Browse

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

ID PMID Title PublicationDate abstract
16677409 The validity of a rheumatoid arthritis medical records-based index of severity compared wi 2006 Outcome measures play an extremely important role in clinical trials and observational research. Outcome measures for rheumatoid arthritis cover a whole array of domains, ranging from measures describing the inflammatory process to measures describing the ultimate consequences of long-term disease, such as joint damage, physical function and quality of life. There is a scientific need to be able to quantify what is called the 'severity of rheumatoid arthritis', so that patients with rheumatoid arthritis can be clustered according to their propensity to develop an unfavourable outcome. It is a challenge to find an appropriate measure for severity. One attempt has been the development of the Rheumatoid Arthritis Medical Record-Based Index of Severity. This commentary elaborates on how such a measure of severity should be validated to determine whether it is appropriate for practical use.
17042021 Why do patients with rheumatoid arthritis use complementary therapies? 2006 Jun OBJECTIVES: (1) to develop an understanding as to how the use of complementary therapy (CT) affects a patient's perspective of health and well-being, (2) to offer the rheumatology professional insight and understanding as to why a patient chooses to use a CT, and (3) to raise awareness as to the forms of CT most commonly used by patients with rheumatoid arthritis. METHODS: This qualitative study was based on phenomenological principles applied through focused inquiry to develop an understanding of the lived experience of the study participants. The inclusion criteria of an established diagnosis of rheumatoid arthritis and known use of CT were applied to a convenience sample of patients attending a rheumatology outpatient department clinic on two consecutive days. Of the 15 eligible patients identified, five were randomly selected for inclusion in the study. Narrative data were collected through analysis of transcripts taken from audiotape recordings of unstructured interviews with study participants. A manual indexing system was used to develop four significant categorisation themes to reflect the findings: (1) incentives to use CT, (2) perceived benefits of CT use, (3) the choice of CT used, and (4) perceived disadvantages and risks of CT use. RESULTS: Incentives to use CT included dissatisfaction with conventional treatment, often in the form of side effects, and drug ineffectiveness. Social factors, such as loss of employment and social activities, were also indicated, as were psychological changes in the form of depression, hopelessness and fear. Perceived benefits were categorised as either physical or psychological with associated aspects of choice and control viewed as important elements of personal empowerment. The choice of CT used fell into three categories; physical, spiritual and herbal. The most commonly used of these were herbal remedies and supplements, closely followed by aromatherapy massage. Disadvantages and risks were identified as physical (pain and discomfort), psychological (fear and uncertainty), and/or material (cost). CONCLUSIONS: This study suggests that regular use of CT by patients with rheumatoid arthritis offers holistic benefits. Compared to conventional treatments, CT is seen to have advantages in terms of a lower incidence of adverse reactions, greater patient choice, psychological comfort and an increased quality of the patient/therapist relationship. The use of CT by patients with rheumatoid arthritis indicates a need for evidence-based information about its use and safety in order to direct practice within a rheumatology department.
16921781 [An update on diagnostic and prognostic biomarkers of early rheumatoid arthritis]. 2006 Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that leads to inevitable joint destruction. The revised American College of Rheumatology (ACR) criteria for the diagnosis of RA are not sensitive enough for classification of the very early onset of the disease. They lack the predictive value for identifying patients at high risk of rapid joint damage and for assessing the efficacy of treatment. To improve the situation, several new biomarkers are currently studied to help to achieve this goal. Respecting the pathophysilogy of RA, several markers reflecting immune response, inflammation, joint destruction, and genetic factors are discussed in this review. Finally, the potential use of several markers in the clinical practice is depicted.
