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ID PMID Title PublicationDate abstract
16164227 [Gene transfer to treat rheumatoid arthritis]. 2005 Sep Intraarticular transfer of exogenous genes could be useful for treatment of rheumatoid arthritis. The joints are not easy for drug accession while gene therapy can deliver therapeutic genes directly into the joints. Also, long-term expression of the transferred genes is expected. Anti-inflammatory genes, including interleukin-1 receptor antagonist gene, have been used in experimental arthritis models and in a clinical trial for treatment of rheumatoid arthritis. However, during gene therapy of other diseases, tragic accidents associated with viral vectors occurred. Since then, they have hampered clinical application of the gene therapy. Genes for treatment should be selected carefully and gene delivery methods should be optimized to resume clinical trials.
16342084 A disease-specific self-help program compared with a generalized chronic disease self-help 2005 Dec 15 OBJECTIVE: Both the Arthritis Self-Management Program (ASMP) and the generic Chronic Disease Self-Management Program (CDSMP) have been shown to be successful in improving conditions in patients with arthritis. This study compared the relative effectiveness of the 2 programs for individuals with arthritis. METHODS: Patients whose primary disease was arthritis were randomized to the ASMP (n = 239) or to the CDSMP (n = 116). Analyses of covariance were used to compare the outcome measures for the 2 programs at 4 months and 1 year. Measures included quality of life outcomes (self reported, health distress, disability, activity limitation, global health, pain, and fatigue), health behaviors (practice of mental stress management, stretching and strength exercise, aerobic exercise), self efficacy, and health care utilization (physician visits and hospitalizations). RESULTS: Both programs showed positive results. The disease-specific ASMP appeared to have advantages over the more generic CDSMP for patients with arthritis at 4 months. These advantages had lessened slightly by 1 year. CONCLUSION: The disease-specific ASMP should be considered first where there are sufficient resources and participants. However, both programs had positive effects, and the CDSMP should be considered a viable alternative.
15938538 [Mechanisms of formation of morning stiffness in rheumatoid arthritis: the role of segment 2005 AIM: To study function of the segmental part of the autonomic nervous system as shown by mm interossei dorsalis excitability threshold (ET) in patients with rheumatoid arthritis (RA) of different activity and under morning stiffness. MATERIAL AND METHODS: The ET was studied in 38 healthy subjects (control group) and 111 RA patients using a diagnostic electric acupuncture device "Prognosis-6". RESULTS: Mm. interossei dorsalis ET rise was registered in 84.7% RA patients. A step-by-step (4 clusters) increase in hand muscle rheobase was seen demonstrating influence of inflammation activity on muscular ET. In morning stiffness, weak current failed to register ET of the studied muscles in RA patients. CONCLUSION: The disturbed neuromuscular transmission present segmental vegetative mechanisms of morning stiffness formation in RA.
16284342 High dose chemotherapy and syngeneic stem cell transplantation in a patient with refractor 2005 Dec BACKGROUND: Immunoablative therapy combined with haematopoietic stem cell transplantation (SCT) is a possible treatment for patients with severe rheumatoid arthritis (RA). CASE REPORT: A patient with rheumatoid factor positive, progressively erosive RA, refractive to treatment, was treated with high dose cyclophosphamide, followed by reinfusion of an unmanipulated peripheral blood graft derived from her identical twin sister. The clinical response was unsatisfactory, necessitating reinstitution of treatment with disease modifying antirheumatic drugs, which was associated with persistence of host serum autoantibodies and a cellular infiltrate in synovium, notably of plasma cells. DISCUSSION: The effectiveness of syngeneic SCT may be critically dependent on the degree of immunoablation achieved or on the composition of the graft.
17090565 Early functional disability predicts both all-cause and cardiovascular mortality in people 2007 Apr OBJECTIVE: To investigate the predictive value of early functional disability in patients with inflammatory polyarthritis (IP), for all-cause and cardiovascular disease (CVD) mortality. METHODS: 1010 subjects with new-onset IP from the Norfolk Arthritis Register were studied. All were seen at baseline and at 1 year. Health Assessment Questionnaire (HAQ) scores were obtained at both time points. Vital status at 10 years from registration was established through central records. Mortality (all-cause and CVD) per 1000 person-years were calculated by HAQ stratum (HAQ scores<1, 1-2 and>or=2). The predictive value of HAQ (per unit increase) at the two time points, adjusted for age at onset of symptom, sex and other factors found to predict mortality, was assessed using Cox regression models. The analysis was repeated for those who satisfied the 1987 American College of Rheumatology criteria for rheumatoid arthritis (RA) by 5 years. RESULTS: By 10 years, 171 (16.9%) subjects had died. 89 deaths (52%) were attributed to CVD. Mortality was greatest in the highest HAQ group at both time points. Following adjustment for other predictors, HAQ score at year 1 remained a significant predictor of all-cause mortality (HR 1.46; 95% CI 1.15 to 1.85) and CVD mortality (HR 1.49; 95% CI 1.12 to 1.97). The predictive value of HAQ at year 1 was similar in the RA subgroup. CONCLUSIONS: Our data show that at 1 year of follow-up, HAQ score is an important independent predictor of subsequent all-cause and CVD mortalities in people with IP and RA. Baseline HAQ scores are of less value.
