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ID PMID Title PublicationDate abstract
14631545 Hyperviscosity as a complication in a variety of disorders. 2003 Oct For a considerable time, hyperviscosity syndrome has been widely recognized as a serious manifestation of polycythemia and plasma cell dyscrasia. In this article a number of conditions will be considered in which the association with hyperviscosity has been more recently recognized and is less widely known. These conditions are hyperleukocytosis, retinoic acid therapy, and connective tissue disease such as rheumatoid arthritis. The essential problems in the first two are the hugely elevated white cell count (WCC) and the mechanical properties of the leukocytes, in other words, their relatively poor deformability and their adhesiveness for the endothelium. In the last, the essential problem is hugely elevated plasma viscosity due to immunocomplexes. They lead to increased flow resistance, especially in the microvessels, abnormal flow, and significant clinical symptoms. The details of the causes of the hyperviscosity, the symptoms that result, and the forms of treatment are discussed.
13677318 Two patients with acute thrombocytopenia following gold administration and five-year follo 2003 Jun Thrombocytopenia is a well-known side effect following intramuscular gold therapy in patients with rheumatoid arthritis. Thrombocytopenia may occur at any time and it can be irreversible and sometimes fatal despite cytotoxic or immunosuppressive therapy. We describe two patients who presented with haemorrhagic diathesis on the day after the administration of aurothioglucose. The thrombocytopenia in these patients was caused by aurothioglucose-induced antibody-mediated platelet destruction. Both patients made an uneventful recovery and the platelet count returned to normal within several weeks without further treatment. Antibody-detecting tests were repeated five years later and could not demonstrate the presence of antibodies. Also after incubation with aurothioglucose no antibodies could be demonstrated.
19810961 Acid-sensing ion channels and pain: therapeutic potential? 2003 Sep Many painful inflammatory and ischemic conditions such as rheumatoid arthritis, cardiac ischemia and exhausted skeletal muscles are accompanied by local tissue acidosis. In such acidotic states, extracellular protons provoke the pain by opening excitatory cation channels in nociceptors. From recent molecular investigations into sensory neurons, two important candidate genes (or gene families) encoding proton-activated cation channels - acid-sensing ion channel and transient receptor potential vanilloid receptor subtype-1 have emerged. Since both channels can be major pharmacological targets for pain therapy and therefore, for the development and screening of new analgesics, it is of great importance to confirm their involvement in acid-evoked pain in humans and to know their relative contribution to the nociception. The authors' recent psychophysical studies focused on these points and the data is presented and discussed in this review.
12688223 Carpal tunnel syndrome in the elderly. 2003 Mar Carpal Tunnel Syndrome (CTS) involves a compression of the median nerve in the carpal tunnel. Incidence rates increase with age for men, whereas for women the rates peak at 45-54 years. Prevalence among older people is almost four times greater for women than for men. Fifty percent of cases are idiopathic and the rest associated with Colles' fracture, rheumatoid arthritis, hormonal agents and/or oophorectomy, diabetes mellitus, and among men, occupations with excessive use of hands. Age is a risk factor for slowing of sensory conduction of the median nerve. Examination includes provocative, sensibility and thenar muscle strength tests. Electrophysiologic studies confirm diagnosis. No evidence that NSAIDs, pyridoxine or diuretics work. Wrist splints, rest, local injections and oral steroids work better. Surgery is successful and even the very elderly show significant improvement. Although the level of satisfaction is lower than in younger adults, surgery is still worthwhile.
12406430 Ankylosing spondylitis and current disease-controlling agents: do they work? 2002 Sep In contrast to rheumatoid arthritis (RA), the concept of disease modification in ankylosing spondylitis (AS) remains to be clarified. Endpoint measures employed in AS trials primarily assess features related to symptomatology while endpoints considered more relevant to the concept of disease modification, such as spinal mobility, acute-phase reactants and radiological progression, either lack sensitivity to change or have not been comprehensively validated. NSAIDs alleviate symptoms of AS but most trials have been short term, precluding meaningful conclusions regarding disease modification. Among disease-modifying therapies used in RA, sulfasalazine has been studied in several controlled trials mostly in patients with longstanding disease, effect sizes being small and limited to those with peripheral synovitis. No conclusions can be drawn from the limited studies evaluating methotrexate.
