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ID PMID Title PublicationDate abstract
18947372 What magnetic resonance imaging has told us about the pathogenesis of rheumatoid arthritis 2008 Modern imaging modalities, including magnetic resonance imaging (MRI), are valuable diagnostic and therapy monitoring tools in rheumatoid arthritis (RA). This article reviewed how these imaging modalities have greatly improved our understanding of pathogenic mechanisms in RA, namely the link between inflammation and damage. For example, traditional paradigms regarding the mechanisms of joint destruction, including the idea that synovitis and damage are uncoupled, have been challenged. As the power of MRI increases, there is a need to define normality since apparently normal joints occasionally exhibit MRI evidence of synovitis in the absence of symptoms.
17931319 Rheumatoid arthritis patients' education - contents and methods. 2007 Nov AIMS AND OBJECTIVES: The purpose of this study is to describe the contents and methods used by rheumatology nurses when they educate their patients with rheumatoid arthritis. BACKGROUND: Rheumatology nurses have an important role in educating patients with rheumatoid arthritis. However, there is a lack of knowledge on the content provided and the methods used by rheumatology nurses. DESIGN AND METHODS: The sample was drawn in using stratified random sampling and the data were collected from 80 rheumatology nurses with a questionnaire in 2003-2004 (response rate was 65.2%). The data were analysed using descriptive and non-parametric statistical tests. RESULTS: Medical treatment was the most commonly taught issue, as 76% of rheumatology nurses gave information on anti-rheumatic drugs prescribed to the rheumatoid arthritis patients and blood tests (64%) which must be taken as follow-up controls. Only 45% of the nurses discussed self care at home. Individual oral patient education (88%) and written materials by the local hospitals or drug industries (71%), were the most commonly used methods. Patients with rheumatoid arthritis were educated mostly in special health care units. A rheumatology nursing course did not have an effect on the chosen contents or methods when educating rheumatoid arthritis patients. CONCLUSIONS: It is important that rheumatology nurses teach more self-care abilities to patients with rheumatoid arthritis and use also the other teaching methods than oral individual method such as group sessions, teleinformatics and internet. The contents of rheumatology nursing course should be developed further to stress the importance of appropriate teaching methods and to point out the importance of self care abilities for patients. RELEVANCE TO CLINICAL PRACTICE: The results provided useful insight into education of patients with rheumatoid arthritis. Nurses should avoid the routine teaching programmes. They should take time to discuss with their patients and plan together the contents and methods, that education of patients with rheumatoid arthritis is based on patients' information needs and their individual learning capabilities.
19040342 Treatment strategies for a rheumatoid arthritis patient with interstitial lung disease. 2008 Dec This review article describes our present understanding of interstitial lung disease (ILD) complicating rheumatoid arthritis (RA). It discusses its high prevalence and clinical relevance, our recent improvement in understanding both its pathology and physiology, and our expectations of ongoing research into the immunology and genetics of the disease. An important section relates to the effects of drugs routinely used in the treatment of the articular manifestations of RA on the lung, especially in the presence of ILD. The major focus of the article is on therapeutic intervention, and here we discuss traditional and often unsuccessful approaches to treatment, leading on to discuss newly introduced therapeutic options such as anticoagulation and oral N-acetylcysteine. In the later sections, we focus our attention on several promising new therapeutic agents, including mycophenolate and new monoclonal antibody therapies, reviewing the limited literature available to support the use of these agents, concluding with a number of other aspects of treatment that are worthy of consideration.
17404481 [Role of matrix metalloproteinase-3 in joint destruction in rheumatoid arthritis]. 2007 Apr Matrix metalloproteinase-3 (MMP-3) , which is induced by inflammatory cytokines such as interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) in rheumatoid synovium, degrades a number of extracellular matrix components of cartilage, and plays central roles in rheumatoid joint destruction. In addition, serum MMP-3 level is a clinically useful maker for predicting joint destruction and for disease activity in rheumatoid arthritis (RA) . In this review, I summarized the role of MMP-3 in rheumatoid joint destruction, and clinical usefulness of serum MMP-3 level as a laboratory marker in RA.
