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ID PMID Title PublicationDate abstract
17221243 [Macrophage specific MRI imaging for antigen induced arthritides. A potential new strategy 2007 Jan PURPOSE: The present work describes the potential of iron oxides for the detection of macrophages in synovitis in experimental, antigen-induced arthritis. METHODS: The pivotal role of macrophages in rheumatoid arthritis (RA) in humans and in antigen-induced arthritis (AIA) in animal models is discussed. The latter appear to be very similar in many aspects to the human RA. We show the potential for iron oxide-enhanced magnetic resonance imaging (MRI) to determine the macrophage content in the arthritic synovial membranes. The results of our own research, as well as those of other research groups, are presented and discussed. RESULTS: MRI after the intravenous (i.v.) administration of iron oxides enables the depiction of macrophage content in arthritic synovial membranes in AIA through the effects of the intracellular compartmentalisation of iron oxide particles. These effects can be demonstrated in 24-h delayed images after i.v. contrast application, on T2-weighted spin-echo or turbo-spin-echo sequences, and especially on T2*-weighted gradient-echo sequences. The signal effects are not only apparent in high field strength (4.7 Tesla) but also on 1.5 Tesla clinical scanners. CONCLUSIONS AND PERSPECTIVES: The use of iron oxides enables the determination of the macrophage content in synovitis in animals with AIA. This parameter represents a potential marker to determine disease activity, and possibly represents a marker to evaluate the effectiveness of specific therapies in human RA. Current knowledge of iron oxide-enhanced MRI is limited to animal models. The clinical evaluation of this new method in patients with RA has not yet been performed. However, based on the considerations presented here, significant progress in the diagnostic work-up of RA can be expected.
17642231 [Mortality and functional prognosis in rheumatoid arthritis]. 2007 Jul Rheumatoid arthritis (RA) is characterized with inflammation of joints and damage of joints tissue. Therefore it induced the disability and handicap in RA patients. This paper described the mortality and functional prognosis in rheumatoid arthritis patients. The numerous number of studies concerning on mortality in RA patients revealed that RA is not benign disease, provided excess rate of mortality compared to normal population. The degree of joints damages was conventionally assessed with radiographic images. So X-P images reflects the course of disease activity and disabilities in RA. The previous assessments with X-P images revealed that the bone erosions and joint space narrowing occurred within two years after onset of RA among approximately 70 % patients. Now it is considered that the joint destruction induced early stage of RA, therefore the promising therapy are needed for the patients who are at risk of poor prognosis. It should be investigated whether the biologic drugs, including TNFalpha inhibitor can alter the mortality and functional prognosis in RA patients.
18817647 Inhibiting interleukin-6 in rheumatoid arthritis. 2008 Oct Interleukin (IL)-6 is the most abundant proinflammatory cytokine in the circulation and synovial joints of patients with active rheumatoid arthritis. It has pivotal roles in the immune response and inflammation. In rheumatoid arthritis, it causes synovitis, joint destruction, and many systemic manifestations. Clinical trials of tocilizumab, a humanized anti-IL-6 receptor monoclonal antibody that blocks IL-6 signaling, have demonstrated therapeutic benefit. It heralds a new era of anticytokine therapy in rheumatoid arthritis.
16649008 Pregnancy outcomes in women with rheumatoid arthritis in Washington State. 2006 Jul OBJECTIVE: To determine whether rheumatoid arthritis (RA) is associated with increased adverse obstetric or neonatal outcomes. STUDY DESIGN AND SETTING: Washington State birth records and hospital discharge data between 1987 and 2001 identified a cohort of women with rheumatoid arthritis and a comparison group of women without rheumatoid arthritis. Pregnancy and neonatal outcomes were compared using general linear models for common outcomes, calculating approximate relative risks and 95% confidence intervals. RESULTS: There were 243 women with rheumatoid arthritis and 2,559 controls. Infants of women with rheumatoid arthritis had increased risk of cesarean delivery (adjusted approximate relative risk, aRR=1.66, 95% CI (1.22, 2.26)), prematurity (aRR=1.78, 95% CI (1.21, 2.60)), and longer birth hospitalization (aRR=1.86, 95% CI (1.32, 2.60)) compared to those born to women without rheumatoid arthritis. CONCLUSIONS: We speculate that the increased risks for cesarean delivery, prematurity, and longer hospitalization at birth among infants born to women with rheumatoid arthritis may be due to the pathophysiologic changes associated with rheumatoid arthritis or medications used to treat the disease.
