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ID PMID Title PublicationDate abstract
16308666 Isolated pulmonary hypertension secondary to rheumatoid arthritis. 2006 Nov The authors report a case of a woman with pulmonary hypertension secondary to rheumatoid arthritis, whose treatment with azathioprine resulted in normalization of pulmonary artery pressure and resolution of clinical symptoms. Different etiologies for pulmonary hypertension are discussed and literature review is presented.
15940556 Relationship between clinically detected joint swelling and effusion diagnosed by ultrason 2005 Jun The aim of this study was to compare the relationship between clinically detected swelling and effusion diagnosed by ultrasonography (US) in elbow joints in patients with rheumatoid arthritis (RA). Fifty consecutive patients with RA entered the study and 20 healthy persons formed a control group. Altogether 100 elbow joints of the RA patients and 40 of the controls were studied. All the clinical assessments were performed by one doctor and the US investigations by the other and they were blinded to each others results. In 77 elbow joints of the RA patients the clinical assessment and the US gave similar results, whereas they differed in the remaining 23 joints. The kappa coefficient between these investigations was 0.371. In the control group no elbow joint showed either swelling in the clinical assessment or effusion in the US investigation. The results of this study indicate that clinical assessment of swelling and evaluation of effusion by US in elbow joints in patients with RA show only fair agreement. Thus, US may improve the accuracy of diagnosis of synovitis in many cases in these patients.
15693109 Is there a need for new therapies for rheumatoid arthritis? 2005 Feb Although traditional disease modifying and biological response modifying agents are very useful in controlling disease activity, limiting disease progression, and improving function in patients with rheumatoid arthritis (RA), very few patients achieve full remission from treatment with these medications either when given alone or in combination. The combination of methotrexate (MTX) and the biologic agents appears to provide the highest level of response that is presently achievable. A contributory factor to the limited benefit from such regimens in some patients is that patients are unable to continue these medications, either because of lack of efficacy or adverse events. As even the most effective currently available interventions are not ideal in all patients, the search for new therapies -- which may be able to improve on the best possible clinical effect achievable to date -- is therefore necessary, desirable, and justified. One approach to new treatment paradigms for RA is to evaluate the role of B cells in RA and the effect of targeted B cell therapy on clinical outcome, based on a sound rationale and encouraging emerging clinical evidence. This approach will be examined in this and the following articles.
16455344 4. Autoimmunity, vasculitis, and autoantibodies. 2006 Feb Autoimmune diseases are distinct clinical syndromes characterized by various alterations in normal immune responsiveness, such that there is a loss of tolerance to particular host constituents. In most cases, despite years of intense investigation, the etiopathogenic antigens initiating these systemic inflammatory conditions remain undefined. However, a great deal has been learned about the changes in components of the immune response relevant to the propagation and sustenance of these often chronic disorders. In addition, various hormonal, environmental, physiologic, and other influences that affect their expression have been identified. The expression and ultimate clinical outcome of autoimmune diseases usually relate to inflammation-related damage to the target organ with subsequent dysfunction. Certain immune conditions, such as autoimmune thyroid disease, largely affect a single organ, whereas others, such as systemic lupus erythematosus, heterogeneously affect sundry organ systems. Autoantibodies directed against normal host antigens are a common feature of many autoimmune diseases. In some cases they are pathogenic, whereas in others they serve as markers for organ involvement or outcomes. Clinical descriptions of autoimmune diseases date back many decades in some cases. Recent efforts at formulating classification criteria have allowed clearer distinctions and more accurate stratification. Greater understanding of the immunopathogenesis of autoimmune conditions has led to the development and introduction into the clinic of novel immunomodulatory therapies and treatment paradigms that have substantially improved the outcomes for patients affected by these serious conditions.