17106534 Rheumatoid arthritis, cytokines and hypoxia. What is the link? 2006 Nov Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that affects approximately 1% of the population, in a female to male ratio of 3:1. The disease can occur at any age, but it is most common among those aged 40-70 years. Despite many years of study, the etiology of RA is still undefined. However, with increased understanding of the immune system the pathogenesis of RA has become clearer. A large bulk of data suggests that T lymphocytes and macrophages play a critical role in the initiation and perpetuation of synovial inflammation. Recently, the cytokine profile of T helper cells has been associated with the disease, the cytokine repertoire of inflamed synovia is categorized as that of T helper 1 response. Moreover, in RA elevated levels of pro-inflammatory or inflammatory cytokines such as Tumor Necrosis Factor - alpha (TNF-alpha) and Interleukin -1 beta (IL-1beta) have been detected. Hypoxia up-regulates TNF-alpha and IL-1beta; therefore, considerable research interest has been focused on the biological consequences of the hypoxic nature of the rheumatoid synovium. Hypoxia might underlie the functional polarization of the T cells and cytokine production, and thus may contribute to the progression and persistence of the disease. In this short review, we discuss our current knowledge of the link between cytokines and RA and the role of hypoxia in the pathogenesis of the disease.
19041075 Imaging in rheumatoid arthritis--status and recent advances for magnetic resonance imaging 2008 Dec Sensitive and reproducible tools for diagnosis, monitoring of disease activity and damage, and prognostication are essential in the management of patients with rheumatoid arthritis (RA). Conventional radiography (X-ray), the traditional gold standard for imaging in RA, is not able to detect early disease manifestations such as inflammatory changes in the soft tissues (synovitis, tensynovitis, enthesitis etc.) and the earliest stages of bone erosion. In contrast, magnetic resonance imaging (MRI) and ultrasonography (US) allow direct visualization of early inflammatory and destructive joint changes, and have several documented and potential applications in RA patients. This chapter will review key aspects of the current status and recent important advances in imaging in RA, briefly discussing X-ray and computed tomography, and particularly focusing on MRI and US. Suggestions for use in clinical trials and practice are provided.
17049202 Treatment of early rheumatoid arthritis in developing countries. Biologics or disease-modi 2006 Dec Biologics are highly effective in the treatment of rheumatoid arthritis (RA), but they are very expensive. The costs of biologics should limit their usage in patients with RA, especially in the developing countries. Therefore, it is necessary to develop suitable strategies for treating RA patients in these countries. In this article, the efficacy, toxicity, and cost-effectiveness of conventional DMARDs and biologics will be investigated. The therapeutic strategies for treating early RA will also be proposed.
18651051 Citrullination: the loss of tolerance and development of autoimmunity in rheumatoid arthri 2008 Apr Rheumatoid arthritis is a chronic inflammatory disease characterized by synovial inflammation and pannus formation leading to destruction of cartilage and bone. Several self proteins have been suggested to be disease-driving autoantigens. Proteins are encoded by a limited number of genes in our genome. Post-translational modifications such as citrullination of the arginine residues, can increase the morphological and the functional diversity of the proteome. The positivity of anti-citrullinated peptides autoantibodies occurs then at an early stage of the disease development. Several factors, among which the synovial tissue inflammatory and the nitric oxide reaction, are involved in the regulation of the citrullination reaction. All of them have to be analysed and considered to understand the loss of tolerance and the development of autoimmunity leading to the disease.
