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ID PMID Title PublicationDate abstract
16804738 Effects of rheumatoid factor isotypes on disease activity and severity in patients with rh 2007 Apr The value of rheumatoid factor (RF) isotypes for assessing rheumatoid arthritis (RA) remains debatable. In this study, we have examined the relationships between RF isotypes and disease activity and severity in RA patients. Sixty-two patients with RA, 48 women and 14 men, were studied. RF was measured by nephelometry (RF-N) and IgG-, IgA-, and IgM-RF isotypes were measured using enzyme-linked immunosorbent assay. Serum C-reactive protein and erythrocyte sedimentation rate were also determined. The patients were classified according to disease activity, joint damage, functional status, and presence of pulmonary involvement, rheumatoid nodule, and secondary Sjögren's syndrome. Although the patients with active disease had significantly higher IgA-RF and IgM-RF levels compared to inactive patients, IgA-RF and IgM-RF were not found to be independently associated with disease activity in multivariate analysis. In patients with severe joint damage, IgA-RF and RF-N were significantly higher than those of the other patients. Multiple regression analysis showed that IgA-RF was the unique variable independently associated to severe joint damage. The patients with class III and IV functional index had significantly higher IgM-RF, IgA-RF, and RF-N levels compared to the patients with class I and II functional index; however, RFs were not significantly associated with functional status in multivariate analysis. IgA-RF and IgM-RF were significantly associated with pulmonary involvement and rheumatoid nodule, respectively. No significant associations were found between RF isotypes and secondary Sjögren's syndrome. Our results suggest that the clinical usefulness of IgA and IgM isotypes is better than RF-N. Elevated IgA-RF may be a marker of erosive disease. The usefulness of RF isotypes for monitoring disease activity or functional status appears to be limited.
15901632 Comparison of long term outcome of patients with rheumatoid arthritis presenting with undi 2006 Jan BACKGROUND: The outcome of undifferentiated arthritis (UA) ranges from remission to rheumatoid arthritis (RA) fulfilling the American College of Rheumatology (ACR) classification criteria. OBJECTIVES: To report the outcome of UA after 1 year of follow up and compare the disease course of patients who presented with UA, but evolved into RA within 1 year (UA-RA group), with that of patients who presented with RA fulfilling the ACR criteria (RA-RA group). METHODS: The diagnosis of 330 patients who presented with UA was recorded at 1 year. The UA-RA and RA-RA groups were then followed up for 3 more years. Outcome measurements were radiographic progression, disease activity, and functional capacity. RESULTS: From 330 patients who were diagnosed UA, 91 had evolved into RA at 1 year; 62 patients had presented with RA. No significant differences were detected between the UA-RA and RA-RA groups in median Sharp/van der Heijde score at baseline, radiographic progression rates, disease activity, and functional capacity. However, significantly more disease modifying antirheumatic drugs were prescribed in the RA-RA group. CONCLUSION: The disease outcome of patients who present with UA that evolves into RA within 1 year is the same as that of patients who present with RA as measured by radiographic progression, disease activity, and functional capacity.
16973112 Ultrasonography and magnetic resonance imaging in early rheumatoid arthritis: recent advan 2006 Oct Efficient methods for diagnosis, monitoring, and prognostication are essential in early rheumatoid arthritis. Data on the value of ultrasonography and MRI are accumulating rapidly, fueling their increasing use in early rheumatoid arthritis. This review focuses on recent advances in the clinical applications of these imaging modalities.
