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ID PMID Title PublicationDate abstract
16465652 Course of patient-reported health outcomes in rheumatoid arthritis: comparison of longitud 2006 Feb OBJECTIVE: To describe health outcomes reported by patients with rheumatoid arthritis (RA), i.e., pain, disability and health-related quality of life, as a function of disease duration in a longitudinal approach, and to compare the course of patient-reported health outcomes by a longitudinal versus a cross-sectional approach. METHODS: Data were collected with 4 series of questionnaires between 1997 and 2002 among patients with RA (maximum number = 882) of varying disease duration. The course of patient-reported health outcomes as a function of disease duration was evaluated using both longitudinal data and cross-sectional data of the first series. RESULTS: The course of RA shows a different pattern for various health outcomes. We observed similar trends in health outcomes in this large patient sample using the longitudinal and the cross-sectional approach. CONCLUSION: Although longterm consequences of RA are preferably assessed in longer duration followup studies, cross-sectional studies, including patients with a broad range of disease durations, seem to provide fairly reliable estimates of the course of health outcomes.
16214085 Altered circadian rhythms in rheumatoid arthritis patients play a role in the disease's sy 2005 Nov The circadian changes in the metabolism or nocturnal secretion of endogenous corticosteroids (reduction) observed in rheumatoid arthritis (RA) patients are responsible, in part, for the time-dependent changes that are observed in the inflammatory response and related early morning clinical symptoms of the disease. Melatonin (MLT), another circadian nocturnal hormone that is the secretory product of the pineal gland, has been implicated in the time-dependent RA inflammatory reaction with effects that are opposite to those of corticosteroids. As a consequence, altered functioning of the HPA axis (early morning reduced corticosteroid production) and of the pineal gland (night increased MLT production) found in RA patients, seem to be important factors in the appearance and perpetuation of the clinical circadian symptoms of the disease. Consistently, human proinflammatory Th1-type cytokine production (related to MLT stimulation) exhibits a diurnal rhythmicity with peak levels during the night and early morning, at a time when plasma cortisol (inducing the Th2-type cytokine production) is lowest and MLT is highest. Reduced daily light exposure as observed in northern Europe (Estonia), at least during the winter, might explain the higher and more prolonged serum MLT concentrations that were observed in northern RA patients, as well as some epidemiological features versus southern Europe patients.
15950837 The impact of pain on psychological well-being in rheumatoid arthritis: the mediating effe 2005 Jul The aim of this study was to determine whether self-esteem and adjustment to disease can mediate the association between pain and psychological well-being in patients with Rheumatoid Arthritis (RA). Coefficients of correlation, multiple linear regressions and Structural Equation Model (SEM) were employed in order to examine the direct and indirect relationships between pain, self-esteem, adjustment to disease and psychological well-being in a sample of 160 recently-diagnosed RA-patients. The outcomes of the analyses indicate that self-esteem and adjustment to disease are important links between pain and psychological well-being. Moreover, the results suggest the increasing importance of personality variables in mediating the relationship between pain and psychological well-being as the disease advances. The findings provide evidence for considerations that psychosocial interventions, focused on increasing the self-esteem and improving the adjustment to disease, may reduce the impact of pain on patients' psychological well-being and quality of life in general.
15789055 Disease association of two distinct interleukin-18 promoter polymorphisms in Caucasian rhe 2005 May Interleukin (IL)-18 is an important mediator of innate and adaptive immunity. We searched for an association of IL-18 promoter single-nucleotide polymorphisms (SNP) with rheumatoid arthritis (RA) in Caucasians. The entire study population was composed of two independent cohorts from Germany (n=200) and Scotland (n=410). Presence of IL-18 SNP at positions -607 and -137 was determined by allele-specific PCR in 327 RA patients and 283 healthy donors (HD). Diplotype distributions of both loci were in Hardy-Weinberg equilibrium (HWE) in the German and Scottish HD cohorts. In contrast, locus -607 was in HW disequilibrium in German, and locus -137 in Scottish RA patients. Diplotypic exact chi(2) tests suggested that -607CC was overrepresented in German, and -137CC in Scottish RA patients, but conservative chi(2) trend analyses could not prove any significant disease association of these single loci. SNP -607 and -137 were in strong linkage disequilibrium. The -607C(*)-137C haplotype was more prevalent in German RA (3.2 vs 1.2%) and in Scottish RA patients (4.1 vs 0.9%) than in the respective HD cohorts. These observations suggest that SNP of both positions contribute to the genetic background of RA pathogenesis.
