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ID PMID Title PublicationDate abstract
17121482 Rheumatology in 2006: crossroads or crisis? 2006 Rheumatology has made remarkable advances in patient treatment in the past decade related to the impressive array of new drugs that have been approved or are undergoing clinical trial. While this situation should engender optimism for the future, concerns about sustaining momentum have been raised. These concerns relate to uncertainty in the research agenda for major diseases such as osteoarthritis and fibromyalgia, lack of informatics systems to allow accurate assessment of risks and benefits of new treatments, and a paucity of clinical trials in rheumatoid arthritis aimed at sustained remission or cure. Fortunately, the opportunities for the future remain very bright because of burgeoning research in biomedicine and outcomes assessment as well as progress in developing personalized medicine to individualize treatment better.
17088744 [Osteoid osteoma of the olecranon]. 2006 Sep We report a case of osteoid osteoma of the olecranon which developed in the greater sigmoid cavity. The patient was a 22-year-old male who complained of arthritic-like symptoms limited to the elbow joint and progressing for three years. Rheumatoid arthritis then tuberculosis were entertained as possible diagnoses. The diagnosis of osteoid osteoma was not established until the disease had progressed for three years and had already become stiff due to epiphyseal remodeling. Resection of the nidus only alleviate pain and joint motion was not improved.
16164207 [Regulation of osteoclastogenesis by activated T cells]. 2005 Sep Bone destruction in rheumatoid arthritis (RA) is caused by osteoclasts, multinuclear cells of the monocyte/macrophage lineage. Since osteoclast differentiation factor RANKL (receptor activator of NF-kappaB ligand) is expressed on activated T cells and T cells, especially Th1 type cells, are implicated in the pathogenesis of RA, it has been believed that they play an important role in the osteoclastogenesis in RA lesions. However, main Th1-type cytokine IFN-gamma strongly suppresses osteoclastogenesis, casting doubt on the relevancy of Th1 cells as stimulators of osteoclastogenesis. Recently, IL-17 from T cells has been reported to enhance osteoclastogenesis. Characterizing real Th subsets which support osteoclastogenesis would be beneficial to solving a clinically important problem, bone destruction in RA.
15773215 [New therapies in ophthalmology: inhibitors of cytokines and chemokines: new treatment per 2005 Jan 12 Anti-TNF-alpha (infliximab and etanercept) are potent, selective inhibitors of the inflammatory cascade. They have been widely used in the therapy of rheumatoid arthritis, Crohn's disease and psoriasis. Their efficacy in ophthalmology has been recently proven. The wide use of cytokines inhibitors could also be very useful in the therapy of neovessels in macular degeneration age-related, since the role of inflammation in the proliferation of neovessels has been recently discovered.
15695580 Clinical trials with complementary therapies. 2005 Mar As interest in complementary and alternative therapies grows, nurses can expect to be asked for advice regarding their use, but there are few clinical studies on which nurses can base their responses. Conducting research with complementary therapies is therefore important for nursing, but there are some pitfalls in doing research with these products, particularly if one is using standard clinical-trials methods. In this article, the authors outline some of those pitfalls based on their experience conducting a clinical trial to examine the effects of elk velvet antler on symptoms of rheumatoid arthritis. They discuss design issues related to justification, method, and ethics and explore some important regulatory issues of which nurses should be aware. Some recommendations are presented to help nurses engaging in such research to avoid problems that could interfere with the smooth conduct of their studies.
20704836 Malignancy risk in autoimmune rheumatic diseases. 2005 Dec Extract: All domains of medical knowledge are rapidly increasing. For example, we now understand more about the fascinating collection of "autoimmune diseases" that share one common feature: an overactive immune system that reacts against normal tissue, causing inflammation and often damage. Simultaneously, there has been an explosion of knowledge in the field of oncology, particularly related to hematological malignancies, including lymphomas. It is in part because of this increased understanding of both autoimmune disorders and malignancy that we have begun to appreciate the links between autoimmune rheumatic disease and cancer risk. In the world of rheumatology (the speciality responsible, in large part, for autoimmune rheumatic conditions), a large body of evidence has been accumulating regarding cancer risk in rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, and scleroderma/systemic sclerosis. A more detailed description of this topic was published elsewhere.
