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ID PMID Title PublicationDate abstract
15897279 Impaired early B cell tolerance in patients with rheumatoid arthritis. 2005 May 16 Autoantibody production is a characteristic of most autoimmune diseases including rheumatoid arthritis (RA). The role of these autoantibodies in the pathogenesis of RA remains elusive, but they appear in the serum many years before the onset of clinical disease suggesting an early break in B cell tolerance. The stage of B cell development at which B cell tolerance is broken in RA remains unknown. We previously established in healthy donors that most polyreactive developing B cells are silenced in the bone marrow, and additional autoreactive B cells are removed in the periphery. B cell tolerance in untreated active RA patients was analyzed by testing the specificity of recombinant antibodies cloned from single B cells. We find that autoreactive B cells fail to be removed in all six RA patients and represent 35-52% of the mature naive B cell compartment compared with 20% in healthy donors. In some patients, RA B cells express an increased proportion of polyreactive antibodies that can recognize immunoglobulins and cyclic citrullinated peptides, suggesting early defects in central B cell tolerance. Thus, RA patients exhibit defective B cell tolerance checkpoints that may favor the development of autoimmunity.
15693081 T cell proliferative response to type II collagen in the inflammatory process and joint da 2005 Feb OBJECTIVE: To investigate the role of T cell responses to type II collagen (CII) in disease progression in patients with rheumatoid arthritis (RA). METHODS: T cell proliferative responses to bovine CII by peripheral blood mononuclear cells (PBMC) from patients with early RA (duration < 5 yrs) were assayed by mixed lymphocyte culture. Clinical and laboratory variables including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the time of sampling. Radiographic damage on hand radiographs was evaluated by the method of Steinbrocker and Sharp. RESULTS: In a cross sectional study, patients (n = 22) with positive T cell responses (stimulation index 2) had higher levels of CRP and ESR than those (n = 21) not showing T cell responses. The number of damaged joints (by Steinbrocker's method) and damaged joint scores (by Sharp's method) were significantly higher in patients with positive T cell responses than in those without. The joint space narrowing scores correlated well with T cell responsiveness to CII. Patients (n = 15) with both positive T cell responses and RA-susceptible allotypes HLA-DR1 or DR4 had higher damaged joint scores than the remainder of the patients (n = 24). CONCLUSION: T cell proliferative responses to CII are associated with inflammatory activity and radiographic severity in RA. RA-susceptible allotypes positively relate to the radiographic progression associated with T cell responses to CII. Our data suggest that CII-reactive T cells may play a role in the pathogenic process of joint damage, especially in genetically susceptible patients.
16869001 A randomized controlled trial with an anti-CCL2 (anti-monocyte chemotactic protein 1) mono 2006 Aug OBJECTIVE: Chemokines such as CCL2/monocyte chemotactic protein 1 (MCP-1) play a key role in leukocyte migration and are potential targets in the treatment of chronic inflammatory disorders. The objective of this study was to evaluate the effects of human anti-CCL2/MCP-1 monoclonal antibody (ABN912) treatment in patients with rheumatoid arthritis (RA). METHODS: Patients with active RA were enrolled in a randomized, placebo-controlled, dose-escalation study of ABN912. Infusions were administered on day 1 and day 15. In the dose-escalation phase, 4 cohorts of 8 patients each underwent serial arthroscopic biopsy of synovial tissue. Immunohistochemistry and digital image analysis were used to characterize biomarkers in synovial tissue. Laboratory evaluation included pharmacokinetic analysis and immunotypic studies of peripheral blood mononuclear cells. To assess the clinical effects of treatment with ABN912, an additional 21 patients were treated with the highest dose tolerated. RESULTS: The total study population comprised 45 patients: 33 patients received ABN912, and 12 patients received placebo. ABN912 treatment was well tolerated. Unexpectedly, there was a dose-related increase in ABN912-complexed total CCL2/MCP-1 levels in peripheral blood, up to 2,000-fold. There was no detectable clinical benefit of ABN912 compared with placebo, nor did treatment with the study drug result in a significant change in the levels of biomarkers in synovial tissue and peripheral blood. CONCLUSION: ABN912 treatment did not result in clinical or immunohistologic improvement and may have been associated with worsening of RA in patients treated with the highest dose. The results might be related to the greatly increased level of total CCL2/MCP-1 in serum that was observed following treatment with ABN912. This observation may be relevant for a variety of antibody-based therapies.
