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ID PMID Title PublicationDate abstract
17195065 Adaptation of the RAQoL for use in Australia. 2007 May Quality of life is an important patient-reported outcome of rheumatoid arthritis (RA) in addition to structural and functional outcomes. The RAQoL (Rheumatoid Arthritis Quality of Life questionnaire) was developed in the UK and the Netherlands as a disease-specific tool. It was adapted for use in the Australian social context and the reliability and validity was tested. A lay panel assessed the UK version and adapted the wording for use within Australia. Reliability and validity were assessed by a postal survey of the RAQoL and comparator questionnaires to 100 patients with RA. The RAQoL was easily adapted into Australian-English. Test-retest reliability was high with a Spearman rank correlation coefficient of 0.93. RAQoL scores correlated well with patient-perceived disease activity and severity--indicating good validity. The Australian version of the RAQoL is a valid and reliable tool for the assessment of quality of life. It is practical, easy to administer and has good potential for use in clinical settings and trials in Australia.
16185865 Rapamycin analogs with reduced systemic exposure. 2005 Dec 1 The synthesis and biological activities of rapamycin (I) analogs modified at the C-40 position are reported. Emphasis placed on compounds that potentially have an improved safety profile on account of their shorter in vivo half-life when compared with rapamycin.
15988998 [Clinical and laboratory markers of immune dysfunction in patients with rheumatoid arthrit 2005 AIM: To ascertain clinical and laboratory signs of immune disorders in patients with rheumatoid arthritis (RA), their healthy blood relatives and healthy females without autoimmune disease family history. MATERIAL AND METHODS: Immune status was studied in 66 RA patients, their 56 female relatives of the first and 10 female relatives of the second degree of kinship, 63 healthy females without family history of autoimmune disorders. Immune response was assessed conventionally. RESULTS: 87.5% relatives of the first degree had symptoms of immune dysfunction (control--50.8%). Combinations of immunopathological syndromes were registered in 41.1% examinees of this group (control--17.5%). Autoimmune syndrome was most frequent (64.3%, control--19%). Infectious syndrome occurred in 51.8% relatives and 33.3% controls (the difference is significant). Despite immunosuppressive therapy, occurrence of infectious syndrome in RA (18.6%) was much lower than in controls. It was found that before RA onset 81.4% patients suffered from frequent long-term infections. RA onset reduced the infections frequency. Allergy was in 12.5, 19 and 6.2% of the relatives, controls and patients, respectively. The relatives demonstrated a significant decline of compliment activity close to such in patients. CONCLUSION: Immune disorders in blood relatives of women suffering from RA are more frequent and severe than in women without autoimmune disorders in family history. However, subclinical immunopathological symptoms in them did not realize in certain disease during the observation period. This may be explained by weaker congenital defects of immune system functioning or the existence of compensatory mechanisms suppressing development of pathological autoimmune processes.
16881123 Possession of assistive devices is related to improved psychological well-being in patient 2006 Aug OBJECTIVE: To investigate the relationship between the possession of assistive devices and psychological well-being in patients with rheumatic conditions. METHODS: Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) were selected from rheumatology outpatient clinics in 2 adjacent regions in The Netherlands and Germany. A total of 142 patients completed a questionnaire on the possession of assistive devices and psychological well-being. Questions on sociodemographics, clinical status, and health status were included. Hierarchical multiple linear regression analysis was used to determine the unique association between the number of assistive devices per patient and psychological well-being, controlling for confounding variables. RESULTS: Univariately, the number of assistive devices per patient was negatively associated with psychological well-being. Multivariately, the number of assistive devices per patient was positively associated with psychological well-being. Functional status was a negative confounder of the relationship between the possession of assistive devices and psychological well-being. CONCLUSIONl The possession of assistive devices was positively related to psychological well-being of patients with rheumatic diseases, after controlling for differences in functional status.
16273795 A 3-page standard protocol to evaluate rheumatoid arthritis (SPERA): efficient capture of 2005 Sep An efficient 3-page format known as the "standard protocol to evaluate rheumatoid arthritis" (SPERA) has been developed to collect essential baseline clinical data in clinical trials and clinical research studies. The three pages address: 1) clinical features of rheumatoid arthritis (RA), 2) medications taken, and 3) a 42-joint count. Two additional documents, a patient questionnaire and a radiographic scoring sheet, are included for a comprehensive database. The 15-20 minutes needed to complete the SPERA generally adds efficiency over time in standard clinical care, and does not preclude the collection of additional information for clinical care and/or clinical research. The SPERA is presented not as the most desirable format, but rather as an example of a possible approach to the development of a consensus in the rheumatology community regarding a common format for the collection of core clinical data in RA.
