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ID PMID Title PublicationDate abstract
16344189 Long-term results of silicone wrist arthroplasty in patients with rheumatoid arthritis. 2005 Nov PURPOSE: The surgical treatment of the rheumatoid wrist is key in managing the affected hand. Wrist fusion is often the treatment of choice in cases of severe destruction and deformation although most patients would prefer a motion-preserving procedure. The implantation of a wrist prosthesis might be an alternative to partial arthrodesis for selected cases. In this series we analyzed the long-term results (minimum follow-up period, 10 y) of the Swanson silicone spacer for the wrist in patients with rheumatoid arthritis. METHODS: Sixteen patients with rheumatoid arthritis with 18 silicone spacers for the wrists were reviewed after a minimum follow-up period of 10 years (average, 15 y). Subjective evaluation, clinical examination, and radiographic analysis were included. An additional 9 patients (9 wrists) were interviewed by telephone. RESULTS: In 12 of the patients the subjective result was good or very good, mostly because of adequate pain relief. The average range of motion for flexion (average, 28 degrees )/extension (average, 15 degrees ) was 43 degrees with a wide variation within the series. Radiologically all wrists had diminished residual carpal height at follow-up evaluation and 9 of the wrists had evidence of osteolysis and foreign-body granuloma. The initial good correction of the ulnar translation of the wrist was lost partially in the follow-up period (1.1 vs 4.0 mm). Three of the patients needed surgical revision within the follow-up period; all were converted to wrist fusion. CONCLUSIONS: These long-term results suggest that the silicone wrist spacer still may be considered as an alternative to wrist fusion or more complex wrist joint prostheses in patients with rheumatoid arthritis, especially in severe cases and in patients with low demands. In the long term osteolysis caused by foreign-body granulation is to be expected and has to be considered.
15693110 Common mechanisms in immune-mediated inflammatory disease. 2005 Feb Characterization of the K/BxN mouse model of spontaneous arthritis contributed to the rediscovery of immune complex-mediated inflammation in rheumatoid arthritis (RA). Serum from these animals can transfer joint-specific inflammation to normal mice. Fc receptors, interleukin 1, mast cells, and complement are all essential for the development of arthritis after serum transfer. In RA, additional amplifying factors have been identified, including cytokines and intracellular signaling molecules, such as mitogen-activated protein kinases and nuclear factor kappa B, that perpetuate inflammation. Understanding the autoimmune and inflammatory pathways implicated in disease has led to targeted drug development and improved clinical outcomes.
16522674 The perception of rheumatoid arthritis core set measures by rheumatologists. Results of a 2006 Sep OBJECTIVE: To investigate the perception of values of individual core set measures by rheumatologists, and how it differs across measures and across physicians. METHODS: We designed a survey in which 44 international expert rheumatologists explicitly marked positions on the scales of seven core-set measures that in their opinion corresponded to cut-points between remission, low, moderate and high disease activity. The measures comprised swollen and tender joint counts (SJC, TJC), CRP, ESR, patient and evaluator global assessments of activity (PGA, EGA), and the Health Assessment Questionnaire Disability Index (HAQ). RESULTS: The interpretation of measures across physicians was most consistent for ESR and PGA, while for CRP and joint counts there was most variation. Joint counts and CRP implied active disease at lower relative values (using normalized scales) than did PGA, EGA or ESR (P < 0.01 for most comparisons; Bonferroni-adjusted Wilcoxon signed rank test), and most physicians tended to tolerate higher numbers of tender joints than swollen joints to define similar levels of disease activity. Given these cut-points, more RA patients in a typical cross-sectional cohort would be regarded as being in remission according to joint counts (SJC, 35%; TJC, 55%) than to global scores (PGA, 18%; EGA, 9%), and fewer patients would be regarded as being in remission by physician-derived or laboratory measures than by patient-derived ones. CONCLUSION: These data give insights into the integrative process of activity evaluation and will be informative for future survey designs, studies using physician opinion as the gold standard for criterion validity of disease activity, and allow 'activity mapping' of values on different scales based on expert opinion.