12351573 Molecular genetics of calcium sensing in bone cells. 2002 Oct 1 The molecular mechanisms regulating bone remodelling are only partially understood. One of the controversial issues discussed during the past few years is the role that calcium signalling plays in this process and, in particular, in the functioning of the osteoclast. Calcium is involved in the recruitment and activation of osteoclasts and their subsequent detachment from bone. Parathyroid hormone and vitamin D are part of a systemic mechanism regulating calcium availability, storage and disposal. But there are conflicting results suggesting the presence of a local calcium-sensing mechanism in osteoclasts, in osteoblasts or in both. If this system could be characterized, it would be of therapeutic relevance for diseases such as postmenopausal osteoporosis and rheumatoid arthritis. Genetic data, animal models and cell-based assays have not yet been used to their full extent in this area. Here we review the available data and outline possible future strategies.
12024779 [Chemokines a hope of specific anti-inflammatory treatment]. 2002 Mar 7 Inflammation is a serious medical problem that causes suffering in many common diseases such as rheumatoid arthritis and asthma. Despite the fact that the clinical signs of inflammation--rubor, tumor, calor and dolor--have been known for almost two thousand years, our knowledge of the molecular pathways that mediate inflammation is still limited. Today's anti-inflammatory drugs are non-specific and have many undesirable side effects. The discovery of chemokines as small specific regulatory proteins of the immune system has increased our understanding of the inflammatory process. We have reason to believe that chemokines and their receptors are going to be targets for a new kind of anti-inflammatory therapy.
11896886 Mizoribine: mode of action and effects in clinical use. 2002 Apr Mizoribine is a new immunosuppressive drug and was authorized by the Japanese Government in 1984. The strong immunosuppressive activity of mizoribine was already demonstrated in various animal models, in renal transplantation and in steroid-resistant nephrotic syndrome. Recently, the remarkable clinical advantages of an imidazole for adults with rheumatoid arthritis, lupus nephritis and other rheumatic diseases were reported. Mizoribine is an imidazole nucleoside and the metabolites, MZ-5-P, exerts its activity through selective inhibition of inosine monophosphate synthetase and guanosine monophosphate synthetase, resulting in the complete inhibition of guanine nucleotide synthesis without incorporation into nucleotides. Thus, mizoribine is superior to azathioprine, in that it may not cause damages to normal cells and normal nucleic acid.
15940563 Pleural amyloidosis as the first sign of IgD multiple myeloma. 2005 Jun We describe a case of IgD myeloma with amyloid and plasmocytic pleural localisations. At the onset of the disease it mimicked rheumatoid arthritis, which can be the first presentation of both AL amyloidosis and multiple myeloma. Pleural effusion can happen first in IgD myeloma, but our observation is of interest in that it confirms the very rare possibility of pleural amyloid and plasmocytic localisations devoid of pleural effusion.
15533219 Adverse oral reactions associated with the COX-2 inhibitor rofecoxib. 2004 Nov Rofecoxib is an inhibitor of the enzyme cyclo-oxygenase 2 (COX-2) used as an analgesic and anti-inflammatory agent especially in rheumatoid arthritis and osteoarthritis. The adverse effects are generally less than with other anti-inflammatory drugs (NSAIDs), and no oral adverse reactions have been reported in the literature. We present three cases of oral lesions caused by rofecoxib. Extensive erosions appeared, which in all cases resolved on withdrawal of the drug.
14671390 Potential of human embryonic stem cells in regenerative medicine. 2003 Stem cells can give rise to more stem cells or differentiate into more specialized cells. In the last 5 years not only have researchers succeeded in isolating human embryonic stem (hES) cell lines but also in identifying adult stem cells with possible pluripotent differentiation capacity. The shortage of donor organs or tissues for regenerative medicine has further stimulated research into the capacity of stem cells to differentiate into different cells and their use in replacement therapy in diseases such as Parkinson's, diabetes, rheumatoid arthritis and myocardial infarction. Current problems and recent progress with respect to hES cells and their potential use for clinical applications will be discussed. The potential of adult stem cells for differentiation and tissue repair is reviewed elsewhere.