16875130 [Optimization of laboratory assessment of the activity of an inflammatory process in patie 2006 Jun The paper proposes to measure the serum content of medium-weight molecules as a simple and available means of rapidly and adequately assessing the total activity of an inflammatory process (including the minimal one) in patients with rheumatoid arthritis. The method may be performed at any powered clinical diagnostic laboratories; it does not require expensive reagents and equipment, and special staff training.
16504820 The pharmacoeconomics of newer therapeutics for rheumatic diseases. 2006 Feb Rheumatic diseases are common, serious conditions characterized by alterations in normal immune homeostasis with resultant end-organ injury. Although diverse in clinical expression and pathophysiologic basis, therapeutic approaches for these conditions frequently overlap. Over the past decade, several important new therapies have been introduced into the clinic for the treatment of many rheumatic conditions. Although these agents have proven highly effective, their higher costs have raised questions concerning their most appropriate use in the clinic. This issue has been analyzed in greatest detail in rheumatoid arthritis. Increasing data suggest that newer therapeutics may be cost-effective for rheumatoid arthritis and other rheumatic diseases.
16365685 Disease activity and functional changes of RA patients receiving different DMARDs in clini 2006 Sep The aim of this study was to compare the effectiveness of different disease-modifying anti-rheumatic drugs (DMARDs) in improving disease activity and functional status in patients with rheumatoid arthritis (RA). One hundred and fifty-two Thai RA patients treated with at least one DMARD were enrolled in this 1-year cohort. Demographic characteristics, baseline and end-of-study data on disease activity and Health Assessment Questionnaire (HAQ) Disability Index of the subjects were compared among different DMARD options. Predictors of HAQ score were investigated using regression analysis. The results showed that the studied patients had established RA with mild to moderate activity. More than 85% were prescribed methotrexate (MTX) as single or combined DMARDs. At 1 year, improvement in most activity measures was experienced. However, all patients had functional declines. Patients taking antimalarial agents had the maximal rate of functional deterioration. Patients taking MTX-based DMARDs had significantly lower rate of functional decline than patients taking DMARDs without MTX (p=0.018). Only patients receiving MTX-based DMARDs had clinically meaningful improvement in HAQ score. The predictors of HAQ score at 1 year included baseline HAQ score and patient global assessment at end of study. In conclusion, although DMARD treatment was shown to improve disease activity in RA patients, functional deterioration was evident in our cohort. Thus, measures of functional status are more appropriate than measures of disease activity to evaluate treatment effects of DMARDs in established RA in clinical practice. MTX-based DMARDs should be prescribed where possible in RA patients with persisting activity due to their ability to delay functional deterioration.
16942947 A comparison of conventional pain coping skills training and pain coping skills training w 2006 Sep Pain coping skills training (PCST) has been shown to produce immediate improvements in pain and disability in rheumatoid arthritis (RA). However, some patients have difficulty maintaining these gains. This study compared a conventional PCST protocol with a PCST protocol that included maintenance training (PCST/MT). Patients with RA (n = 167) were randomly assigned to either conventional PCST, PCST/MT, arthritis education control, or standard care control. Daily data were collected on joint pain, coping, coping efficacy, and mood. Multilevel analyses showed that at posttreatment, conventional PCST was superior to all other conditions in joint pain, coping efficacy, and negative mood, whereas PCST/MT was superior to all other conditions in emotion-focused coping and positive mood. At 18 months follow-up, both PCST conditions were superior to standard care in joint pain and coping efficacy. Interpretation of follow-up outcomes was limited by higher dropout rates in the 2 PCST groups. For RA, a maintenance training component does not appear to produce significant improvements over conventional PCST. PERSPECTIVE: This article reports a trial evaluating a conventional pain coping skills training protocol and a similar protocol that included a maintenance training component. Overall, results indicate similar results for both the conventional and the modified protocols.
