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ID PMID Title PublicationDate abstract
16273804 An Early Rheumatoid Arthritis Treatment Evaluation Registry (ERATER) in the United States. 2005 Sep An Early Rheumatoid Arthritis Treatment Evaluation Registry (ERATER) was established in 2001 to enroll patients with a disease duration of 3 years or less, in order to analyze treatment patterns in an era of biological therapies and to study the long-term outcomes of rheumatoid arthritis (RA). Patients were assessed at baseline according to a standard protocol to evaluate their rheumatoid arthritis (SPERA). Similar data from earlier cohorts with RA in the same community will allow for comparisons with treatments and outcomes from previous decades. This essay describes the background regarding the identification of the cohort, methods for data collection, and observations to date.
17164997 The therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy in the 2006 The purpose of the present study was to retrospectively evaluate the therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy (MISAA). From 1995 to 2003, MISAA was performed on 30 knees of 18 rheumatoid arthritis patients. The mean follow-up period was 74.4 months. Radiographic assessment according to Larsen's radiological classification, the conversion ratio to total knee arthroplasty (TKA), and postoperative change of the range of flexion were evaluated retrospectively. There were 10 knees in grade I, 14 knees in grade II, and 6 knees in grade III, preoperatively. All the knees in grade I and 8 of 14 knees in grade II maintained the same grade until the latest follow-up. The other 6 knees in grade II and all the knees in grade III deteriorated to grade IV and were converted to TKA after MISAA. The mean range of flexion significantly increased postoperatively except the knees that were converted to TKA. MISAA is effective for rheumatoid knees in grade I or II, and improves range of flexion.
17042012 High disease activity scores predict the need for additional health services in patients o 2006 Mar OBJECTIVE: To determine whether we meet perceived need, in terms of appropriate supportive health services (physiotherapy, occupational therapy, chiropody and footwear, surgery, education and information), of patients aged 60 years and over with rheumatoid arthritis (RA). DESIGN: A cross-sectional survey. PARTICIPANTS: 123 patients attending rheumatology outpatient clinics. RESULTS: The response rate was 82% (99/123). Of the respondents 78% had one or more perceived needs. Respondents were more likely to express a need for chiropody or footwear (46%), education about RA (29%), or physiotherapy (22%) than for occupational therapy (7%) or surgery (6%). Further analysis compared this group with the 'non-needy' group. There was a correlation between high disease activity scores and high anxiety scores and greater perceived need for additional health services. CONCLUSION: There was significant unmet demand for chiropody and footwear, education about RA, physiotherapy, occupational therapy and surgery. It is possible that strategies to reduce anxiety and improve control of active inflammatory disease may reduce demand for supportive services in certain patients.
15801001 An autopsy case of acute pancreatitis with a high serum IgG4 complicated by amyloidosis an 2005 Apr 7 We report an autopsy case of acute pancreatitis with a high serum IgG4 concentration complicated by systemic amyloid A amyloidosis and rheumatoid arthritis (RA). The patient was a 42-year-old Japanese female with a 22-year history of rheumatoid arthritis. She was diagnosed with myasthenia gravis when she was 31-year old. At the onset of pancreatitis, the patient was anti-nuclear antibody-positive, and had high serum gamma globulin and IgG4 levels. Dexamethasone and conventional therapy induced clinical remission and significantly decreased the serum IgG4 and gamma globulin. However, despite the decreased disease parameters, the patient developed a bleeding pseudocyst and died of cardiac failure. In the autopsy examination, it was determined that pancreatitis was probably caused by ischemia due to vascular obstruction caused by amyloid deposition in the pancreas. Even though acute pancreatitis is a rare complication in RA patients, we speculate that an autoimmune pancreatitis-related mechanism and ischemia due to vascular obstruction by amyloid deposition might be attributable to a single source that leads to acute pancreatitis in our particular case.
16010071 Atlantoaxial joint distraction for treatment of basilar invagination secondary to rheumato 2005 Jun We present our experience of treating two cases of rheumatoid arthritis involving the craniovertebral junction and having marked basilar invagination by an alternative treatment method. In both the cases, the facets were osteoporotic and were not suitable for screw implantation. The patients were 66 and 72 years of age and both patients were females. Both the patients presented with complaints of progressively increasing spastic quadriparesis. Surgery involved attempts to reduce the basilar invagination and restore the height of the 'collapsed' lateral mass by manual distraction of the facets of the atlas and axis and forced impaction of titanium spacers in the joint in addition to bone graft harvested from the iliac crest. The procedure also provided stabilization of the region. No other fixation procedure involving wires, screws, plate and rods was carried out simultaneously. Following surgery both the patients showed symptomatic improvement and partial restoration of craniovertebral alignments. Follow-up is of 2 and 24 months. Distraction of the facets of atlas and axis and impaction of metal implant and bone graft in the facet joint can assist in reduction of basilar invagination and fixation of the region in selected cases of rheumatoid arthritis involving the craniovertebral junction.
