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ID PMID Title PublicationDate abstract
17080513 Geode of the femur: an uncommon manifestation potentially reflecting the pathogenesis of r 2006 Dec Geodes are noted frequently in rheumatoid arthritis (RA), but large geodes of the femur are uncommon. We describe a patient with RA and a large geode in his femur; histological findings were consistent with a rheumatoid nodule and chronically inflamed synovium. We review the literature of large femoral geodes and what this particular manifestation may reflect about the pathogenesis of RA.
16328417 A case of overlap syndrome with rheumatoid arthritis, systemic lupus erythematosus, system 2006 Jul We report an unusual case of overlap syndrome that had the coexistence of five autoimmune diseases. A 45-year-old woman initially developed seropositive erosive rheumatoid arthritis (RA) 11 years ago. She then developed progressive systemic sclerosis (PSS) (including pulmonary hypertension, esophageal dysfunction, cardiac involvement and sclerodactilitis), systemic lupus erythematosus (SLE) (including photosensitivity, nephritis, leukopenia, lymphopenia, thrombocytopenia and Coombs positive hemolytic anemia and positive anti-dsDNA), and secondary Sjögren's syndrome (SSS) in the last 7 years before she was admitted to our clinic. The patient fulfilled classification criteria for RA, SLE, PSS and SSS, as determined by American College of Rheumatology. Hypothyroidism with positive autoantibodies due to Hashimoto's thyroiditis, the beginning of which could not be defined, was coexistent with this overlap syndrome. In the literature, although overlap syndromes in different combinations were reported, we very rarely observed a complex case like this patient. In our opinion, this is the first well-documented case of RA, PSS, SLE, SSS and Hashimoto's thyroiditis existing together in the same patient. Although immunosuppressive therapy was administered, the disease rapidly deteriorated and the patient died.
16817625 Characterization of pulsed magnetic field therapy in a rat model for rheumatoid arthritis. 2006 Recent studies have shown that pulsed magnetic fields (PMF) provide a practical, exogenous method for inducing cell and tissue modifications, as therapy for selected pathological states. A number of clinical studies, in vivo animal experiments and in vitro cellular and membrane research reports suggest that PMF stimulation can significantly reduce pain and accelerate the healing process. However, PMFs are still not widely used in clinical medicine. This research examines the effects of PMFs using an animal model that resembles human rheumatoid arthritis. Using serum protein electrophoresis (SPE) and joint edema evaluation, we were able to monitor disease progression and PMF therapeutic effectiveness. We have used these methods to correlate changes in an acute phase serum protein, alpha-2-macroglobulin, with other indicators of rheumatoid arthritis in Lewis rats treated daily with PMF therapy. The results indicate that PMFs may be a promising non-invasive treatment for chronic inflammatory diseases like rheumatoid arthritis.
16039353 A qualitative assessment of rheumatoid hand surgery in various regions of the world. 2005 Jul Differences in opinion between rheumatologists and hand surgeons result in disparate practice patterns among different states in the United States regarding the use of surgery for hand deformities in the rheumatoid population. The purpose of this project was to study the practices of rheumatoid hand surgery from countries in various regions of the world.
15801038 Reversing myocardial microvascular disease in a patient with rheumatoid arthritis. 2005 Apr Rheumatoid arthritis (RA) is associated with increased cardiovascular mortality. This is regarded as being due to accelerated coronary atherosclerosis. We describe a 62-year-old man with seropositive erosive RA and extraarticular manifestations but no history of cardiovascular disease. Noninvasive assessment of myocardial blood flow by adenosine stressed thallium scanning showed reversible ischemia and diffusely poor myocardial perfusion. Repeat assessment after intensive immunosuppression for rheumatoid vasculitis revealed resolution of the ischemic changes and generally increased myocardial perfusion. Coronary angiography revealed no significant atheroma, suggesting that myocardial microvascular disease was responsible for the ischemia. This may be an important determinant of cardiovascular outcome in RA, and this case indicated that it can be reversed with immunosuppression.
15616807 [Partial arthrodesis and total fusion of the rheumatoid wrist]. 2005 Jan The hand (wrist and fingers) is one of the regions most frequently affected by rheumatic arthritis (RA). Obviously, the functional handicap affects activities of daily living and imposes an additional psychological burden, because the nature of the alterations means that the clinical picture can be interpreted as RA from external appearances. Thus, treatment of the rheumatoid wrist is a prodigious challenge for hand surgeons. Radiolunate arthrodesis (RLA), as pioneered by Chamay and Della-Santa, has become an established surgical technique for stabilizing and relieving pain in wrists destroyed by RA. RLA has been described by Stanley as the "golden standard" for the treatment of rheumatoid wrists. For patients with a severe wrist deformity and pain, a complete wrist arthrodesis may be the only viable surgical option.