14532147 Role of tumour necrosis factor (TNF) in host defence against tuberculosis: implications fo 2003 Nov Studies in mouse infection models clearly demonstrate tumour necrosis factor (TNF) to be a critical component of both the antibacterially protective and the inflammatory immune response to Mycobacterium tuberculosis. It is therefore not surprising that treatment of patients-for example, those with rheumatoid arthritis-with biological agents interfering with TNF activity have shown an increased risk of reactivating tuberculosis. However, conceivably, TNF targeting biological agents can be developed that because of their particular mode of action and their specific pharmacodynamics may be less likely to have this side effect.
12685397 [Quantitative assessment of protein replacement in therapeutic plasmapheresis]. 2003 AIM: To calculate parameters of replacement in which the amount of total protein (TP) in the circulating blood remains above critical level after removal of 17-75% of circulating plasm volume (CPL). MATERIAL AND METHODS: Therapeutic plasmapheresis (TPA) was made in 96 patients with rheumatoid arthritis, bronchial asthma, systemic lupus erythematosus and other diseases. The plasm was replaced by 0.9% sodium chloride solution, rheopolyglucine and albumin solutions in isovolemic regime. Albumin was given in quantities equivalent to 50-65% of the removed protein. RESULTS: Close correlation was observed between the expected and actual concentrations of total protein in 96 patients who have undergone 206 TPA procedures. In removal of up to 35% CPL protein deficiency is compensated by its mobilization from the deposits and due to protein-synthetizing function of the liver. In removal of 75% and more and in initial hypoproteinemia 50% of the protein should be replaced. CONCLUSION: It is confirmed that rheopolyglucin can be used for plasm replacement in TPA in patients with hyperproteinemia having no contraindications.
12038208 Augmentation of a retrognathic chin. I. Use of HTR-polymer implants in a long-term prospec 2002 A total of 37 patients have had chin augmentation procedures with HTR-polymer implants. Indications were mandibular retrognathia in connection with dentofacial deformities in 13 and the remaining 24 had a normal occlusion. Three patients with micrognathia also had juvenile rheumatoid arthritis. The patients have been followed for at least one year and in 17 cases up to five years both clinically and radiographically. Cephalometric measurements of the effects and stability of augmentation showed that chin augmentation has highly predictable results, and few side-effects.
12952549 Antioxidant intake, plasma antioxidants and oxidative stress in a randomized, controlled, 2003 Jul 30 BACKGROUND: Previously we have reported that patients with rheumatoid arthritis (RA) obtained a significant reduction in disease activity by adopting a Mediterranean-type diet. The present study was carried out to investigate the antioxidant intake, the plasma levels of antioxidants and a marker of oxidative stress (malondialdehyde) during the study presented earlier. METHODS: RA patients randomized to either a Mediterranean type diet (MD group; n = 26) or a control diet (CD group; n = 25) were compared during a three month dietary intervention study. Their antioxidant intake was assessed by means of diet history interviews and their intake of antioxidant-rich foods by a self-administered questionnaire. The plasma levels of retinol, antioxidants (alpha- and gamma-tocopherol, beta-carotene, lycopene, vitamin C and uric acid) and urinary malondialdehyde (MDA), a marker for oxidative stress, were determined using high performance liquid chromatography. The Student's t-test for independent samples and paired samples were used to test differences between and within groups. For variables with skewed distributions Mann-Whitney U-test and Wilcoxon signed ranks test were performed. To evaluate associations between dietary intake of antioxidants, as well as between disease activity, MDA and antioxidants we used Pearson's product moment correlation or Spearman's rank correlation. RESULTS: The MD group had significantly higher intake frequencies of antioxidant-rich foods, and also higher intakes of vitamin C (p = 0.014), vitamin E (p = 0.007) and selenium (p = 0.004), and a lower intake of retinol (p = 0.049), compared to the CD group. However, the difference between the groups regarding vitamin C intake was not significant when under- and over-reporters were excluded (p = 0.066). There were no changes in urine MDA or in the plasma levels of antioxidants (after p-lipid adjustments of the tocopherol results), from baseline to the end of the study. The levels of retinol, vitamin C and uric acid were negatively correlated to disease activity variables. No correlation was found between antioxidant intake and the plasma levels of antioxidants. CONCLUSIONS: Despite an increase in reported consumption of antioxidant-rich foods during the Mediterranean diet intervention, the levels of plasma antioxidants and urine MDA did not change. However, the plasma levels of vitamin C, retinol and uric acid were inversely correlated to variables related to RA disease activity.