17001436 Reliability, validity and responsiveness of the German Short Musculoskeletal Function Asse 2006 Sep OBJECTIVE: The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to demonstrate the reliability, validity and responsiveness of the German version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-D) in patients undergoing surgical or conservative treatment. METHODS: Three hundred and thirty-two patients suffering from osteoarthritis of the hip or knee, rheumatoid arthritis or rotator cuff tear undergoing surgical or medical inpatient treatment were followed up for 12 month. Patients underwent both SMFA-D and other assessments and clinical as well as radiological examinations. Reliability, validity and responsiveness of the SMFA-D were evaluated. RESULTS: Values of the SMFA-D subscales, Function index (M 22-49, SD 12-20, range 0-96) and Bother index (M 29-52, SD 15-23, range 0-100), showed a normal distribution. Internal consistency (0.88-0.97) and retest reliability (0.71-0.96) coefficients were satisfactory to excellent. In most cases, the SMFA-D correlated significantly with function tests, physicians' function ratings, patients' pain ratings and other quality-of-life questionnaires in all patient subgroups. The results support both the construct and criterion validity of the measure. Different patient groups and subgroups could be discriminated with the SMFA-D scales. The standardized response means of SMFA-D subscales were in surgical patients better than in conservatively treated patients and comparable to those of the SF-36 Physical Component Summary scale. CONCLUSIONS: The German version of SMFA is a reliable, valid and responsive questionnaire in patients with osteoarthritis of the hip or knee, rheumatoid arthritis or rotator cuff tear undergoing surgical or medical inpatient treatment. Thus, the use of the SMFA-D in these patients can be recommended.
21794253 [Resource utilization in a cohort of rheumatoid arthritis patients attended in rheumatolog 2005 Oct OBJECTIVE: To determine resource use over a 1-year period in patients with rheumatoid arthritis (RA) attended in rheumatology units in hospitals within the Spanish public health system. PATIENTS AND METHODS: An observational, longitudinal, prospective, multicenter, 1-year study was performed in randomly selected rheumatology units in hospitals of the Spanish public health system. Patients with RA were randomly selected in each hospital. Four visits (at baseline and every 4 months) were conducted by a rheumatologist not routinely involved in the care of the patient. Demographic and disease-related variables were collected. Patient diaries and systematic interviews were used to gather data on resource use. RESULTS: A total of 301 patients were included and 190 (83% females) completed the study. The mean age was 59 ± 13 years and the mean disease duration was 10 ± 10 years. The resources most heavily used were medical. All of the patients made medical visits with a median of four visits to rheumatologists (1-13). Ninetynine percent of the patients took at least one drug. The most frequent drugs were paracetamol (41%), deflaza-cort (32%), and methotrexate (24%). Laboratory tests were performed in all patients, and x-rays were performed in 59%. Sixty-one patients (32%) were hospitalized; 75% of these patients were non-surgical. The most frequently used non-medical direct resources were meals and home visits by non-medical staff (39%). Thirtyone patients (16%) had some type of work disability. CONCLUSIONS: AR is associated with substantial utilization of medical and non-medical resources related to the disease and work disability.
17110308 Undifferentiated connective tissue diseases (UCTD). 2006 Nov The term undifferentiated connective tissue diseases is used to define conditions characterized by the presence of signs and symptoms suggestive of a systemic autoimmune disease that do not satisfy the classificative criteria for defined connective tissue diseases (CTD) such as systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), rheumatoid arthritis (RA) and others. A small percentage of patients presenting with an undifferentiated profile will develop during the first year follow up of a full blown CTD, however an average of 75% will maintain an undifferentiated clinical course. These patients may be defined as having a stable undifferentiated connective tissue diseases (UCTD). The most characteristic symptoms of UCTD are represented by arthritis and arthralgias, Raynaud's phenomenon, leukopenia, while neurological and kidney involvement are virtually absent. Eighty percent of these patients have a single autoantibody specificity, more frequently anti-Ro and anti-RNP antibodies. Stable UCTD are considered as distinct clinical entities and therefore it has been proposed to define those conditions as UCTD. Classificative criteria have also been proposed and a work to better define them is still under way.