16010277 Transoral anterior approach for extensive anterior decompression at the C3 vertebra level 2006 Jan STUDY DESIGN: We report a successful extensive transoral anterior decompression for an elderly patient with myelopathy and occipitalgia due to severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with rheumatoid arthritis (RA). OBJECTIVE: To describe the treatment of an exceptional pathological condition involving severe vertical subluxation. SETTING: University-affiliated hospital in Gifu, Japan. METHODS: A 73-year-old woman was referred to our clinic because of myelopathy and occipitalgia due to severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with RA. Plain radiographs revealed severe atlantoaxial vertical subluxation and sagittal magnetic resonance (MR) imaging revealed severe compression of the spinal cord at the level of the C2/3 disc space due to both posterior subluxation of C2 and rheumatoid pannus at the C2/3 disc space. As MR images demonstrated that the C2/3 disc space was located just behind the retropharyngeal wall, we performed successful anterior decompression from C2 to C3 via the standard transoral approach without mandibular osteotomy. RESULTS: The patient has been followed for 4 years and her symptoms are currently much improved without further surgical treatment. CONCLUSIONS: The present case illustrates that severe atlantoaxial vertical subluxation and posterior subluxation of the axis associated with RA can be treated successfully by anterior decompression of C2 and C3 via the standard transoral approach.
16249269 Rituximab treatment of refractory rheumatoid arthritis. 2005 Dec OBJECTIVE: To review published literature using rituximab for treatment of refractory rheumatoid arthritis (RA). DATA SOURCES: An English-language literature search was conducted using MEDLINE (1966-May 2005) and EMBASE (1980-May 2005). References of identified articles were subsequently reviewed for additional data. DATA SYNTHESIS: Evidence suggests that B lymphocyte depletion in patients suffering from refractory RA may be a key component in the interruption of the disease pathogenesis. Successful depletion of B lymphocytes with rituximab in patients with RA has been reported in case reports, open-label pilot studies, and a randomized, double-blind, placebo-controlled trial. CONCLUSIONS: Based on the limited published data, rituximab, when used in combination with other agents (ie, cyclophosphamide or methotrexate), appears to be a reasonable treatment option for refractory RA. However, additional controlled trials need to be conducted to further define optimal dosing, response rates, comparative long-term efficacy, and RA treatment algorithm placement of rituximab in this patient population.
16765714 Rheumatoid pleural effusion. 2006 Jun OBJECTIVES: To describe the clinical and laboratory features of rheumatoid pleural effusion (RPE) and the diagnostic and therapeutic approaches to this condition. METHODS: The review is based on a MEDLINE (PubMed) search of the English literature from 1964 to 2005, using the keywords "rheumatoid arthritis" (RA), "pulmonary complication", "pleural effusion", and "empyema". RESULTS: Pleural effusion is common in middle-aged men with RA and positive rheumatoid factor (RF). It has features of an exudate and a high RF titer. Underlying lung pathology is common. Generally RPE is small and resolves spontaneously but symptomatic RPE may require thoracocentesis. Rarely, RPE has features of a sterile empyematous exudate with high lipids and lactate dehydrogenase, and very low glucose and pH levels. This type of effusion eventually leads to fibrothorax and lung restriction. Superimposed infective empyema often complicates RPE. Oral, parenteral, and intrapleural corticosteroids, pleurodesis and decortication, have been used for the treatment of sterile RPE. Infected empyema is treated with drainage and antibiotics. CONCLUSIONS: RPE may evolve into a sterile empyematous exudate with the development of fibrothorax. Symptomatic effusions or suspicion of other causes of exudate (infection, malignancy) require thoracocentesis. The "rheumatoid" nature of the pleural exudate in patients without arthritis mandates a pleural biopsy to exclude tuberculosis or malignancy. The optimal therapy of RPE has yet to be established. The role of cytokines in the course of RPE and the possible usefulness of cytokine blockade in the treatment of this RA complication require further evaluation.