17088752 [Bipolar shoulder prosthesis for rheumatoid arthritis with irreparable rotator cuff tear: 2006 Oct PURPOSE OF THE STUDY: The goal of this study was to assess the clinical and radiological outcome of bipolar shoulder prosthesis in twelve shoulders with rheumatoid arthritis (RA) and irreparable rotator cuff tears. MATERIAL AND METHODS: The follow-up was more than five years (range 2-9 years). In addition, in order to investigate the effect of rheumatoid arthritis on outcome, results were compared with ten bipolar shoulder prostheses implanted for osteoarthritis with massive rotator cuff tears. RESULTS: The mean preoperative Constant score was 16.9 points with 2.6 points for pain, 4.2 points for activity, 9.5 points for motion and 0.6 points for force. The preoperative active motion was 63.8 degrees for forward flexion, 45 degrees for abduction and 12 degrees for active external rotation. At last follow-up, the average Constant score was 39.4 points with 10.7 points for pain, 10.8 points for activity, 13.8 points for motion and 4.1 points for force. Regarding the active motion, mean forward flexion was 83.7 degrees, 70.4 degrees for abduction and 29.1 degrees for external rotation. The complication rate was low, mainly superior migration due to infraspinatus tear and glenoid wear. Satisfactory deltoid arm level was achieved in all patients and no loosening was observed. Preoperative and postoperative scores of the rheumatoid group were not significantly different from the arthritis group (p<0.001). DISCUSSION: Our findings suggest that bipolar shoulder prosthesis provides a viable replacement alternative in RA combined with massive rotator cuff tear with a low rate of complication. Bipolar shoulder prosthesis demonstrates no clear superiority over conventional hemiarthroplasty regarding improved motion and glenoid wear. In addition, no significant difference with arthritis was observed (p<0.05), assuming that outcome depends principally on the preoperative condition of the rotator cuff. CONCLUSION: Some massive tears involving the subscapularis tendon can lead to anterior recurrence after bipolar shoulder prosthesis. They might be a limit to the procedure and require a reversed shoulder prosthesis or a glenohumeral arthrodesis.
16164219 [Biological effects of bisphosphonates in patients with rheumatoid arthritis]. 2005 Sep Loss of bone mineral density(BMD) has frequently been observed in patients with rheumatoid arthritis (RA) and main causes of osteoporosis were reported to be steroid osteoporosis, postmenoposal osteoporosis, and disuse bone atrophy associated with polyarticular impairment. It is becoming clear that the increase in bone resorption such as these osteoporosis and RA is underling the molecular mechanism; the facilitation of osteoclast differentiation and activation by the inflammatory cytokines TNFalpha and IL-1. Bisphosphonates, which are taken up by osteoclasts and macrophages to inhibit the activity of these cytokines, are expected to function as an inhibitor of inflammation induced by these cells. Bisphosphonates reduce also osteoclast numbers and activity by induction of osteoclast apoptosis, and could be a therapeutic goal for new anti-osteoclast drugs. As for the periarticular osteoporosis, bisphosphonate has also anti inflammatory effects and inhibition of bone destruction in RA.
16142762 Is the disease course of rheumatoid arthritis becoming milder? Time trends since 1985 in a 2005 Sep OBJECTIVE: Based on comparisons of short-term cohort studies or cross-sectional samples of patients from different calendar times, it has been suggested that present patients with rheumatoid arthritis (RA) have a milder disease course compared with that of patients in past decades. This study was undertaken to investigate whether the course of disease activity and functional disability in patients with RA has become milder over the past several years. METHODS: We used the Nijmegen inception cohort of early RA, which included all patients with newly diagnosed RA who had attended the department of rheumatology at Radboud University Nijmegen Medical Centre since 1985. Patients were assessed for disease activity by the Disease Activity Score in 28 joints (DAS28) every 3 months and for functional disability by the Health Assessment Questionnaire (HAQ) disability index (DI) every 6 months. Within the total cohort, 4 subcohorts were defined, based on the date of inclusion of the patients (1985-1990, 1990-1995, 1995-2000, 2000-2005). To investigate whether the course of disease activity and functional disability (over time) was different between the subcohorts, longitudinal regression analysis (linear mixed models) was used, with the DAS28 and HAQ DI over time as outcome variables, respectively, and subcohort as the independent variable, correcting for baseline demographic and clinical characteristics. The treatment strategy was compared between the subcohorts. RESULTS: The DAS28 at baseline and over the first 5 years of disease was lower in the more recent subcohorts. The HAQ DI did not show improvement but instead a trend toward worsening functional disability. Using longitudinal regression it was shown that disease activity improved early in the disease course and stabilized thereafter, and that this improvement was greater in patients in the more recent subcohorts and in patients with a higher baseline DAS28. Initially, the HAQ DI also improved but stabilized thereafter, and this initial improvement was less pronounced in patients in the more recent subcohorts and was greater for patients with a higher baseline HAQ DI. The treatment strategy was more aggressive in the more recent subcohorts, as shown by a shorter duration from diagnosis to the start of treatment with prednisone or disease-modifying antirheumatic drugs (DMARDs), and a greater prevalence of DMARD therapy. CONCLUSION: The course of disease activity in RA patients has become milder in more recent years. The reason for this improving trend remains to be elucidated, although the trend coincides with a more aggressive treatment strategy.
