Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
17029047 Rheumatoid arthritis complicated with myeloperoxidase antineutrophil cytoplasmic antibody 2005 This article describes a patient with rheumatoid arthritis (RA) with crescentic glomerulonephritis (CrGN) associated with myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA), who responded well to methotrexate (MTX). A 48-year-old woman with a 4-year history of RA was admitted with fever and elevated C-reactive protein. On laboratory evaluation, her level of MPO-ANCA was 422 EU, and urinalysis revealed proteinuria and hematuria. Because she was also suffering from episcleritis, vasculitis was considered. A renal biopsy was performed, which revealed necrotizing CrGN. We diagnosed RA complicated with MPO-ANCA-associated vasculitis. We considered treatment with high-dose oral prednisolone for vasculitis, but the patient refused this treatment. We started MTX at a dose of 8 mg/week for RA from the time of admission, and the patient responded immediately. Biochemical parameters, including C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and MPO-ANCA, improved. Seven months later, MPO-ANCA had decreased to 46 EU. In clinical studies, few patients have been reported with RA complicated with ANCA-associated CrGN. This case differs from previous cases in the treatment given. No high-dose steroid with intensive immunosuppression or plasma exchange was required.
16327702 [Adult-onset Still disease with hemophagocytic syndrome treated with cyclosporine]. 2005 Dec 3 INTRODUCTION: Adult-onset Still disease can have severe manifestations, the treatment of which is not yet codified. CASE: The authors report a case of life-threatening adult-onset Still disease with hemophagocytic syndrome, which improved dramatically with cyclosporin A. Despite the presence of severe pancytopenia, adult-onset Still disease is suggested by the combination of sore throat, myalgia, rash, hepatitis, high serum ferritin, low glycosylated ferritin, and negative etiologic findings. DISCUSSION: Still disease may be present in patients with febrile pancytopenia, and cyclosporine may be a useful treatment after corticosteroid failure.
16312891 [Observation on therapeutic effect of acupuncture and moxibustion in 60 cases of Sjogren s 2005 Feb OBJECTIVE: To observe clinical therapeutic effect of acupuncture on Sjogren syndrome. METHODS: Treatment group (n=60) were treated with acupuncture of clearing away dryness and toxic substance and removing obstruction in collaterals at Quze (PC 3), Taichong (LR 3), Xuehai (SP 10), Sanyinjiao (SP 6) and Taixi (KI 3), and the control group (n=60) with prednisone. Their therapeutic effects were compared. RESULTS: The total effective rate was 73.3% in the treatment group and 56.7% in the control group with a significant difference between the two groups (P < 0.05); there was no reverse effect in the treatment group. CONCLUSION: The needling method for clearing dryness and removing obstruction in collaterals is effective and safe for treatment of Sjogren syndrome.
16880196 Experience with experimental biological treatment and local gene therapy in Sjogren's synd 2006 Nov Sjögren's syndrome is an autoimmune exocrinopathy, mainly affecting the lacrimal and salivary glands, and resulting in ocular and oral dryness (keratoconjunctivitis sicca and xerostomia). The aetiology and pathogenesis are largely unknown, and only palliative treatment is currently available. Data obtained from experimental animal and human studies using biological agents or gene therapeutics can offer insight into the disease process of Sjögren's syndrome. This article reviews the current literature on these approaches and assesses the lessons learnt about the pathogenesis of Sjögren's syndrome.
16465479 Kikuchi-Fujimoto disease coexisted with Sjogren's syndrome. 2007 Apr Here we described a case of primary Sjogren's syndrome that coexisted with Kikuchi-Fujimoto disease.
16440922 Unusual presentation of Sjögren syndrome. 2005 Dec This case report describes a patient with Sjögren syndrome (SS) whose sole presenting feature was bilateral and painful submandibular gland enlargement. Extensive workup for alternate etiologies was negative and while serologies specific for SS were unremarkable, the diagnosis was eventually suggested by excisional biopsy. This case highlights the difficulty in making an early diagnosis of SS and demonstrates the important role of excisional biopsy in that diagnosis.