15902515 Measuring utilities by the time trade-off method in Tunisian rheumatoid arthritis patients 2006 Feb The objective of this study was to determine the feasibility, reliability and validity of the time trade-off (TTO) in Tunisian rheumatoid arthritis (RA) patients. The TTO was used to measure the utility in 122 RA patients with increasing difficulty in performing activities of daily living. The 1-week test-retest reproducibility was studied in 57 patients using the intraclass correlation coefficient (ICC). Validity was evaluated by comparison with other outcome measures: utility rating scale (RS), quality of life (QOL) [arthritis impact measurement scale 2 (AIMS2), rheumatoid arthritis quality of life (RAQOL)], functional status [health assessment questionnaire (HAQ), Lee index] and disease activity score (DAS). Eight patients (6.6%) did not complete the TTO. The median value of the TTO score was 0.655 (0.019-1.000). The ICC for reliability of the TTO was 0.89 (p<0.001). The TTO showed poor to moderate correlation (Spearman's correlation coefficients between 0.2 and 0.409, p<0.01) with AIMS2, RAQOL, HAQ and Lee index. We did not find any correlation between TTO and DAS. Multiple regression analysis showed that only 32% of TTO scores could be explained. The TTO method appeared to be reliable in a group of Tunisian RA patients, but TTO values were poorly to moderately related to measures of QOL, functional ability, and disease activity. We think that TTO and RS are not feasible for use in RA patients.
16218466 Cardiovascular involvement in rheumatoid arthritis. 2005 Cardiovascular (CV) disease morbidity and mortality are increased in patients with rheumatoid arthritis (RA) and much of the excess CV disease morbidity appears to be due to atherosclerosis. The pathogenesis of atherosclerosis (ATS) in RA is complex and there is increasing evidence that many factors including novel and traditional cardiovascular risk factors, RA treatments and the RA inflammatory disease process are involved in the development of CV disease in these patients. Of particular interest are the effects of chronic inflammation and immune dysregulation associated with RA. These have been shown to be associated with endothelial dysfunction, which is an early, potentially reversible, functional abnormality of the arterial wall. However, as several CV disease risk factors and drug prescribing are also influenced by RA disease severity it is very difficult to separate out the effects of the inflammatory disease burden on the cardiovascular system in RA.
16404867 [DNA-abzymes in rheumatoid arthritis: pathogenetic and clinical significance]. 2005 AIM: To study possible pathogenetic role and clinical significance of DNA-hydrolysing autoantibodies (autoAB) or DNA-abzymes in patients with rheumatoid arthritis. MATERIAL AND METHODS: Prevalence of DNA-abzymes and their catalytic activity were studied in 400 patients with rheumatoid arthritis (RA) and 88 healthy donors matched by age and gender. RESULTS: Associated with DNA-binding autoAB DNA-hydrolysing activity was detected in 41.5% cases of RA. DNA-abzymes were maximally active in men with rheumatoid factor (RF) and women without RF, while it was minimal in men without RF and women with RF. By catalytic activity there was no significant differences between patients with RF and without it. The highest catalytic activity of DNA abzymes was detected in patients with distinct extraarticular pathology. DNA-abzymes were also active in patients with x-ray stage III-IV of the disease in association with high prevalence of catalytic autoAB. DNA abzymes were also active in patients with RA activity stage II and III. CONCLUSION: It is possible to use DNA-abzymes in clinical practice for monitoring of the disease activity in RA.