16159946 Fas (CD95)-related apoptosis and rheumatoid arthritis. 2006 Jan Abnormal proliferation and/or persistence of synoviocytes and inflammatory cells has long been described in inflammatory arthritis conditions, but only relatively recently has substantial attention been drawn to the relevance of abnormal apoptotic processes in disease pathogenesis and treatment. This review summarizes a current understanding of the Fas (CD95)-Fas ligand (CD178) apoptotic system, which has most predominantly been examined in rheumatoid arthritis. There, synovial inflammation is often characterized by a unique resistance to Fas-related apoptosis, and agonistic therapeutic interventions upon Fas have consistently been found beneficial in both animal and human disease models. Therefore, modulation of the Fas pathway will hopefully be of both pathogenic and therapeutic interest in the study of inflammatory arthritis conditions in general.
15862156 [Expression of MMP-2 and MMP-9 in the tartrate-resistant acid phosphatase (TRAP)-positive 2005 May AIM: To examine the role of matrix metalloproteinases(MMP) expressed by the tartrate-resistant acid phosphatase (TRAP)-positive mononuclear and multinucleated cells in articular cartilage damage. METHODS: C57BL/6 mice were immunized by injection of chicken type II(CII) collagen to construct the collagen-induced rheumatoid arthritis(CIA) model. The presence of TRAP positive cells in the synovial tissue of CIA mice was examined by enzyme histochemistry and expression of MMP-2,9 was assessed in TRAP positive cells by immunohistochemistry. RESULTS: Expression of MMP-2 (gelatinase A) and MMP-9 (gelatinase B) was detected in TRAP positive mononuclear and multinucleated cell. Quantity of TRAP positive cells and the destruction of articular cartilage had a positive correlation (r(s) =0.903, P<0.01). Expression of MMP-2 and MMP-9 in TRAP positive cells was also correlated significantly with the destruction of articular cartilage (r(s) =0.954, P<0.01). CONCLUSION: This study suggests that MMP-2 and MMP-9 expression by TRAP positive mononuclear and multinucleated cells are involved in articular cartilage destruction in CIA.
16214319 Animal models of arthritis caused by systemic alteration of the immune system. 2005 Dec Animal models are instrumental in understanding the etiology and pathogenetic mechanisms of rheumatoid arthritis. Several new mouse models have either been produced, including transgenics, gene-knockouts, and gene knock-ins, or established as a spontaneous disease due to natural gene mutations. These models are suitable for addressing the roles of T cells, autoantibodies, cytokines and innate immunity in the development and progression of rheumatoid arthritis. In particular, they now provide insights into how systemic alterations of the immune system result in a local development of chronic arthritis that leads to joint destruction.