16211145 Common variable immunodeficiency mimicking rheumatoid arthritis with Sjögren's syndrome. 2005 Oct Several autoimmune diseases have been reported to be associated with common variable immunodeficiency disease (CVID), including rheumatoid arthritis and Sjögren's syndrome. On the other hand, approximately 20-30% of patients with rheumatoid arthritis develop secondary Sjögren's syndrome. A 26-year-old woman had a 6-year history of chronic symmetric polyarthritis and 3-year history of sicca syndrome prior to admission for pneumonia. Rheumatoid arthritis with secondary Sjögren's syndrome had been diagnosed 1 year before. The patient had experienced 3 episodes of pneumonia during the previous 3 years. Markedly depressed serum immunoglobulin levels prompted a suspicion of common variable immunodeficiency, and the impression was confirmed after a series of examinations. Monthly administration of intravenous immunoglobulin (IVIG) alleviated the polyarthritis and improved the sicca syndrome. IVIG replacement therapy was ultimately successful in curing recurrent bacterial infections, chronic polyarthritis, and improving the severity of sicca syndrome.
16136019 Repetitive transcranial magnetic stimulation in a patient suffering from depression and rh 2005 Aug Repetitive transcranial magnetic stimulation (rTMS) has been suggested as antidepressive treatment strategy. The mechanism of action by which the antidepressive effect is brought about remains unclear at present. Here, we report findings in a patient suffering from recurrent major depression and rheumatoid arthritis. Improvement of depressive symptoms during 20 Hz rTMS of the left dorsolateral prefrontal cortex was repeatedly associated with a systemic inflammatory reaction, suggesting that rTMS induced an immunomodulatory effect.
17083766 Remission as the treatment goal--the FIN-RACo trial. 2006 Nov The Finnish Rheumatoid Arthritis Combination Therapy (FIN-RACo) trial is the first rheumatoid arthritis (RA) clinical trial in which remission served as the primary outcome measure. This chapter reviews the philosophical background, study design, and results of the FIN-RACo trial. The study showed that a third of patients with active early RA may achieve remission with a combination of methotrexate (MTX), sulfasalazine (SSZ), hydroxychloroquine (HCQ), and prednisolone.
17209445 [The functional condition of the left ventricle in patients suffering from rheumatoid arth 2006 The purpose of the study was to evaluate the systolic and diastolic left ventricular (LV) function in patients with the system form of rheumatoid arthritis (RA) with subcutaneous rheumatoid nodules (SRN). The subjects, 105 patients with proved RA, were divided into two groups. The main group consisted of 40 patients suffering from system RA with SRN. The comparison groups included 40 patients suffering from the articular-and-visceral form of RA without SRN, and 25 patients with the articular form of RA. The systolic LV function was evaluated in all the 105 RA patients using M-mode Echo CG. In 20 patients with SRN systolic and diastolic LV function was evaluated with radionuclide ventriculography (RVG). The hemodynamic parameters obtained with Echo CG and RVG were processed according to variation statistics rules, presenting the data in groups as a mean and the standard error (M +/- m); the results were compared between the patients and between the patients and healthy controls. The significance was estimated using Student criterion (p < 0.05). In the group of RA patients with SRN, Echo CG and RVG found a significant decrease in LV systolic function parameters vs. patients without SRN and healthy controls. RVG revealed LV diastolic dysfunction in RA patients with SRN. Systolodiastolic LV dysfunction in these patients suggests myocardial involvement. Present-day instrumental methods of the evaluation of functional heart condition may be used to evaluate systolic and diastolic LV function in RA patients, especially during the dynamic observation of the effectiveness of RA treatment with modern anti-rheumatic preparations.
16421640 [Pneumocystis jiroveci pneumonia (PcP) in patients with rheumatic diseases: case report an 2006 Feb A 74-year-old female patient with rheumatoid arthritis was diagnosed with Pneumocystis jiroveci pneumonia (PcP) following therapy with methotrexate and prednisone. Although bactrim treatment was initiated and PcP was not detected by a control bronchoalveolar lavage, the patient died. The precise cause of death remains unknown. As this case illustrates, PcP must be considered as a differential diagnosis in immunocompromised patients with rheumatic disease. The typical course, diagnosis, prophylaxis and treatment of PcP in this patient group are discussed.
