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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
24387182 Anterior tibial compartment syndrome following rupture of a popliteal cyst. 2003 Jun Abstract A ruptured popliteal cyst usually results in calf pain and swelling. We report the case of a patient with rheumatoid arthritis who developed anterior compartment syndrome of the leg following rupture of a popliteal cyst. Since acute compartment syndrome requires prompt treatment, clinicians should be aware of this rare complication.
12844259 Persisting uveitis antedating psoriasis in two boys. 2003 Sep Two young boys had a severe uveitis which was difficult to treat. They both developed psoriasis located in the pubic area almost 1 year and several years later respectively. One boy also developed arthritis of an intermittent character. Both boys were ANA and HLA-B27 negative. CONCLUSION: in children, the possible association between uveitis and psoriasis with or without arthritis has to be kept in mind.
15201596 Assessment of outcome in psoriatic arthritis. 2004 Jul PURPOSE OF REVIEW: A number of drugs for psoriatic arthritis have been tested in randomized clinical trials, and more agents are likely to be evaluated in the future. Such studies have highlighted the relative lack of well-validated or agreed-on outcomes that should be assessed. RECENT FINDINGS: Consensus exercises have identified core domains for intervention studies in psoriatic arthritis. Many of the tools used to measure these domains have been borrowed from rheumatoid arthritis or ankylosing spondylitis, but increasing data relate to psoriatic arthritis specifically. Nonetheless, there are gaps in the measurement toolkit, particularly with respect to assessing dactylitis and axial inflammation. Further validation of functional disability instruments, radiologic scoring methods, and enthesitis instruments is also required. Currently available composite responder criteria are based principally on peripheral joint inflammation and may not be inclusive enough to represent fully the spectrum of patients with psoriatic arthritis. SUMMARY: There have been significant developments in robust tools for assessing outcome in psoriatic arthritis. Since October 2002, much of the activity in this area has been developed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and will have culminated in the Outcomes Measures in Rheumatology Clinical Trials meeting in May 2004. Relatively little of this work has been published at the time of this review. Nevertheless, this effort will have a significant influence on the design and reporting of clinical trials in psoriatic arthritis.
15775115 [Therapeutic approaches to increased bone resorption]. 2003 Apr The accelerated bone resorption contributes significantly to the pathophysiology of diseases such as osteoporosis, Paget's disease, hypercalcemia, bone metastasis, and inflammation of bone associated with rheumatoid arthritis. Several antiresorptive agents have been validated as a means to control bone resorption in these diseases. A recent understanding of the molecular mechanism of osteoclastic bone resorption is providing opportunities for developing novel antiresorptive agents.
14740812 Acupuncture for chronic venous ulceration. 2003 Dec Acupuncture was used to treat a 69-year-old man for bilateral ankle pain related to his rheumatoid arthritis. This led to a dramatic improvement in one of his chronic venous leg ulcers. There is very little recent literature on such cases, where acupuncture may be a useful additional treatment.
24387646 The national burdens of rheumatoid arthritis and osteoarthritis in Japan: projections to t 2004 Sep Abstract We projected the national burdens of rheumatoid arthritis (RA) and osteoarthritis (OA) in Japan in the year 2010, together with future changes in severity distribution. The age-, sex-, and in/outpatient-specific prevalence rates of RA and OA from the 1999 National Patient Survey were multiplied by the National Census population projections for 2000 and 2010. The years lived with disability (YLD) of RA or OA in 2010 were adjusted for the projected changes in the summed measure of severity distribution (i.e., the sum products of the percentage distribution and the health-related quality of life score for three severity classes) using the corresponding regression equations. Between 2000 and 2010, the numbers of patients with RA and OA in Japan will increase by 14% (from 0.31 million to 0.36 million) and 27% (from 0.77million to 0.98 million), respectively, and accordingly, the YLD of RA and OA will increase by 3% (from 42.8 to 43.6 per 100 000) and 21% (from 65.8 to 79.1 per 100 000), respectively. Because of the decreasing proportion of severely affected patients, the increase in YLD may be smaller compared with the increase in the number of patients. As in other developed countries, the national burdens of RA and OA in Japan will increase between 2000 and 2010. However, any projection is likely to be an overestimate unless it considers future changes in the severity distribution associated with medical progress.
