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

ID PMID Title PublicationDate abstract
16374576 Efficacy of arthroscopic synovectomy for the effect attenuation cases of infliximab in rhe 2006 Nov To investigate whether arthroscopic synovectomy is effective for nonresponders to infliximab, anti-tumor necrosis factor-alpha antibody, for the treatment of rheumatoid arthritis (RA), we assessed seven patients including ten arthroscopic synovectomies in knee joint, in shoulder joint, and in ankle joints. We compared C-reactive protein (CRP) and DAS28 (ESR) before and after surgery at 6 and 50 weeks. After arthroscopic synovectomy, we continued the infliximab treatment with methotrexate in a routine manner. We detected synovium proliferation with vascular increase in patellofemoral joint and around the meniscus and femoral and tibial side of the anterior cruciate ligament in the knee joints. We also found synovial proliferation in rotator interval in the glenohumeral joint and fatty changing in subacromial bursa in the shoulder. In the ankle joint, we found synovial proliferation with white meniscoid between tibiofibular joint to develop impingement. Serum CRP was improved from 3.45+/-0.4 to 1.12+/-0.2 at 6 weeks to 1.22+/-0.4 at 50 weeks after arthroscopic synovectomy. There is no severe side effect of arthroscopic synovectomy during infliximab treatment; however, one patient had slight rash that was improved. DAS28 was improved from 5.58+/-0.23 to 3.87+/-0.47 at 6 weeks to 2.58+/-1.49 at 50 weeks after arthroscopic synovectomy. It is possible that arthroscopic synovectomy can be one of the effective methods to continue with the infliximab treatment when its efficacy decreased or in the nonresponders of infliximab for RA patients.
15696555 Physical activity, physical fitness, and general health perception among individuals with 2005 Feb 15 OBJECTIVE: To describe self-reported physical activity and physical fitness and to identify correlates of physical activity and general health perception. METHODS: Data on self-reported physical activity, physical fitness, activity performance, and disease activity were collected from a sample of 298 patients with rheumatoid arthritis (RA). RESULTS: Forty-seven percent of our sample reported physical activity behaviors that did not comply with public health recommendations. A majority of the patients had decreased lower-limb muscle function (72%), grip force (94%), joint motion (94%), and functional balance (68%). Correlations between self-reported physical activity and other variables were r(s) = 0.25 or less. Variation in general health perception was explained (total adjusted R(2) = 0.65) by pain and activity performance. CONCLUSION: Our findings indicate that there is a case for recommendations on and support for healthy physical activity behaviors among people with RA.
16465671 Development of polymyositis after long-standing rheumatoid arthritis. 2006 Feb Rheumatoid arthritis (RA) and polymyositis (PM) are distinct clinical syndromes. The concurrent diagnoses of RA and PM in the same patient are rare. We describe a patient who developed outright PM after 16 years of well established RA, review the literature, and highlight the need to consider a broad base of differentials including PM in the diagnosis of muscle weakness in RA.
17471836 [Quality of life and activity of disease in patients with rheumatoid arthritis]. 2006 PURPOSE: The aim of this study was to evaluate the quality of life in patients with rheumatoid arthritis (RA) considering their age, activity of the disease, its duration and radiological stage. MATERIAL AND METHODS: The study group consisted of 151 women (mean age 55.0 years, mean duration of RA 9.4 years) and 45 men (mean age 55.0 years, mean duration of RA 9.4 years). All subjects were treated at the Department of Rheumatology and at the SPSK-1 rheumatology outpatient clinic in Szczecin. Diagnosis of RA was established according to ARA criteria of 1987. The radiological stage of the disease was established according to Steinbrocker's criteria. The patient's quality of life was evaluated with the Health Assessment Questionnaire. The activity of RA was determined with the Disease Activity Score DAS 28. RESULTS: Significant correlation between HAQ score and DAS 28 was found (correlation coefficient--R = 0.38; p < 0.001). Age (R = 0.31, p < 0.001) and radiological stage of RA (R = 0.26, p < 0.001) were also found to affect the quality of life. CONCLUSIONS: The quality of life of patients with rheumatoid arthritis is significantly influenced by their age, activity of the disease, and radiological stage of RA.
