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ID PMID Title PublicationDate abstract
18561872 Disease activity in rheumatoid arthritis as a predictor of difficult intubation? 2008 Oct BACKGROUND AND OBJECTIVES: Rheumatoid arthritis is a lifelong systemic disease that can affect any joint with a synovium. Managing intubation in patients with rheumatoid disease is a special challenge in these patients especially if specific joints, which play an important role during intubation, are affected. We aimed to investigate if there was a correlation between the activity and duration of the disease and the commonly used predictors of difficult intubation in rheumatoid arthritis. METHODS: Sixty-six patients with the diagnosis of rheumatoid arthritis and 60 control patients were included in the study. Patient characteristics were recorded. Body mass index, disease activity scores, Mallampati classification, sternomental distance, thyromental distance, inter-incisor distance and atlanto-occipital joint extension were measured for each patient. Every patient was asked to complete the Stanford Health Assessment Questionnaire (HAQ score). Disease activity score (DAS 28 score) including 28 joints was used to assess the activity of the disease. Correlation between the predictors of difficult intubation and activity was assessed and was compared with the control group. RESULTS: Mallampati scores were higher (P = 0.000), sternomental distance (P = 0.005) and inter-incisor distance (P = 0.003) were shorter and also occlusal surfacetragus line angle were smaller in the rheumatoid arthritis group compared with controls (P = 0.000). We did not observe a correlation between the disease activity scores and the Mallampati score (P = 0.619), sternomental distance (P = 0.195), thyromental distance (P = 0.174), inter-incisor distance (P = 0.764), angle I (P = 0.372) and angle II (P = 0.609). There was no correlation between the HAQ score and the Mallampati score (P = 0.872), sternomental distance (P = 0.455), thyromental distance (P = 0.841), inter-incisor distance (P = 0.162), angle I (P = 0.768) and angle II (P = 0.287). There was no correlation between the duration of the disease and the Mallampati score (P = 0.619), sternomental distance (P = 0.505), thyromental distance (P = 0.426), inter-incisor distance (P = 0.813), angle I (P = 0.377) and angle II (P = 0.600). CONCLUSION: Tests of disease activity and the duration of the disease were not found to be correlated with the predictors of difficult intubation in this study. Thus, performing the predictive tests for difficult intubation especially in patients with very low scores or short disease is recommended.
18218667 Rheumatoid arthritis is milder in the new millennium: health status in patients with rheum 2008 Dec OBJECTIVES: During the last decades major advances have occurred in the treatment of patients with rheumatoid arthritis (RA), and improvements in the burden of the disease have been suggested. We examined whether there was a secular change towards less severe disease from 1994 to 2004 among patients within the representative setting of the Oslo Rheumatoid Arthritis Register (ORAR). METHODS: All living patients in the ORAR received a postal questionnaire in 1994, 1996, 2001 and 2004, including the Modified Health Assessment Questionnaire (MHAQ), SF-36, Arthritis Impact Measurement Scales 2 (AIMS2) and visual analogue scales for the patient global assessment of disease severity, pain and fatigue. A mixed model approach was used for longitudinal analysis adjusting for sex, age, co-morbidity, and for disease duration and DMARD if indicated. RESULTS: The numbers of respondents aged between 20 and 79 years in 1994, 1996, 2001 and 2004 were 931, 1025, 829 and 914 patients with similar demographic characteristics (mean age in 1994 was 60.6 years, mean disease duration 12.6 years, 78% females). Health status in the population with RA was consistently improved in all dimensions of health, and this improvement was statistically significant for the physical dimension, global health and pain over the 10-year period until 2004. Both year of examination and year of disease onset had an effect on measures of longitudinal health status outcome. CONCLUSIONS: Health status in RA improved from 1994 to 2004, probably due to access to better and more aggressive treatments.
16300987 Statins in rheumatology. 2006 Mar Statins were developed for the treatment of lipid disorders and have been proved to reduce cardiovascular morbidity and mortality when used for primary or secondary prevention. Beneficial effects in patients with osteoporotic fractures or rheumatoid arthritis (RA) have been suggested but remain unproven. Cardiovascular morbidity and mortality are increased in patients with RA or systemic lupus erythematosus, who should undergo serum lipid assays. When these show dyslipidemia, statin therapy should be started according to current recommendations.