16739201 Development of classification and response criteria for rheumatic diseases. 2006 Jun 15 RELEVANCE TO THE CLINICIAN: Clinicians already know that not all patients who are diagnosed with rheumatic diseases really have them. Moreover, determining which patients have improved and by how much is also difficult. Classification criteria allow clinical researchers to recruit patients with similar diseases (e.g., rheumatoid arthritis or systemic lupus erythematosus) into studies. Response criteria help to determine whether treatments really work, i.e., whether they actually produce clinically important improvement. As the science of clinical research advances, we must update our standards for considering classification and response criteria. In this editorial, members of the American College of Rheumatology (ACR) Subcommittee on Classification and Response Criteria describe the purpose of criteria sets, their development and validation, and the role of the ACR in adopting them.
16565898 Remitting seronegative symmetrical synovitis pitting oedema after BCG instillation. 2006 Jul Remitting seronegative symmetrical synovitis pitting oedema (RS3PE) is a distinct form of seronegative rheumatoid arthritis like polyarthritis. It is characterized by late onset symmetrical joint involvement and pitting oedema of hands and feet (JAMA 254(19):2763-2767, [1]). Polyarthritis secondary to intravesical Bacillus Calmette Guerin (BCG) therapy has been reported (Clin Rheumatol 21:536-537, [2]). To our knowledge, about 0.5% of patients receiving BCG instillation presented polyarthritis, but only one case of RS3PE has been reported (J Rheumatol 28:1699-1701, [3]). We described the second case of RS3PE following intravesical BCG instillation of bladder carcinoma.
17029090 Prevalence of Helicobacter pylori infection and risk of upper gastrointestinal ulcer in pa 2005 We evaluated the prevalence of Helicobacter pylori infection and the association of H. pylori infection and/or nonsteroidal anti-inflammatory drug (NSAID) use with upper gastrointestinal (UGI) ulcers in a cohort of Japanese patients with rheumatoid arthritis (RA). Using the clinical database of the cohort of RA patients and the serum titers of H. pylori antibody, 1815 patients were analyzed. Clinical data were successfully collected for 1529 patients over 2 years, and the history of NSAID use and the occurrence of newly diagnosed UGI ulcer were ascertained by patient self-reports and confirmed by their medical records. A total of 871 patients (49.3%) were H. pylori antibody-positive. Rates of positivity for H. pylori in patients with and without NSAID use were 47.5% and 54.7%, respectively (odds ratio = 0.75, 95% confidence intervals [CI]: 0.58-0.96). The incidence of newly diagnosed UGI ulcer was 0% in the H. pylori-/NSAID- group, 1.24% in the H. pylori-/NSAID+ group, 1.06% in the H. pylori+/NSAID- group, and 3.46% in the H. pylori+/NSAID+ group. The odds ratios of H. pylori infection and NSAID for the occurrence of new UGI ulcers after adjusting for age and sex were 2.97 (95% CI: 1.19-7.38) and 4.31 (95% CI: 0.57-32.4), respectively. Although the prevalence of H. pylori antibody was low in patients with RA compared with that in healthy Japanese individuals, H. pylori infection was a significant risk factor for UGI ulcer in patients with RA.