18429656 Economic evaluations in rheumatoid arthritis: a critical review of measures used to define 2008 We reviewed the clinical measures used in rheumatoid arthritis (RA) economic evaluations with respect to their relevance and sensitivity to changes in survival, health-related quality of life (HR-QOL) and costs. We compared the measures from the economic perspective and discussed the validity of methods used to extrapolate beyond the trial data. Cost-effectiveness evaluations of disease-modifying antirheumatic drugs in RA were identified by searching MEDLINE, EMBASE, Econlit and NHS EED databases. Studies were retained if they extrapolated beyond randomized controlled trial evidence using relationships between clinical measures, costs and utilities. In the 22 studies identified, clinical severity was measured using the Health Assessment Questionnaire (HAQ) Disability Index, the American College of Rheumatology (ACR) response criteria, the Disease Activity Score (DAS) or a combination of the HAQ and DAS. The HAQ is correlated with mortality, costs and HR-QOL instruments, and several studies used linear relationships to model these associations. However, a polynomial relationship or discrete states may be more appropriate for patients at the extremes of the disease spectrum, and numerous HAQ health states may be required to capture differences in mortality risk. While the ACR response criteria is a more comprehensive measure than the HAQ, it is a relative measure, which creates difficulties when estimating absolute changes in HR-QOL, costs and mortality risk. The evidence base linking DAS scores with HR-QOL instruments, costs and mortality is less robust, possibly due to the comparatively recent development of the measure and the limited number of possible scores (mild/moderate/severe). While there is some evidence of a relationship between DAS scores and costs, the DAS does not capture all aspects of HR-QOL, and no significant relationship has been established with mortality risk. Evidence suggests the HAQ to be the primary clinical measure for use in economic evaluations as it is measured in almost all clinical studies, and is closely correlated to health utilities, mortality and costs. While new developments suggest the sensitivity of health states may be improved by combining the HAQ with measures such as the DAS, further research is required in this area. Further research is also required to explore the advantages in using either continuous or discrete health states.
18565264 Simplified composite disease activity measures in rheumatoid arthritis: should they be use 2008 Mar OBJECTIVE: To examine the validity, reliability, and predictive value of two recently developed composite disease activity measures, the Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) in rheumatoid arthritis (RA) patients. METHODS: A systematic review of the published literature was performed between February 2003 and November 2007. Data was extracted regarding correlations of the SDAI and CDAI with standard clinical trial measures, the predictive ability of the measures and correlations with changes in radiographic scores. The ability of the measures to categorize patients according to their disease activity status compared to standard categories was also examined. RESULTS: Among 17 studies initially identified, 12 provided information on the validity and reliability of the SDAI and CDAI. These measures were found to be strongly correlated with the Disease Activity Score (DAS28) with correlation coefficients ranging from 0.80 to 0.93. Areas under the curve (AUC), from receiver operating characteristic (ROC) curve analysis predicting physician responses, varied from 0.821 to 0.923. Moderate association with changes in the HAQ and radiographic scores was found with correlation coefficients ranging from 0.30 to 0.59. Several studies reported mixed results between the measures when categorizing patients according to disease severity with the SDAI and CDAI the more stringent at remission. CONCLUSION: The SDAI and the CDAI were found to have concurrent validity and were highly predictive of a change in therapy, but not predictive of future functional capacity or joint damage. Differences were found when categorizing patients according to disease activity level. Further studies should be conducted, especially at remission and low disease activity status, before these measures are used independently in a clinical setting.
17083758 Definitions of remission for rheumatoid arthritis and review of selected clinical cohorts 2006 Nov Various definitions of remission in rheumatoid arthritis (RA) have been proposed. The ACR (American College of Rheumatology--formerly ARA, American Rheumatism Association) remission criteria are strict and include nonspecific symptoms such as fatigue. More recently remission according to the Disease Activity Index (DAS) and DAS28 has been described. However, patients who meet the DAS28 remission cut point of < 2.6 may nonetheless have tender and/or swollen joints. The ACR remission criteria are more rigorous than the requirement of DAS28 <2.6. Newer tools for evaluation of RA activity include the Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI), and cut points for remission according to these new indices have been defined. However, all available remission criteria may ignore important aspects of RA, including physical function and radiographic damage.