24387204 Neuroendocrine-immune system in patients with rheumatoid arthritis. 2003 Sep Abstract The neuroendocrine-immune system plays an important role in maintaining homeostasis. Since patients with rheumatoid arthritis (RA) tend to be exposed to long-term physical and psychological stress during the course of the disease, it is hypothesized that their neuroendocrine-immune system will become dysregulated. In order to understand the disturbances in the neuroendocrine-immune systems objectively, we measured and compared various components of the peripheral blood which were considered to reflect the state of these systems, in patients with RA and in control individuals. The serum levels of norepinephrine, interleukin-6 (IL-6), and the CD4/CD8 ratio were higher, whereas the levels of β-endorphin, adrenocorticotropic hormone, and NK cell activity were lower in the RA subjects than in the control subjects. On the other hand, the serum levels of methionine-enkephalin, epinephrine, corticotropin-releasing factor, cortisol, and CD57 were not significantly different in the two groups. In addition, we demonstrated the effects of hearty laughter, deep emotion with tears, or general anesthesia on the neuroendocrine-immune system. What need the most attention are changes in the IL-6 levels of RA patients. Serum IL-6 levels in RA were significantly higher than in controls, and fell rapidly to as low as half of their initial value after a bout of hearty laughter. Our results suggest that adequate mental intervention might serve to modulate the neuroendocrine-immune system of RA patients which had failed for various reasons.
24387113 Outcome of patients with rheumatoid arthritis treated by step-wise administration of disea 2003 Mar Abstract Disease-modifying antirheumatic drugs (DMARDs) are expected to relieve polyarthritis, and thereby improve the patient's quality of life and eventually alter the prognosis of rheumatoid arthritis (RA) or the progressive joint destruction caused by it. DMARDs may cause adverse reactions and become less effective over time in some patients. Using changes in disease activity and X-ray findings as indicators, we retrospectively evaluated the long-term results of the step-wise administration of DMARDs in 200 patients with RA. The patients had been treated with gold compounds, SH compounds, and methotrexate, in this order, over a total of 10 years since initially being diagnosed with the disease in its relatively early stages. The step-wise administration of DMARDs had decreased and controlled RA activity and inflammatory response over the 10 years. Although X-ray findings for the wrists worsened over time in most of the patients, no knee or hip joint destruction was observed in patients in whom disease activity had been controlled well for a long period of time. The progression of destruction of major joints can be prevented in cases in which the Lansbury activity index and C-reactive protein are maintained at levels not more than 30% and 1.5 mg/dl, respectively. Since no drugs are now available which specifically prevent the progression of joint destruction, it is important to control RA activity for as long as possible.
24387724 Survival after total joint arthroplasty in patients with rheumatoid arthritis. Comparison 2004 Dec Abstract A total of 867 patients with rheumatoid arthritis (RA) underwent 1764 total joint arthroplasties (total hip arthroplasty and/or total knee arthroplasty) over three decades from 1970 to 1999. A survey on their postoperative survival was conducted in December 2000 in which these patients were divided into two groups. The patients who had their initial arthroplasty in the period 1970 to 1989 were classified as the "70s and 80s group," and those who had their initial arthroplasty from 1990 to 1999 were classified as the "90s group." Using the Kaplan-Meier method, their cumulative survival rates were compared. The survival rates of the 70s and 80s group, consisting of 433 patients, were 84.8% at the 5th postoperative year, 60.1% at the 10th year, and 45.3% at the 15th year. Although the survey period of the 90s group is shorter than that of the 70s and 80s group, their survival rates were 90.2% at the 5th year and 84.3% at the 10th year. At present, the life expectancies of the 90s group are good, and their cumulative survival rate is significantly greater than that of the 70s and 80s group (P < 0.01). It seems that this improvement has been contributed to by the recent increase in the number of RA patients with good prognoses and the well-timed application of arthroplasty, which decreases the number of patients with poor risk.
12794050 Hypothalamo-pituitary-adrenal axis and chronic immune activation. 2003 May Corticosteroids have potent immunosuppressive and anti-inflammatory effects. Although corticosteroids are an important weapon in the clinical arsenal for treating inflammatory episodes, the mechanisms underlying the actions and regulation of endogenous corticosteroids remain obscure. In the late 1980s and early 1990s, a hypothesis was proposed that suggested that susceptibility to autoimmune disease was linked to a hypoactive hypothalamo-pituitary-adrenal (HPA) axis. It was further suggested that this defect in regulation of the HPA axis was situated at the level of the hypothalamus. This compelling hypothesis directly linked control of the HPA axis with susceptibility to disease rather than just severity of inflammation. The initial findings acted as a stimulus to further research, and over the next decade the hypothesis was tested. Recent studies suggest that the original hypothesis is in need of modification and that susceptibility is more complex and requires the involvement of more than a single parameter. These data are discussed together with recent developments concerning regulation of the HPA in disease in preclinical models and patients with rheumatoid arthritis. The latter studies in patients with rheumatoid arthritis provide evidence for the existence of a subpopulation of these patients with altered negative feedback regulation of the HPA axis.