16478685 Using epidemiology and archaeology to unearth new drug targets for rheumatoid arthritis th 2006 Jan Epidemiological and archaeological evidence suggests that RA could be a consequence of enhanced immunity to Mycobacterium tuberculosis, and that by understanding this connection, new RA drug targets may be uncovered.
16629448 [An autopsied case of a woman with rheumatoid arthritis attacked by multiple cerebral embo 2006 Mar A 45-year-old woman, who had had rheumatoid arthritis for 12 years, had three attacks of cerebral embolism over two months and died after the final attack. Intensive clinical laboratory investigations did not disclose any specific origins of emboli, but an autopsy revealed a nodule at the base of the aortic valve which was pathologically proved to be a rheumatoid nodule. The thrombi were present from the distal part of left internal carotid artery up to the proximal part of the left middle cerebral artery. They were rich in fiber, but poorly organized endothelial cell, raising the possibility that they originated from other parts and have recently reached there. On the top of the rheumatoid nodule, a thrombus was present. It was easily ablated and a small amount of fibrin stuck the nodule. Based on these results, we concluded that cerebral emboli were originally generated at the top of a rheumatoid nodule in the heart. In patients with RA, rheumatoid nodules are rarely seen in the heart. If present, they usually cause cardiac failure or atrioventricular block, and seldom result in cerebral infarction. This is the first case in which an autopsy proved rheumatoid nodule in the heart which had caused multiple cerebral emboli. We should consider the possibility of rheumatoid nodules in the heart as an origin of cerebral emboli in patients with rheumatoid arthritis.
17195357 [Follow-up studies of rheumatoid arthritis patients with the presence of antiphospholipid 2006 May The aim of the study was 2 years follow-up observation of clinical course in RA patients with the presence of anticardiolipin antibodies (aCL). METHODS: Among 395 patients with RA hospitalized in the Clinic of Rheumatology from January 2003 to December 2004 (2 years), in 39 patients with suspicion of antiphopspholipid syndrome the aCL antibodies were determined. In 7 cases we confirm the presence of aCL antibodies. Patients positive for antiphospholipid antibodies were invited to the Clinic on the beginning of 2006 (after 2 years from previous hospitalization) to analyze clinical course of disease and to perform laboratory examination. RESULTS: In the group of patients with RA positive for antiphospholipid antibodies, 3 had active RA with vascular changes. Aggressive therapy with disease modifying antirheumatic drugs (DMARDs) and corticosteroids caused conversion of anticardiolipin antibodies. Analogically antibiotic therapy in 2 patients with concomitant infections (urinary tract, respiratory system) caused conversion of aCL antibodies. 1 patient developed blastic coat cell lymphoma. 1 patient died because of cardiovascular complications. CONCLUSION: Presence of anticardiolipin antibodies can be the indicator of serious prognosis, it can predict vasculitis, persistent infections, cardiovascular complications or neoplasmatic disease. We suggest that antiphospholipid antibodies should be measure in patient with aggressive course of rheumatoid arthritis.
15868611 Frequency of remissions in early rheumatoid arthritis defined by 3 sets of criteria. a 5-y 2005 May OBJECTIVE: To study the frequency of remission using 3 sets of criteria in patients with rheumatoid arthritis (RA) at 5 years after the diagnosis. METHODS: All adult patients with recent onset inflammatory arthritis who did not meet criteria or show clinical signs of other specific arthritides were included in the RA1997 inception cohort at Jyväskylä Central Hospital, Finland, and were assessed for remission at 5-year control examination. Remission was defined as (1) American College of Rheumatology (ACR) remission (fatigue excluded), (2) clinical remission with no tender and no swollen joints and normal erythrocyte sedimentation rate, and (3) radiographic remission with no worsening of erosions and no new erosions from baseline to 5 years. RESULTS: The study included 127 patients with early RA (mean age 56 yrs, 61% female, 54% with positive rheumatoid factor, and 25% with erosions). At 5 years, 111 patients were examined, 17% (95% CI 11%-25%) of whom met ACR remission criteria, 37% (95% CI 28%-47%) met clinical remission criteria, and 55% (95% CI 49%-68%) met radiographic remission criteria. Only 13 (12%) patients met all 3 sets of remission criteria. The rate of remission was statistically significantly different (p < 0.001) using the 3 sets. CONCLUSION: The rate of remission in RA depends on the criteria used. No gold standard exists for defining remission in RA. A set of criteria including no sign of inflammatory activity and no radiographic progression might be a basis for development of clinically relevant remission criteria for RA.