16208668 Patients' perceptions of fatigue in rheumatoid arthritis: overwhelming, uncontrollable, ig 2005 Oct 15 OBJECTIVE: Fatigue is commonly reported by patients with rheumatoid arthritis (RA) but is rarely a treatment target. The aim of this study was to explore the concept of fatigue as experienced by patients with RA. METHODS: Fifteen patients with RA and fatigue (> or =7 on a 10-cm visual analog scale) were individually interviewed and asked about the description, cause, consequence, and management of fatigue. Transcripts were systematically analyzed by 2 researchers independently, relevant phrases were coded, and earlier transcripts were checked for the emerging codes. A random sample of analyses were independently reviewed. A total of 191 codes arising from the data were grouped into 46 categories and overarching themes. RESULTS: Vivid descriptions reflect 2 types of fatigue: severe weariness and dramatic overwhelming fatigue. RA fatigue is different from normal tiredness because it is extreme, often not earned, and unresolving. Participants described physical, cognitive, and emotional components and attributed fatigue to inflammation, working the joints harder, and unrefreshing sleep. Participants described far-reaching effects on physical activities, emotions, relationships, and social and family roles. Participants used self-management strategies but with limited success. Most did not discuss fatigue with clinicians but when they did, they felt it was dismissed. Participants held negative views on the management of fatigue. CONCLUSION: The data show that RA fatigue is important, intrusive, and overwhelming, and patients struggle to manage it alone. These data on the complexity of fatigue experiences will help clinicians design measures, interventions, and self-managment guidance.
16540549 Progression of radiographic joint damage in different eras: trends towards milder disease 2006 Sep BACKGROUND: Severity of rheumatoid arthritis and progression of radiographic joint damage have decreased over the last decades. AIM: To examine whether this trend is attributable to an underlying trend towards milder disease or to improved treatment. METHODS: The study used an inception cohort of patients with early rheumatoid arthritis seen at the Wichita Arthritis Center, Wichita, Kansas, USA, since 1973 and monitored prospectively since their first clinic visit through clinical, radiographic, laboratory, demographic and self-reported data. The radiographic disease progression in patients with disease onset in the 1970s, 1980s and 1990s was compared using a multivariate regression model for longitudinal data. The analysis was adjusted for differences in baseline predictors, type of disease-modifying antirheumatic drugs (DMARDs) and steroid use. RESULTS: 418 patients with rheumatoid arthritis with radiographic follow-up were included. Patients in earlier decades used fewer DMARDs, had longer disease durations and higher tender joint counts at their first visit. Other important predictors of disease progression did not differ significantly between decades of disease onset. The unadjusted rates of radiographic progression differed between decades (analysis of variance, p = 0.01), with a significant trend towards less radiographic progression in more recent times (trend, p<0.001). However, after adjusting for DMARD use, steroid use and baseline predictors, differences between decades vanished (analysis of variance, p = 0.40) and the trend towards less radiographic progression disappeared (trend, p = 0.45). CONCLUSION: These results suggest that the observed trend towards milder disease in rheumatoid arthritis is attributable to more effective antirheumatic treatment and not to a secular trend.
16287586 Remodeling a rheumatology practice to facilitate early referral. 2005 Nov In the next 12 months, 7500 Canadians and 75,000 Americans will be afflicted with the onset of rheumatoid arthritis. Little is known about the health care use of patients with early RA. Nonetheless, rheumatologists and outcomes researchers strongly endorse the need for early diagnosis and treatment of this population. This article reviews trends and impediments to early referral of new-onset arthritis patients. The slow growth of early arthritis clinics is summarized in a survey that characterizes 23 early arthritis programs in North America. Also, several screening tools and models to capture these early-onset arthritis patients are presented.
16331792 Synovial tissue analysis in clinical trials. 2005 Dec Synovial tissue analysis has considerable potential for future randomized controlled trials (RCT). The synovial membrane is the target tissue in treatment strategies of rheumatoid arthritis and other arthropathies. Effective modulation of synovitis is critical when attempting to control symptoms and signs, to prevent joint damage, and to maintain function. In RCT, the systematic evaluation of changes in synovial tissue after commencing treatment enables identification of an early therapeutic effect, using relatively small numbers of patients. This special interest group is working on establishing the evidence to have this endpoint meet the OMERACT filter criteria.
