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ID PMID Title PublicationDate abstract
16913584 Arthropathy and cutaneous manifestations in a 28-year-old patient with cystic fibrosis. 2006 Jun We report on a 28-year-old man with known cystic fibrosis who presented with pain and cutaneous nodules in the elbow joints. His symptoms had appeared episodically in the previous months, they were always self-limiting, and independent of pulmonary exacerbations. A radiograph of the joints was unremarkable. These findings fit well with a special form of CF-related arthritis. As in the case of classical CF arthritis, the treatment to be considered is, in particular, symptomatic administration of non-steroidal anti-inflammatory drugs and possibly glucocorticoids. Also under discussion as a further possibility is the use of antibiotics. Our patient has always refused medication. The condition again proved to be self-limiting. In contrast to the classical form of CF arthritis, the special form is not associated with either joint swelling or local warmth. In the presence of arthritic symptoms in CF patients, consideration must always be given to a hypertrophic pulmonary osteoarthropathy. The latter, however, shows typical radiological changes and is exacerbated by lung infections. The presence of arthritic pathologies in a patient with CF further underscores the fact that CF is a multiorgan morbid condition.
16164001 Neuropathies in the rheumatoid patient: a case of the heavy hand. 2005 Aug Rheumatoid Arthritis (RA) is a common inflammatory arthritis' with pain and loss of function among its most disabling symptoms. These are mostly secondary to inflammation or mechanical damage to the joints. However it is also important to consider disease complications as a cause of symptoms, especially when the response to treatment is suboptimal. We report an RA patient whose symptoms were resistant to standard therapy, and were actually due to peripheral neuropathy.
16886694 [Diagnostic image (282). A woman with invalidating hip complaints]. 2006 Jul 15 A 40-year-old woman with a five-year history of rheumatoid arthritis experienced progressive pain of the left hip due to protrusio acetabuli.
16758509 Factors associated with permanent work disability in Mexican patients with rheumatoid arth 2006 Jul OBJECTIVE: To assess factors associated with permanent work disability (PWD) in Mexican subjects with rheumatoid arthritis (RA). METHODS: From a database of 300 salaried workers with RA, we evaluated 35 cases that developed PWD. These cases were compared with 70 controls randomly selected from the same database who were active workers. The assessment included the following variables: sociodemographic, education, employment, and clinical characteristics of the disease. Logistic regression analysis was performed to adjust variables associated with PWD. Odds ratios and their 95% confidence intervals (95% CI) were computed. RESULTS: Factors associated with PWD in the unadjusted analysis were: lower education level (OR 3.27, 95% CI 1.28-8.49, p = 0.006), >or= 2 year delay in prescription of a disease modifying antirheumatic drug (DMARD) (OR 4.29, 95% CI 1.49-12.73, p = 0.02), joint prosthesis (OR 8.93, 95% CI 2.02-45.04, p < 0.001), severe radiographic damage (OR 3.33, 95% CI 1.20-9.46, p = 0.01), comorbidity (OR 7.54, 95% CI 1.94-34.25, p < 0.001), and positive rheumatoid factor (RF) (OR 3.53, 95% CI 0.98-13.76, p = 0.03). In the multivariate model PWD was predicted by lower education (OR 3.3, 95% CI 1.1-9.7, p = 0.03), positive RF (OR 4.9, 95% CI 1.2-19.7, p = 0.03), and delay in the prescription of a DMARD (OR 3.3, 95% CI 1.1-10.1, p = 0.04). CONCLUSION: A low education level, positive RF, and delay in the use of DMARD are risk factors for PWD. Strategies to decrease rates of PWD should include an earlier treatment with DMARD.
16309047 [Therapeutic effect of electroacupuncture combined with medicine on acute rheumatoid arthr 2005 Aug OBJECTIVE: To explore a treatment program for increasing therapeutic effect on rheumatoid arthritis at active stage. METHODS: One hundred and forty-six cases were randomly divided into treatment group (n = 74) and medicine control group (n = 72). The treatment group were treated by electroacupuncture at Quchi (LI 11), Hegu (LI 4), Yanglingquan (GB 34), etc. , combined with meloxicam, sulfasalazine and MTX. The control group treated by simple the Western medicines. Their therapeutic effects were compared. RESULTS: The effective rate was 79.73% in the treatment group and 51.39% in the control group with a significant difference between the two groups (P< 0. 05). CONCLUSION: Electroacupuncture combined with medicine has a better therapeutic effect than the simple medicine on rheumatoid arthritis at active stage.