17689710 Pulmonary hypertension in rheumatoid arthritis--relation with the duration of the disease. 2008 Jul 21 Isolated pulmonary hypertension with clinical implication is rare in rheumatoid arthritis. We sought to study the prevalence of pulmonary arterial hypertension in an unselected population of 45 patients with rheumatoid arthritis (classified according to the ARA criteria) without cardiac disease and corresponding age and sex matched controls by Doppler echocardiography. The pulmonary artery systolic pressure was higher in patients with Rheumatoid Arthritis (27.49+/-12.66 mm Hg) than in controls (20.40+/-8.88) (p=0.003). Incidence of pulmonary artery systolic pressure>30 mm Hg suggesting pulmonary hypertension was significantly higher in patients with RA (26.7% versus 4.5% in controls; p=0.03) and 20% of patients had pulmonary hypertension without lung disease or cardiac disease evident on pulmonary function testing, and echocardiogram respectively. There was also a strong correlation between the pulmonary artery pressure and the disease duration (r=0.68, p<0.0001) suggesting a subclinical involvement of the pulmonary vasculature with disease progression and may be relevant to the high incidence of cardiovascular deaths observed in patients with Rheumatoid Arthritis.
18528693 Peripheral neuropathies of the forearm and hand in rheumatoid arthritis: diagnosis and opt 2008 Aug Although the clinical hallmark of rheumatoid arthritis (RA) involves inflammatory joint disease, extra-articular manifestations may be evident in 20% of patients. Among them neurologic features involving both the peripheral and central nervous system are one of the more common, but little has been noticed about it in clinic. The same mechanisms participating in joint destruction, synovial inflammation, and vasculitis contribute to the various RA neurological complications. In this article, we reviewed clinical outcomes of peripheral neuropathies of the upper extremity associated with RA and discussed the proper diagnosis and operative indication. Magnetic resonance imaging and electrophysiological examination are the best tools to lead the final diagnosis of nerve palsy secondary to RA synovial cyst. Such neuropathies require consideration in the differential diagnosis of wrist and hand disability. Surgical decompression is recommended at prompt timing if neurophysiologic studies demonstrate denervation or significant motor abnormalities, or sensory symptoms progress despite adequate medication.
16872026 Depression and anxiety in rheumatoid arthritis: the role of perceived social support. 2006 Apr BACKGROUND: Rheumatoid arthritis is a common, disabling, autoimmune disease with significant psychiatric sequelae. AIMS: We aimed to identify the prevalence of depression and anxiety in patients with rheumatoid arthritis attending hospitals, and to elucidate the role played by illness variables, disability variables and psychosocial variables in predicting levels of depression and anxiety. METHODS: We assessed depression, anxiety, arthritis-related pain, arthritis-related disability and perceived social support in 68 adults with rheumatoid arthritis. RESULTS: Sixty-five per cent of patients had evidence of depression (37.5% moderate or severe) and 44.4% had evidence of anxiety (17.8% moderate or severe). Both depression and anxiety were highly correlated with several measures of arthritis-related pain and functional impairment. After controlling for age, gender, marital status and duration of arthritis, perceived social support was a highly significant independent predictor of both depression and anxiety. CONCLUSIONS: These findings suggest that increasing social support may be particularly important in the management of depression and anxiety in rheumatoid arthritis.
17922665 Personalized medicine in rheumatoid arthritis: hopes and challenges. 2007 Clinicians have an increasing number of therapeutic agents available for the treatment of rheumatoid arthritis (RA). Pharmacogenetics, the study of genetic variation underlying differential response to drugs, seeks to improve treatment of individual patients. Multiple markers of treatment response have been analyzed in RA, but many of the studies are small and retrospective in nature. There are many obstacles to personalized medicine for RA patients, including incomplete understanding of disease pathogenesis, effecting changes in physician behavior, and acceptance of costs by health insurers. Despite these many obstacles, there are many reasons for optimism for future personalized medicine in RA. There have been remarkable advances in genomics, proteomics, and statistical analyses of large amounts of data. The goal of identifying genetic, serum, and clinical factors that allow profiling of individual patients to predict optimal treatment regimens is a worthy pursuit which will hopefully improve clinical care of RA patients.
