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ID PMID Title PublicationDate abstract
17042021 Why do patients with rheumatoid arthritis use complementary therapies? 2006 Jun OBJECTIVES: (1) to develop an understanding as to how the use of complementary therapy (CT) affects a patient's perspective of health and well-being, (2) to offer the rheumatology professional insight and understanding as to why a patient chooses to use a CT, and (3) to raise awareness as to the forms of CT most commonly used by patients with rheumatoid arthritis. METHODS: This qualitative study was based on phenomenological principles applied through focused inquiry to develop an understanding of the lived experience of the study participants. The inclusion criteria of an established diagnosis of rheumatoid arthritis and known use of CT were applied to a convenience sample of patients attending a rheumatology outpatient department clinic on two consecutive days. Of the 15 eligible patients identified, five were randomly selected for inclusion in the study. Narrative data were collected through analysis of transcripts taken from audiotape recordings of unstructured interviews with study participants. A manual indexing system was used to develop four significant categorisation themes to reflect the findings: (1) incentives to use CT, (2) perceived benefits of CT use, (3) the choice of CT used, and (4) perceived disadvantages and risks of CT use. RESULTS: Incentives to use CT included dissatisfaction with conventional treatment, often in the form of side effects, and drug ineffectiveness. Social factors, such as loss of employment and social activities, were also indicated, as were psychological changes in the form of depression, hopelessness and fear. Perceived benefits were categorised as either physical or psychological with associated aspects of choice and control viewed as important elements of personal empowerment. The choice of CT used fell into three categories; physical, spiritual and herbal. The most commonly used of these were herbal remedies and supplements, closely followed by aromatherapy massage. Disadvantages and risks were identified as physical (pain and discomfort), psychological (fear and uncertainty), and/or material (cost). CONCLUSIONS: This study suggests that regular use of CT by patients with rheumatoid arthritis offers holistic benefits. Compared to conventional treatments, CT is seen to have advantages in terms of a lower incidence of adverse reactions, greater patient choice, psychological comfort and an increased quality of the patient/therapist relationship. The use of CT by patients with rheumatoid arthritis indicates a need for evidence-based information about its use and safety in order to direct practice within a rheumatology department.
15709880 Management of hepatitis C virus-related arthritis. 2005 Jan In recent years, hepatitis C virus-related arthritis (HCVrA) has been recognised as an autonomous rheumatic disorder. Two subsets of the disease have been identified: a polyarthritis involving small joints that resembles rheumatoid arthritis, but is usually milder, and a mono-oligoarthritis that shows an intermittent course and is frequently associated with the presence of cryo-globulins in serum. Few data about HCVrA treatment are reported in the literature. As a consequence, the therapeutic approach for this disorder is still largely empirical. Hydroxychloroquine, low doses of corticosteroids and NSAIDs are frequently administered to patients with HCVrA, but some authors describe an incomplete relief of symptoms, especially in the rheumatoid-like subset. Intake of low doses of corticosteroids and NSAIDs is more effective in subjects belonging to the mono-oligoarthritis group. Use of antiviral drugs (IFN plus ribavirin) shows good results, but IFN can induce or worsen autoimmune disorders. For this reason, in our opinion, this approach should be prescribed only when required by the coexistent liver disease. On the basis of the poor available data, the administration of anti-TNF-alpha agents seems safe in HCV patients, but the usually non-aggressive course of HCVrA does not justify their use as a current therapy.
16921781 [An update on diagnostic and prognostic biomarkers of early rheumatoid arthritis]. 2006 Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that leads to inevitable joint destruction. The revised American College of Rheumatology (ACR) criteria for the diagnosis of RA are not sensitive enough for classification of the very early onset of the disease. They lack the predictive value for identifying patients at high risk of rapid joint damage and for assessing the efficacy of treatment. To improve the situation, several new biomarkers are currently studied to help to achieve this goal. Respecting the pathophysilogy of RA, several markers reflecting immune response, inflammation, joint destruction, and genetic factors are discussed in this review. Finally, the potential use of several markers in the clinical practice is depicted.