16007376 Reverse total shoulder arthroplasty for the treatment of defect arthropathy. 2005 Feb OBJECTIVE: Total shoulder replacement for restoration of function and for pain relief of damaged glenohumeral joint accompanied by extensive irreparable cuff defect. INDICATIONS: Any painful shoulder arthropathy with insufficient and irreparable rotator cuff, especially primary defect arthropathy, rheumatoid arthritis with extensive rotator cuff defect, arthropathy after reconstruction of rotator cuff, mutilating rheumatoid arthritis, and crystal-induced arthropathy. Relative: failure of primary shoulder replacement in the presence of an irreparable cuff defect. CONTRAINDICATIONS: Structural or neurogenic lesion of deltoid muscle. Advanced glenoid destruction. Relative: age < 65 years. SURGICAL TECHNIQUE: Anterosuperior or deltopectoral approach. Exposure of glenoid. Resection of humeral head at epi-metaphyseal junction. Complete detachment of anterior, inferior, and posterior capsule from glenoid neck. Preparation of glenoid for cement-free fixation of glenoid base plate (metaglène). Preparation of humeral shaft for implantation of humeral component in 0-10 degrees of retroversion. Screwing of glenosphere to base plate. Insertion of cemented or cement-free modular humeral component. RESULTS: Between 10/1997 and 03/2001, a reverse total shoulder arthroplasty was done in 57 patients (14 men, 43 women; average age 70.1 years). Average follow-up time was 18.2 months. 98% of patients would agree to repeat surgery. Average Constant Score adjusted to age and gender was 94%, 97% for patients not having undergone previous surgery. All patients reported complete or almost complete freedom of pain. On the condition that the deltoid muscle was not damaged during previous surgery, a good improvement of power and function could be obtained. All functional parameters were normal for the patient's age with the exception of a slight limitation of internal rotation (average L5). The power of maintained abduction also corresponded in general to age-specific values. Only grade 1 or 2 inferior glenoid notching was observed but never reaching or surpassing the inferior screw (grade 3 or 4); no glenoid base plate loosening.
17029104 The study of bone mineral density and bone turnover markers in postmenopausal women with a 2005 The aim of this study was to investigate determinants of reduced bone mineral density (BMD) in postmenopausal women with active rheumatoid arthritis (RA) and to evaluate whether there are common markers of bone loss. We evaluated BMD of the femoral neck using dual-energy X-ray absorptiometry, and the measured biochemical markers included serum bone-specific alkaline phosphatase (BALP), serum osteocalcin (OC), and serum cross-linked N-telopeptidases of type I collagen (NTx). Serum BALP and NTx concentrations were measured by enzyme-linked immunsorbent assay, and OC was measured using an immunoradiometric assay. One hundred and forty postmenopausal Japanese women who had not received treatment with bisphosphonates or hormone replacement therapy were entered into the study. Thirty-four patients (41.0%) had femoral osteopenia (T score -1 to -2.5) and 23 patients (27.7%) had osteoporosis (T < -2.5). The body mass index of patients with normal BMD (T score >or= -1.0) was significantly higher (P < 0.01) than in patients with osteoporosis at the femoral neck. The T score exhibited a significant negative correlation with age and the duration of RA disease. Serum BALP and serum OC, markers of osteoblast function, were negatively related to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and matrix metalloproteinase-3 (MMP-3). However, serum NTx, a marker of resorptive function, exhibited a positive correlation with ESR, CRP, and MMP-3. From these results, this study suggests that generalized bone loss occurs in active RA and is characterized by evidence of bone resorption that is correlated with the high levels of inflammation. Body mass index, disease duration, and high serum NTx level were common risk factors in osteoporosis of postmenopausal women with RA.
16052598 Endogenous interleukin-6, but not tumor necrosis factor alpha, contributes to the developm 2005 Aug OBJECTIVE: To generate a mouse model of reactive arthritis (ReA), an aseptic synovitis that develops in joints distant from the primary bacterial infection site, to examine roles for Toll-like receptors (TLRs) that recognize bacterial components involved in the development of this arthritis, and to identify the cytokine(s) relevant to this arthritis. METHODS: Mice were treated with cell wall extract from Escherichia coli (ECW) gram-negative bacterium by injection into the footpads. Seven days later, the mice were challenged with lipopolysaccharide (LPS), a TLR-4 ligand, which was injected into the knee joint cavity. To investigate the cytokine(s) involved in this arthritis, mice deficient in various arthritogenic cytokines, such as interleukin-6 (IL-6), IL-12, IL-18, interferon-gamma, and tumor necrosis factor alpha (TNFalpha), were sequentially treated with ECW and LPS. RESULTS: ECW-primed mice manifested acute severe arthritis after intraarticular challenge with ECW or LPS, while unprimed mice exhibited modest changes after these challenges. Mutant mice lacking functional TLR-4 or myeloid differentiation factor 88 (MyD88), an adaptor molecule of TLR-4 signaling, were resistant to this arthritis. Although both TNFalpha and IL-6 were equally expressed in the joint after LPS challenge, Il6(-/-) mice, but not Tnf(-/-) mice, were resistant to ECW/LPS-induced arthritis. CONCLUSION: Our present results clearly indicate the importance of priming with ECW and the requirement of TLR-4/MyD88-mediated IL-6, but not TNFalpha, for the development of ECW/LPS-induced arthritis. LPS-induced IL-6, in the absence of TNFalpha, mediates LPS-induced arthritis. These results suggest that IL-6 is a rational target for therapeutic regimens for inflammatory arthritis, including ReA and rheumatoid arthritis.