16935911 Radiological damage in patients with rheumatoid arthritis on sustained remission. 2007 Mar OBJECTIVE: To assess the radiological damage progression in patients with recent rheumatoid arthritis in sustained remission. METHODS: A cohort of 191 patients with active early (<1 year) rheumatoid arthritis was prospectively assessed at baseline, 3 and 5 years by the Disease Activity Score (DAS) and the Sharp-van der Heijde Score (SHS) for radiographic damage. Patients in remission (DAS<1.6) at the 3-year and 5-year time points were compared with patients with a persistently active rheumatoid arthritis by Wilcoxon's signed rank test. RESULTS: 57 patients died, were lost to follow-up or had incomplete data; 30 (15.7% of those who completed) patients were in remission at 3 and 5 years. The SHS in these two groups was not significantly different at baseline (p = 0.15), but was lower in the remission group at 5 years (p = 0.0047). The median (IQR) radiographic score increased from 0.5 (0-7) at baseline to 2.5 (0-14) after 5 years for the remission group (p = 0.18) and from 2 (0-7) to 13 (3-29) in the group with active rheumatoid arthritis (p<0.001). 5 (16.7%) patients in remission had relevant progression of radiographic damage (ie, progression >4.1 points) and 6 (20%) presented new erosions in a previously unaffected joint between the third and the fifth years. CONCLUSION: Patients with early rheumatoid arthritis in sustained remission did not present statistically significant radiographic degradation at the group level; nevertheless, 16.7% of these patients did present degradation. Absence of progression should be part of the remission definition in rheumatoid arthritis.
16922350 [The humoral response in rheumatoid arthritis and the effect of B-cell depleting therapy]. 2006 Jul 29 Recent research has shown that the humoral response plays an important role in the pathogenesis of rheumatoid arthritis. B-cells produce rheumatoid factors and antibodies directed against cyclic citrullinated peptides (anti-CCP antibodies) and are able to present auto-antigens to T-cells. Furthermore, B-cells can produce cytokines and stimulate T-cells. B-cell depletion with rituximab, a monoclonal antibody directed against CD20, has a surprisingly strong and long-lasting therapeutic effect. After administration a sharp decrease of specific auto-antibody titres has been observed. Future developments in B-cell targeted therapy are expected to lead to further improvements in the treatment of rheumatoid arthritis and other autoimmune diseases.
18825134 Dietary antioxidants in inflammatory arthritis: do they have any role in etiology or thera 2008 Nov Rheumatoid arthritis is an autoimmune-mediated inflammatory disease of unknown etiology, and is characterized by joint pain and soft-tissue swelling. The role of dietary antioxidants in the prevention and amelioration of symptoms in inflammatory joint disease has been of interest for many years. Epidemiological studies provide evidence of a link between dietary antioxidant intake and the likelihood of developing inflammatory arthritis. Interventional studies of antioxidant supplementation in established disease have been inconclusive overall; however, the quality of such studies has often been poor. The pathways by which antioxidant compounds might act are now better understood. In this Review, we explore not only some of the accepted mechanisms of antioxidant function but also outline some concepts that could aid further investigation of the potential therapeutic role of dietary antioxidants in inflammatory arthritis.
17931330 Persistent severe fatigue in patients with rheumatoid arthritis. 2007 Nov AIM: To determine whether persistent severe fatigue in patients with rheumatoid arthritis can be predicted by inflammation and disability. METHODS: A follow-up study with a one-year duration was performed. From an existing rheumatoid arthritis cohort, 150 consecutive patients, with established rheumatoid arthritis, were asked to assess fatigue, using the subscale Checklist Individual Strength-fatigue of the Checklist Individual Strength at baseline and 12 months later. The Checklist Individual Strength-fatigue scores were classified into 'normal' (score between 8-27), 'moderate' (score between 27-34) or 'severe' (score 35 or above) fatigue. Disease-related variables were: tender joints, swollen joints, general health, disability and laboratory measures (erythrocyte sedimentation rate, rheumatoid factor and haemoglobin). Predictors of persistent severe fatigue were identified by multiple logistic regression analyses with backward selection (selection criteria: p<0.05). RESULTS: At baseline, 137 patients agreed to participate and 123 patients completed the study. Severe fatigue was experienced by as many as 50% of the patients, both at baseline and at the end of the study (n = 123). Moreover, 49 patients (40%) experienced severe fatigue at baseline as well as at follow-up, which we called 'persistent severe fatigue'. Persistent severe fatigue was predicted by mean general health and disability at baseline [odds ratio (OR) = 2.03 and 2.83, respectively] in this group of rheumatoid arthritis patients with a low-to-moderate level of disease activity and disability. CONCLUSION: The data show that severe fatigue is not resolved spontaneously in rheumatoid arthritis patients, and persistent severe fatigue is mainly predicted by general health and disability. The relation with inflammation or a low level of haemoglobin, which is often assumed in clinical practice, was not found. RELEVANCE TO CLINICAL PRACTICE: Fatigue in patients with rheumatoid arthritis has to be considered as a symptom that needs to be addressed by professionals in the same way as pain and disability. In current care, fatigue is insufficiently addressed.