18022297 Pedography and radiographic imaging for the detection of foot deformities in rheumatoid ar 2008 Jun BACKGROUND: Patients with Rheumatoid Arthritis often suffer from pain and deformities in the feet. Previous studies demonstrated that pedography is a useful tool in clinical practice for detecting structural changes. Therefore, the aim of the present study was to compare Rheumatoid Arthritis patients' clinical, radiographic and pedographic status in order to investigate the relationship between mechanical damage and plantar pressure distribution under the forefoot. METHODS: Sixteen right feet of sixteen patients with Rheumatoid Arthritis and 21 right feet of healthy controls were included. Weight-bearing radiographs of the forefoot were obtained for all rheumatoid feet. The grade of erosion in the forefoot was assessed with the established Larsen score. Foot loading parameters were analyzed with pedography. FINDINGS: The present study revealed no correlation between walking pain and the level of joint destruction in patients with Rheumatoid Arthritis. However, the study revealed a strong correlation between joint erosion in the lateral metatarsophalangeal joints and local pressure values under the lateral forefoot (r=0.85) and a negative correlation between joint erosion in the proximal interphalangeal joint and local pressure values under the lateral toes (r= -0.64). INTERPRETATION: In patients with Rheumatoid Arthritis, the intensity of walking pain does not characterize the degree of joint destruction under the forefoot. Pedography appears useful for an early diagnosis of pathologic changes in the forefoot. However, even though pedographic measurements might be able to provide indications for destructive changes, they cannot provide information about the exact grade of joint erosion.
16793841 Metabolic syndrome is common among middle-to-older aged Mediterranean patients with rheuma 2007 Jan OBJECTIVES: Patients with rheumatoid arthritis have an increased risk for cardiovascular disease (CVD). The prevalence of metabolic syndrome (MetS)-a major contributor to CVD-in a cohort of patients with rheumatoid arthritis and its relationship with rheumatoid arthritis related factors is investigated here. METHODS: 200 outpatients with rheumatoid arthritis (147 women and 53 men), with a mean (standard deviation (SD)) age of 63 (11) years, and 400 age and sex-matched controls were studied. MetS was assessed according to the adult treatment panel III criteria and rheumatoid arthritis disease activity by the disease activity score of 28 joints (DAS28). A standard clinical evaluation was carried out, and a health and lifestyle questionnaire was completed. RESULTS: The overall prevalence of MetS was 44% in patients with rheumatoid arthritis and 41% in controls (p = 0.5). Patients with rheumatoid arthritis were more likely to have low high-density lipoprotein cholesterol compared with controls (p = 0.02), whereas controls were more likely to have increased waist circumference or raised blood pressure (p = 0.001 and 0.003, respectively). In multivariate logistic regression analysis adjusting for demographics and rheumatoid arthritis treatment modalities, the risk of having moderate-to-high disease activity (DAS28>3.2) was significantly higher in patients with MetS compared with those with no MetS components (OR 9.24, 95% CI 1.49 to 57.2, p = 0.016). CONCLUSION: A high, albeit comparable to the control population, prevalence of MetS was found in middle-to-older aged patients with rheumatoid arthritis. The correlation of rheumatoid arthritis disease activity with MetS suggests that the increased prevalence of coronary heart disease in patients with rheumatoid arthritis may, at least in part, be attributed to the inflammatory burden of the disease.
17032593 [Chronic inflammation increases the risk of cardiovascular disease in patients with rheuma 2006 Sep 25 Rheumatoid arthritis is associated with increased cardiovascular morbidity and mortality due to atherosclerosis. This cannot be explained by an increased presence of traditional risk factors but seems to depend on inflammatory mechanisms. The association of inflammatory pathways with atherosclerosis is complex, and more research is required to optimise preventative measures against cardiovascular complications in inflammatory rheumatic diseases.