16732894 Reshaping Cinderella's slipper: the shared epitope hypothesis. 2006 This issue of Arthritis Research and Therapy contains a succinct and elegant paper by Michou and colleagues that advances our understanding of the genetic basis of rheumatoid arthritis (RA) by reclassifying the contribution of RA susceptibility alleles according to their structure. This line of research is potentially important in our conceptualization of the mechanism of disease in RA, in predicting disease course and severity, and as a model for further studies on this topic. The author's approach to reassessing the molecular structure of the shared epitope redirects attention to using the binding properties of the major histocompatibility complex molecules associated with susceptibility to search for the peptides driving the autoimmune process underlying rheumatoid arthritis.
16845710 Using predicted disease outcome to provide differentiated treatment of early rheumatoid ar 2006 Sep OBJECTIVE: To determine the usefulness of a prediction model for making treatment decisions in early rheumatoid arthritis (RA). METHODS: In 152 patients with early RA, progression of radiological damage during the first year [Sharp-van der Heijde (SH) score > 0] was assessed and used to define actual disease outcome. Available variables at baseline were entered in a multivariate regression analysis with progression score as dependent variable. This model was used to predict disease outcome in every patient. Using the standard deviations of the predicted disease outcome, patients were divided into 3 groups: (1) severe disease: high probability (> or = 0.8) for progression > 0, (2) mild disease: high probability (> or =0.8) for progression < or = 0, and (3) not classified: no high probability for either option. It was determined how many patients could be classified by using this model. RESULTS: One hundred nine patients (71.7%) showed joint damage progression during the first year. Baseline variables available were: age, sex, duration of symptoms, duration of morning stiffness, patient's global assessment of disease activity, Health Assessment Questionnaire score, swollen and painful joint count, bilateral compression pain in metatarsophalangeals, rheumatoid factor positivity, erythrocyte sedimentation rate, shared epitope positivity, SH-score, and the presence of erosions. The R2 value (approximately variation explained) of the prediction model was 0.36. By using this model 46.3% of patients could be classified as having severe disease, 0% as having mild disease, and 53.7% could not be classified. CONCLUSION: To be able to make treatment decisions in early RA based on predicted disease outcome, a better prediction of disease outcome is needed, making the search for better prognostic variables urgent.
15286006 Deciding on progression of joint damage in paired films of individual patients: smallest d 2005 Feb Progression of radiological joint damage is usually based on the simultaneous assessment of a series of films from an individual patient ("paired", with or without known sequence). In this setting the degree of progression that can be reliably detected above the measurement error is best determined by the smallest detectable change, and overestimated by the traditionally calculated smallest detectable difference. This knowledge is important for calculation of the proportion of patients showing radiographic progression in clinical trials.
15660458 Gene therapy: what have we accomplished and where do we go from here? 2005 Jan As a potential treatment for arthritis, gene transfer should be viewed within the context of biological therapy. Its particular strengths include the ability to deliver therapeutic gene products, both RNA and protein, to specific cells or tissues in a targeted, sustained, and potentially regulated, cost-effective fashion. An expanded definition of gene therapy includes the delivery of noncoding nucleotide sequences that act, for example, as decoy molecules. Considerable experimental progress has been made in the preclinical development of gene therapies for arthritis. Indeed, there is overwhelming proof of principle in animal models of rheumatoid arthritis (RA) and accumulating evidence of efficacy in animal models of osteoarthritis (OA). Early-phase human clinical trials have been successfully conducted and others are in progress. Additional research is necessary to optimize gene transfer technologies and achieve regulated transgene expression. However, the most urgent need is for interventional studies in human disease and the funding with which to implement them.
15801011 Expanding the definition of clinical differences: from minimally clinically important diff 2005 Apr OBJECTIVE: Minimally clinically important differences (MCID) have become an important way to interpret data of randomized clinical trials (RCT), but do not reflect the degree of improvement consistent with a "really important difference" (RID). To define RID, we compared mean and/or least desirable clinical states with best and/or most desirable states. METHODS: In total, 8931 patients with rheumatoid arthritis (RA) < 65 years of age completed the Health Assessment Questionnaire (HAQ) and Medical Outcomes Survey Short Form 36 Physical Component Score (PCS). Definitions of RID were based on values for HAQ and PCS corresponding with the best and worst category of the following conditions: disabled vs not disabled: joint replacement vs no joint replacement; < poverty level vs > poverty level; very satisfied with health vs not; and independent in participation activities vs not. RESULTS: In contrast to published MCID values for the HAQ of approximately 0.22, RID was as high as 0.76 using objective reference conditions and 0.87 using the subjective measure of dependence vs independence. The HAQ score of independent RA patients was 0.38 (SD 0.45), and was 0.42 (SD 0.53) for those very satisfied with their health. The difference in HAQ scores between disabled and working patients was approximately 0.75. PCS differences were similarly increased. CONCLUSION: RID values are 3 to 4 times greater than MCID values. Although MCID are meaningful statistics for RCT, the RID percentage achieved [(actual improvement/RID) 100%] is a simple way to put the results of RCT in a broader perspective that gives an idea of how much additional treatment effect is needed.