15744656 [Hand surgery in musicians with rheumatoid arthritis]. 2005 Feb Hand surgery in musicians and hand surgery of the rheumatoid hand are main subjects, beside others, of the Hand Surgical Department of the DRK-Clinic in Baden-Baden/Germany, clinically as scientifically, too. There are some special aspects of surgery of the hand in musicians with rheumatoid arthritis. Between 1980 and 2001, seven musicians with this inflammatory disease (3.8 % of all 185 musicians, gathered up to April 2001 in our musician's data bank) did seek help. Among these patients, we performed surgery in five musicians (four professionals, one semi-professional), but altogether 18 operations have been performed in these five musicians. Three of these five musicians were able to continue their original musical activity for many years despite their rheumatoid arthritis, one of them switched from soloist to teaching activity, one we lost to follow up. In musicians, individual considerations about the indication, the type of surgery and its details must be made pre-operatively. These may depend upon the instrument played and which hand or finger is affected. If possible, the expected results of surgery should be assessed during a preoperative recitation, using static or dynamic test-splints or plasters and having the musician play with these external devices.
15948059 Sonographic imaging of mallet finger. 2005 Jun Mallet finger is a flexion deformity of the distal interphalangeal joint (DIPJ) caused by a disruption of the extensor mechanism. The deformity can b e caused by active trauma, minor trauma or other conditions like rheumatoid arthritis or osteoarthritis. AIM: To describe the sonographic findings in mallet finger. METHOD: We performed sonographic examination on thirty patients with traumatic mallet finger, on thirty control patients where we examined the same finger in the opposite hand (,) and thirty patients with rheumatoid arthritis or osteoarthritis and flexion deformity. RESULTS: We found four criteria for traumatic mallet finger which included: discontinuity of the extensor tendon with partial or complete tear, avulsion fracture, no real time movements of the extensor tendon, and fluid in the region of insertion of the extensor tendon. CONCLUSION: Sonographic examination of patients with traumatic mallet finger is an important diagnostic tool and can differentiate between traumatic mallet finger and flexion deformity of rheumatoid arthritis or osteoarthritis.
16798996 Kudo type-5 total elbow arthroplasty in mutilating rheumatoid arthritis: a 5- to 11-year f 2006 Jul We studied 11 patients (14 elbows) with gross rheumatoid deformity of the elbow, treated by total arthroplasty using the Kudo type-5 unlinked prosthesis, and who were evaluated between five and 11 years after operation. Massive bone defects were augmented by autogenous bone grafts. There were no major complications such as infection, subluxation or loosening. In most elbows relief from pain and stability were achieved. The results, according to the Mayo Elbow Performance Score, were excellent in eight, good in five and fair in one. In most elbows there was minimal or no resorption of the grafted bone. There were no radiolucent lines around the stems of the cementless components. This study shows that even highly unstable rheumatoid elbows can be replaced successfully using an unlinked prosthesis, with augmentation by grafting for major defects of bone.
15340864 Health-related quality of life in rheumatoid arthritis in Northern Sweden: a comparison be 2005 Apr Living with a chronic disease affects many aspects of an individual's life. The aim of this study was to compare the health-related quality of life, as measured by the SF-36, in patients with early rheumatoid arthritis (RA) at disease onset and after 2 years. The results were furthermore compared with those of patients with medium-term disease and a control group. Forty patients with early RA as well as 39 RA patients with 21-25 years of disease duration and 40 controls were asked to answer the self-administered SF-36 health profile measure. Both patients with early RA and with medium-term disease reported significantly lower values for all eight subscales compared with the controls. At follow-up after 2 years, the patients reported significant improvements on the role physical (RP) and bodily pain (BP) dimensions compared with at disease onset. Physical functioning (PF) was perceived as better in patients with early RA compared with patients who had had the disease for 21-25 years. Women reported significantly higher values for some of the scales than men. In summary, health-related quality of life is negatively affected in early RA as measured by the SF-36. An improvement was implicated after 2 years. There were some gender differences in reported health-related quality of life among patients with early RA, but not in patients with medium-term disease.
16951483 [Autoantigen and molecular chaperone in rheumatoid arthritis--their roles in metabolism of 2006 Sep The endoplasmic reticulum chaperone; heat shock protein/rheumatoid arthritis-related antigen (HSP47/RA-A47), in addition to its important intercellular functions for collagen maturation and secretion, has chondrocytes-destructive roles such as induction of endoplasmic reticulum (ER)-stress and metabolic gene expressions result in apoptosis when HSP47/RA-A47 is downregulated. Extracellular HSP47/RA-A47 may act as an autoantigen, but also regulate autoimmune inflammation. It is, therefore, a potential new biologic therapy for rheumatoid arthritis.