16164216 [Diagnosis and prediction of joint destruction found in patients with rheumatoid arthritis 2005 Sep Rheumatoid arthritis(RA) is characterized by localized destruction of synovium, cartilage, and bone. Loss of bone in RA is not only localized in joints but is also generalized. In RA, bone loss seems to be related to elevated bone resorption, while data of bone formation are conflicting. Increased bone absorption markers are associated with bone erosion at baseline and may predict radiographic progression. Treatment with TNF blockers and/or disease-modifying anti-rheumatic drug therapy cause the reduction of levels of bone resorption markers. MMP-3 is involved in the pathogenesis of RA, since the synovial fluid from RA patients contains a large amount of MMP-3. The serum concentration of MMP-3 is a useful marker for predicting bone damage in the early stage of RA, and the suppression of MMP -3 production may be an effective therapeutic approach for patients with early RA.
16946997 Occurrence of sacroiliitis in patients with seronegative oligoarthritis. 2007 May The aim of this study was to investigate sacroiliitis in patients with seronegative oligoarthritis. Thirty consecutive patients with seronegative oligoarthritis and no other signs of spondylarthropathy were included. Sacroiliac (SI) joints were investigated by both radiography and magnetic resonance imaging. HLA B27 antigen was studied and family history was reexamined in 2006. Five patients had sacroiliitis. Additionally, 15 patients had HLA B27 antigen or family history of either psoriasis or ankylosing spondylitis. Our conclusion is that during the first decade of seronegative oligoarthritis, HLA B27 antigen, family history, and especially imaging of SI joints reveal in two thirds of the patients the spondylarthritic nature of their disease.
15895884 IL1beta+3953 exon 5 and IL-2 -330 promoter polymorphisms in patients with rheumatoid arthr 2005 Mar OBJECTIVE: Rheumatoid arthritis (RA) is chronic inflammatory disease in which cytokines play an important role. The aim of present study was to evaluate the exon 5 +3953 IL-1beta and IL-2 -330 promoter polymorphisms in patients with RA in association with disease activity and severity. METHODS: In the study 93 patients with rheumatoid arthritis diagnosed according to the criteria of American College of Rheumatology were included. Polymerase chain reaction amplification was used for analysis of the polymorphisms studied. RESULTS: The distribution of IL-1beta and IL-2 genotypes in RA patients did not differ from control subjects. Nevertheless in patients with A2 allele of IL-1beta and GG genotype of IL-2, the active form of RA was more frequently diagnosed. Moreover in these patients the measurements of disease activity (DAS 28 score, ESR, number of swollen and tender joints) were significantly increased. CONCLUSION: We suggest that exon 5 +3953 IL1beta and IL-2 -330 promoter polymorphisms may be a genetic risk factor for RA severity.
16331773 A composite disease activity scale for clinical practice, observational studies, and clini 2005 Dec OBJECTIVE: To develop and validate a composite patient self-report disease activity scale for use in clinical practice and in observational studies and clinical trials. METHODS: A total of 9078 patients with rheumatoid arthritis completed detailed questionnaires that included measure of quality of life in the form of utilities. We evaluated several disease activity scales by measuring their agreement with the utility scales, and also their assessed ability to predict mortality and prescription for anti-tumor necrosis factor therapy. RESULTS: A composite index composed of a visual analog scale (VAS) for pain, a patient global VAS, and the Health Assessment Questionnaire (HAQ) or the HAQ II formed the Patient Activity Scale (PAS) and PAS-II. These scales performed as well as or better than longer, more complex scales. CONCLUSION: A simple, useful clinical scale, the PAS or PAS-II, can be formed by the use of common clinical variables. It is well correlated with and relevant to a wide range of clinical variables. This scale should be useful for comparative studies, clinical care, and regulatory documentation.
17195530 [Clinical and laboratory assessment of endogenic intoxication syndrome in patients with rh 2006 AIM: To detect endogenic intoxication syndrome (EIS) and to assess its severity depending on clinical manifestations of rheumatoid arthritis (RA) using laboratory tests. MATERIAL AND METHODS: Laboratory tests including analysis of synovial fluid, blood count with estimation of leucocytic intoxication index, urinalysis, total protein and protein fractions, seromucoid, syalic acids, peroxide-antioxidant balance, metabolism of proteoglycanes, immunological tests were made in 162 patients with documented RA and 86 healthy controls. Content of middle mass molecules served as an integral biochemical EIS marker. RESULTS: Inflammatory destructive processes in the affected tissues of RA patients lead to marked systemic metabolic and immune disorders accompanied with EIS. Severe EIS are associated with severe metabolic disorders. A significantl rise (p < 0.05) in content of middle mass molecules in the serum was found in all RA patients including in the disease onset and in minimal activity of inflammation and presence of only mono-olygoarthritis of the knee joints. CONCLUSION: RA patients develop EIS the severity of which depends on the activity and distribution of the inflammatory process but not on the disease stage. Metabolic disorders in RA patients can be assessed with an effective method--blood serum middle mass molecule assay.