17191183 Rheumatoid keratolysis: a series of 40 eyes. 2006 Nov PURPOSE: Rheumatoid keratolysis (RK) is a rare but a serious cause of ocular morbidity in rheumatoid patients. The aim of this study was to analyze the presenting features, the subsequent treatment, and the outcome of patients with RK in the authors' department. METHODS: A retrospective study was undertaken of all patients with a diagnosis of RK at Bristol Eye Hospital between January 1987 and June 2002. RESULTS: Forty eyes of 38 patients were identified in total. The mean age at presentation was 70 years. The mean duration of rheumatoid arthritis at presentation was 15 years. Most (22, 55%) ulcers were peripheral. Three patients (8%) developed RK within a month of cataract surgery. Out of the 19 patients who did not have a further RK, 11 were immunosuppressed. A total of 37 grafts were performed on 26 eyes. Twenty-two grafts (59%) failed. Immunosuppression increased the chance of anatomical success following penetrating keratoplasty. Infection was identified as a cause of graft failure for immunosuppressed patients in the postoperative period. Nine patients had reversible side effects from immunosuppressant treatment. Four eyes (10%) had to be surgically removed and a further 10 (25%) had severe visual loss (visual acuity less than 6/60). Eleven of the 38 patients subsequently died (29% mortality). CONCLUSIONS: Although the visual prognosis is often poor, surgical preservation of the eye can be achieved by penetrating keratoplasty and systemic immunosuppression. With careful observation and regular monitoring, immunosuppressive medication appears to be safely tolerated in this group of patients.
16785055 A users guide to measurement in medicine. 2006 Measurement is fundamental to science. In medicine measurement underpins most clinical decisions. Outcome measures for rheumatoid arthritis clinical trials (OMERACT) is an informal collaborative group of professionals dedicated to improving outcome measurement in the rheumatic disease. The methodologic hallmark of the OMERACT process is captured in the OMERACT filter--truth, discrimination, and feasibility. Using the key elements of the OMERACT filter a comprehensive checklist for evaluating reported measures is provided. The checklist guides the potential user through a series of questions. The checklist is also an important resource for researchers working in the field of measurement.
15639055 Sympathetic neurotransmitters in joint inflammation. 2005 Feb This article demonstrates the dual pro- and anti-inflammatory role of the sympathetic nervous system (SNS) in inflammatory joint disease (IJD) by way of distinct adrenoceptors. The dual role of the SNS depends on involved compartments, timing of distinct effector mechanisms during the inflammatory process, availability of respective adrenoceptors on target cells, and an intricate shift from beta-to-alpha adrenergic signaling in the progressing course of the inflammatory disease (beta-to-alpha adrenergic shift). Additional critical points for the dual role of the SNS in inflammation are the underlying change of immune effector mechanisms during the process of disease progression and the behavior of sympathetic nerve fibers in inflamed tissue (nerve fiber loss). This is accompanied by a relative lack of anti-inflammatory glucocorticoids in relation to inflammation. In quintessence, in early stages of IJD, the SNS plays a predominantly proinflammatory role, whereas in late stages of the disease the SNS most probably exerts anti-inflammatory effects. Because patients who have rheumatoid arthritis most often present in the chronic phase of the disease, support of anti-inflammatory sympathetic pathways can be a promising therapeutic option.
16534715 The GSB III elbow prosthesis in rheumatoid arthritis: a 2- to 9-year follow-up. 2006 Feb BACKGROUND: The optimal design of an elbow prosthesis for badly damaged elbows is unkown. We evaluated 23 GSB III semi-constrained (sloppy-hinged) total elbow arthroplasties in 16 consecutive patients with rheumatoid arthritis. PATIENTS AND METHODS: After a mean follow-up period of 5 (2-9) years, we assessed quality of the cementing technique, signs of aseptic loosening, patient satisfaction, range of movement, and determined the Hospital for Special Surgery (HSS) elbow score. 3 patients had died before follow-up; thus, 20 replacements in 16 patients were available for clinical and radiographic study. All patients had endstage rheumatoid arthritis (RA) of the elbow joint. RESULTS: In 2 patients, humeral components were revised due to malorientation. 1 arthroplasty was revised due to aseptic loosening of the humeral component. There were 4 cases of intraoperative fracture which healed uneventfully. The total rate of complications was thus one-third. In 17 of 40 components, the cementing technique was rated as marginal or inadequate. We found no association between cementing technique and loosening. The arc of extension/flexion increased by 19 degrees (0-80), and the range of pronation/supination increased by 31 degrees (0-130). There were no cases of infection or ulnar nerve dysfunction. At the latest follow-up, the HSS elbow score was 84 (40-100) points. 11 of 20 elbows were rated as excellent, 4 elbows were rated as good, 2 elbows were rated as fair, and 3 elbows were rated as poor. 14 of 16 patients were satisfied with the result and the 2 patients who were not satisfied had persistent pain. INTERPRETATION: Despite the inherent problems of cementing in small-calibre medullary cavities, the clinical outcome of the GSB III arthroplasty was encouraging for patients with-end stage RA. The rate of overall complications compared favorably with other studies of semiconstrained elbow arthroplasty for end-stage RA. Most complications of the series were minor and did not necessitate revision.
