Heterogeneity between men and women in the influence of the HLA-DRB1 shared epitope on the 2002 Jun OBJECTIVE: To test the hypothesis that the influence of the HLA-DRB1 shared epitope (SE) on the clinical manifestations of rheumatoid arthritis (RA) differs between men and women. METHODS: We assessed 777 consecutive RA patients for age at disease onset, articular manifestations, subcutaneous nodules, laboratory and radiographic findings, and treatment received. We typed HLA-DRB1 alleles by polymerase chain reaction-sequence-specific primer amplification and categorized the number of SE-containing alleles. We used regression models to adjust comparisons between the sexes for age and clustering by recruitment center, and included SE x sex interaction terms to look for heterogeneity between men and women in the effect of the SE. RESULTS: Among the 777 RA patients, 548 (71%) were women. Men and women differed significantly in the adjusted frequency of SE positivity (women 71.4% versus men 78.4%; P < or = 0.001). The SE was associated with a younger age at symptom onset and RA diagnosis among men, but not among women. The SE likewise had a significant adverse effect on joint tenderness, swelling, and deformity among men only. The SE was associated with a higher erythrocyte sedimentation rate in women and more frequent positivity for rheumatoid factor among both men and women. CONCLUSION: There is heterogeneity between men and women in the effect of the SE on RA susceptibility and clinical expression. Further research is needed to understand the mechanism of this heterogeneity.
12236620 The pathogenesis of rheumatoid arthritis: pivotal cytokines involved in bone degradation a 2002 Sep Proinflammatory cytokines, notably interleukin 1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha), play an important role in initiating and perpetuating inflammatory and destructive processes in the rheumatoid joint. These cytokines regulate many nuclear factor kappaB inducible genes that control expression of other cytokines, cell adhesion molecules, immunoregulatory molecules, and proinflammatory mediators. The expression of cyclooxygenase-2 and inducible nitric oxide synthase (iNOS) and thereby production of prostaglandins (PG) and NO are regulated by cytokines. PGE2 and NO further promote inflammation and likely participate in destructive mechanisms in the rheumatoid joint. In some experimental systems, the effects of IL-1 and TNF-alpha appear synergistic, and correspondingly, concomitant inhibition of both cytokines provides greater than additive antiarthritic effects. Although the actions of IL-1 and TNF-alpha show a large degree of overlap, some differences have been observed in animal models. However, in patients with active rheumatoid arthritis, blockade of either cytokine results in clinical improvement and less radiographic progression.
15609265 Palisaded neutrophilic and granulomatous dermatitis: an unusual cutaneous manifestation of 2004 Dec OBJECTIVE: Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an uncommon skin eruption most often associated with rheumatoid arthritis and other immune-mediated diseases. We present 4 cases to familiarize rheumatologists with the clinical presentation and histopathology of PNGD. METHODS: We report 4 cases to illustrate the clinical and histologic spectrum of this rare skin disease found in rheumatologic patients. The disease pathogenesis and treatment options are discussed. RESULTS: All 4 patients presented with symmetric erythematous-to-violaceous papules and plaques that, upon biopsy, revealed a dermatitis composed of variable numbers of histiocytes and neutrophils. Some cases responded to topical corticosteroid treatment or to dapsone, whereas others resolved spontaneously. CONCLUSIONS: PNGD is a rare cutaneous finding in patients with a variety of immune-mediated systemic diseases, most often rheumatoid arthritis. It is a benign condition that may spontaneously remit or may respond favorably to topical corticosteroids or dapsone.
14599835 Small joint fusion of the hand--a technique using Coughlin cup and cone reamers. 2003 Dec We describe a method of cup and cone arthrodesis using Coughlin concave and convex reamers, which we have used in a series of 22 hand joints in 19 patients. These reamers, originally designed for use in the foot, can be used in the hand to give very accurate preparation of bone surfaces. This results in maximum bone contact and the ability to fuse the joint in any desired position. The procedure is simple, rapid and forgiving. Union was achieved in all 22 cases, usually within 3 months.
12759840 Sterile corneal melting and necrotizing scleritis after cataract surgery in patients with 2002 Sep The onset of post-operative corneal melting and necrotizing scleritis in patients with rheumatoid arthritis and collagen vascular disease who undergo cataract surgery can have devastating ocular and systemic consequences. Even though ocular surface factors such as sicca and surgical trauma are among the important variables that contribute to this entities, signs and symptoms of systemic disease need to be thoroughly investigated in order to prevent life-threatening complications associated with these ocular manifestations. The management of surgical induced corneal melting and necrotizing scleritis in these patients, include local therapy and in most instances, systemic immuno-modulation. Moreover, the development of corneal melting and necrotizing scleritis in an otherwise "healthy" patient after uncomplicated cataract surgery, can be the first manifestation of a serious occult systemic disease. Therefore, an aggressive approach regarding the diagnosis, workup and treatment should be initiated by the ophthalmologist in order to maximize a successful ophthalmic and medical outcome.
14668928 Appropriate and effective rheumatoid arthritis control: role of TNF antagonists. 2003 There are several unmet needs for the appropriate and effective control of rheumatoid arthritis (RA), namely rapid onset of action; effectiveness in disease-modifying antirheumatic drug (DMARD)-resistant disease, including improvements in signs and symptoms, disability, quality of life and radiographic progression; sustainability of response; and a good risk/benefit ratio. Tumor necrosis factor (TNF) antagonists appear to address these needs and consequently have set a new therapeutic standard for the treatment of RA and have made it possible for rheumatologists to target remission as a primary therapeutic goal.
12847676 Association between carotid atherosclerosis and markers of inflammation in rheumatoid arth 2003 Jul OBJECTIVE: To examine the relationship between markers of systemic inflammation and carotid atherosclerosis in patients with rheumatoid arthritis (RA) and healthy controls. METHODS: Carotid artery intima-media thickness (IMT) and carotid plaque were measured using high-resolution B-mode ultrasound in 204 patients with RA, ages 40-85, and 102 age- and sex-matched healthy persons. No subject in either group had ever smoked cigarettes. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to measure systemic inflammation. The relationship of the carotid artery IMT and carotid plaque to inflammation markers was examined, adjusting for age, sex, RA versus control status, and the cardiovascular (CV) risk factors hypercholesterolemia, systolic blood pressure, diabetes mellitus, and body mass index (BMI). RESULTS: A significant linear trend for increased carotid artery IMT was associated with increasing ESR and CRP categories (r = 0.16, P = 0.004 for ESR, and r = 0.13, P = 0.02 for CRP). These trends did not differ among RA cases and controls, and were independent of age, sex, and CV risk factors. The difference in carotid artery IMT between the lowest and highest categories of ESR was 0.221 mm (95% confidence interval [95% CI] 0.767-1.020, P = 0.02). The difference between extreme CRP categories was 0.275 mm (95% CI 0.039-0.509, P = 0.02). Both remained significant after CV risk factor adjustment. Carotid plaque displayed a similar relationship to markers of inflammation. CONCLUSION: Increased carotid artery IMT and the presence of carotid plaque are associated with markers of systemic inflammation in patients with RA and in healthy subjects. This observation is consistent with hypotheses that assign a role to systemic inflammation in atherosclerosis, and may have implications regarding RA and other chronic inflammatory diseases.