18500017 Temporomandibular joint involvement in rheumatoid arthritis: correlation of clinical, labo 2008 OBJECTIVE: Rheumatoid arthritis is a systemic autoimmune disorder that involves many body joints including the temporomandibular joint. The frequency of temporomandibular joint involvement based on clinical and radiological findings is rather diverse and involvement may manifest as pain, restricted range of movement and locking of the joint. The aim of this study is to investigate and correlate the clinical, laboratory and magnetic resonance imaging findings in patients with rheumatoid arthritis. METHODOLOGY: The temporomandibular joint involvement in 43 patients with rheumatoid arthritis, whose diagnoses were based on the revised 1987 criteria of the American College of Rheumatology, were evaluated using clinical examination, laboratory findings and magnetic resonance imaging. RESULTS: Temporomandibular joint involvement was clinically observed in 28 patients (65.1%), and radiologically in 33 patients (76.7%). The most frequent physical examination finding, a "click" in the joint upon opening of the mouth, was found in 21 (48.8%) patients. The most frequently observed radiological finding was synovial proliferation seen in 22 (51.1%) patients. A statistically significant correlation was observed between erythrocyte sedimentation rate and the findings on magnetic resonance imaging; between the rheumatoid factor results and physical examination findings; and between the findings of the physical examination and magnetic resonance imaging. CONCLUSION: The erythrocyte sedimentation rate, the rheumatoid factor results, and the findings on magnetic resonance imaging were found to be important in indicating temporomandibular joint involvement in rheumatoid arthritis. Further studies are necessary to specify the risk factors in more detail.
18230132 The utility of clinical decision tools for diagnosing osteoporosis in postmenopausal women 2008 Jan 29 BACKGROUND: Patients with rheumatoid arthritis have a higher risk of low bone mineral density than normal age matched populations. There is limited evidence to support cost effectiveness of population screening in rheumatoid arthritis and case finding strategies have been proposed as a means to increase cost effectiveness of diagnostic screening for osteoporosis. This study aimed to assess the performance attributes of generic and rheumatoid arthritis specific clinical decision tools for diagnosing osteoporosis in a postmenopausal population with rheumatoid arthritis who attend ambulatory specialist rheumatology clinics. METHODS: A cross-sectional study of 127 ambulatory post-menopausal women with rheumatoid arthritis was performed. Patients currently receiving or who had previously received bone active therapy were excluded. Eligible women underwent clinical assessment and dual-energy-xray absorptiometry (DXA) bone mineral density assessment. Clinical decision tools, including those specific for rheumatoid arthritis, were compared to seven generic post-menopausal tools to predict osteoporosis (defined as T score < -2.5). Sensitivity, specificity, positive predictive and negative predictive values and area under the curve were assessed. The diagnostic attributes of the clinical decision tools were compared by examination of the area under the receiver-operator-curve. RESULTS: One hundred and twenty seven women participated. The median age was 62 (IQR 56-71) years. Median disease duration was 108 (60-168) months. Seventy two (57%) women had no record of a previous DXA examination. Eighty (63%) women had T scores at femoral neck or lumbar spine less than -1. The area under the ROC curve for clinical decision tool prediction of T score <-2.5 varied between 0.63 and 0.76. The rheumatoid arthritis specific decision tools did not perform better than generic tools, however, the National Osteoporosis Foundation score could potentially reduce the number of unnecessary DXA tests by approximately 45% in this population. CONCLUSION: There was limited utility of clinical decision tools for predicting osteoporosis in this patient population. Fracture prediction tools that include risk factors independent of BMD are needed.
17038472 Pharmacoeconomics: friend or foe? 2006 Nov The financial constraints faced by most health systems today make it necessary for manufacturers of new, expensive drugs to demonstrate value for money. This paper describes the different types of economic evaluation; the increasing use of these analysis in decision making; their application to new drugs in the field of in rheumatoid arthritis; and the pros and cons of pharmacoeconomics studies from the perspective of the patients, the physicians, and the general population.
17083759 DAS remission cut points. 2006 Nov The Disease Activity Score (DAS) and DAS28 are continuous measures of rheumatoid arthritis (RA) disease activity. Values of DAS %lt;1.6 and DAS28 %lt; 2.6 correspond with an increased likelihood of being in remission. This review presents development of the DAS and DAS28 remission cut points and their interpretation.