16899498 Very recent onset rheumatoid arthritis: clinical and serological patient characteristics a 2007 Feb OBJECTIVES: Despite early recognition and disease modifying anti-rheumatic drug (DMARD) treatment, a sizable proportion of early rheumatoid arthritis (RA) patients show radiological progression. This study was performed to determine the frequency of erosive arthritis and the pace of radiological progression in an inception cohort of patients with very early RA (
17083757 ACR remission criteria and response criteria. 2006 Nov As additional DMARDs have been added to the armamentarium of rheumatologists over the last 60 years, the approach to the treatment of rheumatoid arthritis has changed. Many clinical studies now are geared toward evaluating the concept of eradicating inflammation as a method to seek the elusive goal of sustained remission in RA. One of the first descriptions of remission in 'RA' was by Short et al in 1948, when he documented the natural progression of the disease. Since that time, various criteria have been developed to define RA remission utilizing clinical, radiographic, and laboratory measures. The most stringent of criteria is the American College of Rheumatology Remission Criteria, developed in 1980, which consists of clinical symptoms and signs of inflammation including fatigue, joint pain, morning stiffness, joint tenderness, joint swelling, and erythrocyte sedimentation rate (ESR). Several reports have compared ACR remission criteria to Disease Activity Score (DAS) values to identify equivalent DAS remission values, and these have been extrapolated to modified versions of the DAS, the Simple Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI). The ACR remission criteria and the response measures were not designed for use as the target or goal for the clinical management of individual RA patients in routine clinical practice. Nevertheless, rheumatologists yearn for the eradication of inflammation in all RA patients, and attaining remission may be achievable in the future.
16185289 Cellular response to tissue hypoxia and its involvement in disease progression. 2005 Oct Multicellular organisms show adaptive reactions for their survival when they are exposed to an atmosphere with reduced oxygen concentration. These reactions include increase in respiratory volume, switch from aerobic to anaerobic metabolism, erythropoiesis and angiogenesis. For these reactions, cells must change the expression of several hypoxia-responsive molecules such as erythropoietin and vascular endothelial growth factor. Hypoxia-responsible element (HRE) was delineated in the genes of hypoxia-responsive molecules as the sequence indispensable for their hypoxia-induced transcriptional activation, and hypoxia-inducible factor 1 (HIF-1) was identified as a transcriptional factor that binds to HRE and regulates the expression of various hypoxia-responsive molecules. Increasing evidence has revealed that HIF-1 is a key molecule regulating the cellular response to tissue hypoxia. HIF-1 is composed of two subunits, HIF-1alpha and HIF-1beta, and HIF-1 activity depends mainly on the intracellular level of HIF-1alpha protein, which is regulated to be in inverse relation to the oxygen concentration by an oxygen-dependent enzyme, prolyl hydroxylase 2 (PHD2). Thus, cells respond to tissue hypoxia by sensing the oxygen concentration as the enzyme activity of PHD2, regulating the HIF-1 activity and consequently changing the expression of various hypoxia-responsive molecules. Cellular response controlled by hypoxia-HIF-1 cascade is also involved in pathological situations such as solid tumor growth, diabetic retinopathy and rheumatoid arthritis. Under these pathological situations, the activation of hypoxia-HIF-1 cascade often leads to the acceleration of disease progression. Understanding an aspect of disease progression triggered by tissue hypoxia might provide a clue to new therapeutic strategies for intractable diseases.
15711232 Safety of exercise in patients with rheumatoid arthritis. 2005 Mar PURPOSE OF REVIEW: Patients with rheumatoid arthritis benefit from long-term moderate or high-intensity exercises. Moderate or high-intensity exercises were found to improve aerobic capacity, muscle strength, functional ability, and psychological well-being, and slow the age-related and sex-related decrease in bone mineral density of the hip. Despite these positive findings, there is also concern about its risks. Studies on the effects of exercise on disease activity and joint damage are reviewed. RECENT FINDINGS: Studies on the effects of moderate or high-intensity exercise in rheumatoid arthritis demonstrate either decreased or stable disease activity. From the few available studies that address exercise and radiologic progression of the small joints, results indicate that exercises are safe for the joints of hands and feet. However, a recent study suggests caution in prescribing long-term high-intensity weight-bearing exercises to patients who have significant radiologic damage of large joints, as some patients might develop additional damage. SUMMARY: Moderate or high-intensity weight-bearing exercises are safe with respect to disease activity and radiologic damage of the hands and feet. In the absence of sufficient data on exercise and radiologic progression of the large joints, patients with significant radiologic damage of the large joints should not be encouraged to participate in moderate to high-intensity weight-bearing exercise unless individualized to protect affected joints. A broader dissemination of the effectiveness and safety of moderate and high-intensity exercise for patients with rheumatoid arthritis is needed among rheumatologists, physical therapists, and patients.