16052588 Increased radiographic damage scores at the onset of seropositive rheumatoid arthritis in 2005 Aug OBJECTIVE: To investigate the impact of patient age at symptom onset on radiographic joint damage at study entry, and on subsequent progression of damage in a cohort of patients with early seropositive rheumatoid arthritis (RA). METHODS: We studied 186 patients with RA of <15 months' duration. All patients had active disease and had not received disease-modifying antirheumatic drugs. At study entry and during followup, total Sharp scores (TSS), RA-associated joint space narrowing (RA-JSN), and erosions were determined on hand and foot radiographs. Baseline radiographs were also scored for osteoarthritis (OA)-related JSN (OA-JSN) and osteophytes. Older patients (>55 years) and younger patients (
16095019 [Enhancing awareness of the modalities in the management of chronic inflammatory diseases] 2005 Jun 18 From an epidemiologic point of view, the incidence of rheumatoid arthritis in the French regions we studied appears relatively stable and about the same as the prevalence of rheumatoid spondylosis. The incidence of Crohn's disease, among the chronic inflammatory bowel diseases, is currently increasing. Treatment for rheumatoid arthritis, other than symptomatic and maintenance treatments, now includes various specific forms of "biotherapy". Their development was made possible through the decoding of the pathophysiological mechanisms of inflammation and joint destruction, basically involving pro-inflammatory cytokines. Currently, it appears that these treatments should be limited to severe or active progressive rheumatoid arthritis that is resistant to maintenance therapy. For rheumatoid spondylosis, the prescription of anti-TNF alpha agents requires early diagnosis and prognostic assessment of the disease, together with the implementation of an individualized therapeutic strategy for the global multidisciplinary management of each patient. The introduction of immunosuppressors and anti-TNF alpha agents for chronic inflammatory bowel diseases constitutes a major advance in the management of their severe forms, but nevertheless raises the issues of whether their use should be systematic or depend on the severity of the disease. They also require the training of practitioners in their use and monitoring. Patients' groups have requested more collegial decision-making, decompartmentalization of practices, widespread development of health care networks, the development of clinical trials and improved communication. The regional disparities in patient management stem from epidemiologic variations in the demand for care and from social and demographic differences in the populations. They also depend on the overall health-care supply. Health networks can be defined as structures of coordination and non-mandatory, non-hierarchical services to patients that help to improve care and/or prevention by the appropriate involvement of various healthcare professionals. Regional particularities are observed, as is shown by the studies conducted in Brittany, the Loire Valley and Nord Pas-de Calais. The questions regarding the networks do not concern their effectiveness in the management of chronic inflammatory diseases, but their structure, day-to-day operations, and financing.
16622905 Socioeconomic status and risk of rheumatoid arthritis: a Danish case-control study. 2006 Jun OBJECTIVE: To examine whether markers of socioeconomic status (SES) are associated with risk of rheumatoid arthritis (RA), and if so, whether selected lifestyle-related factors could explain this association. METHODS: We conducted a frequency matched case-control study; subjects comprised 515 patients (participation rate 83%) attending rheumatology and internal medicine departments in Denmark, with recently diagnosed RA according to the American College of Rheumatology (ACR) 1987 classification criteria for RA (mean disease duration 2.3 yrs), and 769 frequency-matched population controls (participation rate 64%). Information about SES and environmental exposure was obtained by structured telephone interview. Logistic regression analyses evaluated the role of markers of SES. RESULTS: Level of education was significantly inversely associated with risk of RA, with a 2-fold lower risk of RA among those with the longest formal education compared with those having the lowest level of education (multivariate odds ratio = 0.43, 95% confidence interval 0.24-0.76, p trend = 0.001). None of a series of studied lifestyle factors could explain this finding in multivariate logistic regression analyses. When dividing the RA cases into clinical subgroups, the inverse association with level of education was found to apply predominantly to rheumatoid factor (RF)-positive RA. CONCLUSION: The inverse association between level of education and risk of RF-positive RA was not explained by any of the examined lifestyle factors. RF-positive and RF-negative RA may be 2 distinct diseases with different etiologies, with unmeasured factors related to educational level predominantly associated with the risk of RF-positive RA. However, because mechanisms underlying referral to a hospital might be linked to educational level, our observation based on hospital-referred RA patients should be evaluated cautiously. The study stresses the importance of taking SES measures into account in studies that aim at identifying environmental risk factors for RA.