15599493 [Swan-neck and buttonhole deformities on rheumatic long fingers]. 2005 Jan Patients suffering from rheumatoid arthritis in many cases develop typical swan-neck and buttonhole deformities. In the further course of the disease we observe several stages. In the beginning active and later passive correction are still possible, while ultimately a fixed contracture is present. The activities of daily life may be severely reduced. The pathology of the swan-neck deformity is initiated at the level of the metacarpophalangeal joint, while at the origin of the buttonhole deformity the synovitis of the proximal interphalangeal joint is obvious. In the early stages, synovectomy and balancing of the soft tissues are surgically indicated. In advanced stages, complicated soft tissue reconstruction in combination with alloarthroplasty or arthrodeses may become necessary to allow for sufficient finger function.
16257625 Psychological stress as a predictor of psychological adjustment and health status in patie 2005 Nov This study examined the extent to which perceived stress, social support, coping and clinical disease indicators predict physical, psychological and social adjustment in patients with rheumatoid arthritis (RA). Participants were 59 women recruited at an outpatient clinic at University College Hospital, Galway. A range of psychological measures was administered and disease status was assessed by physician ratings of joint involvement and blood assays of inflammatory indices. Findings from correlational and hierarchical regression analyses revealed a number of statistically significant relationships (p<.01). Perceived stress was a better predictor than disease severity of positive and negative emotionality. Coping explained variability on positive and negative affect. Social support was linked to level of social activity. Results demonstrated that disease status predicted illness related functioning but did not predict emotional or social adjustment. Results suggest that a cognitive behavioural intervention to facilitate patient adjustment could usefully include management of stress and its appraisal, the fostering of adaptive coping strategies and utilization of social support resources. It is concluded that improving patient adjustment to rheumatoid arthritis has implications for medical care seeking.
15915322 Reliability of the rheumatoid arthritis articular damage score in Tunisian patients. 2005 Nov The clinical rheumatoid arthritis articular damage (RAAD) score is easy to perform and showed good intraobserver reliability. It correlates well with the Larsen score and disease duration and can be recommended for rheumatoid arthritis patients' follow-up in developing countries.
16960927 Can severity be predicted by treatment variables in rheumatoid arthritis administrative da 2006 Oct OBJECTIVE: Administrative data bases provide rapid access to data regarding treatment and morbidity of rheumatoid arthritis (RA). A serious limitation of administrative data bases is the lack of information regarding RA severity, as in the case of lymphoma, where RA severity may contribute to the cause of the adverse outcome. We examined whether treatment variables could predict RA severity. METHODS: We studied 7541 patients with RA who were participating in a longitudinal study of RA outcomes. Disease severity was determined by the Patient Activity Scale (PAS), which represents on a 0 to 10 scale the mean of 0-10 standardized values of pain (by visual analog scale), patient global severity, and the Health Assessment Questionnaire. We tested the ability of disease modifying antirheumatic drugs (DMARD) and biologic treatment variables and the lifetime number of these treatments to predict severity status. The receiver-operating characteristic (ROC) area under the curve (AUC) was used to describe the association between severity and treatment variables. RESULTS: There was little difference in PAS scores between various treatments and treatment groups, including scores of the 18.3% of patients receiving no DMARD or biologic therapy. The ROC AUC to distinguish PAS scores above and below the median was 0.64 (60.5% correctly classified) and was 0.70 (67.2% correctly classified) in distinguishing first compared to fourth quartiles PAS scores. CONCLUSION: Treatment variables do not accurately or usefully identify severity status. As a corollary, there is little difference in severity between patients receiving different treatment regimens, and actual measures of severity rather than treatment surrogates are required to assess RA severity.