16332955 Epidemiology of primary Sjögren's syndrome in north-west Greece, 1982-2003. 2006 Feb OBJECTIVES: To investigate the incidence and prevalence, as well as the mortality and survival rates, of primary Sjögren's syndrome (pSS) in a defined area of north-west Greece with a population of about 500 000 inhabitants. METHODS: Cases were recorded from the following sources: (i) in- and out-patients referred to the rheumatology clinics of the Ioannina University Hospital and the Ioannina General Hospital; and (ii) patients referred to private rheumatologists practising in the study area. All patients diagnosed between 1 January 1982 and 31 December 2003 who were resident in the study area were included as incident cases. Diagnosis was based on the American-European consensus criteria for SS. Incidence and prevalence rates were calculated as numbers of cases per 10(5) inhabitants. Population data were based on the National Censuses of 1981, 1991 and 2001. RESULTS: A total of 422 incident cases were identified for the study period 1982-2003. Age-adjusted mean annual incidence rate for this period was 5.3 (95% confidence interval [CI] 4.5-6.1) cases per 10(5) adult inhabitants. The female/male ratio of incident cases was about 20/1. The age-adjusted prevalence rate for the adult population was 92.8 (95% CI 83.7-101.9) cases per 10(5) inhabitants on 31 December 2003. The 5-yr survival rate in the incidence cohort was 96.6% and the 10-yr survival rate 92.8%. The standardized mortality ratio in comparison with the general population of the study area was 1.02 (95% CI 0.4-2.0). The main causes of death were cardiovascular diseases and cancer. The occurrence of the disease shows a slightly decreasing, but not statistically significant, trend with time. CONCLUSIONS: The estimated incidence and prevalence of pSS in this study were slightly higher in comparison with data from other studies based on physician-diagnosed cases. The prevalence was significantly lower when compared with the findings of studies based on the examination of a sample of the general population. Mortality rates did not differ significantly between pSS patients and the general population.
15741418 Leflunomide and azathioprine combination in refractory adult-onset Still's disease. 2005 Apr OBJECTIVE: To present a case of Adult-onset Still's disease (ASD) in a patient who was successfully treated with leflunomide and azathioprine. CASE SUMMARY: A 24-year-old woman with ASD was initially treated with indomethacin, corticosteroids, and hydroxychloroquine; there was no clinical improvement. Methotrexate was added to the regimen, followed by azathioprine. The patient still experienced disease flares with this treatment, and cyclophosphamide was started. However, because of persisting disease activity, leflunomide combined with azathioprine was given. Only on this regimen was complete disease control achieved, with a normal erythrocyte sedimentation rate as well as normal C-reactive protein and ferritin levels. No recurrences or adverse effects attributable to leflunomide or azathioprine were observed at the one-year follow-up. DISCUSSION: Clinical experience concerning leflunomide and azathioprine combination in ASD is limited. This combination may be modifying the clinical expression of ASD through its effects on T lymphocyte clonal expansion and production of proinflammatory cytokines. CONCLUSIONS: Leflunomide combined with azathioprine appears to be an effective and safe treatment of ASD.
15610399 Sjögren's syndrome: the diagnostic potential of early oral manifestations preceding hypos 2005 Jan Sjögren's syndrome (SS) is a systemic autoimmune exocrinopathy that affects mainly the salivary and lacrimal glands, leading to progressive reduction in saliva and tear flow. Although the underlying immuno-mediated glandular destruction is thought to develop slowly over several years, a long delay from the start of the symptoms to final diagnosis has been frequently reported. A limited knowledge concerning SS natural history is among the major causes of the actual diagnostic delay. Although very few studies have been focused on the analysis of SS early clinical onset, a series of oral features preceding xerostomia/hyposalivation development in patients eventually diagnosed as having SS have been reported. Sialochemistry alterations, salivary gland swelling, early dental loss and sialorrhea have been observed before the onset of typical signs and symptoms (namely xerostomia and/or hyposalivation), which usually lead to SS clinical presentation and diagnosis. Here we suggest, after evaluating available data, that the traditional 'untouchable' association between SS and xerostomia/hyposalivation might probably be reconsidered, and that astute clinicians should not underestimate the possible presence or development of SS in patients without xerostomia/hyposalivation and presenting these atypical early oral features.
16511937 A case-control sleep study in children with polyarticular juvenile rheumatoid arthritis. 2006 Apr OBJECTIVE: To investigate the relationship between clinical manifestations and sleep abnormalities in patients with juvenile rheumatoid arthritis (JRA). METHODS: Twenty-one patients with active polyarticular JRA and 20 healthy controls were enrolled consecutively. Pain and functional impairment were assessed with standardized, validated Brazilian questionnaires. Sleep evaluation was based on parent reporting of their child's sleep habits and polysomnography; subjects underwent an adaptation night in the sleep laboratory. Sleep architecture was analyzed and spectral analysis of non-rapid eye movement (REM) sleep was carried out by electroencephalography. RESULTS: Patients with JRA exhibited higher indexes of periodic leg movements (PLM; p = 0.02), isolated leg movements (LM), and arousals, as well as increases in alpha activity in non-REM sleep (all p < 0.01), in spite of similar frequency of sleep complaints in comparison to controls. Among JRA patients, greater alpha activity in non-REM sleep was observed in the participants with greater joint involvement assessed by the Escola Paulista de Medicina-Pediatric Range of Motion Scale (p = 0.03) or joint count (p = 0.02). Correlation was observed between morning stiffness and PLM and/or LM (rS = 0.75, Sr = 0.74, p < 0.001 for both), and between self-rating scores of pain and alpha activity in non-REM sleep (rS = 0.74, p < 0.001). CONCLUSION: Pain symptoms and disability are related to sleep fragmentation in patients with active polyarticular JRA.