17404484 [Inhibition of radiographic progression in rheumatoid arthritis by anti-rheumatic drugs (D 2007 Apr From the results of recent randomized controlled clinical trials of disease modifying antirheumatic drugs (DMARDs), slowing radiographic progression has been documented with the use of methotrexate, leflunomide, salazusulfapyridine, IM gold, and cyclosporine. Although the effects of DMARDs is inferior to that of anti-tumor necrosis factor (TNF) agents, DMARDs can stop the progression of joint damage with the achievement of remission or good response.
17330681 Levofloxacin treatment in patients with rheumatoid arthritis receiving methotrexate. 2007 Feb BACKGROUND: Sulfasalazine and tetracyclines are effective against rheumatoid arthritis (RA). Levofloxacin, the bacteriologically active isomer of ofloxacin, is used in the treatment of infections caused by periodontopathic bacteria and facultative anaerobic bacteria. The aim of this study is to evaluate the clinical efficacy, safety, and tolerability of levofloxacin in patients with rheumatoid arthritis. METHODS: In a 6-month, double-blind trial, we randomly assigned 76 patients with persistently active rheumatoid arthritis despite at least 6 months of methotrexate therapy at a stable dose of 15 to 25 mg per week to receive either levofloxacin (500 mg) or placebo orally once daily while continuing to receive methotrexate. The change from baseline to six months in the swollen-joint count and tender-joint count was the primary measure of efficacy. Secondary endpoints included pain, quality of life, duration of morning stiffness, erythrocyte sedimentation rate, C-reactive protein level, and physician's and patient's global assessments. The data were also analyzed to determine the number of patients meeting American College of Rheumatology criteria for 20, 50, and 70% improvement. RESULTS: The levofloxacin plus methotrexate was associated with the greatest reduction in the number of swollen or tender joints (P < 0.001). The levofloxacin plus methotrexate group also had significant improvement in many of the secondary outcome measures (P < 0.001). Levofloxacin was well tolerated. There were no dose-limiting toxic effects. CONCLUSION: In patients with active rheumatoid arthritis who received methotrexate, treatment with levofloxacin significantly improved the signs and symptoms of rheumatoid arthritis.
18001496 Association of ITGAV supports a role of angiogenesis in rheumatoid arthritis. 2007 Motivated by linkage data and the hypothesis that angiogenesis plays a functional role in rheumatoid arthritis (RA), Jacq and colleagues present a family-based, multi-stage, candidate gene association study in French and European Caucasians in a paper on the association of the ITGAV rs3738919-C variant allele with RA (C-containing genotypes: odds ratio 1.94, confidence interval 1.3 to 2.9, P = 0.002). Support comes from a recent genome-wide study, which on its own would have missed identifying the association. Further research into the associating variant will require detailed haplotype analysis, verification in further studies, and research involving intermediate phenotypes or direct functional experiments. This new RA risk factor supports the role of angiogenesis in the disease.
19160638 [Surgery of the rheumatoid foot and ankle]. 2008 Dec 17 Surgery of the rheumatoid foot and ankle Initial presentation of rheumatoid arthritis (RA) will be foot and ankle symptoms in 20% of cases. Eventually, 50-90% of patients will develop foot and ankle alterations. Typical deformities of the forefoot include hallux valgus and dorso-lateral dislocation of the lesser metatarso-phalangeal joints. RA involvement of the hindfoot frequently leads to plano-valgus deformity. Approximately 20% of surgery performed for RA is done at the foot and ankle. Early surgery is efficient against pain and deformity. Patient's satisfaction rate after surgery is high despite a slight higher complication rate compared to conventional foot and ankle surgery.
18177509 Cells of the synovium in rheumatoid arthritis. Synovial fibroblasts. 2007 For some time synovial fibroblasts have been regarded simply as innocent synovial cells, mainly responsible for synovial homeostasis. During the past decade, however, a body of evidence has accumulated illustrating that rheumatoid arthritis synovial fibroblasts (RASFs) are active drivers of joint destruction in rheumatoid arthritis. Details regarding the intracellular signalling cascades that result in long-term activation and synthesis of proinflammatory molecules and matrix-degrading enzymes by RASFs have been analyzed. Molecular, cellular and animal studies have identified various interactions with other synovial and inflammatory cells. This expanded knowledge of the distinct role played by RASFs in the pathophysiology of rheumatoid arthritis has moved these fascinating cells to the fore, and work to identify targeted therapies to inhibit their joint destructive potential is underway.