15641043 Responses of lymphocytes of patients with rheumatoid arthritis to IgG modified by oxygen r 2005 Jan OBJECTIVE: We have previously demonstrated the presence of IgG aggregates modified by oxygen radicals (chlorinated IgG [Cl-IgG]) and peroxynitrite (nitrated IgG [N-IgG]) in synovial fluid of patients with rheumatoid arthritis (RA). A possible explanation for the longstanding chronic inflammatory process in RA is the establishment of an immune response to autoantigens. This study was undertaken to examine whether a T cell response to oxidatively modified IgG contributes to the inflammation in RA. METHODS: We studied in vitro lymphocyte proliferation and interleukin 2 (IL-2) secretion in response to a common antigen (mumps), N-IgG, Cl-IgG, and heat-aggregated IgG (H-IgG) (control) in 15 normal blood donors and 16 RA patients not receiving immunosuppressive drugs. RESULTS: The responses of RA lymphocytes to mumps antigen were significantly lower that those in controls (mean +/- SEM 2,577 +/- 217 versus 6,367 +/- 365 counts per minute/well; P < 0.02). However, whereas in normal donors the cell responses to N-IgG and Cl-IgG were not significantly different than responses to H-IgG (N-IgG/H-IgG ratio 1.2 +/- 0.2, Cl-IgG/H-IgG 1.5 +/- 0.2), the RA lymphocyte responses to N-IgG and Cl-IgG were significantly higher than the responses to H-IgG (N-IgG/H-IgG 7.4 +/- 2.5, Cl-IgG/H-IgG 4.8 +/- 1.2). When ratios in RA cells were compared with normal cell responses as a group, there was a significant difference for both N-IgG (P < 0.017) and Cl-IgG (P < 0.014). When selected normal and RA lymphocyte culture supernatants were assayed for IL-2 secretion, the increase in IL-2 never exceeded 2-fold in normal cell cultures incubated with any of the IgG compared with unstimulated cultures, whereas responses of RA cells, particularly those incubated with N-IgG, were increased (range 2.6-15.7-fold) compared with unstimulated controls. CONCLUSION: These results suggest that in RA there are circulating T cells that are responsive to oxidatively modified IgG, a possible pathogenic mechanism contributing to the chronic inflammatory process within the inflamed joint.
16411034 Patients' perceptions of health related quality of life in rheumatoid arthritis and chroni 2006 Feb OBJECTIVES: To determine how health related quality of life (HRQL) is perceived by patients with rheumatoid arthritis (RA) and chronic low back pain (CLBP) using a textual analysis approach. PATIENTS: Two-hundred and forty-eight outpatients (85% female), mean age 58+/-13 years (40% RA and 60% CLBP). METHODS: Observational descriptive study. Sociodemographic and clinical variables were determined. A questionnaire was designed which included an open question "What does health related quality of life mean to you." which patients answered in writing. Textual data analysis was performed using a previous described method based on multivariate descriptive statistical methods. RESULTS: The two groups were homogenous with respect to gender, educational level, disease duration, comorbid conditions and global functional status. Patients with RA and CLBP used clearly differentiated terms to describe HRQL (RA: to be able (capable), house; CLBP: life, health, quality). RA patients were specific and primarily concerned with functional status and CLBP patients with health and life. The most characteristic phrase used by RA patients was: "to be able to do housework" and for CLBP: "health is the most important thing for quality of life." In the factorial representation, the two pathologies were markedly separated. CONCLUSIONS: A series of characteristic answers on HRQL may be identified in patients with RA and CLBP, showing that they have different perceptions about what HRQL is according to their pathology. The use of open questions in a group of homogenous patients with specific pathologies could result in more disease-specific responses. Textual statistical analysis of open questions may provide more information than standard methods, and may be considered as valid for the analysis of subjective issues such as quality of life.