15639059 Circadian rhythms and arthritis. 2005 Feb The clinical symptoms of rheumatoid arthritis (RA) show a circadian variation; joint stiffness and pain are more prominent in the early morning. An altered functioning of the hypothalamic-pituitary-adrenal axis (cortisol) and of the pineal gland (melatonin) seems to be important factors in the perpetuation and clinical circadian symptoms of RA. Consistently, human proinflammatory cytokine production exhibits a diurnal rhythmicity with peak levels during the night and early morning, at a time when plasma cortisol (anti-inflammatory) is lowest and melatonin (proinflammatory) is highest. Sex hormones also seem to be involved in circadian rhythms of RA symptoms. Increased pain intensity and sleep disturbances are observed during the luteal phase in patients who have RA, when estrogen (and progesterone) levels would be higher than in the follicular phase. The occurrence of circadian rhythms of the inflammatory reaction suggest important implications for scheduling activities of daily living, for measurements in clinical trials, and possibly for the time at which antirheumatic drugs--including corticosteroids and nonsteroidal anti-inflammatory drugs--are administered.
16015096 Therapy of progressive rheumatoid arthritis-associated corneal ulceration with infliximab. 2005 Aug PURPOSE: To review the relative efficacy of the TNFalpha antagonist infliximab in treating 3 patients with rheumatoid arthritis-associated peripheral ulcerative keratitis. METHODS: Review of the clinical course of 3 nonconsecutive patients with progressive rheumatoid arthritis-associated peripheral ulcerative keratitis who were initially treated with conventional immunosuppressant therapy and subsequently treated with infliximab. RESULTS: All 3 patients experienced progressive corneal ulceration on oral prednisone and weekly oral or intramuscular methotrexate. They all demonstrated a marked reduction in conjunctival injection, closure of their corneal epithelial defects, and arrest of corneal thinning after receiving infliximab. Two out of 3 patients required patch grafts for treatment of corneal perforations before starting infliximab, and they had no further keratolysis after receiving this agent. CONCLUSIONS: Infliximab was effective in arresting progressive rheumatoid arthritis-associated peripheral ulcerative keratitis that was refractory to conventional immunomodulatory therapy.
15723199 Overlapping gene expression profiles in rheumatoid fibroblast-like synoviocytes induced by 2005 Jan OBJECTIVE AND DESIGN: The development of therapies directed against TNF alpha and IL-1 beta has underscored the importance of these cytokines in rheumatoid arthritis (RA). In this study, oligonucleotide microarrays were used to identify novel transcriptional events mediated by TNF alpha and IL-1 beta. METHODS: In this study we have used Affymetrix U95A GeneChips representing 12,600 full-length human genes to identify transcriptional events mediated by these cytokines. Fibroblast-like synoviocytes were cultured from rheumatoid synovium from RA patients and stimulated with TNF alpha and IL-1 beta. Gene transcript levels were determined using Affymetrix U95A GeneChips representing 12,600 full-length human genes. RESULTS: A large number of differentially regulated genes were identified (1.7% of array-displayed genes for TNF alpha and 2.4% for IL-1 beta), and the validity of the array protocol was subsequently confirmed using real-time PCR. The majority of the differentially expressed genes were regulated by both TNF alpha and IL-1 beta, reflecting the distal signaling pathways shared by these cytokines. A large number of novel TNF alpha and IL-1 beta-regulated genes were identified. CONCLUSIONS: A panel of novel TNF alpha- and IL-1 beta-regulated genes was identified, and these are promising candidates for further study in relation to RA and other inflammatory diseases.