24387174 Systematic review of NSAID-induced adverse reactions in patients with rheumatoid arthritis 2003 Jun Abstract A systematic review of randomized controlled clinical trials of nonsteroidal antiinflammatory drugs (NSAIDs) in rheumatoid arthritis (RA) patients was conducted to evaluate the risk of NSAID-induced adverse reactions. Double-blind, randomized, controlled trials with 6-week treatments for RA patients were included in the study. The endpoints for the analysis included any adverse reactions, digestive adverse reactions, and upper gastrointestinal (GI) adverse reactions. A fixed-effect model was used for estimation of the risk. Time-to-event analysis of the incidence of adverse reactions was also conducted. A total of 28 trials was included for the analysis, and a total of 30 NSAIDs were used in the trials. The proportion of patients who experienced any adverse reaction was as follows: piroxicam 18.9% (3 trials), diclofenac 18.8% (4 trials), indomethacin 22.1% (14 trials), and aspirin 25.0% (4 trials). The proportion of patients who experienced digestive adverse reactions was as follows: piroxicam 10.2%, diclofenac 10.6%, indomethacin 13.1%, and aspirin 14.1%. Most withdrawals due to adverse reaction occurred during the first 3 weeks after administration of the NSAID. Although the risk of NSAID-induced adverse reaction was different from drug to drug, the risk of adverse reaction was clinically significant.
14696674 Suppressive effects of a Chinese herbal medicine qing-luo-yin extract on the angiogenesis 2003 Qing-Luo-Yin (QLY), a traditional Chinese herbal medicine for the treatment of rheumatoid arthritis, is a combination of the extracts of Sophora flavescens Ait., Phellodendron amurense Rupr., Sinomenium acutum Rehd. et Wils. and Dioscorea hypoglauca Palib. The suppressive effect of QLY on the development of angiogenesis was investigated in a rat model of collagen-induced arthritis (CIA). QLY (0.3 g/kg) was orally administered daily for 27 days. Neo-angiogenesis, pannus and cartilage damage, the expression of metalloproteinases (MMP)-3 messenger RNA (mRNA) and the level of the tissue inhibitor of matrix metalloproteinase (TIMP)-1 in the synovium were examined by histology, in situ hybridization and immunohistochemiscal assays, respectively. It was observed that the articular morphological alterations, the over-expression of MMP-3 mRNA and the reduced production of TIMP-1 in CIA rats were significantly ameliorated by QLY. QLY performed about as effectively as tripterygium glycosidorum tablets (0.1 g/kg) extracted from Tripterygium wilfordii Hook. f.. These results indicate that QLY exerts a suppressive effect on the angiogenesis of CIA rats, and suggest that the therapeutic effect of QLY could be due to restoring the balance of MMP-3 and TIMP-1 in rheumatoid synovium.
17028811 Hemagglutination of preoperative blood donation in patients with rheumatoid arthritis. 2004 We gave preoperative blood transfusions to 37 patients with rheumatoid arthritis (RA) and 35 patients with osteoarthritis (OA), including some whose baseline hemoglobin level was less than 10 g/dl. Transfusion packs can preserve whole blood containing citrate phosphate dextrose (CPD) for 3 weeks. The baseline hemoglobin level of RA cases was 10.4 g/dl (range 8.4-13.1 g/dl), and that of OA cases was 11.9 g/dl (range 10.4-15.0 g/dl). By collecting 200-400 g every week before the operation, the total was 800-1200 g. Erythropoietin was given to patients intramuscularly when their hemoglobin was less than 13 g/dl after blood had been collected. Hemagglutination, with diameters of more than 1 cm, made filter occlusions in 11 RA cases (30%) and one OA case (3%) (P << 0.0031) after retransfusion. There were no differences between hemagglutination patients (agglutination group) and nonhemagglutination patients (nonagglutination group) regarding baseline C-reactive protein (CRP), white blood cells, platelets, or fibrinogen. We could not predict the formation of macrohemagglutination in the packs collected during the clinical course. In RA cases, allogenic transfusions were performed for four cases (36%) in the agglutination group and for one case (12%) in the nonagglutination group. Preoperative transfusion for the RA patients showed hemagglutination in some cases, and highlighted the need for modifications to reduce these hemagglutinations.