17213520 Correlation between methotrexate efficacy & toxicity with C677T polymorphism of the methyl 2006 Nov BACKGROUND & OBJECTIVES: C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene has been proposed as a pharmacogenomic marker for toxicity of methotrexate (MTX). We studied the relationship between the C677T gene polymorphism and toxicity and efficacy of MTX in patients with rheumatoid arthritis (RA) on folate supplementation. METHODS: A total of 150 RA patients fulfilling American College of Rheumatology (ACR) criteria and on MTX treatment were evaluated. The mean age of the patients was 42.9 +/- 11.1 yr, mean disease duration was 7.65 +/- 5.2 yr and the mean duration of MTX treatment was 26.1 +/- 20.6 months. Genotype analysis of MTHFR gene was done by PCR and restriction enzyme method. Primary endpoint for treatment efficacy was change in disease activity score 28 (DAS28) from baseline. Drug toxicity was evaluated by blood count, renal and liver function tests and a standardized questionnaire. RESULTS: The mean DAS at baseline was 5.02 +/- 0.8. All patients received 10 mg/wk folic acid supplementation. Forty two per cent (63/150) of the patients had C677T polymorphism of which 4 were homozygous (T/T) and 59 were heterozygous (C/T). The baseline characteristics of the patients with or without polymorphism were comparable. The frequency of adverse events was not increased in patients with C677T polymorphism with 11 patients experiencing adverse events as compared to 19 in the group without polymorphism (of whom 4 and 7 patients respectively discontinued treatment). The C677T polymorphism was not associated with any difference in response to treatment. INTERPRETATION & CONCLUSION: Our findings suggest that C677T polymorphism in the MTHFR gene is not predictive of toxicity or efficacy of MTX treatment in RA patients receiving folate supplementation. Further studies need to be done to look at polymorphisms in other enzymes that may have association with MTX clinical efficacy and toxicity.
16287930 Patient self-efficacy and health locus of control: relationships with health status and ar 2006 Jan OBJECTIVE: To explore the relationship between measures of self-efficacy, health locus of control, health status and direct medical expenditure among community-dwelling subjects with rheumatoid arthritis (RA) and osteoarthritis (OA). METHODS: This analysis is part of a larger ongoing study of the costs and outcomes of arthritis and its treatments. Community-dwelling RA and OA respondents completed questionnaires concerning arthritis-related expenditure, health status, arthritis related self-efficacy and health locus of control. RESULTS: Data were obtained from 70 RA respondents and 223 OA respondents. The majority of respondents were female with a mean age of 63 yr for RA respondents and 68 yr for OA respondents. Among the RA respondents, those with higher self-efficacy reported better health status and lower overall costs. Health locus of control was not consistently correlated with health status. OA respondents with higher self-efficacy reported better health status and lower costs. Health locus of control had more influence. OA respondents with higher external locus of control reported worse pain and function. A higher belief in chance as a determinant of health was correlated with more visits to general practitioners and a higher cost to both the respondent and the health system. CONCLUSION: Higher self-efficacy, which is amenable to change through education programmes, was associated with better health status and lower costs to the respondent and the health system in this cross-sectional study. Locus of control had less of an influence; however, the tendency was for those with higher external locus of control to have higher costs and worse health status. As the measurement of these constructs is simple and the outcome potentially affects health status, these results have implications for future intervention studies to improve quality of life and reduce the financial impact of arthritis on both the health-care system and patients.