15660235 The -590 IL-4 promoter polymorphism in patients with rheumatoid arthritis. 2005 Nov Rheumatoid arthritis (RA) is a chronic inflammatory disease in which cytokines play an important role. The aim of the present study was to evaluate the -590 IL-4 promoter polymorphism in patients with RA and its association with disease activity and severity. We enrolled 94 patients with RA diagnosed according to the criteria of the American College of Rheumatology. Polymerase chain reaction amplification was used for analysis of the polymorphism at position -590 of the promoter of the IL-4 gene. The distribution of IL-4 genotypes in RA patients did not differ from control subjects. Nevertheless, the active form of RA was more frequently diagnosed in patients with T allele (genotypes CT and TT) as compared with homozygous CC patients. Moreover, in carriers of the T allele, parameters of disease activity (DAS 28 score, ESR, number of swollen and tender joints) were significantly increased. We suggest that the IL-4 -590 promoter polymorphism may be a genetic risk factor for RA severity.
16414461 Augmented subscapularis muscle transposition for rotator cuff repair during shoulder arthr 2006 Jan The effectiveness of rotator cuff repair by augmented subscapularis transposition via the Leeds-Keio artificial ligament was evaluated in patients with rheumatoid arthritis undergoing total shoulder arthroplasty. The minimum follow-up period was 2 years. Final clinical scores (Hospital for Special Surgery scoring system) and the incidence of radiolucency and upward migration of shoulder components in 20 shoulders with rotator cuff repair by augmented subscapularis transposition were superior to those of 19 shoulders with cuff repair by subscapularis transposition alone and similar to those of 22 shoulders with intact rotator cuffs. In shoulders with augmented subscapularis transposition and intact cuffs, clinical scores continued to improve even after the first postoperative year. Our augmented subscapularis transposition did not increase postoperative complications. We conclude that cuff repair by augmented subscapularis transposition is an acceptable alternative for repairing a supraspinatus or supraspinatus and infraspinatus rotator cuff defect in rheumatoid arthritis patients undergoing total shoulder arthroplasty.
16652420 Survival analysis and longterm results of elbow synovectomy in rheumatoid arthritis. 2006 May OBJECTIVE: To evaluate longterm results and survival rate of open synovectomy of the elbow joint in patients with rheumatoid arthritis (RA). METHODS: Between 1986 and 2000, synovectomy of the elbow was performed on 103 joints in 92 patients with RA. Eighty-five joints were included in this study. Mean age at time of surgery was 52 years (range 13 to 62 yrs). On 13 elbows with Larsen stage I and II disease, early synovectomy preserving the radial head was performed; in 72 cases with Larsen stage III and IV, late synovectomy with radial head resection was necessary. RESULTS: In early synovectomy, one joint received prosthetic joint replacement and 2 joints underwent resynovectomy a mean of 9 years after primary surgery. The survival rate (no further operations) was 91% after 5 years and 78% after 10 years. In late synovectomy, 16 elbow joints were operated again a mean of 4.6 years after primary surgery (10 prosthetic joint replacements, 2 resection interposition arthroplasties, 4 resynovectomies). Survival rate was 82% after 5 years and 66% after 10 years. Sixty-one elbows were examined clinically at a mean followup period of 8.7 years (range 2.8-17.3 yrs). There was a significant improvement of the Morrey score at followup, especially due to effective relief of pain. Improvement of joint motion was seen in late synovectomy for pronation and supination. The mean preoperative Larsen stage was 3.11, which decreased significantly to 3.66 at followup. CONCLUSION: Our findings suggest that synovectomy is a safe and effective procedure in differential treatment of RA of the elbow.
16210749 Health as expanding consciousness: seven women living with multiple sclerosis or rheumatoi 2005 Oct The meaning of health as expanding consciousness is explored through stories of seven women who developed multiple sclerosis or rheumatoid arthritis during their lives. Using Newman's hermeneutic-dialectic approach, unstructured interviews were conducted over a 2-year period. Analysis and interpretation of narratives concerning person-environment interactions revealed turning points and separate choice points before four new ways of living including finding simple pleasures, being positive, gaining self-control, and self-differentiation, were found. Support for Newman's stages of expanding consciousness and more comprehensive descriptions of self-transcendence in space and time are presented. Implications for theory development and theory-guided practice are offered.