15940759 Work limitations among working persons with rheumatoid arthritis: results, reliability, an 2005 Jun OBJECTIVE: To describe workplace limitations and the validity and reliability of the Work Limitations Questionnaire (WLQ) in persons with rheumatoid arthritis (RA). METHODS: A total of 836 employed persons with RA reported clinical and work related measures and completed the WLQ, a 25 item questionnaire that assesses the impact of chronic health conditions on job performance and productivity. Limitations are categorized into 4 domains: physical demands (PDS), mental demands (MDS), time management demands (TMS), and output demands (ODS), which are then used to calculate the WLQ index. RESULTS: Of the 836 completed WLQ, about 10% (85) could not be scored, as more than half the items in each domain were not applicable to the patient's job. Demographic and clinical variables were associated with missing WLQ scores including older age (OR 1.7, 95% CI 1.3-2.1), male sex (OR 1.9, 95% CI 1.2-3.0), and Health Assessment Questionnaire (HAQ) scores (OR 1.4, 95% CI 1.0-2.0). Work limitations were present in all work domains: PDS (27.5%), MDS (15.7%), ODS (19.4%), and TMS (28.6%), resulting in a mean WLQ index of 5.9 (SD 5.6), which corresponds to a 4.9% decrease in productivity and a 5.1% increase in work hours to compensate for productivity loss. The WLQ index was inversely associated with Medical Outcomes Study Short Form 36 (SF-36) Mental Component Score (MCS; r = -0.60) and Physical Component Score (PCS; r = -0.49). Fatigue (0.5), pain (0.46), and HAQ (0.56) were also significantly associated with the WLQ index. Weaker associations were seen with days unable to perform (0.29), days activities cut down (0.38), and annual income (-0.10). CONCLUSION: The WLQ is a reliable tool for assessing work productivity. However, persons with RA tend to select jobs that they can do with their RA limitations, with the result that the WLQ does not detect functional limitations as well as the HAQ and SF-36. The WLQ provides special information that is not available using conventional measures of assessment, and can provide helpful knowledge about individual patient problems in the workplace. Whether this information will have greater predictive ability and clinical relevance compared with surrogate measures such as the HAQ and SF-36 has not been determined, but should be the subject of future studies.
16984941 Risk and predictors of infection leading to hospitalisation in a large primary-care-derive 2007 Mar BACKGROUND: The increased mortality observed in patients with rheumatoid arthritis is partly due to an increased occurrence of serious infections. A retrospective study from the Mayo Clinic found that infection risk is increased in rheumatoid arthritis. In particular, serious infection was associated with severe disease and use of corticosteroids. Robust estimates are required from prospective studies of incident cases. OBJECTIVE: To examine the risk of infection leading to hospitalisation and potential factors associated with this risk in an unselected population of patients with inflammatory polyarthritis. DESIGN: A prospective cohort study comparing infection incidence in new-onset patients with inflammatory polyarthritis with local population experience. PATIENTS AND METHODS: 2108 patients with inflammatory polyarthritis from a community-based register were studied and followed up annually (median 9.2 years). The rate of hospitalisations for serious infection was compared with the rate of hospitalisations in the regional population. The contribution of potential predictors was assessed by undertaking a within-cohort analysis. RESULTS: Overall, the incidence of infection was more than two and a half times that of the general population (varying by site). History of smoking, corticosteroid use and rheumatoid factor were found to be significantly independent predictors of infection-related hospitalisation. Patients with inflammatory polyarthritis with all three factors were more than seven times as likely to be hospitalised compared with the rest of the cohort. DISCUSSION: These findings provide background data on the risk of infection associated with rheumatoid arthritis, and are of particular interest given the current awareness of the risk of infection associated with anti-tumour necrosis factoralpha treatments.
15720277 Signal transduction pathways and transcription factors as therapeutic targets in inflammat 2005 Many chronic inflammatory diseases are associated with deregulated intracellular signal transduction pathways. Resultant pathogenic interactions between immune and stromal cells lead to changes in cell activation, proliferation, migratory capacity, and cell survival that all contribute to inflammation. Increasing efforts are now being made in the design of novel therapeutic compounds to interfere with signaling pathways in inflammatory diseases like rheumatoid arthritis (RA). In this review we will outline the major signal transduction pathways involved in the pathogenesis of RA. We will assess advances in targeting a number of key intracellular pathways, including nuclear factor-(kappa)B (NF-(kappa)B), mitogen-associated protein kinases (MAPKs), phosphoinositide 3-kinase (PI3K)/Akt, signal transducers and activators of transcription (STATs), and reactive oxygen species (ROS) production. Finally, we will discuss recently identified lead molecules and the progress of selected compounds towards becoming new drugs for the treatment of inflammatory diseases.