15876300 The respiratory system in connective tissue disorders. 2005 Jun The connective tissue disorders (also called collagen vascular diseases) represent an heterogeneous group of immunologically mediated inflammatory disorders with a large variety of affected organs besides the lungs. The respiratory system may be involved in all its components: airways, vessels, parenchyma, pleura, respiratory muscles, etc. The frequency, clinical presentation, prognosis and response to therapy vary, depending on the pattern of involvement as well as on the underlying connective tissue disorders. The subject of this review is to describe the most frequent type of lung disorders observed in patients with connective tissue disease (CTD). We will focus on the most frequent CTD: systemic lupus erythematosus, rheumatoid arthritis, scleroderma, Sjogren's syndrome, dermatopolymyositis and mixed CTD.
17277865 [Knowledge about their disease and treatment among patients with rheumatoid arthritis]. 2006 Dec BACKGROUND: The transfer of information in the physician-patient relationship is important, especially in chronic diseases such as Rheumatoid Arthritis (RA), since it influences the perception and behavior that the patient has about his or her illness. AIM: To evaluate the level of knowledge and concern of their illness and treatment and their relationship with functional disability, perception of the pain and global assessment of disease activity, in patients with RA. PATIENTS AND METHODS: Cross sectional study of 104 patients (mean age 56 years, 100 women) with RA. Demographic and clinical variables were registered. The knowledge about their illness and requirement of further information and concern about aspects of the illness and treatment, were assessed. Physical functioning was measured using the Health Assessment Questionnaire (HAQ). A visual analogue (VAS) and Likert scales were used for a global assessment of disease activity. RESULTS: Sixty percent of patients had only primary school studies. The median evolution of the illness was 14 years. Ninety eight percent knew their diagnosis and 91% required further information. There was a high degree of concern about the disease and treatment. The average HAQ score was 0.9. There was a statistically significant relationship between HAQ score and pain VAS (r =0.41, p <0.01). There was a moderate agreement between the global assessment of disease activity made by patients and physicians (Kappa =0.499; p =0.000). CONCLUSIONS: Even though patients with RA are informed about their disease, they require further information. Their highest concern is about the functional consequences of RA and they perceive a higher activity of the disease than their treating physicians.
16332951 Ultrasonography shows increased cross-sectional area of the median nerve in patients with 2006 May OBJECTIVES: To examine whether patients with arthritic diseases and carpal tunnel syndrome (CTS) have increased cross-sectional areas of the median nerves measured by ultrasonography (US). Enlarged cross-sectional areas have previously been found in non-arthritic patients with idiopathic CTS. METHODS: During 1 yr, all 12 patients with rheumatoid arthritis (RA) or other arthritic diseases hospitalized in our department for surgery for CTS were included. Nine of the patients had bilateral CTS, giving a total of 21 pathological nerves. The median duration of CTS symptoms was 9.5 months. The controls were 30 randomly selected RA patients without symptoms of CTS and 30 healthy persons. Both CTS patients and controls were examined bilaterally by use of US at the entrance of the carpal tunnel, and the cross-sectional areas of the median nerves were calculated. RESULTS: Cross-sectional areas of the median nerves were significantly higher in the CTS patients compared with the RA controls and healthy persons; median (range) areas were 15.7 mm(2) (11.1-21.8), 8.5 mm(2) (5.8-11.0) and 8.0 mm(2) (4.9-12.0), respectively (P<0.0001). No significant differences in cross-sectional areas were observed between the two control groups, or between the right and left hand in the control groups. CONCLUSIONS: Higher cross-sectional areas were found in the arthritic patients with CTS than in RA patients and healthy persons without CTS. This supports previous studies of idiopathic CTS in which increased cross-sectional areas have been found. Thus, as in idiopathic CTS, arthritic patients may be examined by US of the median nerve when CTS is suspected.