15534553 Matrix metalloproteinases and their clinical applications in orthopaedics. 2004 Nov Imbalance in the expression of matrix metalloproteinases and their inhibitors contribute considerably to abnormal connective tissue degradation prevalent in various orthopaedic joint diseases such as rheumatoid arthritis and osteoarthritis. Matrix metalloproteinase expression has been detected in ligament, tendon, and cartilage tissues in the joint. They are known to contribute to the development, remodeling, and maintenance of healthy tissue through their ability to cleave a wide range of extracellular matrix substrates. Their role has been extended to cell growth, migration, differentiation, and apoptosis. In orthopaedics, their clinical applications constantly are being explored. The multiple steps in matrix metalloproteinase regulation offer potential targets for inhibition, useful in drug therapy. The correlation between matrix metalloproteinases and progression in joint erosion presents potential prognostic and diagnostic tools in rheumatoid arthritis. Matrix metalloproteinases also can be incorporated into scaffold design to control the degradation rate of engineered tissue constructs. This current review aims to summarize and emphasize the importance of matrix metalloproteinases and their natural inhibitors in the maturation of musculoskeletal tissue through matrix remodeling and, therefore, in the generation of a new clinical potential in orthopaedics.
12152404 Gold and its relationship to neurological/glandular conditions. 2002 Jan Despite increasing sales of gold supplements, and claims of benefits for neurological and glandular conditions, gold has received little attention in modern medical literature except as a drug for rheumatoid arthritis. Historically, however, gold had a reputation as a "nervine," a therapy for nervous disorders. A review of the historical literature shows gold in use during the 19th century for conditions including depression, epilepsy, migraine, and glandular problems such as amenorrhea and impotence. The most notable use of gold was in a treatment for alcoholism developed by Keeley (1897). In the modern medical literature, gold-containing medicines for rheumatoid arthritis are known to have occasional neurotoxic adverse effects. There are also a few studies suggesting a role for gold as a naturally occurring trace element in the reproductive glands. One small recent study demonstrated a possible positive effect of gold on cognitive ability. There is a need for more experimental and clinical research of the neuropharmacology and neurochemistry of gold, and for the exploration of gold's possible role as a trace element.
24387170 The levels of leukemia inhibitory factor in synovial tissues of patients with rheumatoid a 2003 Jun Abstract To clarify the effect of leukemia inhibitory factor (LIF) on the destruction of rheumatoid arthritis (RA) joints, we investigated the production of LIF and the expression of LIF mRNA in synovial tissues from patients with RA and osteoarthritis (OA). Synovial fluids from RA were used to measure the LIF concentrations using enzyme-linked immunosorbent assay (ELISA). Immunohistochemistory and RT-PCR were used to examine the expression of LIF by synovial cells. LIF mRNA was detected in all cases in RA synovial cells. Although LIF protein was detected only in 20 cases (19%) in RA synovial fluids, LIF concentration in the synovial fluids significantly correlated with the peripheral leukocyte count (P < 0.001) and C-reactive protein (CRP) (P < 0.01). Moreover, levels of IL-1β, IL-6, and IL-8, but not TNF-α, were significantly correlated with LIF in the RA synovial fluids. LIF production was promoted by IL-1β and TNF-α stimulation; in contrast, IL-1 ra and IL-4 were found to markedly decrease LIF production by cultured synovial cells. LIF appeared to be a cytokine produced by RA synovium leading to a proinflammatory secretion profile. Moreover, IL-4 and IL-1 ra may represent attenuated activity for reducing the effect of the destruction of joints by LIF.
24387169 The expression of chemokine receptor CXCR3: relevance to disease activity of rheumatoid ar 2003 Jun Abstract  CXC chemokine receptor 3 (CXCR3) is selectively expressed on T helper 1 (Th1) type T cells and has been shown to be responsible for Th1-dominant immune responses. In this study, we analyzed the expression of CXCR3 on peripheral blood T lymphocytes of patients with rheumatoid arthritis (RA) by FACS analysis using antihuman CXCR3 monoclonal antibody and determined the clinical relevance in this disease. Significantly higher expression of CXCR3 was found on peripheral blood CD4+ T lymphocytes of RA patients than healthy controls. The CXCR3 expression in RA patients with a high erythrocyte sedimentation rate was significantly higher than in those with a low erythrocyte sedimentation rate. Moreover, we found that the CXCR3 expression in RA patients with long-term disease duration was significantly higher than in those with short-term disease. On the other hand, CC chemokine receptor 4 (CCR4), which was shown to be selectively expressed on Th2-type T cells, was expressed at low levels in RA patients as well as in healthy controls. The serum level of interleukin (IL)-18 in RA patients was higher than that in healthy controls, although there was no statistically significant difference. This study suggests that the Th1 immune response is predominant in RA and that CXCR3 may have relevance in regard to the disease course in RA patients.