17164996 One third of Japanese patients with rheumatoid arthritis use complementary and alternative 2006 We investigated the prevalence and predictors of complementary and alternative medicine (CAM) use by patients with rheumatoid arthritis (RA) in Japan. A cross-sectional descriptive study was performed using the database from a large observational cohort of RA patients in the Institute of Rheumatology, Tokyo Women's Medical University. Logistic regression analysis was carried out to reveal predictive factors for CAM use. Among 3815 RA patients, 1321 (34.6%; 174 males, 1147 females) used at least one type of CAM. Health foods, including dietary supplements, were the most commonly used. CAM was more frequently used by female patients (odds ratio: 0.578; 95% confidence interval [CI] = 0.451-0.740). A multiple logistic regression analysis revealed that sex (odds ratio: 0.489; 95% CI = 0.333-0.718) and degree of satisfaction with disease-modifying antirheumatic drugs (DMARDs) (odds ratio: 0.899; 95% CI = 0.852-0.948) were significant independent predictive factors for CAM use. The serum C-reactive protein level and erythrocyte sedimentation rate showed no significant associations with CAM use. Approximately 35% of RA patients used CAM in Japan. Female patients and patients dissatisfied with DMARDs used CAM more frequently, regardless of their disease activity.
16269427 High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid art 2006 Jul OBJECTIVE: To study the prevalence of cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery, and symptoms that might be associated with the disorders. METHODS: 194 patients with rheumatoid arthritis were referred for orthopaedic surgery at Jyväskylä Central Hospital, 154 (79%) of whom volunteered for the present study including clinical examination, laboratory tests, radiographs of the cervical spine, hands, and feet, and self report questionnaires. Definition of anterior atlantoaxial subluxation (aAAS) was >3 mm and of subaxial subluxation (SAS)>or=3 mm. Atlantoaxial impaction (AAI) was analysed following to the Sakaguchi-Kauppi method. RESULTS: 67 patients (44%) had cervical spine subluxation or previous surgical fusion. The prevalence of aAAS, AAI, SAS, or previous fusion was 27 (18%), 24 (16%), 29 (19%), and 8 (5%), respectively; 69% of patients with cervical spine subluxations (those with fusions excluded) reported neck pain, compared with 65% of patients without subluxations (p=0.71). The prevalence of occipital, temporal, retro-orbital, and radicular pain in upper extremities was similar in patients with or without cervical spine subluxations (54% v 43%; 17% v 31%; 25% v 24%; 47% v 48%, respectively). However, patients with subluxations were older, had longer disease duration, more active disease, poorer function according to the Health Assessment Questionnaire, and had more often erosive disease. CONCLUSIONS: Asymptomatic cervical spine subluxation is common in patients with rheumatoid arthritis waiting for orthopaedic surgery. Regardless of symptoms, the possibility of cervical spine subluxation in patients with severe rheumatoid arthritis should be considered in preoperative evaluation.