17404483 [Repair of bone and articular destruction in rheumatoid arthritis]. 2007 Apr Repair of bone and articular destruction in rheumatoid arthritis (RA) is major problem to treat RA patients recently. However bone destruction starts in early phase of disease duration in RA. Histological meta-analysis of synovium is one of a key to solve the problem in RA. We investigated synovial histology about five factors including synovial proliferation, pillonodular synovium, vascular proliferation, and fibrin deposit and lymphocyte infiltration. Disease duration and pilonodular synovium has significant correlation by multiple regression analysis (p = 0.018). Therefore pillonodular synovium is important to decrease bone destruction in RA. It is possible that biological treatment for RA is effective to bone and cartilage metabolism, however some cases do not improve bone metabolism. Further investigation needs to analyze the factors of efficacy of bone and cartilage metabolism.
17404490 [Efficacy of tacrolimus for joint destruction in rheumatoid arthritis]. 2007 Apr Since joint destruction, the most important problem in rheumatoid arthritis (RA) , progress rapidly at the onset of the disease, initial treatment using appropriate disease-modifying anti-rheumatic drug DMARD such as methotrexate (MTX) is strongly recommended in order to retard progression of joint damage. However, not a few patients are resistant to MTX and/or intolerant of MTX. Oral tacrolimus 1.5-3 mg/day, an immunosuppressive drug, was approved in Japan for the treatment of RA insufficient to other DMARD. The properties of tacrolimus have the much potential of inhibition of T cell activation, suppressing the production of pro-inflammatory cytokines, improvement of joint inflammation, retarding bone and cartilage destruction, overcoming drug-resistance and so on and, thereby, tacrolimus can be the best alternative to MTX and biologics in RA patients who are refractory to or intolerant of these other drugs.
18781313 [Rheumatoid shoulder: does minimally invasive therapy make sense?]. 2008 Oct Surgical treatment of patients with rheumatoid arthritis of the shoulder should be one part of a concept of conservative and surgical treatment. In addition to disease-modifying agents, local minimally invasive surgery can avoid structural damage to the shoulder and furthermore achieve a restitution of shoulder function. According to Larsen Stage 0-III, an arthroscopic synovectomy and bursectomy can achieve a good prognosis and help to avoid further structural damage to the rheumatoid shoulder. Minimally invasive procedures in the surgery of the rheumatoid shoulder lead to less immobilisation and faster rehabilitation, to the benefit of the joints in the operated limb, much like therapy of the knee. It is also possible to treat associated pathologies with minimally invasive surgery, such as bursitis, small rotator cuff defects, and synovitis of the acromioclavicular joint, as well as synovectomy of the glenohumeral joint Good results can be achieved in these cases using minimally invasive surgery. However, minimally invasive reconstructive procedures are limited in the rheumatoid shoulder.
17563541 Forearm haemodynamics, arterial stiffness and microcirculatory reactivity in rheumatoid ar 2007 Jun OBJECTIVES: Cardiovascular disease is the major cause of mortality in patients with rheumatoid arthritis. This work studied the presence of impaired forearm haemodynamics, arterial stiffness and microcirculatory reactivity in young women with rheumatoid arthritis. METHODS: Sixty-five women aged 41-52 years, with rheumatoid arthritis, were screened for the absence of common cardiovascular risk factors. They underwent laser Doppler study on the hand at rest and after ischaemia, endothelium-dependent dilation with colour Doppler ultrasound and pulsewave velocity (PWV). Forty healthy subjects were also examined. RESULTS: Microcirculatory flux at rest with laser Doppler was reduced in rheumatoid arthritis patients (112 +/- 45 versus 220 +/- 65 perfusion units (PU, arbitrary units); P < 0.005), post-ischaemic peak flow was lower in rheumatoid arthritis patients (235 +/- 65 versus 329 +/- 76 PU; P < 0.05); percentage increase in peak flow was higher in rheumatoid arthritis patients compared with healthy subjects (153 +/- 12 versus 65 +/- 18%; P < 0.005). Time to peak flow was longer in rheumatoid arthritis patients (12.7 +/- 8 versus 6.2 +/- 2 s; P < 0.005). Higher microcirculatory resistance was detected in rheumatoid arthritis patients (0.656 +/- 0.011 versus 0.358 +/- 0.009 mmHg/PU; P < 0.05). Endothelium-dependent dilation was impaired in rheumatoid arthritis patients (increase in artery dilation 8.2 +/- 2 versus 11.5 +/- 3%; P < 0.05) and correlated directly with actual C-reactive protein. PWV was higher in rheumatoid arthritis patients (9.3 +/- 0.2 versus 8.4 +/- 0.4 m/s; P < 0.05) and correlated directly with the duration of disease. District resistance by the arm was higher in rheumatoid arthritis patients (1098 +/- 190 versus 661 +/- 55 mmHg/l per minute; P < 0.005). CONCLUSION: Female rheumatoid arthritis patients present with impaired microcirculatory reactivity, endothelial dysfunction and increased arterial stiffness. Alterations in the vascular bed are extended and may explain the increased incidence of cardiovascular events in these patients.