15995292 [Recent progress of pathogenesis and treatments in rheumatoid arthritis]. 2005 Jul Bone homeostasis is maintained by a balance between bone resorption by osteoclasts and bone formation by osteoblasts. Osteoclast maturation requires stimulation by RANKL expressed on osteoblasts and other cells. During the processes, pro-inflammatory cytokines such as TNF-alpha cause an imbalance in bone metabolism via direct and/or indirect effects on osteoclasts. These inflammatory signals originate from the immune system, the largest source of cell-derived regulatory signals and such immunological signals to the bone results in secondary osteoporosis and bone destruction. Actually, such phenomena mainly occur at the interface between proliferating synovium and bone tissue in rheumatoid arthritis (RA). Thus, therapeutic strategies using biologics including infliximab and etanercept, effective for treating RA disease activity, also reduce joint destruction. Based on an improved understanding of immune signals, investigation of the suppression of cell functions may lead to improved understanding and better treatment of bone destruction and osteoporosis.
15692956 Why Atlas, why not Heracles: reflections on the rheumatoid cervical spine. 2005 Feb Rheumatoid involvement of the 24 joints of the cervical spine leads to prominent changes in the occipito-atlanto-axial area. Eight different subtypes of such changes are recognized, depicted, and defined. The frequencies of these 8 subtypes in rheumatoid arthritis and other arthritides are tabulated. A central role in these disorders is played by a small-size, heavy-duty fitting piece or adapter, atlas, between the occiput and C2. The history of the fate of Atlas, who led the fight of godlike titans against the new gods of Olympos, is recapitulated. In particular, for a short moment Atlas was released from his heavy physical ordeal by another strongman, the heavy-weight wrestler of his times, Heracles. The reasons for the current nomenclature and answer to the question "Why Atlas, why not Heracles" are provided.
16164215 [Recent progress in image analysis of rheumatoid arthritis]. 2005 Sep The establishment of better methods than the conventional radiological examination in the management of rheumatoid arthritis is one of the key issues to be achieved in near future. The conventional X-ray examinations are not so sensitive or specific to early pathologies of inflammation and subtle changes. However, from the economical and clinical point of view, still plane X-ray images have several advantage. Several grading system including Steinbrocker, Larsen grade and Sharp score had been developed. Magnetic resonance image offers improved sensitivity to early inflammation of synovial tissue and bone destructive changes in the joints in RA patients. There are clear evidence for MRI synovitis representing true synovial inflammation. The clinician who intends to manage the inflammatory joint diseases should have the knowledge of these evaluation systems.
15608301 Capability for daily activities in old people with rheumatoid arthritis: a population base 2005 Jan OBJECTIVE: To describe the functional capacity for daily activities in old people with clinical rheumatoid arthritis (including juvenile rheumatoid arthritis (JRA)) in a population based cohort. METHODS: A cohort of 700 people was randomly collected from the population older than 75 years in a Finnish town. Altogether 601 persons (86%) participated. Data were collected from clinical records and by interview, clinical examination, and questionnaire. Ability to carry out activities of daily living (ADL) was assessed by the Barthel index, and the IADL (instrumental activities of daily living) by the Lawton and Brody questionnaire. RESULTS: 16 people had clinical rheumatoid arthritis (one with JRA). The prevalence was 16/601 (2.7% (95% confidence interval, 1.7% to 4.5%)). Eight patients with rheumatoid arthritis (50%) obtained the best possible ADL figures, while three (19%) had very poor results. Seven (44%) could not dress themselves without help. Three (19%) were unable to walk, and five (31%) could not climb stairs. Sex and age adjusted results showed no statistical difference (ADL and IADL) between patients with clinical rheumatoid arthritis and rest of the cohort. Four patients (25%) had dementia, which was associated with the poor functional capacity. CONCLUSIONS: The prevalence of the disease was unexceptional. The ability of old people with rheumatoid arthritis to carry out activities of daily living did not differ from the general population, but the disease may lead to severe disability on an individual level, especially when associated with dementia. It therefore remains a considerable challenge to the health care and social systems.