12672185 Response to etanercept (Enbrel) in elderly patients with rheumatoid arthritis: a retrospec 2003 Apr OBJECTIVE: Approximately 3% of the US population over the age of 65 years has rheumatoid arthritis (RA). We compared the safety and efficacy of etanercept (Enbrel) in patients with RA who were > or = 65 years to those < 65 years in open-label and double-blind, randomized clinical trials. METHODS: Patients from 4 double-blind, randomized controlled trials and 5 open-label trials were included in this retrospective analysis. Patients were grouped by age (< 65 or > or = 65 yrs) at time of study entry. All patients received etanercept subcutaneously twice weekly. Improvement in signs and symptoms was assessed by the proportion of patients who achieved the American College of Rheumatology definition of improvement (ACR 20). The ACR 50 and ACR 70 responses were calculated in an analogous fashion. Safety was assessed at regularly scheduled visits. RESULTS: Of 1128 patients enrolled in etanercept trials, 197 (17%) were > or = 65 years of age. Clinical response was rapid and sustained and did not differ between age groups. At one year, 69% of patients < 65 years and 66% of patients > or = 65 years met the ACR 20. Forty percent of the patients > or = 65 years met the ACR 50 and 17% met the ACR 70. Etanercept was well tolerated. Although injection site reactions, headache, and rhinitis occurred somewhat more frequently in younger patients, the overall rates and types of other adverse events were comparable in both groups. CONCLUSION: Etanercept is a new treatment option for older patients with RA and has substantial benefit and comparable safety regardless of patient age.
11968560 [Traumatic jejunal entrapment in a patient with Bechterew disease]. 2002 Jan We report an unusual case of incarceration of small bowel between the 4th and 5th lumbar vertebrae in a patient with rheumatoid spondylitis. Incarceration of the loop of jejunum within the fracture or between dislocated lumbar vertebrae is an uncommon entity. The cases of traumatic jejunal entrapment have been previously reported in the literature [1, 2, 3, 4, 5, 6, 7, 8, 9, 11]: 2 cases occurred in adults and 8 in children. There has been no report on this injury in patients with rheumatoid spondylitis (Bechterew arthritis).
12674232 Digital tomosynthesis of hand joints for arthritis assessment. 2003 Mar The two principal forms of hand arthritis, rheumatoid arthritis (RA) and osteoarthritis (OA) have large clinical and economic costs. Radiography has been shown to be a useful tool to assess the condition of the disease. A hand radiograph, however, is a two-dimensional projection of a three-dimensional object. In this report we present the results of a study that applied digital tomosynthesis to hand radiography in order to extract three-dimensional outcome measures that should be more sensitive to arthritis progression. The study was performed using simulated projection radiographs created using micro computed tomography (microCT) and a set of five dry-bone hand skeletons. These simulated projection images were then reconstructed into tomographic slices using the matrix inversion tomosynthesis (MITS) algorithm. The accuracy of the tomosynthesis reconstruction was evaluated by comparing the reconstructed images to a gold standard created using the microCT data. A parameter from image registration science, normalized mutual information, provided a quantifiable figure of merit. This study examined the effects of source displacement, number of reconstructed planes, number of acquisitions, noise added to the gray scale images, and errors in the location of a fiducial marker. We also optimized the reconstruction as a function of two variables k and alpha, that controlled the mixing of MITS with conventional shift-and-add tomosynthesis. A study using hand delineated joint margins demonstrated that MITS images provided a better measurement of average joint space width. We found good agreement between the MITS slices and the true planes. Both joint margins and trabecular structure were visible and the reconstructed slices showed additional structures not visible with the standard projection image. Using hand-delineated joint margins we compared the average joint space width of the gold standard slices to the MITS and projection images. A root-mean square deviation (RMSD), calculated for this comparison, gave RMSDproj = 0.18 mm and RMSDMITS = 0.14 mm for the projection and MITS images, respectively. We have demonstrated the potential of digital tomosynthesis for imaging of the hand to assess arthritic changes. We have also developed a methodology that can be used to optimize the technique and have studied the issues that will control the feasibility of clinical implementation.