16793841 Metabolic syndrome is common among middle-to-older aged Mediterranean patients with rheuma 2007 Jan OBJECTIVES: Patients with rheumatoid arthritis have an increased risk for cardiovascular disease (CVD). The prevalence of metabolic syndrome (MetS)-a major contributor to CVD-in a cohort of patients with rheumatoid arthritis and its relationship with rheumatoid arthritis related factors is investigated here. METHODS: 200 outpatients with rheumatoid arthritis (147 women and 53 men), with a mean (standard deviation (SD)) age of 63 (11) years, and 400 age and sex-matched controls were studied. MetS was assessed according to the adult treatment panel III criteria and rheumatoid arthritis disease activity by the disease activity score of 28 joints (DAS28). A standard clinical evaluation was carried out, and a health and lifestyle questionnaire was completed. RESULTS: The overall prevalence of MetS was 44% in patients with rheumatoid arthritis and 41% in controls (p = 0.5). Patients with rheumatoid arthritis were more likely to have low high-density lipoprotein cholesterol compared with controls (p = 0.02), whereas controls were more likely to have increased waist circumference or raised blood pressure (p = 0.001 and 0.003, respectively). In multivariate logistic regression analysis adjusting for demographics and rheumatoid arthritis treatment modalities, the risk of having moderate-to-high disease activity (DAS28>3.2) was significantly higher in patients with MetS compared with those with no MetS components (OR 9.24, 95% CI 1.49 to 57.2, p = 0.016). CONCLUSION: A high, albeit comparable to the control population, prevalence of MetS was found in middle-to-older aged patients with rheumatoid arthritis. The correlation of rheumatoid arthritis disease activity with MetS suggests that the increased prevalence of coronary heart disease in patients with rheumatoid arthritis may, at least in part, be attributed to the inflammatory burden of the disease.
17032593 [Chronic inflammation increases the risk of cardiovascular disease in patients with rheuma 2006 Sep 25 Rheumatoid arthritis is associated with increased cardiovascular morbidity and mortality due to atherosclerosis. This cannot be explained by an increased presence of traditional risk factors but seems to depend on inflammatory mechanisms. The association of inflammatory pathways with atherosclerosis is complex, and more research is required to optimise preventative measures against cardiovascular complications in inflammatory rheumatic diseases.
15750680 Outcome of late-onset rheumatoid arthritis. 2005 Sep The objective of this study was to determine possible differences in the outcome of patients with rheumatoid arthritis (RA) with disease onset early and late in life. As part of a broader outcome study of RA which included patients seen in the division of Rheumatology of Hospital Universitario Marqués de Valdecilla of Santander, Cantabria (Northern Spain) with disease duration between 2 and 7 years, we selected patients with an age at disease onset of or=65 years. The medical records of all eligible patients were reviewed for relevant clinical and laboratory variables; the patients were then further evaluated for disease activity using biological tests and joint indices such as joint counts and Thompson's Index, functional capacity using the American College of Rheumatology (ACR) functional classification (ACR-FC) and the modified Health Assessment Questionnaire (M-HAQ), and anatomical damage using the number of joint damage (NJD) and radiographs read by the Sharp's scoring method for joint erosion (JE), joint narrowing (JN), and overall. Patients in both subsets were then compared. For the multivariable analyses all patients in the original larger cohort were included, so that age could be used as a continuous variable and the power of the analyses could increase; 31 younger (mean age+/-SD: 36+/-7 years) and 35 older (73+/-6 years) patients were available for assessment. No differences in disease duration and gender distribution were observed. Likewise, both subsets had similar levels of disease activity, both articular indices, and biological markers. In contrast, elderly patients showed more functional limitations as per the M-HAQ [median (interquartile range): 0.4 (0.13-1.2) vs 0.13 (0-0.6), p=0.007] and greater anatomical damage as per the NJD [median (interquartile range): 2 (0-4) and 0 (0-2), respectively, p=0.04] and the JE, JN, and total Sharp Index score (p=0.001, 0.02, and 0.001, respectively). Although older patients took fewer disease-modifying antirheumatic drugs (DMARD) and combined DMARD treatments (2.5+/-1.4 vs 1.9+/-1.3, p=0.05 and 0.8+/-1.1 vs 0.3+/-0.6, p=0.01, respectively), multivariable analysis demonstrated an independent association between age at disease onset and the number of DMARD and functional and anatomical decline. Late-onset RA does not present a better prognosis than the early-onset form of the disease. At the very least the disease is comparable between both patient groups. However, disease compounded by age-associated factors may in fact have a worse prognosis late than early in life.
15844764 [Recent views on the pathogenesis of cardiovascular damage associated with rheumatoid arth 2005 Feb Cardiovascular disease is the commonest cause of premature mortality in rheumatoid arthritis and several data have shown that rheumatoid arthritis is an independent risk factor for the development of atherosclerotic disease. In last years it has become evident that atherosclerosis is an immune-mediated inflammatory disorder sharing a number of pathogenic features with rheumatoid arthritis. It is conceivable, therefore, that chronically raised concentrations of proinflammatory cytokines and pathological immune response characterizing rheumatoid arthritis may play a key role in inducing acceleration of atherosclerotic processes and, consequently, in the development of cardiovascular disease in these patients.