18364158 [Rheumatoid arthritis with atlanto-axial subluxation. Pre-and postoperative symptoms, radi 2008 Feb 18 INTRODUCTION: The aim of the study was to study pre- and postoperative symptoms, radiological findings and operative complications in rheumatoid arthritis (RA) patients, operated in the atlantoaxial joint. MATERIALS AND METHODS: A retrospective study of 31 RA patients (24 women, seven men) operated for anterior atlantoaxial subluxation (aAAS) at the Neurosurgical Department, Aarhus University Hospital, in the period of 1993-2003. Information was obtained retrospectively from the patients charge. RESULTS: Mean age at RA debut was 38 years (16-69 yrs), and neck symptoms were seen after a mean time of 15 years (0-39 yrs) of illness. Radiological examination at this time showed irreversible atlantoaxial changes, and operation was performed within 0-9 years (mean 1.6 yrs). The patients were characterized by high disease activity: C-reactive protein, anaemia, positive IgM-rheumatoid factor (84%), and progressive radiological changes in the peripheral joints. All patients were treated with DMARDs (disease modifying anti rheumatic drugs). Neck pain (100%) and neurological symptoms/manifestations (87%) were seen preoperatively. After operation symptoms were relieved in 68% of the patients, while 22% were unchanged, and 10% had worsened. Postoperative complications included cardiac death, dislocation of the cervical spine, fracture of arcus atlantis, hemiparesis, dysphagia, bed sores and infection of the surgical scar (29%). CONCLUSION: Neck symptoms were seen after 15 years of illness, and within the following 1.6 years patients were operated for aAAS. After the operation most of the patients (68%) had relief from symptoms, while 29% had postoperative complications, including cardiac death, dislocation of the cervical spine, fracture of arcus atlantis, hemiparesis, dysphagia, bed sores and infection in the surgical scar.
17957454 Association and expression study of PRKCH gene in a French Caucasian population with rheum 2008 Mar We study the association between three protein kinase C, eta gene polymorphisms (+8134C/T, rs912620, rs959728), and susceptibility to rheumatoid arthritis. One hundred French Caucasian rheumatoid arthritis trio families were genotyped. Relative quantification of protein kinase C, eta mRNA expression was performed from whole blood in 24 unrelated rheumatoid arthritis patients and in 16 healthy controls. Our results showed no significant association or linkage between the protein kinase C, eta polymorphisms, and rheumatoid arthritis. The protein kinase C, eta mRNA was expressed at lower level in rheumatoid arthritis unrelated patients than in healthy controls. This study shows that protein kinase C, eta gene is not a Rheumatoid Arthritis major susceptibility genetic factor in the French Caucasian population. Furthermore, the lower expression of this gene in rheumatoid arthritis patients comparing to healthy controls suggests that protein kinase C, eta could be associated with the patho-physiologic mechanism of rheumatoid arthritis.
16213772 The rheumatoid shoulder: current consensus on diagnosis and treatment. 2006 Mar Shoulder involvement is usually inconspicuous in patients with rheumatoid arthritis, and the clinical manifestations are nonspecific. Nevertheless, shoulder involvement should be sought routinely and detected early. Range of motion at the shoulder should be evaluated. Although normal radiographic findings do not rule out shoulder involvement, radiographs are crucial for detecting micro- and macro-geodes during follow-up. The development of glenohumeral joint space narrowing is a turning point that indicates a risk of rapid joint destruction. Magnetic resonance imaging is useful for assessing the lesions and guiding the treatment strategy. Stepwise use of local interventions as indicated by imaging findings is recommended. Joint replacement should not be left too late, and surgical procedures on the shoulder should be built into the overall treatment plan.
16563189 IFNGR1 single nucleotide polymorphisms in rheumatoid arthritis. 2006 On the basis of their biological function, potential genetic candidates for susceptibility to rheumatoid arthritis can be postulated. IFNGR1, encoding the ligand-binding chain of the receptor for interferon gamma, IFNgammaR1, is one such gene because interferon gamma is involved in the pathogenesis of the disease. In the coding sequence of IFNGR1, two nucleotide positions have been described to be polymorphic in the Japanese population. We therefore investigated the association of those two IFNGR1 single nucleotide polymorphisms with rheumatoid arthritis in a case-control study in a central European population. Surprisingly, however, neither position was polymorphic in the 364 individuals examined, indicating that IFNGR1 does not contribute to susceptibility to rheumatoid arthritis, at least in Caucasians.
