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ID PMID Title PublicationDate abstract
23105494 Altered pattern of lipids in plasma and erythrocyte membranes of rheumatoid arthritis pati 2005 Jan The present study has investigated the levels of lipids, lipoprotein cholesterol (HDL and LDL cholesterol), thiobarbituric acid reactive substances (TBARS) and vitamin E in plasma and erythrocyte membranes of twenty two clinically diagnosed adult rheumatoid arthritis patients and an equal number of age matched healthy subjects. The levels of lipids and lipoprotein cholesterol were markedly reduced in patients with rheumatoid arthritis as compared to healthy subjects. The altered lipid pattern may be related to decreased lipoprotein cholesterol, fatty acids and impairment in antioxidant defence mechanism.
15693080 Autoimmunity and tuberculosis. Opposite association with TNF polymorphism. 2005 Feb OBJECTIVE: To examine the influence of the -308 and -238 single nucleotide polymorphisms (SNP) of tumor necrosis factor-a gene (TNF) on patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), primary Sjogren's syndrome (SS), and tuberculosis (TB). METHODS: Genomic DNA from patients with RA (n = 165), SLE (n = 100), primary SS (n = 67), and TB (n = 135) and ethnically matched controls (n = 430) was genotyped for TNF -308 and -238 SNP by PCR-RFLP. RESULTS: TNF -308A allele was associated with RA (odds ratio, OR 1.8, p = 0.002), SLE (OR 2.6, p < 0.0001), and primary SS (OR 2.9, p < 0.0001). TNF -308G was associated with TB (OR 1.8, p = 0.02). The -308 GG genotype was protective for autoimmunity (p < 0.003). TNF -238A allele was protective for autoimmunity but represented a susceptibility factor for TB (OR 2.2, p < 0.0001). Haplotype -308A-238G was a protective factor against TB, whereas it carried susceptibility for RA, SLE, and primary SS (p < 0.0001). CONCLUSION: The results show an opposite association of TNF polymorphism with autoimmunity and TB, and suggest the existence of heterozygote advantage, sustaining the hypothesis that autoimmune diseases are a consequence of natural selection for enhanced TB resistance. Data also provide genetic evidence supporting the common variants/multiple disease hypothesis, which emphasizes that many disease genes may not be disease-specific, and that similar immunogenetic mechanisms underlie autoimmune diseases.
20528498 Outcomes associated with early rheumatoid arthritis. 2006 Oct Rheumatoid arthritis is a common disease affecting 1% of adults in the UK and western countires. No single outcome measure comprehensively captures the full range of potential outcomes in early rheumatoid arthritis, so a range of measures are needed. This article evaluates the clinical and economic outcomes of early rheumatoid arthritis. These include pain, which is a major concern for patients, fatigue and persisting disease activity. The key therapeutic goal - remission of these clinical features - is achieved by 10-36% of early rheumatoid arthritis patients using currently available treatment. Disability, erosive damage and work disability are other important negative outcomes of early rheumatoid arthritis. Together, they account for its high direct and indirect medical costs. These various outcomes are outlined in this article.
15645140 Constitutive production of proinflammatory cytokines RANTES, MIP-1beta and IL-18 character 2005 Feb Large granular lymphocyte (LGL) leukemia is a lymphoproliferative disease often associated with autoimmune disorders such as rheumatoid arthritis. High levels of soluble Fas ligand have been implicated in development of chronic neutropenia. However, a comprehensive analysis of constitutive chemokine and lymphokine production in LGL leukemia has not previously been reported. Here, we utilized RNase protection assays and enzyme-linked immunosorbent assays (ELISAs) to address this question. RANTES, IL-8, MIP-1alpha, MIP-1beta, IL-1beta, IL-10, IL-12 p35, IL-18, IFN-gamma and IL-1Ra were the cytokine transcripts expressed in elevated levels from RNA of peripheral blood mononuclear cells of LGL leukemia patients. Confirmatory ELISAs indicated that sera from LGL leukemia patients have elevated levels of RANTES, MIP-1beta, IL-18, and to a lesser extent IL-8 and IL-1Ra. This pattern of cytokine upregulation is similar to that seen in some chronic infections or in autoimmune diseases, thus characterizing LGL leukemia as a proinflammatory disorder.