17038472 Pharmacoeconomics: friend or foe? 2006 Nov The financial constraints faced by most health systems today make it necessary for manufacturers of new, expensive drugs to demonstrate value for money. This paper describes the different types of economic evaluation; the increasing use of these analysis in decision making; their application to new drugs in the field of in rheumatoid arthritis; and the pros and cons of pharmacoeconomics studies from the perspective of the patients, the physicians, and the general population.
17083759 DAS remission cut points. 2006 Nov The Disease Activity Score (DAS) and DAS28 are continuous measures of rheumatoid arthritis (RA) disease activity. Values of DAS %lt;1.6 and DAS28 %lt; 2.6 correspond with an increased likelihood of being in remission. This review presents development of the DAS and DAS28 remission cut points and their interpretation.
16905578 Methotrexate pharmacogenomics. 2006 Sep Observations of clinical effects of methotrexate will help in patient‐management decisions
16277693 Pyridoxine supplementation corrects vitamin B6 deficiency but does not improve inflammatio 2005 Patients with rheumatoid arthritis have subnormal vitamin B6 status, both quantitatively and functionally. Abnormal vitamin B6 status in rheumatoid arthritis has been associated with spontaneous tumor necrosis factor (TNF)-alpha production and markers of inflammation, including C-reactive protein and erythrocyte sedimentation rate. Impaired vitamin B6 status could be a result of inflammation, and these patients may have higher demand for vitamin B6. The aim of this study was to determine if daily supplementation with 50 mg of pyridoxine for 30 days can correct the static and/or the functional abnormalities of vitamin B6 status seen in patients with rheumatoid arthritis, and further investigate if pyridoxine supplementation has any effects on the pro-inflammatory cytokine TNF-alpha or IL-6 production of arthritis. This was a double-blinded, placebo-controlled study involving patients with rheumatoid arthritis with plasma pyridoxal 5'-phosphate below the 25th percentile of the Framingham Heart Cohort Study. Vitamin B6 status was assessed via plasma and erythrocyte pyridoxal 5'-phosphate concentrations, the erythrocyte aspartate aminotransferase activity coefficient (alphaEAST), net homocysteine increase in response to a methionine load test (DeltatHcy), and 24 h urinary xanthurenic acid (XA) excretion in response to a tryptophan load test. Urinary 4-pyridoxic acid (4-PA) was measured to examine the impact of pyridoxine treatment on vitamin B6 excretion in these patients. Pro-inflammatory cytokine (TNF-alpha and IL-6) production, C-reactive protein levels and the erythrocyte sedimentation rate before and after supplementation were also examined. Pyridoxine supplementation significantly improved plasma and erythrocyte pyridoxal 5'-phosphate concentrations, erythrocyte alphaEAST, urinary 4-PA, and XA excretion. These improvements were apparent regardless of baseline B6 levels. Pyridoxine supplementation also showed a trend (p < 0.09) towards a reduction in post-methionine load DeltatHcy. Supplementation did not affect pro-inflammatory cytokine production. Although pyridoxine supplementation did not suppress pro-inflammatory cytokine production in patients with rheumatoid arthritis, the suboptimal vitamin B6 status seen in rheumatoid arthritis can be corrected by 50 mg pyridoxine supplementation for 30 days. Data from the present study suggest that patients with rheumatoid arthritis may have higher requirements for vitamin B6 than those in a normal healthy population.
16824621 Molecular and cellular basis of rheumatoid joint destruction. 2006 Jul 15 Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with joint destruction. Synovial fibroblasts are key players in this pathological process. They favorise a pro-inflammatory environment in the synovial tissue, interact with the immune system and regulate the differentiation of monocytes into osteoclasts. Synovial hyperplasia is another characteristic of RA, reflecting not only an imbalance between proliferation and apoptosis, but also the migration of cells into the synovial tissue. Gene transfer experiments have been used as important tools for the understanding of molecular and cellular changes that characterize the activated RA synovial fibroblasts. Activated synovial fibroblasts can invade cartilage and bone. Synovial activation is driven by cytokines, such as TNFalpha and IL-1, as well as IL-15, 16, 17, 18, 22, 23, but also by cytokine-independent mechanisms that involve the innate immune system (i.e. TLRs), a unique communication network of microparticles and epigenetic changes (e.g. L1 retroelements).