16278281 A critical review of foot orthoses in the rheumatoid arthritic foot. 2006 Feb Foot orthoses are commonly prescribed by health professionals as a form of intervention for the symptomatic foot in rheumatoid arthritis. However, there is a limited evidence base to support the use of foot orthoses in this patient group. This article provides a critical review of the use of foot orthoses in the management of rheumatoid arthritic foot pathologies. A search was conducted in the Cochrane Controlled Trials Register (current issue of the Cochrane Library), Physiotherapy evidence database (PEDro), Medline, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine (AMED) and from reference lists in journal articles. The language was restricted to English. Searching of the databases was undertaken between December 2004 and March 2005. The results indicated there is no consensus of opinion on the choice of foot orthoses used for the management of pathology in the rheumatoid foot, although there is strong evidence that foot orthoses do reduce pain and improve functional ability. The type of foot orthoses used ranged from simple cushioned insoles to custom-made rigid cast devices. Methodological issues raised included small sample size and poor use of valid and reliable outcome measures. There is limited evidence pertaining to cost-effectiveness. The results indicated a need for further investigation into the most clinically and cost-effective foot orthoses to prescribe in the management of the rheumatoid arthritic foot. This review highlights the need to identify the various types of foot orthoses that are most effective in the management of the established rheumatoid arthritic foot.
15960070 Rare extra-articular manifestation of rheumatoid arthritis: scleromalacia perforans. 2005 May Rheumatoid arthritis is a systemic disease with manifestations in many organs. In most cases, involvement of the locomotor system dominates the clinical picture. However, extra-articular manifestations can be detected in almost any organ system with varied incidence in different series. Ophthalmic presentations include Sjogren's syndrome, episcleritis, and scleritis. The most severe form of scleritis, scleromalacia perforans, is a very rare ophthalmic manifestation. We present the case of a 60-year-old man who had had rheumatoid arthritis for more than 10 years. He had scleromalacia perforans but no other extra-articular manifestations.
15769287 A model of impairment and functional limitation in rheumatoid arthritis. 2005 Mar 15 BACKGROUND: We have previously proposed a theoretical model for studying physical disability and other outcomes in rheumatoid arthritis (RA). The purpose of this paper is to test a model of impairment and functional limitation in (RA), using empirical data from a sample of RA patients. We based the model on the disablement process framework. METHODS: We posited two distinct types of impairment in RA: 1) Joint inflammation, measured by the tender, painful and swollen joint counts; and 2) Joint deformity, measured by the deformed joint count. We hypothesized direct paths from the two impairments to functional limitation, measured by the shirt-button speed, grip strength and walking velocity. We used structural equation modeling to test the hypothetical relationships, using empirical data from a sample of RA patients recruited from six rheumatology clinics. RESULTS: The RA sample was comprised of 779 RA patients. In the structural equation model, the joint inflammation impairment displayed a strong significant path toward the measured variables of joint pain, tenderness and swelling (standardized regression coefficients 0.758, 0.872 and 0.512, P
16932711 Therapy Insight: managing cardiovascular risk in patients with rheumatoid arthritis. 2006 Jun Chronic low-grade inflammation was recognized during the past decade as an important risk factor for the development of atherosclerosis and, more recently, for the development of heart failure. Patients with rheumatoid arthritis (RA) are at increased risk of morbidity and mortality from ischemic cardiovascular events and heart failure. Epidemiologic and clinical studies indicate that RA is an independent risk factor for cardiovascular disease, which suggests that chronic exposure to high levels of inflammatory mediators contributes to this enhanced risk. The relative contribution of conventional risk factors to the acceleration of cardiovascular disease does not seem to be increased in patients with RA compared with control populations. Nonetheless, some preclinical laboratory measures of risk factors (e.g. insulin sensitivity) are adversely modulated in the context of the highly inflammatory rheumatoid microenvironment. Discerning the net effect of RA therapies on cardiovascular disease is also challenging because, theoretically, their biologic effects could either promote or attenuate atherosclerosis and ventricular dysfunction; however, available data suggest a beneficial effect on cardiovascular morbidity and mortality in patients with RA. This review provides an overview of the potential influence of RA and its treatment on the development and progression of cardiovascular disease, and outlines some preliminary recommendations for prevention and management of this complication in patients with RA.