16245748 [Diagnosis of rheumatoid uveitis in children and teenagers]. 2005 We have done a retrospective study of juvenile rheumatoid uveitis of hospitalized cases between 1993-2002. 96 juvenile uveitis were available and 18 of this cases were diagnosed with juvenile rheumatoid uveitis. Juvenile rheumatoid arthritis associated uveitis is one of the most difficult of the uveitic entities to manage. Juvenile rheumatoid arthritis is the most common rheumatic disease of childhood. The classic presentation is an asymptomatic, bilateral, non-granulomatous iridocyclitis and the latency between onset of arthritis and detection of uveitis is around two years. Arthritis precedes the onset of uveitis, so the ophthalmologist will usually see the patients after the diagnosis has been established by the pediatrician or rheumatologist.
17041992 Internet information on rheumatoid arthritis: an evaluation. 2005 OBJECTIVE: To evaluate the quality of internet information, readily accessible by the public, relating to rheumatoid arthritis and to investigate the relationship between financial interests of websites and the quality of information provided. METHODS: Five well-known search engines on the internet were investigated in an attempt to replicate a search undertaken by a typical patient. The phrase 'rheumatoid arthritis' was used for each search and the first 20 results were evaluated. Each site was evaluated in terms of 'general website criteria' and 'specific criteria' in relation to rheumatoid arthritis. The websites were scored out of 30. RESULTS: Fifty-five websites were evaluated. The mean total quality score was 12.15 (SD = 6.53) and 40 sites (72.7%) scored < 50% of the total marks available. Information about authorship, ownership and currency were missing in more than 75% (n = 42) of cases; only 20% (n = 11) of sites gave clear references to scientific literature; 64% (n = 35) of sites were judged to have a financial interest and these scored significantly lower total quality scores compared to the informative sites (p = <0.01). Information about the role of physiotherapy in the management of rheumatoid arthritis was absent in 70.9% (n = 39). CONCLUSION: The internet is a poor source of information for rheumatoid arthritis patients. Quality information is scarce and finding it is time-consuming. Guidelines are needed to regulate information that is published on the internet and define who is eligible to publish it. Until then the internet should not be recommended as a single source of patient information unless professionally endorsed websites are recommended.
23105613 Positive influence of Methotrexate-Hydroxychloroquine combination on the expression of GM- 2006 Sep Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) has been inducted as a mediator of inflammation in rheumatoid arthritis. Methotrexate combination therapy forms an important component of the treatment regimen in rheumatoid arthritis. The present study was undertaken to evaluate the influence of Methotrexate-Hydroxychloroquine (MTX-HCQ) combination and Sulfsalazine- Hydroxychloroquine (SSZ-HCQ) combination on the expression GM-CSFR in neutrophils isolated from synovial fluids. 15 cases of confirmed rheumatoid arthritis patients who presented at the hospital for surgical correction of joint deformities were selected for the study. Neutrophils isolated from the synovial fluids were used as the source of the receptor for quantitation on an enzyme immunoassay (EIA). The EIA was developed and standardized in our laboratory for quantification of the GM-CSF R. The findings are suggestive of the fact that the administration of MTX-HCQ combination has positive influence on the expression of the GM-CSF R on neutrophils as against SSZ-HCQ combination. The physiological basis of this increase needs further investigation.
15608317 Lupus erythematosus with leflunomide: induction or reactivation? 2005 Jan BACKGROUND: Leflunomide is a new oral disease modifying antirheumatic drug with a good safety profile. CASE REPORT: The first case of lupus erythematosus in a 58 year old white woman after administration of leflunomide for primary Sjögren's syndrome is reported. The relationship between induced lupus and leflunomide was confirmed by the resolution of the skin rash when the drug was stopped and its recurrence when it was reintroduced following a dose-response effect. DISCUSSION: Peripheral blood cells from this patient, from 15 patients with rheumatoid arthritis, and from healthy controls were used in a bioassay, which suggested that leflunomide affected the Th1/Th2 balance. Such a side effect might be related, in part, to the anti-tumour necrosis factor alpha activity of leflunomide.
15682575 Total knee replacement in juvenile rheumatoid arthritis. 2005 Jan In general, longer operative times and in some cases increased blood requirements can be expected with TKA in patients with juvenile rheumatoid arthritis. Complications also are more frequent. Pain relief is usually good to excellent, and function and deformity are significantly improved. Range of motion after TKA for juvenile rheumatoid arthritis is usually less than that obtained in osteoarthritis, but still allows for dramatic improvements in performing activities of daily living (Figure 3).