16708647 [Matrix metalloproteinases and tissue inhibitors of metalloproteinases in the pathogenesis 2006 Feb Rheumatoid arthritis (RA) is a chronic inflammatory disorder of joints characterized by the accumulation of mononuclear cells and the proliferation of the synovium-lining layer. The role of lymphocytes, macrophages and fibroblasts infiltrating the synovium is not fully understood. These cells are supposed to be involved in the tissue destruction by several mechanisms, including the production of proinflammatory cytokines and matrix metalloproteinases. Matrix metalloproteinases (MMPs) are the enzymes that participate in the proteolytic degradation and remodelling of the extracellular matrix. Their action is controlled by tissue inhibitors of metalloproteinases (TIMPs). In this review we describe the role of metalloproteinases and their tissue inhibitors in the pathogenesis of rheumatoid arthritis.
16854951 Increased incidence of and impaired prognosis after acute myocardial infarction among pati 2007 Feb OBJECTIVE: To examine the incidence and outcome of acute myocardial infarction (AMI) in patients with rheumatoid arthritis compared with the general population, and to examine whether care and treatment of an AMI differs between patients and controls. METHODS: The Multinational Monitoring of Trends and Determinants of Cardiovascular Disease register for northern Sweden was used to compare those incidences of AMI in a cohort of patients with rheumatoid arthritis with that in the general population. 35 patients with rheumatoid arthritis who had also experienced an AMI were identified. For each patient with rheumatoid arthritis, three controls with a history of AMI but without rheumatoid arthritis were randomly selected from the same register, and matched for age, sex and year of the AMI for evaluation of case fatality and potential differences in treatment of AMI. RESULTS: The standardised incidence ratio for AMI was 2.9 in patients with rheumatoid arthritis compared with the general population (p<0.05). During the first 10 years after an AMI, patients with rheumatoid arthritis had a higher overall case fatality compared with controls (hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.02 to 2.71). Survival time was decreased in the rheumatoid arthritis group compared with controls despite the same care and treatment. CONCLUSION: Both the incidence of and case fatality after an AMI were higher among patients with rheumatoid arthritis than among the general population. The results emphasise the necessity of optimising the preventive, diagnostic and caring strategies for AMI in rheumatoid arthritis.
18210133 [Expression analyses for rheumatoid arthritis]. 2008 Feb Inflammatory rheumatic diseases with their unclear aetiology are a challenge for the routine clinical practice. The dominating inflammatory processes with many facets of autoimmune phenomena have been extensively studied during the last decades. Modern high throughput technologies provide for the first time the opportunity to obtain an insight into the many different molecular aspects in one patient in parallel. Step by step, concepts can be developed to understand the relationships and interdependencies of the molecular processes and to place them in order of importance for each individual separately. Thus, studies have demonstrated that the risk of disease severity can be estimated and the response to therapy can be objectified based on molecular investigations. Exemplarily, the potential has been demonstrated that the therapeutic outcome towards a defined treatment may be predicted. Despite the high cost, it is becoming more and more obvious that an extensive increase of knowledge depends on the detection of a multitude of parameters, a task which will need to be accomplished in the near future.
17535147 Most people with rheumatoid arthritis undertake leisure-time physical activity in the Neth 2007 QUESTION: What type of physical activity or exercise is undertaken by people with rheumatoid arthritis? What type of physical activity or exercise do they prefer? What is their attitude towards physical activity or exercise? What are the perceived barriers to undertaking physical activity or exercise? DESIGN: Survey of a random sample of people with rheumatoid arthritis. PARTICIPANTS: Four hundred people with rheumatoid arthritis in the Netherlands. RESULTS: Of the 252 people who returned the questionnaire (63% response) 201 (80%) people participated in some type of physical activity or exercise. Significantly more inactive people were male, less educated, and older than the active people. Of the active people, 45 (22%) participated exclusively in supervised activities, 72 (36%) in unsupervised activities, and 84 people (42%) combined supervised and unsupervised activities. Cycling and walking were the two unsupervised activities people performed most often. Supervised group exercise and unsupervised individual physical activity were reported as the favourite activities. Further, more people preferred being physically active under expert supervision than without supervision and preferred water-based over land-based activities. The most frequently-mentioned barriers were lack of energy, presence of pain, lack of motivation, lack of information, and fear of joint damage. CONCLUSION: The majority of people with rheumatoid arthritis participated in some physical activity or exercise, mostly under supervision. Preferences for types of activity varied, underpinning the need for a variety of options for people with rheumatoid arthritis.