14978846 [Clinical case of the month. Adult onset Still's disease: a rare cause of acute febrile he 2003 Dec A 63-year-old woman was hospitalized for the third time in one year for asthenia, fever and chills, jaundice, cytolysis and cholestasis. An adult onset Still's disease was diagnosed. Hepatic manifestations, diagnostic criteria and efficient therapy of AOSD will be reviewed.
12505099 Binding of rheumatoid and lupus synovial fluids and sera-derived human IgG rheumatoid fact 2002 Nov BACKGROUND: Altered glycosylation of immunoglobulin G (IgG) has been demonstrated in patients with rheumatoid arthritis (RA). Specificity of IgG rheumatoid factor (RF) in recognizing degalactosylated IgG (Fab)(2) and Fc was analyzed in the present study. METHODS: (Fab)(2) and Fc fragments were prepared from IgG of normal healthy subjects. Enzymes, including peptide-N-glycosidase (PNGase), neuraminidase, and beta-1,4-galactosidase, were used to digest (Fab)(2) and Fc fragments. Binding capacity of IgG RF from patients with RA, systemic lupus erythematosus (SLE), and from healthy subjects to (Fab)(2) and Fc treated with glycosidase, was measured with immunoassay. RESULTS: Treating (Fab)(2) and Fc with PNGase significantly diminished their binding capacity to IgG RFs. Degalactosylated (Fab)(2) revealed higher affinity to IgG RF in all tested groups. Fc lacking terminal galactose on oligosaccharide chains showed elevated binding with synovial IgG RF of RA patients. However, lesser binding was observed in sera of patients with RA and SLE. CONCLUSIONS: Our data suggest that IgG molecules containing less terminal galactose on their oligosaccharide moieties are preferentially recognized by IgG RF. Furthermore, IgG RF display alternative binding specificity to degalactosylated (Fab)(2) and Fc in synovial fluids and sera of RA patients.
15170361 Biologic agents for the treatment of juvenile rheumatoid arthritis: current status. 2004 Biologic therapies, primarily anticytokine therapies, are being increasingly used in patients with juvenile rheumatoid arthritis (JRA). Levels of a variety of proinflammatory cytokines have been shown to be elevated in the peripheral blood and synovial fluid and tissue in children with JRA. In a blinded, randomized, controlled trial in children with severe, long-standing, polyarticular-course JRA not responsive to standard therapies, etanercept showed a statistically significantly greater response rate than placebo. Approximately 75% of these children responded to etanercept. Etanercept has been efficacious in 50-60% of children with active systemic JRA in open clinical trials with acceptable tolerance. Adverse events seen in children treated with etanercept have been similar in type and frequency to those reported in adults. Infliximab has been studied in several open clinical trials in both polyarticular and systemic JRA and found to, overall, have demonstrated efficacy in approximately 60% of patients. Approximately 3-5% of patients have demonstrated infusion reactions or frank allergic reactions and 9% developed new autoantibodies. Anakinra has been studied in children with polyarticular JRA. Approximately 65% of patients developed injection-site reactions and 68% demonstrated a response to the medication. Anakinra may have increased efficacy in systemic JRA. Interleukin (IL)-6 is highly related to the systemic disease manifestations in systemic JRA and two patients treated with a monoclonal antibody to the IL-6 receptor have demonstrated significant improvement with prolonged clinical control with continued treatment. A particular pediatric concern is the effect of immunosuppressive biologics in children who are exposed to or develop varicella. These children should be treated, both in terms of prophylaxis and aggressive antivaricella treatment, as for other immunosuppressed children. Anticytokine biologics have demonstrated great promise in the treatment of JRA and a variety of other pediatric rheumatic diseases, although at this time the randomized, placebo-controlled data are limited only to etanercept in children with polyarticular JRA. Randomized trials are ongoing to better define both the efficacy and safety of these novel treatments for children with JRA and other rheumatic diseases.