16095125 Lack of effect of rapamycin in anti-CCP antibody production in a rheumatoid arthritis kidn 2005 Jul Autoimmune diseases may lead to end-stage renal disease and, as a consequence, kidney transplantation. Classical immunosuppressive drugs, such as cyclosporine or corticosteroids, are well-established therapies for both transplantation and autoimmune diseases. Rapamycin is a new immunosuppressant useful for allograft transplantation and with a promising future for autoimmune diseases, although it has not been extensively studied in humans. Here the case of a patient diagnosed with rheumatoid arthritis (RA) who received a renal allograft is reported. She was started on prednisolone, azathioprine and cyclosporine immunosuppression and changed to rapamycin instead of cyclosporine 4 years after transplantation, because of chronic allograft nephropathy. At present, the patient has a functioning graft. However, the arthritis symptoms reappeared after the change in immunosuppressant. Titers of RA-specific anti-cyclic citrullinated peptides antibodies increased whereas rheumatoid factor titers decreased. This case report suggests that rapamycin used for kidney transplantation might have a different influence on the spectrum of RA autoantibodies.
16808317 [Caplan's syndrome: case report]. 2005 Aug A case of a 56-years old male with rheumatoid arthritis and unclear tumoral radiological changes in the lungs was described. Since noninvasive diagnostic procedures failed to explain nature of the pulmonary changes, an open pulmonary biopsy was performed. Pathological examination revealed presence of rheumatoid nodules and pneumoconiosis, typical for Caplan's syndrome. In the past, the patient had been working in foundry industry for 16 years and he had been exposed to silica and iron dust. Articular symptoms were revealed prior to finding the lung changes even dust exposure had occurred many years earlier. In spite of the fact that rheumatoid arthritis is a relatively common disease and pneumoconiosis is also not rare entity, the coexistence of both conditions i.e. Caplan's syndrome has been rarely diagnosed and described.
17236298 Correlation between different components of synovial fluid and pathogenesis of rheumatic d 2006 Biochemical analysis of synovial fluid is important in orientating the diagnosis of joint effusions. Its composition reflects the metabolic status of synovial tissue correlated with different rheumatic pathologies. The aim of this study was to compare the information provided by usual biochemical tests and proton magnetic resonance spectroscopy (MRS) analysis of synovial fluid, in order to detect potential characteristics of joint effusion correlated to the pathogenesis of arthritis. PATIENTS AND METHODS: This study included 99 synovial fluid samples obtained from patients with different etiology of arthritis--rheumatoid arthritis (RA), osteoarthritis (OA), gout, seronegative spondylarthropathies and septic arthritis, which underwent routine laboratory tests available in the Department of Rheumatology, Cantacuzino Clinical Hospital, Bucharest. Patients were admitted in the hospital between January 2003 and June 2005. Synovial samples were examined in parallel using MRS determination. Spectra have been recorded on a Bruker Avance DRX 400 MHz spectrometer. RESULTS: We obtained a good correlation between biochemical analysis and MRS determination. RA samples have offered the most important information regarding the complex composition of pathological synovial fluid. In addition to the markedly elevated lactate (p < 0.009) and diminished glucose concentration (p < 0.02) in RA samples vs. OA, MRS analysis provides evidence for reduced mean chain length of very-low-density-lipoprotein (VLDL)-associated triacylglycerols (p < 0.05), high levels of ketone bodies (p < 0.05), ceramide (p < 0.02) and citrulline (p < 0.04). OA samples have shown a characteristically increased level of N-glucosamine (p < 0.04) and creatine (p < 0.04). For the other pathologies, there are no characteristic markers detected, except for the extremely increased level of lactate and the decreased concentration of glucose in septic arthritis. CONCLUSIONS: This study gave us the possibility to provide a complex exploration of the biochemical environment of synovial fluid using the MRS method, that offers us the opportunity to understand more about the pathogenesis of rheumatic diseases, to provide information regarding the degree of inflammation, immune infiltration and apoptosis in RA, cartilage degradation and muscular secondary atrophy in OA. The most valuable information is focused on the possibility to have a simultaneous detection of more than 26 different metabolites in synovial fluid samples.