15940761 Rheumatoid arthritis: evidence for bone loss in premenopausal women. 2005 Jun OBJECTIVE: To assess bone mineral density (BMD) status in patients with rheumatoid arthritis (RA). METHODS: Rheumatoid factor-positive premenopausal women with RA meeting the American College of Rheumatology criteria were enrolled. Exclusion criteria included diseases or drugs that affect BMD, except for glucocorticoids, and smoking. Evaluation consisted of a questionnaire, physical examination, and laboratory tests. Lumbar spine and right proximal femur BMD were measured with a DPX-Lunar DEXA scanner. Data were analyzed by Student t test, chi-square, and multivariate analysis. RESULTS: We studied 78 patients with RA and 39 controls; 82% were Caucasian, with mean age 35.5 +/- 6.7 years, and mean disease duration 48 +/- 51 months. Among patients, 74.4% had been treated with glucocorticoids, with a mean daily dose of 9.7 +/- 5.9 mg. Mean lumbar spine BMD was 1.157 +/- 0.124 g/cm2 in the RA patients, and 1.223 +/- 0.147 g/cm2 in controls (p < 0.01). Mean right proximal femur BMD did not differ significantly. Lumbar spine osteopenia correlated with "no physical activity at work" status, low body weight, and duration of glucocorticoid therapy. Femoral neck osteopenia correlated with "no physical activity at work" status, Steinbrocker class III, erosions of the hands, and high erythrocyte sedimentation rate (ESR). Trochanteric osteopenia correlated with "no physical activity at work" status, erosions on hand radiographs, low body weight, high ESR, and anemia. CONCLUSION: Patients with RA of relatively short disease duration already exhibited significantly lower lumbar spine BMD. The identification of prognostic markers for bone loss in patients with RA should not only prompt early therapeutic intervention, but also facilitate early preventive measures.
15936489 Doppler sonography in assessing disease activity in rheumatoid arthritis. 2005 Jun The purpose of this study was to evaluate the use of spectral Doppler in the assessment of patients with rheumatoid arthritis (RA). The study group consisted of 32 patients with RA followed up clinically and by ultrasound using the resistive index (RI) measurements in the patients' wrists as indicator of inflammation. Lower RI values were recorded at baseline compared with data derived at 1-y follow-up examination from patients in remission and normal controls (p < 0.001). Discrimination by spectral Doppler between patients in remission and those who had a relapse within six months after the examination was possible with an accuracy of 95.6%. Patients in remission who had a flare-up within six months after the examination had significantly lower (p < 0.01) RI values vs. patients who remained in stable remission. In conclusion, RI measurements may serve as an objective marker of disease activity and potentially as a predictor of the disease course in RA.
16391515 Clinical significance of anti-filaggrin antibody recognizing uncitrullinated filaggrin in 2005 Dec 31 Filaggrin is expressed in the cornified layer of epidermis and known to be one of the antigenic targets in rheumatoid arthritis. Although the citrulline residue in filaggrin is thought to be an antigenic determinant recognized by autoantibodies, the diagnostic sensitivity of synthetic citrullinated peptide is variable. To investigate the implication of anti-filaggrin antibodies recognizing uncitrullinated filaggrin in rheumatoid arthritis, we assayed antibody titers using unmodified recombinant filaggrin in the sera from 73 patients with rheumatoid arthritis, 150 patients with other connective tissue diseases and 70 normal controls. We also performed the correlation analysis between antibody titers and the clinical variables in patients with rheumatoid arthritis. Titers of IgG anti-filaggrin antibodies were significantly higher in rheumatoid arthritis patients compared to normal controls (P=0.02), but not in patients with osteoarthritis, ankylosing spondylitis or systemic lupus erythematosus. IgG anti-filaggrin antibodies were more frequently found in patients with rheumatoid arthritis compared to normal controls (12.3% vs 1.4% respectively, P=0.04). An anti-filaggrin antibody titer was correlated with visual analogue scale of pain, tender joint count, Ritchie articular index or C-reactive protein, but not with anti-nuclear antibody or rheumatoid factor. These results suggest that anti-filaggrin antibody recognizes the uncitrullinated filaggrin as an antigen and its titer correlates with clinical parameters, explaining the variable sensitivity of anti-filaggrin antibody test.