16997472 Higher levels of pain readiness to change and more positive affect reduce pain reports--a 2007 Feb The objective of the study was to analyze the relationships between Pain Readiness to Change, weekly measures of positive and negative affect and pain over eight subsequent weeks in patients with rheumatoid arthritis (RA). Factor analysis based on data from three different samples of patients with rheumatic diseases and other chronic pain conditions suggested a three factor solution for the Norwegian version of the Pain Stages of Change questionnaire (PSOCQ) representing Precontemplation, Contemplation, and Action/Maintenance (ACT) stages from the original Transtheoretical Model. Multilevel analyses on the weekly assessed data from a sub sample of 40 patients with RA revealed that higher levels of Pain Readiness to Change represented by high ACT scores were associated with more positive affect from week to week while no association was found between Readiness to Change and weekly pain. However, there was an interaction effect between Pain Readiness to Change and weekly positive affect on weekly pain, indicating that those persons having a higher level of Readiness to Change reported less pain in weeks when they also experienced increased positive affect. This may imply that a combination of cognitive factors and positive affect is most effective in relation to pain reduction. Results encourage continued investigation of apparent interactions between chronic pain, affect, and pain self-management.
16761484 Intestinal necrosis in a patient with rheumatoid arthritis receiving anti-TNF treatment. 2006 Mar Vasculitis leading to intestinal necrosis is a rare complication of rheumatoid arthritis. The introduction of anti-TNF treatment for methotrexate-resistant cases improved disease-control substantially in these often more aggresive forms of rheumatoid arthritis. As far as we know only two cases of severe vasculitis following anti-TNF treatment have been reported. We describe a 45-year old female patient with severe rheumatoid arthritis, who presented with an epileptic insult, renal failure and a quickly deteriorating general condition due to intestinal vasculitis, while she had been receiving anti-TNF treatment for 6 months.
16691137 Arthroscopic synovectomy in wrists with advanced rheumatoid arthritis. 2006 Aug We evaluated the effects of arthroscopic wrist synovectomy for patients with advanced rheumatoid arthritis. We retrospectively reviewed data for 11 patients with moderately advanced arthritis and joint space narrowing of 25% to 50% (Group A) treated from May 1993 to March 2000. We compared effects of these patients with effects of six patients with earlier disease and joint space narrowing of 0% to 25% (Group B). For Group A, the total modified Mayo wrist scores increased from an average of 26.36 points preoperatively to an average of 56.36 points postoperatively. Postoperative scores for pain and return to work status, and two components of the modified Mayo wrist score also showed differences compared with the respective preoperative scores. There was an increase in final followup scores in return to work status and total modified Mayo wrist scores. Group A showed larger differences than Group B. Our data suggest that arthroscopic synovectomy is a useful treatment for modest and moderate stages of rheumatoid arthritis. It is especially effective for decreasing pain and improving function, allowing patients to return to work. LEVEL OF EVIDENCE: Therapeutic study, Level III. See the Guidelines for Authors for a complete description of levels of evidence.
16265713 Attributes and skills of an effective musculoskeletal consumer. 2005 Nov The OMERACT 7 Effective Musculoskeletal Consumer Workshop brought together people with rheumatoid arthritis, healthcare professionals, and researchers to discuss what they thought made a musculoskeletal consumer effective at managing their disease. Preliminary work before OMERACT provided a draft list of potential characteristics of an effective consumer. Participants at the workshop provided feedback about the list including relevance, missing items, format, and language. The feedback provided was useful and will be incorporated into a revised list to aid in the development of an instrument to measure health consumer effectiveness.
16284769 Possible association of the X-ray cross complementing gene 1 (XRCC1) Arg280His polymorphis 2006 Jun Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by the invasion of synovial cells into cartilage and bone, exhibiting certain features of transformed cells. To examine whether retardation of DNA repair pathway of oxidative damage is a possible mechanism in altered phenotypes of these cells, we analyzed SNPs of the base excision repair (BER) protein, X-ray repair cross complementing gene 1 (XRCC1), among RA patients. Genomic DNA was extracted from blood cells of 40 RA patients and SNPs of the three allele of the XRCC1 coding region (codons 194, 280 and 399) were determined by PCR, followed by sequencing. Of the three polymorphisms, only the XRCC1 Arg280His allele was associated with increased RA risk (odds ratio 13; 95% confidence interval 1.1-147) after adjustment for smoking. These data provide evidence for the first time that BER, which is involved in the recovery from oxidative damage, may correlate with RA.