17526155 [From the bath- and massage to the sports clinic--the Rheumatological Department of Bispeb 2006 At the turn of the previous century, the number of inhabitants in the City of Copenhagen increased greatly. A new large hospital, Bispebjerg Hospital, stood ready in 1913. At the time, access to light, fresh air, and open spaces was considered to be important factors in the battle against disease. Physical treatment such as different forms of bathing, massage, exercise, electricity and radioactivity were also much relied upon, and a large building for this treatment in the form of a Roman thermal bath was built at the clinic of physical medicine. The first head of the clinic, Hans Jansen (1875-1933), was a specialist in internal medicine who studied physical treatments for a wide range of diseases, including phototherapy, as a collaborator of the Nobel Prize laureate Niels Finsen. Later, Jansen focused on the treatment of rheumatoid arthritis. It was left to the internal medicine ward at Bispebjerg Hospital to introduce the first effective treatment with the gold compound Sanocrysin during the 1930's. In 1918, physical therapy, physiatry (in Danish, fysiurgi), was established as a medical speciality in Denmark. The next head of the clinic, from 1933 Knud Aage Rasmussen (1897-1976), a specialist in fysiurgi, focused on the treatment of regional and general rheumatic pain syndromes. The rehabilitation of patients with different diseases by gymnastic exercises had been in use from the start of the clinic, but in the late 1940's more emphasis was put on this treatment under the influence of impulses from the USA, and as a response to demographic change with an increased number of older individuals with physical challenges in the City of Copenhagen. A rehabilitation ward was established and together with the clinic of physiotherapy formed a new department in 1968 under the leadership of Lone Gjørup (1923-2005). At the same time, interest in the treatment of inflammatory rheumatic diseases rose after the discovery of glucocorticoids as potent anti-inflammatory compounds. The department at Bispebjerg Hospital followed this dual course of treatment of inflammatory diseases with new drugs and rehabilitation. Recent new technology and interest in sports medicine promoted research in physical training in the clinic and eventually gave rise to a separate research and development unit devoted to sports medicine.
16372731 Implementing a patient-led service for chronic conditions. 2005 Dec 6 Many chronic conditions with fluctuating levels of disease activity are traditionally managed by lifelong regular medical reviews. However, this means appointments do not always coincide with patient need, while the volume of reviews makes it difficult to respond quickly to requests for help. Research in rheumatoid arthritis suggests that hospital-initiated reviews can be replaced by patient-initiated reviews, supported by nurse-led initiatives.
17038464 More relevant, precise, and efficient items for assessment of physical function and disabi 2006 Nov OBJECTIVES: Patient reported outcomes (PROs) have become standard study endpoints. However, little attention has been given to using item improvement to advance PRO performance which could improve precision, clarity, patient relevance, and information content of "physical function/disability" items and thus the performance of resulting instruments. METHODS: The present study included 1860 physical function/disability items from 165 instruments. Item formulations were assessed by frequency of use, modified Delphi consensus, respondent judgement of clarity and importance, and item response theory (IRT). Data from 1100 rheumatoid arthritis, osteoarthritis, and normal ageing subjects, using qualitative item review, focus groups, cognitive interviews, and patient survey were used to achieve a unique item pool that was clear, reliable, sensitive to change, readily translatable, devoid of floor and ceiling limitations, contained unidimensional subdomains, and had maximal information content. RESULTS: A "present tense" time frame was used most frequently, better understood, more readily translated, and more directly estimated the latent trait of disability. Items in the "past tense" had 80-90% false negatives (p<0.001). The best items were brief, clear, and contained a single construct. Responses with four to five options were preferred by both experts and respondents. The term physical function may be preferable to the term disability because of fewer floor effects. IRT analyses of "disability" suggest four independent subdomains (mobility, dexterity, axial, and compound) with factor loadings of 0.81-0.99. CONCLUSIONS: Major improvement in performance of items and instruments is possible, and may have the effect of substantially reducing sample size requirements for clinical trials.