16904869 Anti-MBL autoantibodies in patients with rheumatoid arthritis: prevalence and clinical sig 2006 Sep Occurrence of autoantibodies in patients' sera is the characteristic feature of autoimmune disorders. We assessed the presence of anti-mannose binding lectin (MBL) autoantibodies in the sera of 107 rheumatoid arthritis (RA) patients and 121 control subjects by enzyme immunoassay. Elevated levels of anti-MBL autoantibodies in the sera of RA patients (P<0.0001) was detected for the first time. The ratios of anti-MBL positive in RA patients and controls were respectively 60.7% and 1.65%. Experiments were then designed to understand the functional relevance of these autoantibodies. An inverse correlation of anti-MBL autoantibodies with serum MBL levels (P=0.001) and MBL complex activity (P=0.02) was observed without genetic association between MBL polymorphisms and anti-MBL autoantibody secretion. A significant increase (P=0.038) in the level of anti-MBL autoantibodies was observed in 23 synovial fluid samples in comparison to the serum samples. Moreover, the anti-MBL autoantibodies were found to be more often present in the sera of RA patients (60.75% sensitivity, 98.35% specificity and 0.913 area under the ROC curve) in comparison to the IgM and IgG isotypes of rheumatoid factors (RF). Anti-MBL autoantibodies were still positive in 25.23% RA patients when both the RF isotypes were negative. Also, in RA patients, at all stages of disease activity and joint deformity, anti-MBL autoantibodies were more often present than both the RF isotypes. Therefore, the significant presence of anti-MBL autoantibodies enunciates that anti-MBL autoantibodies might have a diagnostic value; however, more studies are needed to confirm the role of anti-MBL autoantibodies in the diagnosis of rheumatoid arthritis.
15761728 Renin and angiotensin-converting enzyme (ACE) as active components of the local synovial r 2005 May Local functional renin-angiotensin systems (RAS) have been demonstrated in many organ and tissue systems. Angiotensins, the effector growth factors of the RAS, are essentially cytokines and growth factors which actively contribute to many inflammatory reactions. Among the components of RAS, angiotensin-converting enzyme (ACE) and renin have been previously investigated separately in RA. In this study, ACE levels and renin concentrations were measured in the sera of 16 patients with RA (median age: 45 (26-69), male/female: 3/13), 13 patients with osteoarthritis (OA) (median age: 55 (28-72), male/female: 5/8), and 11 healthy adults (median age: 44 (35-70), male/female: 6/5). Synovial ACE levels and renin concentrations were also measured concurrently in patients with RA and OA. Serum ACE levels were comparable between the groups. However, synovial fluid ACE levels were significantly higher in the patients with RA than in patients with OA. Likewise, synovial fluid renin concentrations were higher in RA patients than in OA patients, while serum renin concentrations were similar in patients with RA and OA and in healthy controls. Moreover, there was a significant negative correlation between the duration of the disease and synovial renin concentrations in RA patients. In conclusion, locally-generated active renin and ACE could contribute to joint destruction in rheumatoid arthritis.
15996054 Treatment with tumor necrosis factor blockers is associated with a lower incidence of firs 2005 Jul OBJECTIVE: To investigate the risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) treated with tumor necrosis factor (TNF) inhibitors, compared to a standard RA population. METHODS: Patients were recruited from a regional register, which includes over 90% of patients with RA started on TNF blockers in 1999 or later, and a local community based cohort of RA patients, established in 1997. Of a total of 983 patients in the combined cohort, 531 received treatment with etanercept or infliximab during the study period. The total cohort (n = 983) was linked with national registers for inpatient care and cause of death through December 31, 2001. CVD was defined as the first inpatient care or death from CVD without inpatient care for CVD prior to study entry. First CVD events in those treated versus not treated with TNF blockers were estimated, using age and sex adjusted incidence density computations with treatment and disease severity markers as time-dependent covariates. RESULTS: In the anti-TNF-treated patients, the age-sex adjusted incidence rate of first CVD event was 14.0/1000 person-years at risk (95% CI 5.7-22.4), compared with 35.4/1000 person-years (95% CI 16.5-54.4) in those not treated. Controlling for disability, the age-sex adjusted rate ratio was 0.46 (95% CI 0.25-0.85, p = 0.013) in anti-TNF-treated versus not treated. CONCLUSION: These findings suggest that the risk of developing CVD is lower in patients with RA treated with TNF blockers. This is compatible with the hypothesis that inflammation contributes to the development of cardiovascular events.