18973928 Thymic Hassall's corpuscles, regulatory T-cells, and rheumatoid arthritis. 2010 Apr OBJECTIVE: To review evidence for the involvement of thymic Hassall's corpuscles (HC) in the pathogenesis of rheumatoid arthritis (RA). METHODS: We used PubMed to search for articles dedicated to the involvement of HC and regulatory T-cells (Tregs) in the pathogenesis of RA, and articles on thymic B-cells. RESULTS: Tregs are central players mediating tolerance to self. The functional defects in Tregs observed in patients with active RA may contribute to RA pathogenesis, promoting the premature immunosenescence of T-cells. This may partly explain the persisting expansion of CD4+ effector T-cell clones in peripheral blood, as well as the parallel improvement of RA activity and numbers of Tregs observed in the third trimester of pregnancy. HC play a major role in the selection of natural Tregs in the thymus, potentially altering the peripheral Tregs repertoire. The promiscuous expression of tissue-specific antigens by thymic medullary epithelial cells shapes the repertoire of natural Tregs. Thus, the presence of 2 major RA autoantigens (immunoglobulins and filaggrin) in the cytoplasm of normal human HC is puzzling, particularly given that thymic B-cells are also concentrated around HC, where CD55 (DAF) and CD59 are strongly expressed. Defects in HC could alter the repertoire of thymic B-cells and Tregs in RA patients, promoting the onset of this disorder. CONCLUSION: The identification of other joint-specific antigens, like gp-39, in HC and medullary epithelial cells, would provide new insights into the mechanisms of RA pathogenesis and may lead to more specific and physiologic methods of immunomodulation.
19170375 Role of immune system, apoptosis and angiogenesis in pathogenesis of rheumatoid arthritis 2007 Dec BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disorder of unknown cause that is notorious for the chronic polyarticular synovial inflammation and progressive destruction of affected joints. Understanding the pathogenesis of RA provides the basis for optimal management of that disease in patients. The pathogenesis of RA was largely explored in many studies in human as much as in mice models with collagen II induced arthritis, nevertheless the pathogenesis puzzle is still incomplete. AIM: The aim of this systematic review was to collect the results of many observations and to put them down into an original story of RA set up. METHODS: An exhaustive electronic and library search of the relevant literature was carried out through "science direct" and "interscience wiley" web sites. The key words used for the search were "rheumatoid arthritis", "pathogenesis", "apoptosis", "angiogenesis", "immune response" and "joint destruction". RESULTS: The suspected responsible antigen isn't yet determined although the great specificity of anti-CCP antibodies suggests that this antigen carries probably many citrullinated residues. The immuno-pathogenesis of RA involves both the innate and the adaptive immune system. In the other hand, apoptosis defect contribute to hyperplasia of rheumatoid synovium and in extended half life of fibroblast like synoviocytes (FLS), neutrophils and many other cells implied in rheumatoid synovitis. Hyperplasia of synovium leads to ischemia and that results in neo-angiogenesis with increase of proangiogenic factors such as VEGF. The last part of the pathogenesis of RA is the joint destruction resulting from increased MMP production and activation of osteoclasts which leads to the breakup of cartilage and to bone damage.
17573069 Effect of conjugated linoleic acid on bone formation and rheumatoid arthritis. 2007 Jul 30 Conjugated linoleic acid (CLA) has shown a variety of biologically beneficial effects. Dietary CLA inhibits eddosteal bone resorption, increases endocortical bone formation, and modulates the action and expression of cyclooxygenase (COX) enzyme, thereby decreasing prostaglandin-dependent bone resorption. CLA also enhances calcium absorption and may improve bone formation in animals, although results are not consistent. Since CLA can also affect inflammatory cytokines, it is hypothesized that CLA may be a good tool for prevention or reduction of rheumatoid arthritis symptoms. The possible mechanisms by which CLA prevents rheumatoid arthritis as well as other inflammatory diseases is discussed.