16511918 Short-term outcome after anti-tumor necrosis factor-alpha therapy in rheumatoid arthritis: 2006 Mar OBJECTIVE: To evaluate the Disease Activity Score (DAS) using various aggregated dimensions to quantify treatment outcome in patients with rheumatoid arthritis (RA), in order to determine the best instrument to be used as an endpoint that indicates good response in terms of EULAR response criteria and DAS28 remission criteria, and which satisfies the demands of clinical rheumatology. METHODS: Using raw data for each patient subjected to anti-tumor necrosis factor-a therapy (81 patients), before and 6 months after treatment, DAS28 was calculated 4 times using the standard equation, as follows: (1) DAS 1 (the standard DAS28): tender joint count (TJC), swollen joint count (SJC), patient global assessment (PGA), erythrocyte sedimentation rate (ESR); (2) DAS 2: TJC, SJC, PGA, C-reactive protein (CRP); (3) DAS 3: TJC, SJC, physician global assessment (PhGA), ESR; and (4) DAS 4: TJC, SJC, PhGA, CRP. Disease activity was identified if DAS score exceeded 5.1. A clinically significant response was recorded if there had been improvement of > 1.2 of the DAS score. RESULTS: DAS 2, DAS3, and DAS4 were superior to the current DAS score used for assessment of RA activity (effect size differences were -0.35, -0.13, and -0.48, respectively). Assessment of disease activity using TJC, SJC, PhGA, and CRP was the best tool to assess response to therapy. ESR was marginally superior to CRP in its sensitivity to monitor disease activity changes (effect sizes 1.08 and 1.03, respectively). CONCLUSION: These results suggest that self-report indices on their own, such as PGA and pain score, are inadequate indicators of disease activity. The DAS might profitably be amended by one or 2 continuous measures for better quantification of the degree of improvement of patients on a given therapeutic modality. Using PhGA and CRP instead of PGA and ESR, respectively, in the DAS equation discriminated better between different patients' responses than the traditional DAS score.
16254790 Inflammation 2005 - Seventh World Congress. Rheumatoid arthritis and cell signaling. 2005 Oct Novel targets for antirheumatic therapy were discussed including synoviocyte CD97 and the T-cell co-receptor CTLA-4: an immunoglobulin fusion protein of CTLA-4 (abatacept (Bristol-Myers Squibb Co)) has recently been revealed to be a well-tolerated and effective therapeutic agent for rheumatoid arthritis. Furthermore, cell-signaling molecules were a major topic, and cytoplasmic adaptors of toll-like receptor responses, the kinases JNK and Lyn and the macrophage surface molecule CD200 were considered as potential targets for novel therapies.
16671950 Interleukin-18 promoter polymorphism in patients with rheumatoid arthritis. 2006 May Rheumatoid arthritis (RA) is a chronic inflammatory disease in which interleukin (IL)-18 plays an important role. However, there are controversial reports on IL-18 promoter polymorphism as an independent marker of RA susceptibility. The aim of present study was to examine the IL-18 promoter polymorphism in patients with RA, and its association with disease susceptibility, activity and severity. We examined 309 patients with RA from a Polish population diagnosed according to the criteria of American College of Rheumatology. An allele-specific polymerase chain reaction was used for analysis of the polymorphisms in positions - 137 and - 607 in promoter region of IL-18 gene. A significantly decreased number of subjects with AC/AC and AG/AG diplotypes was observed among RA patients as compared with healthy controls (OR - 0.51, 95%CI 0.28-0.95, P = 0.045) and (OR - 0.12, 95% CI 0.02-0.97, P = 0.042), respectively. Nevertheless, there was no significant association with disease activity, joint erosions, extra-articular manifestations, rheumatoid factor. Above results suggest that IL-18-137 and - 607 promoter polymorphisms are not the significant factors influencing RA course and severity in a Polish population.
16551663 Inferring causal relationships among intermediate phenotypes and biomarkers: a case study 2006 Jun 15 MOTIVATION: Genetic association analysis is based on statistical correlations which do not assign any cause-to-effect arrows between the two correlated variables. Normally, such assignment of cause and effect label is not necessary in genetic analysis since genes are always the cause and phenotypes are always the effect. However, among intermediate phenotypes and biomarkers, assigning cause and effect becomes meaningful, and causal inference can be useful. RESULTS: We show that causal inference is possible by an example in a study of rheumatoid arthritis. With the help of genotypic information, the shared epitope, the causal relationship between two biomarkers related to the disease, anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) has been established. We emphasize the fact that third variable must be a genotype to be able to resolve potential ambiguities in causal inference. Two non-trivial conclusions have been reached by the causal inference: (1) anti-CCP is a cause of RF and (2) it is unlikely that a third confounding factor contributes to both anti-CCP and RF.