16191448 Late onset rheumatoid arthritis: clinical and laboratory comparisons with younger onset pa 2006 Mar We aimed to compare the clinical and laboratory profiles of the patients presenting late onset rheumatoid arthritis (LORA) with younger onset rheumatoid arthritis (YORA) patients. During the period between January 1995 and December 2004, 124 patients with LORA were identified from a retrospective chart review of inpatients and outpatients. They were compared with 150 YORA patients examined during the same period including their clinical and laboratory findings. The mean ages of the patients with LORA and YORA were 71.7+/-5.9 years, and 52.1+/-11.5 years, respectively. The gender ratio (female/male) was 1.48 in LORA and 2.85 in YORA (p = 0.012). The average ages of the disease onset were 42.2+/-10.4 years in YORA and 68.4+/-4.6 years in LORA. The duration of the diagnosis was longer in LORA than in YORA (20.7+/-14.3 months versus 10.3+/-6.2 months, p < 0.001). Rheumatoid arthritis (RA) duration was shorter in LORA than in YORA (43.5+/-64.4 months versus 126.3+/-101.0 months, p < 0.001). Although LORA patients had more significant frequent shoulder joint involvements (p < 0.001), proximal interphalangeal (PIP), metacarpophalangeal (MCP), elbow, metatarsophalangeal (MTP) and ankle involvements were common in YORA. Wrist, knee and hip involvements were not different in the groups. Classical rheumatoid hand deformities, interstitial lung disease and Sjögren's syndrome (SS) were significantly lower in LORA than in YORA. LORA patients had more common weight loss, myalgia, lymphadenopathy, polymyalgia rheumatica (PMR)-like syndrome and neuropathy. The frequencies of RF, ANA, anti-SSA/Ro and anti-SSB/La positivities were lower in LORA than in YORA, whereas elevated erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) and anemia associated with chronic disease were higher in LORA. Patients with LORA, according to the accepted international criteria, present with different clinical and laboratory profiles when compared with younger patients. These results suggest that age may influence the presentation of RA at onset.
16972685 [Bone disease related to rheumatoid arthritis]. 2006 Sep Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by progressive bone destruction, in which proinflammatory cytokines such as tumor necrosis factor-alpha play essential roles. Recent studies have revealed an important involvement of osteoclasts in bone destruction of RA. In this review, I would like to explain the molecular mechanism of osteoclast development in RA, and propose the possibility of anti-osteoclast therapy to the disease.
15721651 Fractal analysis of acceleration signals from patients with CPPD, rheumatoid arthritis, an 2005 Mar Arthritis is one of the leading causes of disability and affects a major segment of the population. Consequently, accurate diagnosis of arthritis is important. Arthritis due to calcium pyrophosphate deposition disease (CPPD), rheumatoid arthritis, and spondyloarthropathy, induce complex changes in the cartilage and the articular surface. The fractal dimension provides a measure of the complexity of a signal. Recently, we have developed non-invasive acceleration measurements to characterize the arthritic patients. The question remains if the fractal dimension of the acceleration signal is different for different arthritis conditions. The purpose of this study was to distinguish between different types of arthritis of the finger joint using the fractal dimension of the acceleration signal obtained from the finger joint of the arthritic patients. Acceleration signals were obtained from the finger joint of arthritis patients with rheumatoid arthritis, spondyloarthropathy, and calcium pyrophosphate deposition disease of the finger joint. ANOVA results showed that there were significant differences between the fractal dimension of acceleration signals from patients having calcium pyrophosphate deposition disease and rheumatoid arthritis and spondyloarthropathy. Fractal dimension of acceleration signals, in concert with other clinical symptoms, can be used to classify different types of arthritis.
16461801 Costimulatory pathways in rheumatoid synovitis and T-cell senescence. 2005 Dec The pathogenesis of rheumatoid arthritis (RA) is determined by a complex interaction of genetic and environmental factors. Of all risk factors, age has the largest impact. RA occurs most often during the postmenopausal period of life, with incidence rates peaking in the eighth decade. While age is generally accepted as an etiologic factor for failure of immunocompetence, much less is understood about the role of T-cell senescence in autoimmunity. We have hypothesized that senescent T cells are particularly prone to be activated in specialized microenvironments, such as the synovial membrane. CD4 T cells in the senescence program were identified by the loss of CD28. Gene expression profiling documented that CD28- T cells have acquired a spectrum of regulatory receptors that are usually seen only on NK cells. Such regulatory receptors include stimulatory and inhibitory members of the killer immunoglobulin-like receptor (KIR) family, the stimulatory c-type lectin receptor NKG2D, and CX3CR1, the receptor for the chemokine fractalkine. Synovial fibroblasts express the relevant ligands, thus providing stimulatory signals to tissue-infiltrating T cells. The signaling pathways of these regulatory receptors are complex and dependent on the individual T cells, some of which express important adapter molecules such as DAP10 and DAP12. Inhibitory KIRs on T cells are often only partially functional. Our data suggest that, by virtue of altered receptor profiles, conventional tolerance mechanisms can be evaded in the aging host. By acquiring a new set of regulatory receptors, senescent CD4 T cells become responsive to novel environmental cues and find ideal stimulatory conditions in the synovial microenvironment.