16736847 [Anti-CCP antibody test: diagnostic and pronostic values in rheumatoid arthritis]. 2006 Mar Rheumatoid arthritis is an auto-immune disorder which diagnosis is based on clinical, radiological and biological criteria. Disease progression is characterized by appearance of bone erosions and progressive articular deformations which attenuate functional mobility. Only rheumatoid factor is actually considered as biological factor among recognized diagnostical criteria despite its weak sensibility and specificity rates. Anti-cyclic citrullinated peptides antibodies are directed toward citrullinated isoforms of some filaggrin's epitopes. Their sensitivity and specificity reach respectively 80 and 99%. Their presence is correlated to disease activity and to bone erosions development. They allow early identification and treatment of rheumatoid arthritis affected patients which is actually considered as a priority.
17874631 [Cyclophosphamide in the therapy of rheumatoid arthritis and its complications]. 2007 Jun Cyclophosphamide has been used in the therapy of rheumatoid arthritis (RA) for nearly fifty years. An experience gathered throughout that time helped to identify indications, profits, restrictions and side effects related to its use. As a result of the progress in RA therapy in the recent years, including introduction of anti - TNF alpha therapy, the importance of cyclophosphamide significantly decreased. However, despite all restrictions related to its use, there are still RA patients for whom cyclophosphamide can be considered as a first choice drug. In this article we review the current knowledge on the issue.
17765842 Wound healing complications and infection following surgery for rheumatoid arthritis. 2007 Sep The goal of the foot and ankle surgeon is to achieve balanced correction of deformity in patients who have rheumatoid arthritis (RA) while minimizing the risk for complications. To achieve these goals, a large number of procedures may be required at a single or in a staged operative setting. In this article, the evaluation of the patient to assess operative risks and the management of perioperative complications in the RA foot and ankle patient are presented.
17083764 Low disease activity state in rheumatoid arthritis: concepts and derivation of minimal dis 2006 Nov With recent advances in therapy, the proportion of patients achieving a satisfactory state of minimal disease activity (MDA) is becoming a more important measure with which to compare different treatment strategies. MDA is between high disease activity and remission and anyone in remission will also be in MDA. This paper summarizes the process of coming to a definition of minimal disease activity in rheumatoid arthritis. Two equivalent preliminary definitions of minimal disease activity for use as secondary outcome measures in clinical trials in RA are proposed: a core-set definition based on the WHO/ILAR core set and a DAS-based definition based on the DAS28.
17607076 [Absolute risk for fracture and WHO guideline. Epidemiology of rheumatoid arthritis]. 2007 Jul Japan has been assumed to be a country with a low prevalence of rheumatoid arthritis (RA) . However, when comparing the RA prevalence among different countries in the middle age or in the older ages, in which RA predominantly occurs, RA prevalence of Japan is somewhat lower than that of United Kingdom, Finland, and United States, but is similar to that of Norway, France, and Greece. Several reports showed that RA incidence has been decreasing recently. This indicates that non-genetic factors are related to the occurrence of RA and that such factors have been decreasing with time.
19076355 Anti-CCP Antibody, a Marker for the Early Detection of Rheumatoid Arthritis. 2008 Nov Rheumatoid arthritis (RA) is a common autoimmune disease characterized by chronic inflammation of synovial joints. In most cases this will lead to the formation of pannus tissue, ultimately leading to joint destruction. Early diagnosis, coupled with aggressive use of disease-modifying antirheumatic drugs, has been shown to have a favorable effect on the course of the disease. Therefore, early and accurate diagnosis has become increasingly important. Several sets of criteria have been published to achieve such an early diagnosis, and all of them include measurement of antibodies directed to citrullinated peptides or proteins. This review summarizes our present knowledge about the most well-known and established test to measure these antibodies, the anti-CCP test, which measures antibodies directed to cyclic citrullinated peptides. We describe the current views on how these antibodies are generated and how genetic and environmental parameters are important in this process. The anti-CCP test is more specific than the commonly used RF test (95% versus less than 90%) and has a comparable sensitivity (more than 70%). These antibodies are detectable very early in the disease and are reported to predict the development of erosive RA. Increasing evidence supports a role for these antibodies in the pathology of the disease. In conclusion, testing for anti-CCP autoantibodies is widely accepted as an indispensable tool for diagnosis and early treatment in the management of rheumatoid arthritis patients.