16277688 Effect of a small molecule inhibitor of nuclear factor-kappaB nuclear translocation in a m 2005 A small cell-permeable compound, dehydroxymethylepoxyquinomicin (DHMEQ), does not inhibit phosphorylation and degradation of IkappaB (inhibitor of nuclear factor-kappaB [NF-kappaB]) but selectively inhibits nuclear translocation of activated NF-kappaB. This study aimed to demonstrate the antiarthritic effect of this novel inhibitor of the NF-kappaB pathway in vivo in a murine arthritis model and in vitro in human synovial cells. Collagen-induced arthritis was induced in mice, and after onset of arthritis the mice were treated with DHMEQ (5 mg/kg body weight per day). Using fibroblast-like synoviocyte (FLS) cell lines established from patients with rheumatoid arthritis (RA), NF-kappaB activity was examined by electrophoretic mobility shift assays. The expression of molecules involved in RA pathogenesis was determined by RT-PCR, ELISA, and flow cytometry. The proliferative activity of the cells was estimated with tritiated thymidine incorporation. After 14 days of treatment with DHMEQ, mice with collagen-induced arthritis exhibited decreased severity of arthritis, based on the degree of paw swelling, the number of swollen joints, and radiographic and histopathologic scores, compared with the control mice treated with vehicle alone. In RA FLS stimulated with tumor necrosis factor-alpha, activities of NF-kappaB components p65 and p50 were inhibited by DHMEQ, leading to suppressed expression of the key inflammatory cytokine IL-6, CC chemokine ligand-2 and -5, matrix metalloproteinase-3, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1. The proliferative activity of the cells was also suppressed. This is the first demonstration of an inhibitor of NF-kappaB nuclear translocation exhibiting a therapeutic effect on established murine arthritis, and suppression of inflammatory mediators in FLS was thought to be among the mechanisms underlying such an effect.
17183718 Modulation of T cell function by combination of epitope specific and low dose anticytokine 2006 Dec 20 Innate and adaptive immunity contribute to the pathogenesis of autoimmune arthritis by generating and maintaining inflammation, which leads to tissue damage. Current biological therapies target innate immunity, eminently by interfering with single pro-inflammatory cytokine pathways. This approach has shown excellent efficacy in a good proportion of patients with Rheumatoid Arthritis (RA), but is limited by cost and side effects. Adaptive immunity, particularly T cells with a regulatory function, plays a fundamental role in controlling inflammation in physiologic conditions. A growing body of evidence suggests that modulation of T cell function is impaired in autoimmunity. Restoration of such function could be of significant therapeutic value. We have recently demonstrated that epitope-specific therapy can restore modulation of T cell function in RA patients. Here, we tested the hypothesis that a combination of anti-cytokine and epitope-specific immunotherapy may facilitate the control of autoimmune inflammation by generating active T cell regulation. This novel combination of mucosal tolerization to a pathogenic T cell epitope and single low dose anti-TNFalpha was as therapeutically effective as full dose anti-TNFalpha treatment. Analysis of the underlying immunological mechanisms showed induction of T cell immune deviation.