16181910 Rheumatoid pleural effusion in the absence of arthritic disease. 2005 Oct Rheumatoid pleural effusion is an unusual complication of rheumatoid disease that typically presents subsequent to other more common manifestations of rheumatoid illness. The case of a 72-year-old woman with a rheumatoid pleural effusion is discussed. The patient presented with dyspnea, but without any history of rheumatoid arthritis. The patient was treated by thoracentesis, followed by video-thoracoscopy and pulmonary decortication. Postoperatively, the patient's effusion partially reaccumulated. Steroid therapy resulted in prompt and permanent resolution of the effusion. The patient remains asymptomatic 1 year after her presentation. The biochemical, serologic, and cytologic characteristics of rheumatoid effusions are reviewed.
16395767 Systemic lupus erythematosus evolving into rheumatoid arthritis. 2006 Jan We describe 3 patients who presented with clinical and serological evidence of systemic lupus erythematosus (SLE) and 10 or more years later developed for the first time clinical and serological manifestations of rheumatoid arthritis (RA). Each patient now meets the American College of Rheumatology criteria for both SLE and RA.
16504819 The definition and measurement of disease modification in inflammatory rheumatic diseases. 2006 Feb This article focuses on measures that are used to evaluate disease activity, damage, and function in three major inflammatory musculoskeletal disorders. The instruments used in rheumatoid arthritis, where most of the methodologic work has been done, are extensively discussed and instruments for the respective domains in psoriatic arthritis and ankylosing spondylitis are likewise presented.
16239394 How does B cell depletion therapy work, and how can it be improved? 2005 Nov The past few years have seen a surge of interest in B cell depletion therapy for patients with rheumatoid arthritis. This paper outlines the possible mechanism(s) by which B cell depletion therapy works. It is likely there is more than one mechanism and the relative importance of each mechanism depends on the target cell. These include CD20-induced apoptosis, complement dependent cytotoxicity, antibody dependent cell-mediated cytotoxicity, and selective targeting and depletion of B cell subsets. The implications of these mechanisms in the further improvement of B cell depletion therapy in rheumatoid arthritis and other autoimmune diseases are discussed.
16953393 Outcome of patients with reactive amyloidosis associated with rheumatoid arthritis in dial 2006 Oct The aim was to analyze the clinical outcome of a group of 51 patients diagnosed with systemic amyloidosis associated with rheumatoid arthritis who received hemodialysis (HD) as renal replacement therapy. We monitored the clinical course of the disease and factors that could influence survival. Determination of the onset of the underlying disorder was made retrospectively by reviewing the patient's chart when a diagnosis of amyloid was confirmed. During a 96.9 person-year follow-up, 42 patients died. Survival of these 51 patients from the initiation of HD at 251 days was 50%. Poor prognosis in amyloid patients was mainly due to a large number of sudden deaths immediately following HD therapy. Out of 51 patients 21 needed unplanned initiation of HD. The unplanned initiation was significantly associated with poor survival. Seventy-five percentile of creatinine clearance (Ccr) was 9.7 ml/min, and 75% of these patients who initiated HD had highly impaired renal functional states. These data indicated that amyloidotic patients with HD showed a high mortality rate; therefore, planned initiation of HD was highly recommended to improve the patient's survival. Particular attention was given to the Ccr levels, because the levels of serum creatinine may not be a useful marker for some patients with amyloidosis.