16149411 [Efficacy of intensive therapeutic exercise and interval hypoxic training in rheumatoid ar 2005 Jul Three-month follow-up of 142 patients with mildly active rheumatoid arthritis (RA) discovered that maximal improvement of clinical picture and peroxide-antioxidant imbalance can be achieved in patients doing intensive physical exercise at home according to a special program. Clinical effects of standard therapeutic exercises were insignificant. A course of interval hypoxic training resulted, as a rule, in relief of pain.
15924836 Hydroxyapatite-coated total knee arthroplasty in rheumatoid arthritis patients: a short-te 2005 Jun OBJECTIVE: To determine the outcome of cementless hydroxyapatite-coated total knee prosthesis in rheumatoid patients. DESIGN: Analytical. PLACE AND DURATION OF STUDY: University of Yamanashi Hospital, Japan, from October 1999 to September 2002. PATIENTS AND METHODS: Twenty total knee arthroplasties using HA-coated Scorpio Superflex CR and Delta 7000 series were performed in 17 rheumatoid patients. Pre and postoperative results were compared using JOA scores. RESULTS: Male: female ratio was 16:1, average age was 67 years and mean duration of follow-up was two years. JOA scores improved significantly (p<0.05) postoperatively from an average of 37 to 80. Varus and valgus angular deformities improved significantly and 90% of the knees had alignment between zero and 5 degrees of valgus angulation with an average tibiofemoral angle (FTA) of 172. The radiographic findings revealed no radiolucent lines at two years follow-up. Distal femur osteolysis was not observed. CONCLUSION: The clinical results were excellent at 2-year follow-up, which are in agreement with other reports using hydroxyapatite-coated knee prosthesis.
15980935 Lupus arthropathy: a case series of patients with rhupus. 2006 Mar Among the clinical manifestations of systemic lupus erythematosus (SLE) is an arthropathy, which is usually nonerosive. In many cases the joint involvement is mild. A subset of patients have deforming, nonerosive Jaccoud's arthropathy, and a minority have an arthropathy with clinical findings similar to rheumatoid arthritis (RA) that has been called "rhupus." We report our series of eight patients (seven female, one male) with rhupus arthropathy. Patients were between the ages of 17 and 38 years (average: 30.3 years) at disease onset. All had deforming or Jaccoud's arthropathy, and three had erosive disease. The arthritis was typically the first disease manifestation. Other symptoms of lupus including vasculitis and glomerulonephritis appeared after an average of 2.8 years. All had positive antinuclear antibody and rheumatoid factor. Rhupus arthritis is not a combination of RA and SLE, but should be regarded as a variant of the arthropathy of lupus.
19388592 [Anti-citrullinated peptide antibodies: novel markers for rheumatoid polyarthritis]. 2006 Rheumatoid arthritis is a multi-factorial autoimmune disease in which patho-physiological mechanisms have been partially elucidated these past few years. These recent advances have led to new and effective treatments that must be started early in the course of the disease. This review focuses on new serological markers, the anti citrullinated peptides antibodies which seem to be useful in early diagnosis and prognosis of rheumatoid arthritis and probably provide new insights in its pathogenesis.
15813429 [Molecular unraveling of disease by means of DNA-microarrays]. 2005 Mar 19 Determination of the human genome sequence and the development of microarray technologies allowing the rapid measurement of all genes in the genome have generated new perspectives for our current biomedical research. Gene expression analysis will make a major contribution to our insight into the underlying biology of disease and will lead to improved methods for diagnostics, prognosis and treatment. Microarray studies create the possiblity to subclassify patients with diseases such as rheumatoid arthritis, diffuse large B-cell lymphoma and breast cancer, with both prognostic and therapeutic consequences. The simultaneous quantification of the activity of all genes in tissues or cells from patients by microarray technology, linked to the clinical parameters, creates a large number of data points, which cannot be analysed without the aid of the advanced application of bioinformatics. As a result, genomic research has become, in part, a bioinformatics discipline that will be integrated with clinical medicine. The microarray technology makes it possible to develop personalized medicine, with a more accurate diagnosis and prognosis for every patient and subsequently a tailored treatment strategy.