17183618 Toll-like receptor-2 expression is upregulated in antigen-presenting cells from patients w 2007 Feb OBJECTIVE: To study Toll-like receptor-2 (TLR-2) and TLR-4 expression in antigen-presenting cells from patients with psoriatic arthritis (PsA). METHODS: We measured expression of TLR-2 and TLR-4 in monocyte-derived dendritic cells from patients with PsA and with rheumatoid arthritis (RA), and in healthy controls. Dendritic cells were obtained from freshly isolated monocytes, stimulated with granulocyte macrophage-colony stimulating factor (GM-CSF) and interleukin 4 (IL-4) after 6 days in culture. To obtain mature dendritic cells, lipopolysaccharide stimulation and 2 additional days in culture were necessary. The expression of TLR-2, TLR-4, HLA-DR, and CD86 was studied at baseline, at 6 days, and at 8 days by flow cytometry. To establish the functional properties of TLR expression we studied the following cytokines in cell supernatants: tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, and GM-CSF. TLR-2 expression was confirmed by Western blot analysis. RESULTS: Ten PsA patients with active disease and 8 healthy controls were studied, along with 4 patients with RA. TLR-2 expression was increased in immature dendritic cells from patients with PsA. Monocytes and mature dendritic cells did not show statistically significant differences. No difference was observed in the expression of TLR-4 in any cell type. The supernatant expression of cytokines showed a Th1 pattern, mostly with increased expression of TNF-alpha, IFN-gamma, and IL-2. Western blot analysis confirmed the increased expression of TLR-2. CONCLUSION: Upregulation of TLR-2 expression provides support for a role of the innate immune system in the pathogenesis of PsA.
15885639 Ethinyl estradiol treats collagen-induced arthritis in DBA/1LacJ mice by inhibiting the pr 2005 May We previously demonstrated the therapeutic effects of ethinyl estradiol (EE), an orally active estrogen and a component of birth control pills, in encephalitogenic autoimmune encephalomyelitis (EAE). In this study, we report the effectiveness of EE in treating collagen-induced arthritis (CIA) induced with bovine type II collagen (bCII) in DBA/1LacJ mice, a CIA susceptible strain. Both low and high doses of EE notably suppressed clinical and histological signs of CIA in a dose-dependent manner compared to vehicle-treated controls. Oral treatment with EE decreased proliferation and secretion of pro-inflammatory factors, TNF-alpha IFN-gamma, MCP-1 and IL-6 by bCII peptide-specific T cells, production of bCII-specific IgG2a antibodies, and mRNA for cytokines, chemokines and chemokine receptors in joint tissue. This is the first report demonstrating effective treatment of joint inflammation and clinical signs of CIA with orally administered ethinyl estradiol, thus supporting its possible clinical use for treating rheumatoid arthritis in humans.
17113740 Immunomodulatory activity of the rhizomes of Impatiens pritzellii var. hupehensis on colla 2007 Feb 12 Impatiens pritzellii Hook. f. var. hupehensis Hook. f. (Balsaminaceae) has been well-known and widely used in China as an anti-rheumatoid arthritis (anti-RA) herb. In this present study, mice with collagen-induced arthritis (CIA) have been treated with the methanol (MeOH) extract (0.56, 1.12, 1.68 and 2.24 g/kg body weight) and the n-butanol (BuOH) fraction (0.13, 0.27, 0.40 and 0.53 g/kg body weight) of the rhizomes of Impatiens pritzellii orally for 3 weeks. The progression of CIA was evaluated by macroscopic scoring. Administration of the MeOH extract at dose of 1.12 g/kg and the BuOH fraction at 0.53 g/kg suppressed the development of CIA in mice significantly. The spleen and thymus indexes were measured and the levels of IgG, IL-10, INF-gamma and IL-18 in the serum of CIA mice were examined after the treatment of the MeOH extract (1.12 and 1.68 g/kg body weight) and the BuOH fraction (0.40 and 0.53 g/kg body weight). Administration of the MeOH extract and the BuOH fraction of Impatiens pritzellii decreased the spleen and thymus indexes, down-regulated the levels of IgG, INF-gamma, IL-18, and up-regulated the concentration of IL-10 in the serum of mice with CIA. From the results, it was concluded that administration of Impatiens pritzellii had obviously therapeutic effects on RA including immunomodulatory activity. Moreover, the BuOH fraction exerted the activity of anti-RA of Impatiens pritzellii.