16899109 Interleukin-6: a new therapeutic target. 2006 The therapeutic success of biological agents, especially the tumour necrosis factor (TNF) inhibitors, has opened a new chapter in the book of therapies for rheumatoid arthritis. Nevertheless, more than 50% of patients may not respond by > 50% improvement. New compounds have recently entered the treatment arena. One of these is rituximab, which depletes B cells, and another, abatacept, interferes with T-cell co-stimulation. However, although these agents may be effective in a number of patients who fail to respond to TNF blockade, they only rarely induce remission and overall 50% response rates do not exceed those with the TNF inhibitors. Among the major proinflammatory cytokines, IL-6 plays a pleiotropic role both in terms of activating the inflammatory response and osteoclastogenesis. Here, we review recent phase II trials of tocilizumab, a humanized anti-IL-6 receptor antibody that achieves a significant therapeutic response rate.
15827391 [Adaptation of health-related quality of life ("SF-36") questionnaire, its validation and 2005 OBJECTIVE: To adapt the Lithuanian "SF-36" questionnaire, to assess psychometric and life quality criteria for patients with rheumatoid arthritis and for control group. MATERIAL AND METHODS: Linguistic and cross-cultural adaptation of the Lithuanian "SF-36" questionnaire was made on the basis of the stages referred to in the international project of health quality assessment. For the evaluation of psychometric criteria, data from Vilnius rheumatoid arthritis register (502 patients) and those of the control group (83 people) were used. The reliability of "SF-36" questionnaire was assessed by determining homogeneity, internal consistency of scales and scale stability in time and by calculating the intraclass correlation coefficient. Face, contents and construct validity of the "SF-36" questionnaire has been evaluated, as well as the quality of life of patients with rheumatoid arthritis and those of the control group. RESULTS: After making linguistic and cultural adaptation of the questionnaire, its final version has been prepared. In assessing the homogeneity of "SF-36", a high and middle-sized correlation between different items of the questionnaire has been noticed in the control group (r=0.51-0.71) and in patients with rheumatoid arthritis (r=0.57-0.83). Internal consistency for the items was also good enough (Kronbach alpha=0.79-0.85) for both tested groups. Stability in time was high for all items of the questionnaire, for the exception of vitality (r=0.074). Face and contents validity of the questionnaire is rather good. Estimates of the correlation between items of the quality of life questionnaire and other questionnaires have shown good convergent and discriminant construct validity. Evaluations of the quality of life in almost all spheres, except emotional, by patients with rheumatoid arthritis were worse than by the rest. CONCLUSIONS: Questions of health-related quality of life questionnaire are easy to understand and acceptable for the respondents. Reliability and validity of the questionnaire is rather high. For the exception of emotional status, quality of life in almost all spheres was considered as bad by patients with rheumatoid arthritis. The control group had more complaints about the emotional status.
16859508 Association of the FCRL3 gene with rheumatoid arthritis: a further example of population s 2006 Association of a functional promoter polymorphism mapping to the Fc receptor-like 3 (FCRL3) gene has recently been reported and replicated with rheumatoid arthritis (RA) in Japanese populations. The aim of this study was to investigate association of the FCRL3 gene with RA in UK subjects. DNA was available from 1065 patients with RA and 2073 population controls from the UK. Four single nucleotide polymorphism (SNP) markers (FCRL3-169*C/T (fclr3_3, rs7528684), fclr3_4 (rs11264799), fclr3_5 (rs945635), fclr3_6 (rs3761959)) all previously associated with RA in a Japanese population were genotyped in 761 RA samples and 484 controls. In the remaining samples, only the putative disease causal polymorphism, FCRL3-169*C/T, was tested. Genotyping was performed using either the Sequenom MassArray iPlex platform or a 5' Allelic discrimination assay (Taqman, ABI). Extensive linkage disequilibrium was present across the promoter SNPs genotyped (r2 values = 0.60-0.98). Allele frequencies did not differ between RA cases and controls either for the putative disease causal polymorphism (odds ratio FCRL3-169*C allele = 0.97 (0.87-1.07), p = 0.51) or for the other SNPs tested. Similarly, no association was detected with RA using haplotype analysis or when stratification by shared epitope carriage or by presence of rheumatoid factor was undertaken. This study was powered to detect an effect size of 1.24 or greater for the FCRL3-169*C/T functional promoter polymorphism but no evidence for association was detected, suggesting that this gene will not have a substantial effect in determining susceptibility to RA in populations of Northern European descent.