16980210 Treating very early rheumatoid arthritis. 2006 Oct Rheumatoid arthritis (RA) is common and leads to joint damage due to persistent synovitis. The persistence of inflammation is maintained by hyperplastic stromal tissue, which drives the accumulation of leukocytes in the synovium. Aggressive treatment after the first 3-4 months of symptoms, with either disease modifying anti-rheumatic drugs or anti-tumor necrosis factor (TNF)-alpha therapy, reduces the rate of disease progression. However, it rarely switches off disease such that remission can be maintained without the continued need for immunosuppressive therapy. There is increasing evidence that the first few months after symptom onset represent a pathologically distinct phase of disease. This very early phase may translate into a therapeutic window of opportunity during which it may be possible to permanently switch off the disease process. The rationale for, and approaches to, treatment within this very early window are discussed.
16357724 Section 4: treating the patient in pain. 2005 Apr Physicians may choose from a variety of pharmacologic and nonpharmacologic options to treat patients with painful rheumatic diseases. Osteoarthritis (OA) is the most common type of arthritis requiring pain management. New disease-modifying antirheumatic drugs and biologic response modifiers can improve disease states in patients with rheumatoid arthritis (RA). After the inflammatory component of RA is minimized with such agents, treatment goals shift to those similar to secondary OA and other degenerative joint diseases. Relief of pain and improvement in functional status are essential components of effective therapy. A pure analgesic such as acetaminophen and nonsteroidal antiinflammatory drugs, including the cyclooxygenase-2-selective inhibitors for those at risk for gastrointestinal side effects, may be used at the lowest effective doses. Combination therapy for acetaminophen and an opioid may maximize pain relief and provide greater speed and duration of action than the separate components. Use of the atypical opioid tramadol with acetaminophen often results in an improved side-effect profile compared with stronger opioids, with similar levels of pain relief. Adjunctive therapy with agents such as topical analgesics, intraarticular hyaluron, tricyclic antidepressants, anticonvulsants, muscle relaxants, and anxiolytics may also be helpful. Nonpharmacologic therapies such as exercise, physical therapy, and psychologic counseling may also diminish pain and improve outcome in patients with rheumatic diseases. One may also consider yoga, acupuncture, biofeedback, massage, relaxation techniques, and other alternative therapies.
16306484 Looking back: developments in our understanding of the genetic epidemiology of rheumatoid 2005 Dec The contribution of the arc Epidemiology Unit over its 50-yr history to the study of the genetic epidemiology of rheumatoid arthritis (RA) has been reviewed. Early family and population based studies carried out by John Lawrence were important in establishing the role of both genetic and environmental factors in determining susceptibility to RA. More recently, under the leadership of Alan Silman, population-based cohorts, twin- and family-based studies have formed the basis for an extensive programme of research aimed at identifying specific genetic factors that might influence susceptibility and outcome. A review of linkage and association studies is presented.
17621798 [Current therapeutic strategy for rheumatoid arthritis]. 2006 Oct 19 The success of the treatment of rheumatoid arthritis depends primarily on early diagnosis. In most cases, basic therapy begins with methotrexate. Depending on the stage and course of the disease (radiographically detected early erosion and/or progression), basic immunosuppressive therapy can be combined or supplemented with cytokine antagonists. Furthermore, for specific indications, several alternative active substances (DMARD monotherapies) are available. Today the goal of therapy is always remission.