15729122 Multiple rheumatoid nodules with rapid thin-walled cavity formation producing pneumothorax 2005 Feb We report a rare case of multiple rheumatoid nodules that on chest CT demonstrated peripheral location with thin-walled cavity formation, rapid increase in size within several months, and complicating pneumothorax, pneumomediastinum, and subcutaneous emphysema due to bronchopleural fistula formation.
16441532 Impact of a rheumatology expert nurse on the wellbeing of patients attending a drug monito 2006 Feb AIM: This paper reports a study to test the hypothesis that consultation with a clinical nurse specialist in a drug monitor clinic has a measurable impact on the well-being of patients with rheumatoid arthritis. METHOD: A single blinded randomized controlled trial was carried out with 71 patients with rheumatoid arthritis who were starting new disease-modifying anti-rheumatic therapy at a district general hospital. Patients were randomized into two groups over a 3-year recruitment period. Intervention group patients were monitored by a rheumatology clinical nurse specialist using Pendelton's framework to assess patient needs alongside safety monitoring. Control group patients were seen by an outpatient staff nurse for safety monitoring only over a 1-year period. The primary outcome measures were the Arthritis Impact Measurement Scales and the Rheumatology Attitude Index. Data were also collected on the Disease Activity Score, number of consultations with healthcare professionals and changes in drug therapy. Data were collected at baseline, 3, 7 and 12 months between 1999 and 2002. RESULTS: The Intervention group had greater change scores than the Control group for the Arthritis Impact Scale, with statistical significance shown at 7 months (P = 0.03). At 12 months the Rheumatology Attitude Index had improved by a mean of 1.8 in the Intervention group and deteriorated by 0.3 in the Control group. Changes in the Disease Activity Score were greater in the Intervention group at all time points, with statistical significance at 12 months (P = 0.048). There was little difference in the number of consultations or changes in drug therapy between the two groups. CONCLUSION: Consultation with an expert rheumatology nurse in a drug monitor clinic may add value in terms of improving patients' perceived ability to cope with the arthritis.
15778241 Impact of pregnancy on health related quality of life evaluated prospectively in pregnant 2005 Oct OBJECTIVE: To gain insight into patient experience of the disease course and health related quality of life during and after pregnancy in women with rheumatoid arthritis and ankylosing spondylitis. METHODS: 10 patients with rheumatoid arthritis, 10 patients with ankylosing spondylitis, and 29 age matched healthy pregnant controls were evaluated by the medical outcomes study short form 36 (SF-36) health survey once at each trimester and at 6, 12, and 24 weeks postpartum. A group of non-pregnant age matched female patients (40 rheumatoid arthritis, 16 ankylosing spondylitis) was studied for comparison. RESULTS: Impaired physical dimensions as well as increased bodily pain was observed in healthy women in late pregnancy. Patients with rheumatoid arthritis showed improved physical functioning scores in the second trimester and reduced pain in the third trimester. Among pregnant patients, those with ankylosing spondylitis suffered the greatest impairment of health related quality of life during pregnancy. In all patient groups the physical impairment in the third trimester was less pronounced than in healthy controls. Mental health scores remained stable even with persisting active disease during pregnancy, or with a postpartum flare. CONCLUSIONS: Pregnancy reduced physical functioning in healthy women and patients, but had no impact on mental and emotional health, even at times of disease aggravation. The pregnancy experience documented in our patients may be helpful when counselling patients contemplating pregnancy.
16273792 The Disease Activity Score and the EULAR response criteria. 2005 Sep In rheumatoid arthritis (RA), inflammatory activity cannot be measured using one single variable. For this reason the Disease Activity Score (DAS). has been developed. The DAS is a clinical index of RA disease activity that combines information from swollen joints, tender joints, the acute phase response and general health. The DAS-based European League Against Rheumatism (EULAR) response criteria were developed to measure individual response in clinical trials. The EULAR response criteria classify individual patients as non-, moderate, or good responders, dependent on the extent of change and the level of disease activity reached.