15956749 Effects of relaxin in a model of rat adjuvant-induced arthritis. 2005 May A reduction in the incidence and severity of rheumatoid arthritis is seen in pregnant women. Relaxin, a hormone of pregnancy, has been implicated in decreased immune responsiveness. Consequently, the effects of relaxin and estradiol valerate, alone or in combination, were assessed in the development of adjuvant-induced arthritis in the rat. Combination hormone therapy reduced adjuvant-induced paw inflammation. Radiographic analysis of the tarsal joints showed that estradiol valerate plus relaxin treatment minimized soft tissue damage and bone changes when compared to vehicle-treated arthritic controls. These results indicate that relaxin may be a factor in reducing inflammation during pregnancy.
15759952 Juvenile rheumatoid arthritis: physical therapy and rehabilitation. 2005 Feb Juvenile arthritis is one of the most prevalent chronic diseases in the childhood period (ages 0 to 16 years). This disease was first defined in the first half of the 16th century. In the course of time, its differential diagnosis and characteristics have been determined, and it has been classified. Incidence and prevalence values are 10 to 20 in 100,000 and 56 to 113 in 100,000, respectively. Various factors are suggested for its underlying cause. Its denomination is also in dispute. Treatment of juvenile arthritis includes education, medical treatment, physical therapy, and occupational therapy. This article summarizes the objectives and methods of physical therapy and rehabilitation that are important parts of treatment.
15918992 Primate spondyloarthropathy. 2005 Jun Spondyloarthropathy is a common occurrence in Old World primates, with only limited presence in New World monkeys. Clearly distinguished from rheumatoid arthritis, this erosive arthritis afflicts 20% of great apes, baboons, and rhesus macaques and had been increasing in frequency. Habitat-dependent infectious agent diarrhea-induced reactive arthritis is implicated on a background of genetic predisposition. A gorilla-derived therapeutic preventative approach has possible application in human clinical medicine.
16273806 A Norwegian DMARD register: prescriptions of DMARDs and biological agents to patients with 2005 Sep Information concerning the effectiveness of drug therapy cannot be obtained only from randomized controlled clinical trials, due to limitations such as a short time frame and narrow inclusion and exclusion criteria. Therefore, complementary longitudinal observational studies performed in a real life setting are required. NOR-DMARD, a Norwegian 5-center register, was established in December 2000. All DMARD prescriptions to patients with inflammatory arthropathies are included, and patients are followed longitudinally with a variety of assessments. As of 2005, 4683 DMARD regimens have been included. Methotrexate is the most commonly used DMARD in rheumatoid arthritis and psoriatic arthritis. The proportions of patients who have received anti-TNF drugs in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile arthritis and other diseases have been 22.5, 21.6, 53.8, 36.9 and 9.7%, respectively. The proportion of patients receiving anti-TNF drugs is considerably higher in 2004 than earlier, and criteria for prescribing anti-TNF drugs appear to be trending toward patients with less severe and active disease. Confounding by indication or channeling bias represents a challenge for the group comparisons of longitudinal effectiveness data, but can be addressed by modern statistical techniques. The NOR-DMARD register may in the future provide comparative real life effectiveness data that may also be used in cost-effectiveness analyses.
15899062 Role of regulatory T cells in experimental arthritis and implications for clinical use. 2005 CD4+CD25+ T regulatory cells are avidly studied because they modulate immune responses. Their possible role in autoimmunity and more specifically in rheumatoid arthritis (RA) has been highlighted by a string of reports, one of which is in the last issue of Arthritis Research & Therapy. There are, however, key questions that have not yet been addressed before their use can be considered as a real therapeutic option. The first is the actual, in a clinical setting, efficacy of Treg to treat active chronic autoimmune diseases such as RA. The second is how we can practically deliver their therapeutic activity in patients. Once these points have been addressed we will have a new and potentially very effective 'magic bullet' for the treatment of chronic autoimmune diseases.