16362443 Severity of rheumatoid arthritis: the SEVERA study. 2006 Sep This study aims to assess the severity of rheumatoid arthritis (RA) in rheumatology practice in our population. All outpatients and inpatients with RA seen by registered rheumatologists over a 1-year period were included. Severity was measured using the Larsen score for hands and wrists and the Modified Health Assessment Questionnaire (M-HAQ). Two hundred ninety-eight RA cases were included. Mean age was 51.5 years. Among them, 261 (87.6%) were females. Disease duration was less than a year in 26 subjects (8.7%) and 10 years and above in 108 (36.2%) with a mean of 8.9. There were 220 (73.8%) subjects who had M-HAQ score <1. In 61 (20.5%) subjects, M-HAQ score was > or =1 and <2, and 17 (5.7%) had M- HAQ score > or =2. In relation with disease duration, M-HAQ starts with an average (SD) value of 0.7 (0.6) during the first year, decreases to 0.4 (0.4) at 5-year disease duration and increases after 10 years of disease progression to an average of 0.9 (0.8). Mean (SD) Larsen score was 51.9 (29.5) and median was 45. A total of 25% had a Larsen score > or =50% of maximum. Larsen score increased significantly (p<0.0001) with disease duration, starting at an average (SD) of 36.1 (14.9) during the first year, rising to 42.5 (15.8) around 5 years and reaching 73.9 (36.9) after 10 years. RA severity in our practice is comparable to that reported in Western populations in terms of radiological damage; however, functional status differs, possibly reflecting cultural differences.
16484876 Kartagener syndrome and rheumatoid arthritis. 2006 Feb We report the case of a 38-year-old female patient, affected with Kartagener syndrome (primary ciliary dyskinesia), who developed seropositive and erosive rheumatoid arthritis. According to our review, there are only 6 cases reported so far with this association without a definite etiopathogenic linkage recognized in common. Chronic infections resulting from the ciliary dysfunction might be a trigger for rheumatoid arthritis.
16594204 Disease modifying treatment for feline rheumatoid arthritis. 2005 Feline erosive polyarthritis includes the more common periosteal proliferative polyarthritis (PPP) and the rarely seen rheumatoid arthritis (RA) (11). During the past three years, 12 patients with definite feline rheumatoid arthritis, which did not respond well to conventional therapy, were treated with 7.5 mg of Methotrexate and 70 mg Leflunomide, given weekly by the oral route. The average age of the cats was 5.9 years (range 2.5 to 10 years). Siamese cats were over represented. Seven of the 12 (58%) cats showed a marked improvement, usually within four weeks. Once maximum improvement was obtained the dosage was decreased. Serious toxicity was not noted and carcinogenetic effect was not seen during the course of this study.
16989407 [Immunologic laboratory testing in clinical practice for rheumatoid arthritis]. 2006 Aug The recent clinical practices for rheumatoid arthritis have changed greatly. First, biologic agents such as tumor necrosis factor blocker have been developed as well as disease-modifying antirheumatic drugs, with great efficacy in intractable RA. On the other hand, the importance of early effective therapeutic intervention has been recognized since early treatment prevents the progression of joint damage. However, early diagnosis of RA is not so easy because of the lack of appropriate diagnostic criteria. New laboratory tests have appeared for the diagnosis and prognostic prediction of RA. Among them, anticyclic citrullinated peptide antibodies (anti-CCP), which bind epitopes containing citrulline, seem to be attracting the most attention. Although rheumatoid factor (RF) is the only serologic marker among the seven classification criteria of the American College of Rheumatology (ACR) for RA, variability of the RF assay within laboratories and/or between laboratories, and quality assurance has not been established. We must address the standardization of RF assay as soon as possible.
15828369 [Interest of magnetic resonance imaging in rheumatoid arthritis]. 2005 Mar 9 Magnetic Resonance Imaging (MRI) is the best imaging method in early detection and management of rheumatoid arthritis (RA). There are other imaging methods available as ultrasound, scintigraphy, computed tomography and plain radiography for imaging RA but MRI provides the best sensitivity in detecting inflammatory changes in the joints. MRI shows the best intra and interobserver reliability and low variation between repetitive examinations. MRI has shown the best visualisation and the greater sensitivity to detect erosion in early RA, compared to standard radiography. The use of a contrast agent further increases the sensitivity in detecting erosions and differentiate synovial proliferation from fluid collections. Otherwise, intraossous cyst, tenosynovitis, bone marrow edema, that are concomitant manifestations of the disease, are best imaged by MRI. MRI assists in the early detection of rheumatoid arthritis, which allows earlier initiation of treatment.