16462444 Inflammatory arthritides of the spine: surgical versus nonsurgical treatment. 2006 Feb Ankylosing spondylitis and rheumatoid arthritis are disorders that cause marked alterations in the structure and function of the axial skeleton. Ankylosing spondylitis causes calcification of spinal structures causing limited motion. Rheumatoid arthritis causes synovial hypertrophy, joint destruction, and spinal instability. Surgical therapy for patients with ankylosing spondylitis corrects angular deformities with spinal osteotomies, and stabilization for spinal fractures. Spinal operative therapy for rheumatoid arthritis concentrates on correction of abnormal motion in the cervical spine. Advances in the medical therapy of spondyloarthritis have resulted in control of the inflammation of the axial skeleton halting the damage to spinal structures. The new biologic therapies for ankylosing spondylitis prevent progression of disease. Similarly, these same biologic therapies can also control the progression of rheumatoid arthritis including the cervical spine. The new medical therapies are very effective in preventing joint damage. The need for surgical intervention for patients with ankylosing spondylitis and rheumatoid arthritis will become a rare event in the setting of the new medical therapies for these inflammatory arthropathies.
19807258 Quality of life and costs for different treatment strategies for rheumatoid arthritis. 2005 Aug Rheumatoid arthritis is a chronic, inflammatory, systemic disease. In the past, treatment (strategy) for this disease has changed dramatically, becoming more aggressive and new drugs have become available. Furthermore, closely monitoring the disease and treatment has been advocated. Rheumatoid arthritis has an extensive impact on quality of life and the cost of the disease to society is high. Since rheumatoid arthritis is a chronic disease with life-long treatment, the long-term assessment of cost-effectiveness of new treatment (strategies) frequently implies modeling. This article reviews the assessment of the diagnosis, disease process and outcome (including quality of life and costs) and methodology of cost-effectiveness (modeling) studies in rheumatoid arthritis. Furthermore, it describes the recent trends in the treatment of rheumatoid arthritis and summarizes current evidence regarding the effects on quality of life, costs and cost-effectiveness of these new treatment strategies. Since traditional disease-modifying antirheumatic drug treatment is inexpensive, early aggressive treatment with these drugs is probably cost effective since these strategies do not appear to result in elevated toxicity and are usually found to be effective. Also, closely monitoring patients, if successful, is probably cost effective. The exact place (i.e., as a first-, second- or third-line drug) of new drugs for the treatment of rheumatoid arthritis remains somewhat controversial, since cost-effectiveness analyses have varying results and methodology. Expected future developments in the field are also discussed.
16219707 Diagnosis and management of adult onset Still's disease. 2006 May BACKGROUND: Adult onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown aetiology that is responsible for a significant proportion of cases of fever of unknown origin and can also have serious musculoskeletal sequelae. OBJECTIVE: To assess and synthesise the evidence for optimal diagnosis and management of AOSD. METHODS: The key terms, adult onset Still's disease, AOSD, adult Still's disease, ASD, Still's disease were used to search Medline (1966-2005) and PubMed (1966-2005) for all available articles in the English language. Clinically relevant articles were subsequently selected. Bibliographies, textbooks, and websites of recent rheumatology conferences were also assessed. RESULTS: Data on diagnosis and treatment of AOSD are limited in the medical literature and consist mainly of case reports, small series, and modest scale retrospective studies. Diagnosis is clinical and requires exclusion of infectious, neoplastic, and other autoimmune diseases. Laboratory tests are non-specific and reflect heightened immunological activity. Treatment comprises non-steroidal anti-inflammatory drugs, corticosteroids, immunosuppressive drugs (methotrexate, leflunomide, gold, azathioprine, cyclosporin A, cyclophosphamide), and intravenous gammaglobulin. The recent successful application of biological agents (anti-tumour necrosis factor, anti-interleukin (IL)1, anti-IL6), often in combination with traditional immunosuppressive drugs, has been very promising. CONCLUSIONS: AOSD often poses a diagnostic and therapeutic challenge and clinical guidelines are lacking. The emergence of validated diagnostic criteria, discovery of better serological markers, and the application of new biological agents may all provide the clinician with significant tools for the diagnosis and management of this complex systemic disorder.