16528134 [Xerostomia: clinic, etiology, diagnosis and treatment]. 2006 The aim of this article is to review the problem of xerostomia considering its clinical, etiological, diagnostic and treatment features, basing on the today's tutorials and scientific articles found in databases on the Internet. Recent epidemiologic data on the prevalence of xerostomia in different countries are introduced. There are analyzed the main aspects of clinical manifestations of xerostomia, according to the different etiology analyzed. The most common etiological factors causing xerostomia, especially the main three of them: radiation therapy, Sjögren's syndrome, and drugs, are pointed out. The most popular and accepted clinical and laboratory assays for measuring and evaluating the function of salivary glands are represented. Attention is paid to xerostomia as substantiation of the separate diagnosis and its role in diagnosing other diseases. The concept of possible treatment modalities and prognosis are discussed. The main and most common problems concerning xerostomia are revealed.
15960818 B cell non-Hodgkin's lymphoma: rituximab safety experience. 2005 A substantial body of data supports use of rituximab as first-line and maintenance therapy for the treatment of indolent non-Hodgkin's lymphoma. With 7 years of postmarketing surveillance experience and more than 370,000 patient exposures, the safety profile of rituximab is well defined. Several multicenter trials suggest that infusion reactions associated with rituximab administration are well characterized and generally associated with the first infusion; toxicity is reduced with subsequent doses. Since some adverse events are related to circulating tumor loads of non-Hodgkin's lymphoma, fewer events are anticipated in rheumatoid arthritis. Low infection rates in oncology would indicate similar safety in patients with rheumatoid arthritis.
20476983 Etanercept: an introduction. 2005 Sep Etanercept is a member of a new generation of therapeutic agents referred to as biologics or targeted therapies, which have caused some enthusiasm in the field of autoimmune disorders in recent years. Most of these agents are inhibitors of tumor necrosis factor, a key cytokine in the chronic inflammatory process. Etanercept is a tumor necrosis factor recombinant fusion protein consisting of two molecules of the tumor necrosis factor p75 receptor, which binds to the cytokine and thus antagonizes its effect. This review provides an introduction to the compound and describes its clinical efficacy in the main indications, rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis and juvenile rheumatoid arthritis. Focus has been placed on the newest data on long-term efficacy and radiologic outcome parameters. Reports on the use of the drug in other indications are reviewed as well as the actual data on safety issues. The authors will provide their opinion on the current status of the drug and speculate on its rank in the future.
16816921 Imatinib mesylate inhibits osteoclastogenesis and joint destruction in rats with collagen- 2006 Macrophage colony-stimulating factor (M-CSF) is a key factor for osteoclastogenesis at the bone-pannus interface in patients with rheumatoid arthritis as well as a receptor activator of NF-kappaB ligand (RANKL). Imatinib mesylate inhibits the phosphorylation of c-fms, a receptor for M-CSF. The present study investigates the effect of imatinib mesylate on joint destruction in rats with collagen-induced arthritis (CIA) and on osteoclastogenesis in vitro. Imatinib mesylate (50 or 150 mg/kg), dexamethasone, or vehicle was administered daily to CIA rats for 4 weeks from the onset of arthritis. Hind-paw swelling and body weight were measured weekly. At weeks 2 and 4, the metatarsophalangeal (MTP) joints and the ankle and subtalar joints were radiographically and histologically assessed. The effect of imatinib mesylate on osteoclast formation from rat bone marrow cells with M-CSF and soluble RANKL (sRANKL) in vitro was also examined. Radiographic assessment showed that 150 mg/kg imatinib mesylate suppressed the destruction of the MTP and the ankle and subtalar joints at week 2, and MTP joint destruction at week 4 in CIA rats, although hind-paw swelling was not suppressed. The number of TRAP-positive cells at the bone-pannus interface was significantly reduced in the group administered with 150 mg/kg imatinib mesylate compared with that given vehicle at week 4. Imatinib mesylate dose-dependently inhibited the proliferation of M-CSF-dependent osteoclast precursor cells in vitro as well as osteoclast formation induced by M-CSF and sRANKL. These findings suggest that imatinib mesylate could prevent joint destruction in patients with rheumatoid arthritis.
17029070 Osteoimmunological insight into bone damage in rheumatoid arthritis. 2005 Research into the bone destruction associated with rheumatoid arthritis has highlighted the importance of the interplay of the immune and skeletal systems. Arthritic bone destruction is attributable to the defective control of osteoclastogenesis by T cells. We revealed that excessive expression of receptor activator of NF-kappaB ligand (RANKL) and a paucity of interferon-gamma underlie the enhanced osteoclastogenesis in arthritis. The interdisciplinary research field called osteoimmunology has attracted further attention after identification of a number of unexpected bone phenotypes in mice lacking immunomodulatory molecules. Accumulating evidence suggests that the immune and skeletal systems share not only cytokines but also various signaling molecules, transcription factors, and membrane receptors. Thus, bone turns out to be a dynamic tissue that is constantly renewed, where the immune system participates to a hitherto unexpected extent. This emerging field will be of great importance for a better understanding and treatment of rheumatic diseases.