16052596 Contrasting roles of plasminogen deficiency in different rheumatoid arthritis models. 2005 Aug OBJECTIVE: To investigate the contrasting roles of plasminogen deficiency between models of collagen-induced arthritis (CIA) and antigen-induced arthritis (AIA). METHODS: We developed a new animal model of arthritis, which we have called local injection-induced arthritis (LIA). In this model, we replaced methylated bovine serum albumin, which is normally used as an immunogen and is injected intraarticularly into the knee joint, with type II collagen (CII) to induce AIA. The severity of CIA, LIA, and AIA in wild-type and plasminogen-deficient mice was evaluated by clinical scoring or histologic grading. Necrosis was determined by histology and immunohistochemistry. RESULTS: After CII immunization alone, wild-type mice developed arthritis in most of the paws as well as in the knee joints, whereas plasminogen-deficient mice were totally resistant to the disease. Local knee injections of CII or saline slightly enhanced the severity of the knee arthritis in wild-type mice during a 60-day experimental period. Unexpectedly, the plasminogen-deficient mice also developed arthritis in joints that were injected with CII or saline. However, the arthritis was milder than that in their wild-type littermates. Sustained tissue necrosis was found only in the plasminogen-deficient mice after the local injection. CONCLUSION: Our data show that both the antigen and the joint trauma caused by the local injection are critical to explaining the contrasting roles of plasminogen deficiency in CIA and AIA. This further indicates that CIA and AIA have distinct pathogenic mechanisms. The data also suggest that plasmin may be required for the induction of these arthritis models that are critically dependent on complement activation.
16876600 Long-term incidence of subaxial cervical spine instability following cervical arthrodesis 2006 Aug OBJECTIVE: Cervical spine deformities are well-known complications of RA. A 5- to 20-year follow-up of 51 consecutive rheumatoid patients who underwent posterior cervical arthrodesis is presented to evaluate the recurrence of instability and need for further surgery. METHODS: We conducted a retrospective review of the clinical features of 11 men and 40 women with an established diagnosis of RA and associated cervical deformities who underwent cervical spine surgery at the Mayo Clinic (Rochester, MN) between 1979 and 1990. Their mean age was 61 +/- 10 years (SD), and their duration of RA averaged 21 +/- 8.9 years (SD). There were 22 patients who presented with myelopathy, 7 with radiculopathy, and 22 with instability/neck pain. There were 33 patients with AAS, 2 with SMO process into the foramen magnum, 8 with SAS, and 8 with combinations of these. Preoperative reduction was followed by decompression and fusion using wiring techniques and autologous bone graft. Postoperative halo orthosis was provided for at least 3 months. The mean follow-up was 8.3 +/- 6 years (SD). RESULTS: There were 31 patients (61%) who underwent atlantoaxial arthrodesis, 17 patients (33%) who underwent subaxial, and 3 patients (6%) who underwent occipitocervical arthrodesis. During follow-up, 39% (13/33) of patients with AAS developed nonsymptomatic (6) or symptomatic/unstable (7) SASs subsequent to C1-C2 fusion. The latter 7 patients (21%) subsequently required extension of their arthrodesis. Adjacent segment disease was most common at the C3-C4 interspace after atlantoaxial fusion in 62% (8/13). Among the 8 patients who underwent isolated cervical fusion for SAS, 1 patient (1/8, 12%) developed adjacent instability after a fall and required extension of the previous fusion. No secondary procedure was required for the 6 patients initially stabilized by C1-(C6-T1) fusions for combinations of AAS + SAS. None of the patients initially treated by C1-C2 arthrodesis for AAS progressed to SMO. CONCLUSIONS: The incidence of subaxial instability in patients with rheumatoid disease who underwent cervical arthrodesis may be higher than previously reported, indicating the need for continued follow-up in these patients. Adjacent segment disease may be most common at the C3-C4 level following atlantoaxial fusion. Early stabilization of the C1-C2 complex in the patients with AAS may potentially prevent progression of SMO.