20477085 Leflunomide in the treatment of rheumatoid arthritis. 2006 Jan Rheumatoid arthritis is a chronic and highly morbid disease affecting approximately 1% of the world's population. With the advent of disease-modifying antirheumatic drugs, patients are increasingly able to maintain control of their arthritis and prevent joint destruction. However, not all patients respond adequately to any single disease-modifying antirheumatic drug, and many newer parenteral therapies are cost prohibitive. Leflunomide, an inhibitor of pyrimidine biosynthesis, is the first oral disease-modifying antirheumatic drug to have been approved for rheumatoid arthritis in the USA in the last 15 years, and is now widely used in over 70 countries around the world. Leflunomide is efficacious when used as monotherapy or in combination with methotrexate to treat patients with rheumatoid arthritis, and is generally well tolerated. As clinical use increases, new ways to use leflunomide in order to minimize toxicity and maximize efficacy are being explored.
17029041 Naturopathic management of rheumatoid arthritis. 2005 Complementary and alternative medicines (CAM) are widely used by those with pain and/or musculoskeletal problems, and previous research has shown that high proportions of individuals with rheumatoid arthritis have used these therapies. One of the largest CAM modalities is that of naturopathy, which combines nutritional, herbal, and other complementary practices to treat such conditions. In this review, evidence is examined in relation to those factors which naturopaths believe are significant contributors to rheumatoid arthritis, and are hence the main focus of therapeutic management. These factors include food allergy, increased gut permeability, increased circulating immune complexes, excessive inflammatory processes, and increased oxidative stress. Naturopathic treatment attempts to alleviate symptoms by altering these factors through dietary modification, manipulation of dietary fats, and use of antioxidants and proteolytic enzymes. An understanding of the rationale for these treatments and evaluation of the evidence from their use in clinical settings will assist with the integration of complementary and conventional practices in the treatment of rheumatoid arthritis.
19807580 A pharmacoeconomic review of adalimumab in the treatment of rheumatoid arthritis. 2005 Oct The past 10 years has witnessed a major transformation in the treatment of rheumatoid arthritis, a chronic condition that leads to significant morbidity, impairment in quality of life and mortality. Adalimumab joins a class of biologic response modifiers that prevent joint destruction and maintain functional status. For expensive interventions such as biologic response modifiers to be a valuable use of healthcare resources, they must lower healthcare costs by reducing the prevalence of hospitalizations, assist people with rheumatoid arthritis in maintaining employment and improve patient quality of life. The rheumatoid arthritis market is competitive and growing quickly. Policy makers are faced with decisions surrounding the value of biologic response modifiers over conventional therapies, and whether one biologic response modifier has an advantage over another.
15695535 Anti-citrullinated peptide antibodies may occur in patients with psoriatic arthritis. 2005 Aug BACKGROUND: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are considered highly specific markers of rheumatoid arthritis. Despite the high specificity of the test, anti-CCP antibodies have also been observed in psoriatic arthritis. OBJECTIVE: To determine the frequency of anti-CCP antibodies in psoriatic arthritis and to describe the clinical characteristics of such patients. METHODS: Serum samples from 192 patients with psoriatic arthritis were analysed for anti-CCP antibodies. A previously defined cut off point was applied at a specificity level of > or =98.5% (42 U/ml). Antibodies against pepA and pepB (two synthetic citrullinated peptides) were determined on samples containing anti-CCP antibodies by line immune assay. The swollen joint count and the numbers of affected joints (present or past) were recorded. Clinical features were noted and if available radiographs of hands and feet were scored for erosions. Rheumatoid factor was determined in all samples. RESULTS: Anti-CCP antibodies were found in 15 patients (7.8%); 13 of 15 anti-CCP2 positive samples were also positive for anti-pepA or pepB antibodies. The prevalence of anti-CCP antibodies was higher than expected in view of the highly specific cut off applied in the test. Detailed analysis of the clinical and radiological features makes it improbable that the high prevalence of anti-CCP antibodies resulted solely from concomitant psoriasis and rheumatoid arthritis or from misclassification. CONCLUSIONS: Anti-CCP antibodies may be present in patients with psoriatic arthritis. Although some of the present cohort could have had psoriasis with concomitant rheumatoid arthritis, a proportion at least had the typical characteristics of psoriatic arthritis as the primary diagnosis.