15344419 Anti-inflammatory effect of bee venom on type II collagen-induced arthritis. 2004 Bee venom (BV) has been used to relieve pain and reduce inflammation in traditional Oriental medicine, especially in chronic inflammatory diseases such as rheumatoid arthritis (RA). We previously reported that the BV injection into a traditional acupuncture point (Zusanli) reduced arthritis-associated edema and nociceptive responses in Freund's adjuvant-induced arthritis in rats (Kwon et al., 2001). This study was designed to evaluate the anti-inflammatory and anti-cytokine effect of BV on a murine type-II collagen-induced arthritis (CIA) model. Male mice were immunized by spontaneous injection of 100 microg of an emulsion of bovine type-II collagen and complete Freund's adjuvant (CFA), with a booster injection after 2 weeks. In the experimental group, 0.1 ml BV was injected at acupuncture point (Zusanli) near both knees twice a week for a total of 5 times. In the control group, normal saline was injected at the same frequencies. These injections began 5 weeks after the first collagen injection. Starting the 3rd week after the first collagen injection, we examined limb swelling and severity of arthritis twice a week. At 8 weeks, mice were sacrificed and synovial tissue was examined with the light microscope and serum cytokines (IL-1beta and TNF-alpha) were measured by ELISA. The incidence of arthritis, the mean arthritis index and the number of arthritic limbs were significantly lower in the treatment compared to the control group (63% versus 75%, 3.4% versus 8.5%, 23% versus 75%, respectively). Among the serum proinflammatory cytokines, the production of TNF-alpha in the BV group was suppressed compared to the control group (59 +/- 4.5 versus 99.5 +/- 6.5, p < 0.05), but IL-1beta was not suppressed. The examination of the histopathology of the joints of murine CIA showed decreased inflammation signs and less lymphocyte infiltration after BV acupuncture therapy. Acupuncture therapy with BV suppressed the development of arthritis and caused inhibition of the immune responses in type-II collagen-induced arthritis.
12384130 Peripheral bone density in patients with rheumatoid arthritis and factors which influence 2002 Oct INTRODUCTION: Patients with rheumatoid arthritis (RA) frequently possess a number of risk factors for osteoporosis. Additionally, oral steroids are often used to control active rheumatoid disease and may further potentiate bone loss. We wished to establish the degree of peripheral bone loss in RA and to assess the influence of oral steroids and other risk factors. METHODS: We measured bone mineral density (BMD) in the non-dominant forearm using a DTX 200 osteometer in 191 RA patients who were receiving oral prednisone in a dose of at least 5 mg daily for over 3 months. We compared the results with those of two other groups: 165 RA patients who had never received oral prednisone and 242 normal controls without RA or any history of steroid therapy. Forward stepwise multiple regression analysis was used to determine the effects of age, disease variables and steroids on BMD. RESULTS: Age (P<0.001), RA (P<0.02) and steroid therapy (P<0.05) were all associated with reduced BMD using multiple regression analysis. Duration of RA was also associated with reduced BMD (P<0.05), but activity of disease was not. By WHO criteria (BMD T score<-2.5 S.D.), 95 (50%) of the RA steroid-treated patients (RAS) had osteoporosis, while 48 (25%) of the RA patients not exposed to steroids (RAN) were osteoporotic. Among the normal controls (NC), 48 (20%) had osteoporosis. The mean (S.D.) BMD Z scores for the three groups were -0.8 (1.3) for RAS, -0.4 (1.3) for RAN and 0.0 (1.0) for NC (P<0.01 for all differences). The percentages of patients with a Z score of -1 or less were 51% for RAS, 29% for RAN and 14% for NC. These differences were also significant (P<0.01). Male sex was associated with reduced BMD when compared to female sex (Z<-1) in the RAS (57 vs. 49%; P<0.05) but not in the RAN (25 vs. 31%) groups. For men with RA, the mean (S.D.) BMD Z scores were -1.3 (1.3) for RAS compared to -0.5 (1.3) for RAN (P<0.005), while for women the differences were less marked at -0.7 (1.3) for RAS compared to -0.4 (1.3) for RAN (P<0.05). CONCLUSIONS: In general, patients with RA have a significantly reduced forearm BMD, which correlates with increasing disease duration. Exposure to oral steroids increases bone loss, notably in male patients. Patients with RA on oral steroids need BMD measurements with a view to prophylactic therapy in those with a low result. Previous fractures and a daily dose of 15 mg or more of prednisone are also important factors in determining when prophylaxis is indicated.