17183623 Sustained remission and reduced radiographic progression with combination disease modifyin 2007 Feb OBJECTIVE: To study sustainability of remission and good treatment response, and the association of both with radiographic progression, in early rheumatoid arthritis (RA) in the Finnish Rheumatoid Arthritis Combination Therapy trial (FIN-RACo). METHODS: Patients were randomized to receive either a combination of disease modifying antirheumatic drugs (DMARD; COMBI, n = 97) or a single DMARD (SINGLE, n = 98). Remission was defined according to modified American College of Rheumatology (ACR) remission criteria and Disease Activity Score 28 joint count (DAS28) < or = 2.6, and sustained remission as presence of remission at 6, 12, and 24 months. Good treatment response was defined as DAS28 (3/4) 3.2 and decrease of DAS28 >1.2. RESULTS: In 169 patients with complete data, 33 (42%) COMBI and 18 (20%) SINGLE patients achieved modified ACR remission at 2 years, which was sustained in 11 (14%) COMBI and 3 (3%) SINGLE patients. Fifty-four (68%) COMBI and 37 (41%) SINGLE patients were in DAS28 remission at 2 years, which was sustained in 40 (51%) COMBI and 14 (16%) SINGLE patients. Good treatment response was sustained in 67% of COMBI and 27% of SINGLE patients. Over 2 years, the Larsen score increased by a median of 1 (95% CI 0-2) in patients in sustained DAS28 remission compared to 4 (95% CI 2-16) in patients who were in DAS28 remission at 6 months but lost it later; and by 6 (95% CI 2-10) in patients who were not in remission at 6 months. CONCLUSION: A remarkable proportion of patients with early RA treated with combinations of DMARD were in remission at 2 years, and remission was more often sustained compared to patients treated with a single DMARD. Sustained remission protects against radiographic joint damage.
16949529 Hydroxyapatite augmentation for bone atrophy in total ankle replacement in rheumatoid arth 2006 Sep Although total ankle replacement is routinely used for rheumatoid arthritis of the ankle, it has been hampered by early implant failures such as loosening and subsidence of the tibial component due to poor bone quality. To prevent this complication, total ankle replacement augmented by a specially designed hydroxyapatite coating was used in 14 patients (16 feet). Patients were reviewed after an average follow-up of 23.1 months, and the mean clinical rating scale significantly improved from 30.7/100 points preoperatively to 65.9/100 at final follow-up, especially with respect to pain relief. Radiographs taken immediately postoperatively and at final follow-up were analyzed for the position and sinking of the tibial component. The position was evaluated by measurement of the alpha and beta angles, formed by the tibial long axis and tibial component on anteroposterior and lateral radiographs, respectively. The mean alpha and beta angles were 87.4 degrees and 79.3 degrees postoperatively and 87.7 degrees and 81.0 degrees at final follow-up, respectively. No significant change was noted in either angle between the immediate postoperative views and at final follow-up, and no significant subsidence was noted. Radiographs were also assessed for the presence of a lucent zone: 1 case demonstrated a clear zone between hydroxyapatite and bone, 9 cases between hydroxyapatite and the tibial component, and 6 cases between the tibial component and bone. These results suggest that hydroxyapatite helps to secure implant fixation firmly to the bone, making it a useful augmentation for tibial bone atrophy in total ankle replacement for rheumatoid arthritis.
16429237 Remission of rheumatoid arthritis after acute disseminated varicella-zoster infection. 2007 May A 65-year-old immunocompetent male presented with symmetric polyarthritis of 12 weeks and paresthesias in the distribution of the left median nerve distribution of 4 weeks duration. He had tender joint count of 20 and swollen joint count of 12. He was positive for rheumatoid factor and his erythrocyte sedimentation rate was 52 mm. Nerve conduction study demonstrated polyneuropathy. Radiographs showed severe juxta articular osteopenia at the wrist and the metacarpophalangeal joints. He received methotrexate of 10 mg/week and prednisolone of 0.15 mg/kg/day along with nonsteroidal antiinflammatory drugs (NSAIDs) with a diagnosis of seropositive rheumatoid arthritis (RA). Thirteen weeks after therapy, he presented to the outpatient clinic with disseminated vesicular eruptions all over his body with erythematous base and pneumonia involving the left upper lobe. Tzanck smear from the lesions and serology (IgG) for varicella-virus infection were positive. A diagnosis of acute disseminated varicella zoster with pneumonia was made. The patient improved on parenteral acyclovir and broad-spectrum antibiotics. With the improvement in rash and pneumonia after 2 weeks, the patient noticed a marked improvement in the joint symptoms. Arthritis remained in remission without the need for any disease-modifying drug or NSAID for next the 24 months and continued to be so until the last follow-up. Our case presents a unique phenomenon of RA remission after disseminated varicella-zoster infection in an immunocompetent individual.