15828371 [Treatment of rheumatoid arthritis in 2005: prompt, agressive and customized]. 2005 Mar 9 Treatment of rheumatoid arthritis in 2005: prompt, aggressive and customized Rheumatoid arthritis can be extremely serious (joint destruction, functional loss, decrease in life expectancy). Fortunately, our therapeutic means have recently progressed enormously (better appreciation of efficacy and ways to use DMARDs combinations and new molecules such as leflunomide and anti-TNFs, understanding of the importance of early adequate and intensive treatments when necessary). Huge progresses have also been performed with regards to evaluation and follow-up strategies (disease activity score--DAS, health assessment questionnaire--HAQ), which allows us to adapt the treatment much better. The goal now can and must be quick and total remission of the disease in all patients thus avoiding as much as possible irreversible joint damages with accompanying morbidities.
16891925 Recurrent postpartum episodic rheumatoid arthritis. 2006 Aug It is well known that rheumatoid arthritis improves in the majority of patients during pregnancy and that aggravation of disease symptoms occurs within the first 6 months postpartum. We report a female patient who had 4 postpartum episodes of transient polyarthritis typical of rheumatoid arthritis with positive serum rheumatoid factor and anti-CCP antibodies. All bouts resolved within 4 to 10 weeks after onset without any symptoms in between the episodes.
15843450 Cardiovascular admissions and mortality in an inception cohort of patients with rheumatoid 2005 Nov BACKGROUND: There is increased cardiovascular disease mortality in rheumatoid arthritis. This may reflect an increased prevalence of cardiovascular disease or an increased case fatality in patients with rheumatoid arthritis. OBJECTIVES: To examine whether rheumatoid patients with disease onset in the 1980s-1990s have increased mortality, and to compare cardiovascular admission rates in rheumatoid patients with those of the general population. METHODS: An inception cohort of 1010 rheumatoid patients attending Stockport rheumatology clinics between 1981 and 1996 was followed up to December 2002 through the Office for National Statistics. Standardised mortality ratios (SMR) were calculated for all-cause and cause specific mortality, using the population of Stockport as reference. Cardiovascular disease admission rates were ascertained for a subgroup of patients using national hospital episode statistics; standardised cardiovascular disease admission rates (SAR) and SMRs were calculated for this subgroup. RESULTS: 470 patients (48%) died during a median follow up of 11.4 years. All-cause mortality was increased in men (SMR = 1.45 (95% confidence interval, 1.22 to 1.71)) and women (SMR = 1.84 (1.64 to 2.05)), as was cardiovascular disease mortality in men (SMR = 1.36 (1.04 to 1.75) and women (SMR = 1.93 (1.65 to 2.26)). No difference in cardiovascular disease admission rates was observed in men (SAR 1.20 (0.89 to 1.58) or women (SAR = 1.10 (0.88 to 1.36)), despite excess cardiovascular disease mortality in this subgroup. CONCLUSIONS: Patients with rheumatoid arthritis have reduced life expectancy and excess cardiovascular disease mortality. Nevertheless, standardised admission rates for cardiovascular disease were not raised. This suggests either that cardiovascular disease in rheumatoid arthritis has a higher case fatality than in the general population or that it often goes unrecognised before the fatal event.
16184384 Adaptation of the rheumatoid arthritis quality of life scale for Estonia. 2006 May The aim of the study was to adapt the rheumatoid arthritis quality of life scale (RAQoL) for Estonia and assess its psychometric properties. The RAQoL was translated into Estonian using the dual panel method. The translation was assessed for face and content validity by means of interviews with 15 rheumatoid arthritis (RA) patients. Reproducibility and construct validity were estimated using a further sample of 50 patients. Unidimensionality of the final scale was assessed by Rasch analysis. No major problems occurred in translating the instrument, it was well accepted by interviewees. The Estonian RAQoL had good test-retest reliability, internal consistency and ability to discriminate between groups defined by patient-perceived severity. Predicted convergent and divergent validity was demonstrated. Unidimensionality of the instrument was confirmed by excellent fit to the Rasch model. The RAQoL is appropriate for use in clinical studies and trials involving RA patients.