16832851 A prognostic model for functional outcome in early rheumatoid arthritis. 2006 Aug OBJECTIVE: To construct a prognostic algorithm to predict 5-year functional outcome in rheumatoid arthritis (RA), based on the Health Assessment Questionnaire (HAQ). METHODS: Data from all patients with 5-year followup (n = 985) were used from an inception cohort, the Early Rheumatoid Arthritis Study (ERAS). Possibly relevant prognostic factors considered in the initial stage of the model-building process were standard clinical, radiological, and laboratory features measured at baseline and at 1 year. Multivariate analysis was performed using logistic regression, and the predictive performance of the model was tested using measures of discrimination and calibration. RESULTS: Bootstrap resampling identified 6 variables that consistently predicted severe functional outcome. Functional grade III/IV (odds ratio 6.7) and HAQ at 1 year (odds ratio 2.4) were the most important. Other variables included socioeconomic status, hemoglobin, and radiographic and disease activity scores. Estimates of the regression coefficients and performance were corrected for over-fitting. Reasonably large values for the c-index (0.82) and the Nagelkerke R(2) (0.39) indicate that the set of prognostic factors explains the variation in outcome to a degree that implies good prediction for individual patients. CONCLUSION: The algorithm identifies patients in the first year of RA who are likely to have poor function by 5 years and who could potentially benefit from aggressive drug therapy. A nomogram is produced for simple application of the model in clinical practice. While further external validation is necessary, this model could allow clinicians to target aggressive therapy earlier in a patient's disease course.
16142705 Remission and active disease in rheumatoid arthritis: defining criteria for disease activi 2005 Sep OBJECTIVE: Several composite scores are available to assess the activity of rheumatoid arthritis (RA). Criteria for remission and active RA based on these continuous scores are important for use in clinical practice and clinical trials. We aimed to reevaluate or to define such criteria for the Disease Activity Score in 28 joints (DAS28) and the Simplified Disease Activity Index (SDAI). METHODS: We sampled patient profiles from an observational RA database that included clinical and laboratory variables. Thirty-five rheumatology experts classified these profiles into 1 of 4 categories: remission, low, moderate, or high disease activity. Cutoff values were estimated by mapping scores on the DAS28 and SDAI to these ratings, and analyses of agreement (kappa statistics) and a diagnostic testing approach (receiver operating characteristic curves) were used to validate the estimates. The final criteria were validated using 2 observational cohorts (a routine cohort of 767 patients and an inception cohort of 91 patients). RESULTS: Results from the 3 analyses were very similar and were integrated. The criteria for separating remission, low, moderate, and high disease activity based on the SDAI were scores of 3.3, 11, and 26, respectively; those based on the DAS28 were scores of 2.4, 3.6, 5.5, respectively. In the routine cohort, these cutoff values showed substantial agreement (weighed kappa = 0.70) and discriminated between groups of patients with clearly different functional capacities (P < 0.001). In the inception cohort, these cutoff scores differentiated responders (those with a 20% response on the American College of Rheumatology improvement criteria) from nonresponders (P < 0.01), as well as patients with and without radiologic progression (P < 0.05). CONCLUSION: New criteria for levels of RA disease activity were determined and internally validated. These criteria, which are based on current and explicit expert judgment, are valuable in this era of rapidly advancing therapeutic approaches.
16633927 Efficacy and safety of bucillamine, a D-penicillamine analogue, in patients with active rh 2006 Japanese rheumatologists consider bucillamine (Buc) to be a useful disease-modifying antirheumatic drug (DMARD) and often give Buc to patients with rheumatoid arthritis (RA) prior to administering methotrexate (MTX). However, no large studies on the efficacy and safety of Buc in RA patients have been published in English to date. We therefore investigated the clinical course of RA patients treated with Buc and compared the results with those for patients treated with MTX to evaluate and confirm the place of Buc in therapeutic strategies for RA in Japan. Our results suggested that Buc should be given to patients with moderately active RA either before or after the administration of MTX because its efficacy can be judged within 3 months and because serious adverse events are rare. Issues like the ability of Buc to prevent joint destruction and its efficacy and safety when combined with agents like etanercept require future study.
17037396 Nodular pulmonary amyloidosis. 2006 Sep A 72-year-old woman with a diagnosis of suspected rheumatoid arthritis was admitted with multiple pulmonary nodules in the bilateral lung field. To obtain a diagnosis, a nodule was resected using video-assisted thoracic surgery. Microscopically, amorphous eosinophilic acellular substances were surrounded by inflammatory infiltrates, which were confirmed to be amyloid deposits by congo red staining. Thus, a diagnosis of pulmonary amyloidosis was obtained. The clinical features and diagnostic process are discussed.