17165003 Acute destruction of the hip joints and rapid resorption of femoral head in patients with 2006 We report three rheumatoid arthritis (RA) cases with acute destruction of hip joint and rapid resorption of femoral head. The condition occurred in less than 6 months and closely resembled rapid destructive coxarthrosis. All three patients were postmenopausal women with active RA who had been taking steroids. Two of the patients were taking prednisolone (PSL) of over 20 mg as maximum dose per day, and all patients were resistant to disease-modifying anti-rheumatic drugs (DMARDs). Other than the problems of their hip joints, one had a giant bursitis around the pathological side of the hip joint, another had multiple rheumatoid nodules and skin infarction, and the other suffered from insufficiency fracture of the contralateral femoral subcapital lesion. As a result, all of them had total hip arthroplasty. We recommend taking repetitive radiographs for RA patients with continuing severe hip pain.
16758056 Dermatitis herpetiformis and rheumatoid arthritis. 2006 Jun Dermatitis herpetiformis DH is a rare, intensely pruritic, chronic, recurrent, papulovesicular disease. The disease can be clearly distinguished from the other subepidermal blistering eruptions by histologic, immunologic, and gastrointestinal criteria. Most patients have an associated gluten-sensitive enteropathy GSE that is usually asymptomatic. Both enteropathy and the dermatologic findings disappear with a gluten-free diet, therefore, DH is thought to be the specific dermatologic finding of celiac disease CD. An association between CD and autoimmune disease has been documented in several studies. Similar associations have been reported in DH. We report a 46-year-old man with DH diagnosed more than 10 years previously who developed GSE, pernicious anemia, and rheumatoid arthritis in the following years.
16239387 Presentation and analysis of radiographic data in clinical trials and observational studie 2005 Nov Despite the advent of sophisticated imaging systems, plain radiography continues to be a valuable outcome variable in clinical trials of inflammatory disorders for a number of reasons. This paper discusses the pros and cons of the different ways in which radiographic data in trials is presented; the minimum time needed to demonstrate radiographic progression in the context of a clinical trial; and the best ways to statistically analyse radiographic data.
16273870 [Voice disorders in rheumatoid arthritis]. 2005 The report presents three patients with coincidence of voice disorders and rheumatoid arthritis. Material consisted of 3 females aged 39, 48 and 74 years. Methods included phoniatric examination, videolaryngoscopy, stroboscopy and acoustic voice analysis MDVP). RESULTS: In the two youngest patients the laryngoscopic changes were located on vocal folds, mostly as yellow nodules. The appropriate mobility of both vocal folds was found. The MDVP analysis particularly revealed changes in parameters describing perturbation of amplitude in both cases. In the third case oedema in the region of the crico-arytenoid joints and vestibular folds were observed. MDVP analysis showed slight disturbances in the parameters describing frequency perturbation.
16342109 Analyzing reliability of change in depression among persons with rheumatoid arthritis. 2005 Dec 15 OBJECTIVE: To examine several methods of determining reliability of change constructs in depressive symptoms in patients with rheumatoid arthritis (RA) and to demonstrate the strengths, weaknesses, and uses of each method. METHODS: Data were analyzed from a cohort of 54 persons with RA who participated in a combined behavioral/pharmacologic intervention of 15 months duration. These longitudinal data were used to examine 3 methodologies for assessing the reliability of change for various measures of depression. The specific methodologies involved the calculations of reliable change, sensitivity to change, and reliability of the change score. RESULTS: The analyses demonstrated differences in reliability of change performance across the various depression measures, which suggest that no single measure of depression for persons with RA should be considered superior in all contexts. CONCLUSION: The findings highlight the value of utilizing reliability of change constructs when examining changes in depressive symptoms over time.
17065281 Multiple cavitating masses in an immunocompromised host with rheumatoid arthritis-related 2006 Nov Cytomegalovirus is a known opportunistic infection in immunocompromised individuals. We document multiple cavitating lung masses caused by cytomegalovirus in a patient with rheumatoid arthritis-induced interstitial lung disease on immunosuppressant medication, an unusual expression of CMV pneumonitis. With increasing use of immunosuppressive therapy and increase in AIDS, pulmonary cytomegalovirus infection is expected to be a more frequently encountered disease and familiarity with its uncommon radiological manifestations will be advantageous.