16385521 Ultrasonographic and radiographic results from a two-year controlled trial of immediate or 2006 Jan OBJECTIVE: To compare the impact of immediate and delayed introduction of anti-tumor necrosis factor therapy on inflammation and structural damage in methotrexate (MTX)-treated patients with early rheumatoid arthritis (RA). METHODS: Twenty-four patients with erosive early RA (duration < 3 years) who were receiving MTX were randomized to receive infliximab 5 mg/kg or placebo infusions at weeks 0, 2, and 6, and then every 8 weeks through week 46. Beginning at week 54 and thereafter, all patients received infliximab 5 mg/kg. Metacarpophalangeal joints were scanned using high-frequency ultrasonography and power Doppler imaging. Radiographs were evaluated using the modified Sharp/van der Heijde scoring system. RESULTS: From baseline to week 54, total synovial thickness was significantly improved in the infliximab + MTX group compared with the placebo + MTX group (median reduction 95.8% versus 37.5%; P = 0.005), as was the total color Doppler area (CDA; vascularity assessment) (median reduction 100% and 47.1%, respectively; P = 0.025). From week 0 to week 110, no significant between-group difference was observed in the change from baseline for total synovial thickening or the total CDA. At week 54, greater progression in the Sharp/van der Heijde score was apparent in patients receiving placebo + MTX compared with those receiving infliximab + MTX. Although radiographic progression in the placebo + MTX group was greatly reduced in the second year (after initiation of infliximab therapy), marked differences were observed between the infliximab + MTX group (median change in the Sharp/van der Heijde score 4.0) and the placebo + MTX group (median change 14.5) from baseline to week 110 (P = 0.076). CONCLUSION: The results indicate that the efficacy of 2 years of combination therapy with infliximab + MTX for inhibiting cumulative structural damage was superior to that of 1 year of treatment with MTX alone followed by the addition of infliximab.
16806061 Imatinib mesylate inhibits platelet derived growth factor stimulated proliferation of rheu 2006 Aug 18 Synovial fibroblast is the key cell type in the growth of the pathological synovial tissue in arthritis. Here, we show that platelet-derived growth factor (PDGF) is a potent mitogen for synovial fibroblasts isolated from patients with rheumatoid arthritis. Inhibition of PDGF-receptor signalling by imatinib mesylate (1muM) completely abrogated the PDGF-stimulated proliferation and inhibited approximately 70% of serum-stimulated proliferation of synovial fibroblasts. Similar extent of inhibition was observed when PDGF was neutralized with anti-PDGF antibodies, suggesting that imatinib mesylate does not inhibit pathways other than those mediated by PDGF-receptors. No signs of apoptosis were detected in synovial fibroblasts cultured in the presence of imatinib. These results suggest that imatinib mesylate specifically inhibits PDGF-stimulated proliferation of synovial fibroblasts, and that inhibition of PDGF-receptors could represent a feasible target for novel antirheumatic therapies.