16358365 Patient, disease, and therapy-related factors that influence discontinuation of disease-mo 2006 Feb OBJECTIVE: A major challenge in management of rheumatoid arthritis (RA) is prediction of longterm response to disease-modifying antirheumatic drug (DMARD) treatment. Our objective was to identify the predictors of DMARD discontinuation in an incidence cohort of patients with RA followed continuously from their incidence date. METHODS: Members of a population-based incidence cohort of Rochester, Minnesota, residents aged > or = 18 years diagnosed with RA (by 1987 American College of Rheumatology criteria) from January 1, 1955, to January 1, 1995, were followed longitudinally through their complete medical records until January 1, 2001. Detailed drug exposure data were collected on all DMARD and glucocorticoid regimens. Subjects were considered exposed to a DMARD if duration of use was > or = 30 days. Time to discontinuation of DMARD was estimated using survival analysis techniques. Andersen-Gill models with multiple events per patient were used to assess the influence of demographics, calendar time, comorbidities, disease characteristics [disease duration, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), joint counts, radiographic changes, nodules, RA complications], and therapy characteristics (DMARD use, singly or in combination, glucocorticoid use, first or subsequent regimen, effect of previous therapy) on time from DMARD initiation to discontinuation. RESULTS: The study population comprised 345 DMARD-treated patients (73% female) with mean age of 53.1 years and mean followup 15.4 years. Median time taking any DMARD was 16.0 months for the first, and 17.9 months for all regimens. Methotrexate (MTX) had the longest time to discontinuation, with a median of 30.3 months without folate, and 61.7 months with folate supplementation. Among the various disease characteristics examined, only higher ESR at DMARD initiation was significantly associated with a shorter time taking DMARD [hazard ratio (HR) 1.05 per 10 mm/h increase, 95% CI 1.02, 1.08]. In multivariable Andersen-Gill models considering all DMARD regimens, hydroxychloroquine use (HR 0.77, 95% CI 0.64, 0.92) and MTX use (HR with folate 0.39, 95% CI 0.30, 0.51; HR without folate 0.51, 95% CI 0.39, 0.67) were significantly associated with longer time to DMARD discontinuation, whereas prior MTX use (HR 1.96, 95% CI 1.57, 2.45) was associated with shorter time to DMARD discontinuation, after adjusting for age, sex, calendar year, Charlson comorbidity index, disease duration, and ESR at DMARD initiation. Disease duration was negatively associated with time to DMARD discontinuation; each 10 year increase in disease duration corresponded to a 14% decrease in the risk of discontinuation (HR 0.86, 95% CI 0.75, 0.98). CONCLUSION: Longer RA disease duration does not appear to increase the risk of DMARD discontinuation. However, high disease activity (as assessed by ESR) is associated with a higher likelihood of discontinuing DMARD. MTX failure may identify a subgroup of patients who are less likely to respond to other DMARD and therefore could be considered as candidates for biological therapies.
16174491 Update of TNF-alpha antagonists and cardiovascular disease in rheumatoid arthritis. 2005 Oct Tumor necrosis factor-alpha (TNF-alpha) antagonists were unexpectedly found to have no beneficial effects in moderate-to-severe heart failure in two large randomized clinical trials. In certain doses, the agents were found to be harmful. These results have important implications for rheumatoid arthritis (RA). Patients with the disease have an increased risk for developing cardiovascular co-morbidity, including heart failure. Because of the beneficial effect of the TNF-alpha antagonists in the management of RA, these agents have gained widespread use. Rheumatologists and other physicians who provide care for RA are thus likely to encounter candidates for anti-TNF-alpha therapy who have overt or subclinical heart failure. Although data are currently not sufficient to support evidence-based recommendations, it is possible to make reasonable suggestions to guide clinical practice.
17036505 [Difficulties in differential diagnosis of Sjögren's syndrome and systemic lupus erythema 2006 Sjögren's Syndrome (SS) is the second most common autoimmune disorder after rheumatoid arthritis (RA). It can be found as a lone condition (primary Sjögren's Syndrome) or may accompany other autoimmune rheumatic diseases (secondary Sjögren's Syndrome). Despite such frequent occurrence, accurate diagnosis of Sjögren Syndrome is difficult. These difficulties result from highly variable symptoms of SS as well as from common presence of other autoimmune disorders. In the following article authors present current knowledge concerning clinical symptoms, diagnostic methods and latest clinical guidelines on the diagnosis of SS. Differential diagnosis of SS and systemic lupus erythematosus (SLE) is also discussed.