15660464 Is early intervention worth it? 2005 Jan Historically, the largest components of costs associated with rheumatoid arthritis (RA), the most common inflammatory rheumatic disease, were hospitalizations, principally for joint replacement surgery, and work loss. Thus, for expensive interventions such as biological agents to be "worthwhile," they must reduce the prevalence of joint replacement and assist persons with RA in maintaining employment. However, joint replacement surgery and work losses tend to occur at least several years after onset of disease, even in severe cases. Assessing the cost-effectiveness of expenditures becomes computationally and politically difficult when the expenditure and the outcome are separated in time. The computational issue concerns the translation of future benefits--surgeries avoided and jobs held onto years from now--into present monetary values. The computational issue may be even more complex when the benefits are less tangible than surgery and wages; for example, when measured by quality-adjusted life-years. The political issue concerns the disjuncture between the agents making the expenditures--provincial health insurance in Canada or an employer's health plan in the US--and the agents reaping the benefits, a private disability insurance company or provincial or state workers' compensation fund. In addition, there is an ethical dilemma. In the US, many of the advances in the care for RA such as the biological agents derive, at least in part, from federal research expenditures. Such expenditures are financed by increasingly regressive taxes. Yet the individuals bearing an increasing share of the tax burden find themselves relegated to more restrictive health insurance plans less likely to provide access to those agents. Thus, whether expenditures for early interventions are worthwhile may turn on such issues as how long the expenditure and the benefits are separated in time, how well the interests of the agent making the expenditure and the agent reaping the rewards are aligned, and how equitable the financing of the benefit and the access to it.
15828368 [Clinical evaluation of rheumatoid arthritis in practice]. 2005 Mar 9 Clinical evaluation is an integral part of medical practice. However, recent data have demonstrated that a systematic and standardized evaluation modifies the prognosis of our rheumatoid arthritis patients. The systematic use of activity indexes allows us to better appreciate the needs of our patients and the necessity to optimize and intensifie treatment. Likewise, auto-evaluations tools bring useful information to patient management.
15988997 [Evaluation of rheumatoid arthritis activity in clinical practice]. 2005 AIM: To develop inflammatory activity index (IAI) for assessment of rheumatoid arthritis (RA) activity in wide clinical practice. MATERIAL AND METHODS: Leflunomide was given to 414 patients for 18.4 +/- 5.7 weeks, on the average. The assessment of the drug efficacy was made by arthralgia severity according to visual analog scale (VAS), duration of morning stiffness, the number of painful joints at palpation, number of swollen joints (NSJ), general condition (GC) of the patient, ESR. DAS28 was used as a basic indicator of the disease activity and efficacy. IAI was formed on the basis of DAS28 and 3 baseline components--NSJ (28 joints), GC and ESR. RESULTS: DAS28 and IAI significantly correlated (r = 0.87, p < 0.01). Comparison of pairs of these indices can specify ranges of IAI corresponding to high, moderate and low RA activity in assessment by DAS28. CONCLUSION: IAI is a simple and reliable index of RA activity in clinical practice.
15999629 [Direct and indirect costs of rheumatoid arthritis and the socio-emotional effects of this 2005 May The results of this Austrian study confirm the conclusions of earlier studies that high costs for the individual and for society result from rheumatoid arthritis. We were able to show the figures for direct costs; indirect costs could not be calculated in their entirety. Drugs--especially disease-modifying drugs--and inpatient treatment constitute the largest percentage of direct costs. We describe the enormous psychological and psychosocial impact of rheumatoid arthritis, pain, and reduced quality of life. The study also presents a basis for the decisions to be made by patients, physicians and health policy makers.
17228803 [A case of follicular bronchiolitis preceding rheumatoid arthritis]. 2006 Feb A 52-year-old woman was admitted to Yame General Hospital because of persistent cough, wheeze, and shortness of breath at age 48. Chest X-ray and computed tomography (CT) showed bilateral centrilobular shadows. Pulmonary function test revealed obstructive dysfunction. She also had chronic sinusitis. Initially, diffuse panbronchiolitis was diagnosed and she was given macrolides, but no improvement was observed. Thus video-assisted thoracoscopic lung biopsy (VATS) was performed in order to establish a definitive diagnosis. Histopathological findings were compatible with a diagnosis of follicular bronchiolitis. Treatment with corticosteroid (oral prednisolone, 50 mg/day) improved her condition. However, on reducing the steroid doze, her symptoms and chest X-ray film/CT findings became exacerbated. In addition, polyarthritis appeared. Further investigations revealed a diagnosis of rheumatoid arthritis. Only 2 cases of follicular bronchiolitis preceding rheumatoid arthritis have been reported in Japan.
16164217 [Surgical treatment of rheumatoid arthritis based on EBM]. 2005 Sep Even though the advancement of pharmacotherapy, the maintenance treatment to keep the function of degenerated and destructed joint on rheumatoid arthritis and the surgical treatment for joint reconstruction are very important to prevent the patients from being bedridden and to keep the quality of life. The adaptation of operation varies among disease stage and site of bone destruction. Missing the chance of operation, it becomes impossible to perform surgical treatment. So it is important to consult with specialist finding proper opportunity.