16719936 Aspects of early arthritis. Traditional DMARD therapy: is it sufficient? 2006 There is increasing evidence for beneficial effects of early DMARD (disease-modifying antirheumatic drug) therapy over delayed treatment in patients who present with arthritis of recent onset. However, no universal consensus exists concerning the choice of initial drug or whether single drugs or combinations should be given as initial treatments. Recent studies have focused on the benefits of various strategies in which treatments were tailored to achieve low levels of disease activity, as assessed using validated response criteria. These studies demonstrated superiority of 'aggressive' over 'conventional' approaches. Whether the inclusion of tumour necrosis factor antagonists or other biologic targeted therapies in such strategies confers additional benefits in terms of improved long-term outcomes must be clarified by further studies. Assessment of risks in the individual patient, allowing individual 'tailoring' of the initial treatment, would be desirable.
15993649 Cyclophilin A may contribute to the inflammatory processes in rheumatoid arthritis through 2005 Sep Cyclophilin A (CypA) levels increase in the sera and synovial fluids of rheumatoid arthritis (RA) patients, but the cell types expressing CypA and the function of CypA in the pathogenesis of RA are not known yet. Immunohistochemistry analyses revealed high level CypA staining in the macrophages in the lining layers of human RA and osteoarthritis synovium. Low level CypA staining was also detected in endothelial cells, lymphocytes, and smooth muscle cells in RA synovium. Further investigation of the CypA function using monocyte/macrophage cell lines revealed that CypA induced expression of cytokine/chemokines such as TNF-alpha, IL-8, MCP-1, and IL-1beta and matrix metalloproteinase (MMP)-9 through a pathway that is dependent on NFkappaB activation. Furthermore, MMP-9 staining pattern overlapped with that of CypA in both RA and OA synovium. Our data suggest that CypA may stimulate macrophages to degrade joint cartilage via MMP-9 expression and promote inflammation via pro-inflammatory cytokine secretion.
16463231 [Diagnostic and prognostic significance of antibodies against citrullinated peptides]. 2006 Feb 10 Antibodies against citrullinated peptides are highly specific for rheumatoid arthritis. With second generation ELISA-kits, CCP-antibodies have a specificity of > 96 % and a sensitivity of 68 %. CCP-antibodies can be detected several years before the onset of clinical symptoms. They are, thus, ideally suited for the differential diagnosis between early forms of rheumatoid arthritis and other inflammatory arthritides. As CCP-antibodies are associated with aggressive and treatment resistant courses of rheumatoid arthritis, their high predictive value can be useful in therapeutic strategy decisions in order to verify early treatment with disease modifying drugs or biologicals in line with modern treatment approaches to start aggressive therapy early to prevent bone erosions. In contrast to their role in differential diagnosis and prediction of aggressive disease, however, CCP-antibodies are of no value in monitoring treatment as they do not change essentially over prolonged periods of time.
15619063 [Differential therapy for the rheumatoid thumb]. 2005 Jan The thumb frequently is involved in rheumatoid arthritis and often is a source of significant functional loss, pain, and deformity. Surgical intervention in patients with rheumatoid arthritis of the thumb should be based on the degree of radiological destruction according to Larsen, the natural course of the rheumatoid hand, the nature and stage of deformity as well as the status of tendons, ligaments, and adjacent joints. The goals of surgery are to relieve pain, increase motion, and restore thumb function. The timing for shoulder surgery should be early in the course of the disease, since it determines the long-term prognosis and the remaining surgical options. Treatment options, alone or in combination, include synovectomy, arthrodesis, arthroplasty, and tendon repair or transfer. Joint-preserving surgery is indicated in the early stages of radiological destruction according to Larsen classification O-III, whereas the late stages of destruction (Larsen IV-V) require reconstructive surgery. Especially in hand and finger arthritis, the "wait and see" strategy should no longer be followed. Close interdisciplinary cooperation between surgeon and rheumatologist is necessary for early therapeutic strategy, taking into account the functional unit of the whole upper extremity. The ultimate aim is to provide pain relief, improve function, enhance appearance, and slow the progression of disease. When the pathogenesis and pathoanatomy of the impaired rheumatoid thumb are appreciated, and appropriate treatment is selected, surgical intervention is likely to provide a favorable outcome for the patient.