27407700 Efficacy and Toxicity Profile of Methotrexate Chloroquine Combination in Treatment of Acti 2005 Jan BACKGROUND: The present study was conducted to study the efficacy and toxicity profile of methotrexate chloroquine combination in treatment of active rheumatoid arthritis. METHODS: 24 patients of rheumatoid arthritis confirming to revised American Rheumatism Association (ARA) criteria were studied prospectively for twenty months. Clinical evaluation was made every 3 months. Clinical disease variables measured at each visit were number of joints with swelling, number of joints with tenderness and pain, duration of morning stiffness and physician and patient assessment of disease activity. Blood counts, liver function tests and other adverse effects due to drugs were monitored every 2 months. RESULTS: 10 patients demonstrated more than 50% improvement. 4 patients withdrew from study, 2 because of excessive nausea and vomiting and 2 because of noncompliance. Other side effects noted were hyperpigmentation, photosensitivity, skin rashes, raised transaminases and stomatitis. CONCLUSION: Methotrexate chloroquine combination has good efficacy and toxicity profile. Gastrointestinal side effects are most common and usually responsible for the discontinuation of the drugs.
15790469 Primary ovarian large B-cell lymphoma in patient with juvenile rheumatoid arthritis treate 2005 Apr BACKGROUND: Primary ovarian lymphoma is an extremely rare disease and limited count reports about it have been reported in the literature. Traditionally, patients with rheumatoid arthritis (RA) have increased risk of nodal and extranodal lymphoid malignancies such as non-Hodgkin's lymphoma (NHL). Recently, some studies have also reported association between patients with juvenile rheumatoid arthritis (JRA) treated with Methotrexate (MTX) and malignant lymphoma developing. CASE: We report a 17-year old JRA patient with primary ovarian diffuse large B-cell non-Hodgkin's lymphoma (NHL). The patient had seronegative (rheumatoid factor negative) poliarticular form of JRA and was receiving low dose weekly Methotrexate (MTX) during the past 2 years. Initial presentation was adnexial mass and chronic pelvic pain. The patient was treated with surgery and combined cytotoxic chemotherapy. CONCLUSION: In conclusion, because of increased lymphoid malignancy risk, ovarian masses in JRA patients should be carefully evaluated.
16651348 Ophthalmologic examinations in children with juvenile rheumatoid arthritis. 2006 May Unlike the joints, ocular involvement with juvenile rheumatoid arthritis is most often asymptomatic; yet, the inflammation can cause serious morbidity with loss of vision. Scheduled slit-lamp examinations by an ophthalmologist at specific intervals can detect ocular disease early, and prompt treatment can prevent vision loss.
16112560 Synovial biology and T cells in rheumatoid arthritis. 2005 Oct Events that occur in rheumatoid arthritis synovial tissues are responsible for the signs and symptoms of joint inflammation and for the eventual destruction of articular and periarticular structures that lead to joint dysfunction and disability. The three most abundant cell populations in RA synovium are synovial macrophages (type A synoviocytes), synovial fibroblasts (type B synoviocytes) and infiltrating T lymphocytes. Other important cell populations include B lymphocytes, dendritic cells, plasma cells, mast cells and osteoclasts. Our current understanding of rheumatoid arthritis is moving beyond previous concepts that view this disease as the consequence of a specific and focused humoral or cellular autoimmune response to a single autoantigen. Rather, a new view of rheumatoid arthritis is emerging, which seeks to understand this disease as the product of pathologic cell-cell interactions occurring within a unique and defined environment, the synovium. T lymphocytes in rheumatoid arthritis synovium interact closely with dendritic cells, the most potent antigen-presenting cell population in the immune system. T cells also interact with monocytes and macrophages and cytokine-activated T cells may be, especially, suited to trigger production of the important cytokine TNFalpha by synovial macrophages. Recent evidence also suggests a potent bidirectional interaction between synovial T cells and synovial fibroblasts, which can lead to activation of both cell types. An important role for synovial B lymphocytes has been emphasized recently, both by experimental data and by results of clinical interventions. B cells in synovium can interact with fibroblasts as well as with other cells of the immune system and their potential role as antigen-presenting cells in the joint is as yet underexplored. Rheumatoid arthritis synovium may be one of the most striking examples of pathologic, organ-specific interactions between immune system cells and resident tissue cell populations. This view of rheumatoid arthritis also leads to the prediction that novel approaches to treatment will more logically target the intercellular communication systems that maintain such interactions, rather than attempt to ablate a single cell population.