17332982 Depressive symptoms in early rheumatoid arthritis: a comparative longitudinal study. 2007 May Our objective was to investigate symptoms of depression in early rheumatoid arthritis (eRA) patients, and follow them longitudinally during a 3-year prospective study of 73 Hungarian and 45 Austrian early rheumatoid arthritis patients. Compared to validated national population data, mild symptoms of depression were detected in Hungarian early rheumatoid arthritis patients, which were independent of corticosteroid use. In the Hungarian subgroup, the Beck Depression Inventory scores were found to be stable during follow-up. Except at the baseline visit, depressive symptoms and functional status, as measured by the Health Assessment Questionnaire, were correlated. Significant differences were detected between Austrian and Hungarian patients despite of their geographical and cultural proximity. The mean depression score was higher in the Hungarian when compared to the Austrian patients. Depression is an important feature of early rheumatoid arthritis. Studies assessing depression in rheumatoid arthritis patients must be based on validated national data of normal population.
17404473 [Imaging approach for the evaluation of the bone and joint destruction in rheumatoid arthr 2007 Apr This review summarizes the clinical significance of imaging studies, conventional radiography and magnetic resonance imaging (MRI) imaging, in the evaluation of bone and joint destruction in rheumatoid arthritis (RA) . Conventional radiography is a standard technique for the diagnosis and evaluation of RA, which can demonstrate characteristic features of bone erosion and joint space narrowing in RA. A number of reports have described the efficacy of MRI in demonstrating synovitis and bone changes with a greater sensitivity than conventional radiography. MRI is helpful in diagnosis of early RA, evaluation of treatment effect and prediction of clinical outcome at its early stage. However, the benefits of MRI for the diagnosis and management of rheumatoid arthritis are still being elucidated.
17468731 Corticosteroids, a review. 2007 Mar Recent studies have shown a strong correlation between the nervous, endocrine and immune systems. Knowledge of how these systems interact is important for understanding the pathogenesis of autoimmune diseases such as rheumatoid arthritis (RA) and to open new therapeutic perspectives. New theories suggest that in RA there is an inappropriate response of the hypothalamic-pituitary-adrenal axis to the increase in pro-inflammatory cytokines, resulting in a corticosteroid (CS) insufficiency state. While recent observations have questioned the positive effect of CS on the progression of joint damage, efficacious new drugs such as anti-TNF have attracted attention to agents without the side effects of CS. Cartilage oligomeric matrix protein, a new biohumoral marker, has recently led to a re-evaluation of CS in RA therapy.
17476940 [Pregnancy and rheumatoid arthritis--rheumatic, obstetric and gynecologic aspects]. 2007 Apr Initial onset of rheumatoid arthritis (RA) during pregnancy is very rare. Significant improvement of symptoms and signs of RA occurs in most patients in the first trimester and persists throughout the pregnancy. The disease usually flares up a few months after delivery. Various hormonal changes which occur during pregnancy contribute to the observed amelioration. One of these changes is enhanced activity of T helper cells (Th2) and down-regulation of TH1 cells. As a result there is also decreased production of proinflammatory cytokines such as TNF-alpha and others. In addition, maternal-fetal disparity in the class II antigens HLA-DR and HLA-DQ correlates significantly with the amelioration of RA during pregnancy. Most of the disease-modifying anti-rheumatic drugs are contraindicated or non-recommended during pregnancy and lactation. There is insufficient data about the safety of the new biologic drugs such as anti-TNF-alpha during pregnancy, although a few recently published studies did not reveal any complications or unexpected side effects on the course of pregnancy and outcome of the newborn. The obstetric and gynecologic complications are rare and negligible.