16821264 Cyclooxygenase-2 genotype and rheumatoid arthritis. 2006 Jul OBJECTIVE: To determine the association between cyclooxygenase-2 (COX-2) genotypes and risk and severity of rheumatoid arthritis (RA) in a Korean population. METHODS: A total of 258 Korean patients with RA and 400 control subjects were recruited from Hanyang University Hospital. Subjects were genotyped for the -765G/C polymorphism of the COX-2 gene by RFLP-PCR analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to estimate risk. Severity of RA was assessed by anatomical stage according to Steinbrocker, et al. RESULTS: No association was observed between COX-2 genotype and risk or severity of RA. However, among those without the shared epitope (SE), carriers of the low activity C allele had a lower risk of RA and less severe form of RA than subjects with the G/G genotype. The OR (95% CI) was 0.36 (0.14-0.95) for risk of RA and 0.04 (0.01-0.41) for severity. CONCLUSION: These results suggest that COX-2 genotyping might be useful in predicting the risk and severity of RA in individuals without the SE.
16877533 Severe extra-articular disease manifestations are associated with an increased risk of fir 2007 Jan BACKGROUND: Rheumatoid arthritis is associated with increased cardiovascular mortality and morbidity. OBJECTIVE: To assess the effect of severe extra-articular rheumatoid arthritis (ExRA) manifestations on the risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis. METHODS: Patients with ExRA (n = 81) according to predefined criteria and controls (n = 184) without evidence of extra-articular disease were identified from a large research database of patients with rheumatoid arthritis. In a structured review of the medical records, the occurrence and the date of onset of clinically diagnosed CVD events were noted. Cox proportional hazards models were used to estimate the effect of ExRA on the risk of first ever CVD events after the diagnosis of rheumatoid arthritis. ExRA manifestations were modelled as time-dependent covariates, with adjustment for age, sex and smoking at the diagnosis of rheumatoid arthritis. Onset of erosive disease and rheumatoid factor seropositivity were entered as time-dependent variables. Patients were followed until onset of CVD, death or loss to follow-up. RESULTS: ExRA was associated with a significantly increased risk of first ever CVD events (p<0.001), and also with an increased risk of new-onset coronary artery disease, adjusted for age, sex and smoking (hazard ratio (HR): 3.16; 95% confidence interval (95% CI: 1.58 to 6.33). The association between ExRA and any first ever CVD event remained significant when controlling for age, sex, smoking, rheumatoid factor and erosive disease (HR: 3.25; 95% CI: 1.59 to 6.64). CONCLUSION: Severe ExRA manifestations are associated with an increased risk of CVD events in patients with rheumatoid arthritis. This association is not due to differences in age, sex, smoking, rheumatoid factor or erosive joint damage. It is suggested that systemic extra-articular disease is a major determinant of cardiovascular morbidity in rheumatoid arthritis.
18177511 Cells of the synovium in rheumatoid arthritis. Macrophages. 2007 The multitude and abundance of macrophage-derived mediators in rheumatoid arthritis and their paracrine/autocrine effects identify macrophages as local and systemic amplifiers of disease. Although uncovering the etiology of rheumatoid arthritis remains the ultimate means to silence the pathogenetic process, efforts in understanding how activated macrophages influence disease have led to optimization strategies to selectively target macrophages by agents tailored to specific features of macrophage activation. This approach has two advantages: (a) striking the cell population that mediates/amplifies most of the irreversible tissue destruction and (b) sparing other cells that have no (or only marginal) effects on joint damage.
17657475 [Alterations to the lumbar spine in rheumatoid arthritis]. 2007 Aug In rheumatoid arthritis the anatomical structures of the lumbar spine are affected by the same mechanisms of destruction as are known from other skeletal regions. Although spinal symptoms do not become apparent until the later stages of rheumatoid arthritis, patients do sometimes complain of typical symptoms. We present data recorded in 19 patients with seropositive rheumatoid arthritis who underwent hospital treatment directed exclusively at isolated low-back pain. The patients were questioned in some detail with the aid of instruments including the Oswestry, TypE, HAQ and RADAI questionnaires and a visual-analogue-pain scale. Roentgen exposures were also evaluated. A comparison was drawn between patients treated surgically with decompression and various spondylodeses (n=13) and those who received conservative treatment (n=6). Better results were obtained in the group of patients treated surgically, though a statistical evaluation was not possible. No histological evidence of rheumatoid alterations was found in the intervertebral disc tissue samples available.