15616758 Assessment of fracture risk. 2005 Jun The diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD). There are a number of clinical risk factors that provide information on fracture risk over and above that given by BMD. The assessment of fracture risk thus needs to be distinguished from diagnosis to take account of the independent value of the clinical risk factors. These include age, a prior fragility fracture, a parental history of hip fracture, smoking, use of systemic corticosteroids, excess alcohol intake and rheumatoid arthritis. The independent contribution of these risk factors can be integrated by the calculation of fracture probability with or without the use of BMD. Treatment can then be offered to those identified to have a fracture probability greater than an intervention threshold.
15555848 Pathologic conditions of the heel: tumors and arthritides. 2005 Jan Heel pain is one of the most common presenting complaints to the foot and ankle specialist. There are many causes for subcalcaneal heel pain, including biomechanical, traumatic, those related to several types of arthritides and tumors, and anatomic causes. This article describes pathologic conditions of the heel, concentrating on tumors and arthritides.
17688046 [Primary total hip arthroplasty in patients with rheumatoid arthritis]. 2006 Total hip arthroplasty has become a successful way of treating the painful and destroyed hip joint in the patient with rheumatoid arthritis (RA). Two hundred twenty (135 cemented and 85 noncemented) total hip arthroplasties were performed in 180 patients with rheumatoid arthritis. The average age was 48.61 years and the average follow-up was 8.4 years. Clinical evaluation was based on a Harris hip score that showed significant improvement in pain and function preoperatively compared with pain and function at followup. There were two deep infections requiring removal of the prosthesis. Four cemented acetabular cups and one cemented femoral component were revised due to aseptic loosening. Three acetabular rings were revised due to aseptic loosening. The relatively inferior results of total hip arthroplasty among RA patients is due not only to fixation method, but also to the poorer bone quality and weakening musculature. The results in these patients suggest that cementless total hip arthroplasty might become a successful way of treating the destroyed hip joint in the patient with rheumatoid artritis.
16892136 [Diagnostic values of antibody to citrullinated human fibrinogen in rheumatoid arthritis]. 2006 Aug 18 OBJECTIVE: To study the prevalence of antibody to citrullinated human fibrinogen (ACF) in rheumatic diseases and the diagnostic values in rheumatoid arthritis. METHODS: Human fibrinogen was deiminated by the peptidylarginine deiminase (PAD) in the presence of Ca2+ in vitro. ACF was detected by ELISA in 352 patients with rheumatic diseases (183 RA, 121 SLE and 48 OA) and 108 healthy controls. The sensitivity and specificity in RA were calculated and the correlations between ACF and the clinical and laboratory parameters were analysed by SPSS statistical software. RESULTS: Compared with SLE (25.62%), OA (18.75%) and healthy control (2.78%) respectively, the patients with RA had a significantly higher level of ACF (67.21%, P<0.001). ACF had a sensitivity of 67.21% and a specificity of 84.84% for RA. In the investigated clinical and laboratory parameters of RA, the significant correlations were found between ACF and ESR (r=0.386, P<0.001), anti-CCP antibody (r=0.288, P<0.05) and AKA (r=0.288, P<0.05), respectively. Abnormalities in ESR, radiographic progression, IgM-RF, anti-CCP, AKA and APF were more often in ACF positive patients than in ACF negative patients. Moreover, ACF was positive in 38.00% of IgM-RF negative, 59.81% of AKA negative and 68.22% of APF negative patients, respectively. CONCLUSION: ACF is a sensitive and specific antibody in diagnosing RA. The ACF test is also very useful in diagnosing RA with other autoantibodies negative.
16602015 Fibrous dysplasia localized to spine: a diagnostic dilemma. 2007 Jun Fibrous dysplasia of the spine is uncommon, especially in monostotic form. Isolated vertebral involvement in polyostotic form is very rare. We report a case of polyostotic fibrous dysplasia with lesions localized to dorso-lumbar spine in a 45-year-old rheumatoid arthritis patient. No associated appendicular lesions, cutaneous manifestations or endocrinopathies were seen. The extreme rarity of this type of lesion can pose a diagnostic dilemma, and biopsy is required for diagnosis. The association with rheumatoid arthritis in our case seems to be a chance occurrence.