16932640 A woman with rheumatoid arthritis whose condition did not improve during pregnancy. 2005 Dec BACKGROUND: A 25-year-old woman with a 3-year history of rheumatoid arthritis presented 6 months before her first planned pregnancy. At the time of presentation, she was being successfully treated with infliximab and methotrexate. During her pregnancy, the patient discontinued infliximab and methotrexate and her arthritis relapsed. She was treated with low-dose prednisone, sulfasalazine, nimesulide, and intra-articular corticosteroid injections. Oligohydramnios developed at gestational week 18. INVESTIGATIONS: Laboratory testing, ultrasonography of the fetus and of the patient's affected joints. DIAGNOSIS: Active arthritis during pregnancy and oligohydramnios suspected to be caused by nimesulide. MANAGEMENT: Low-dose oral prednisone, sulfasalazine, repeated intra-articular corticosteroid injections. Infliximab and methotrexate were restarted immediately after delivery.
16119640 The education of patients with rheumatoid arthritis--the knowledge and expectation of pati 2005 Rheumatoid arthritis (RA) is a chronic, progressive, immunologically dependent, systemic diseases of connective tissue, leading to disability, cripplehood or even premature death. Helping to improve the quality of life of RA patients involves teaching them how to cope with disease-related problems of everyday life, with stress and with suffering. The aim of the presented work is to determine the following: the patients' level of knowledge about rheumatoid arthritis; their educational needs; the impact of the level of knowledge on the patients' pro-health behaviours; the knowledge of nurses and their ability to recognize patients' problems; the nurse's tasks in preparing an RA patient for self-care. The subject group consisted of patients with RA diagnosed according to The American Rheumatism Association criteria and nurses from rheumatology clinics and wards. The research method used was a survey questionnaire, which had been constructed for the purpose of the research. The research results indicate a great need of patients, especially those with early rheumatoid arthritis, for education, support and help in adaptation. At the same time, the nurses, even though they do not fully fulfil their educational role, declare a willingness to participate in organized forms of health education.
16542465 Pooled indices to measure rheumatoid arthritis activity: a good reflection of the physicia 2006 Several pooled indices for the assessment of rheumatoid arthritis disease activity are available to rheumatologists. Face and criterion validity of these instruments can be assessed by determining the association of their measurements with opinions of physicians. Several confounding aspects must be considered in such analyses, especially blinding of the person(s) making the decisions to the instruments being studied and to the objective of the study in general. From several studies in the literature, there is currently no evidence that any one of the available composite indices is better or worse than any other. The choice of index in clinical practice should ideally be based on practical considerations related to the needs of the rheumatologist in the respective health care setting.
15660470 Integrating biologic therapy into the comprehensive care of patients with rheumatoid arthr 2005 Jan The advent of biologic therapy has not only provided the opportunity for better care of patients with rheumatoid arthritis (RA), but also has permitted a better understanding of the pathogenesis of this autoimmune/inflammatory disease. The capacity of these agents to suppress signs and symptoms as well as radiographic progression of RA strongly indicates that they can alter the course of the disease. Appropriate analysis of the effect of biologics should provide new insight into the role of the specific targeted molecules in rheumatoid inflammation, and provide information about means to optimize therapy with these highly potent therapeutics.
16234181 Integrated neuroendocrine immune risk factors in relation to rheumatoid arthritis: should 2005 Sep An integrative perspective of neuroendocrine immune (NEI) and related risk factors for the onset of rheumatoid arthritis (RA) is presented, based upon studies of the long-term presymptomatic phase. Besides the recognized genetic markers and familial predisposition, multiple immunological precursors of RA have been identified many years before the clinical onset of inflammatory manifestations. Rheumatoid factors and related antibodies occur in approximately one-half of presymptomatic susceptibles. Cigarette smoking in sufficient amount and duration is a major risk factor for RA, particularly for postmenopausal-onset women and for men. In premenopausal-onset RA, subtle insufficiency of adrenal cortical function is less well recognized. In such women, cytokine imbalance may also precede inflammatory onset of RA. In males alone, multiple hormonal and cytokine correlations were found many years before the onset of RA, implying long-term activation or perturbation of this NEI system. The proposed physiopathogenetic model of RA requires further controlled, prospective studies for validation of the multiyear presymptomatic phase of RA. Such studies promise to clarify the currently unknown causal and sequential chains in this enigmatic disease.