17404482 [MRI is coming up as a new diagnostic imaging andan appraisal method for rheumatoid arthri 2007 Apr MRI is increasingly being used as a new tool in the diagnostic imaging and appraisal of RA. Early bone erosion, bone marrow edema, and synovitis, conditions which cannot be identified on radiographs, are apparent on MRI scans. But it is difficult to use whole body MRI for every RA patients in clinical practice, low-field, dedicated-extremity MR machines are currently under development. MRI, which shows the active lesions in about 90% of patients diagnosed with clinical remission, is an extremely valuable tool aiding in treatment leading to true remission.
16824621 Molecular and cellular basis of rheumatoid joint destruction. 2006 Jul 15 Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with joint destruction. Synovial fibroblasts are key players in this pathological process. They favorise a pro-inflammatory environment in the synovial tissue, interact with the immune system and regulate the differentiation of monocytes into osteoclasts. Synovial hyperplasia is another characteristic of RA, reflecting not only an imbalance between proliferation and apoptosis, but also the migration of cells into the synovial tissue. Gene transfer experiments have been used as important tools for the understanding of molecular and cellular changes that characterize the activated RA synovial fibroblasts. Activated synovial fibroblasts can invade cartilage and bone. Synovial activation is driven by cytokines, such as TNFalpha and IL-1, as well as IL-15, 16, 17, 18, 22, 23, but also by cytokine-independent mechanisms that involve the innate immune system (i.e. TLRs), a unique communication network of microparticles and epigenetic changes (e.g. L1 retroelements).
16191448 Late onset rheumatoid arthritis: clinical and laboratory comparisons with younger onset pa 2006 Mar We aimed to compare the clinical and laboratory profiles of the patients presenting late onset rheumatoid arthritis (LORA) with younger onset rheumatoid arthritis (YORA) patients. During the period between January 1995 and December 2004, 124 patients with LORA were identified from a retrospective chart review of inpatients and outpatients. They were compared with 150 YORA patients examined during the same period including their clinical and laboratory findings. The mean ages of the patients with LORA and YORA were 71.7+/-5.9 years, and 52.1+/-11.5 years, respectively. The gender ratio (female/male) was 1.48 in LORA and 2.85 in YORA (p = 0.012). The average ages of the disease onset were 42.2+/-10.4 years in YORA and 68.4+/-4.6 years in LORA. The duration of the diagnosis was longer in LORA than in YORA (20.7+/-14.3 months versus 10.3+/-6.2 months, p < 0.001). Rheumatoid arthritis (RA) duration was shorter in LORA than in YORA (43.5+/-64.4 months versus 126.3+/-101.0 months, p < 0.001). Although LORA patients had more significant frequent shoulder joint involvements (p < 0.001), proximal interphalangeal (PIP), metacarpophalangeal (MCP), elbow, metatarsophalangeal (MTP) and ankle involvements were common in YORA. Wrist, knee and hip involvements were not different in the groups. Classical rheumatoid hand deformities, interstitial lung disease and Sjögren's syndrome (SS) were significantly lower in LORA than in YORA. LORA patients had more common weight loss, myalgia, lymphadenopathy, polymyalgia rheumatica (PMR)-like syndrome and neuropathy. The frequencies of RF, ANA, anti-SSA/Ro and anti-SSB/La positivities were lower in LORA than in YORA, whereas elevated erythrocyte sedimentation rates (ESR), C-reactive protein (CRP) and anemia associated with chronic disease were higher in LORA. Patients with LORA, according to the accepted international criteria, present with different clinical and laboratory profiles when compared with younger patients. These results suggest that age may influence the presentation of RA at onset.
17661010 [Wrist arthrodesis in rheumatoid patients]. 2007 Aug Chronic synovialitis of the tendon sheaths and intercarpal joints in rheumatoid patients leads to instability and luxation of the extensor carpi ulnaris tendon and the carpus. Wrist arthrodesis is indicated if the luxation is combined with destruction of the carpal bones. Wrist fusion is the oldest procedure for stabilising the rheumatoid wrist and is still seen as the "gold standard." Patient satisfaction is usually very high. The situation of thin skin combined with subcutaneous atrophy has led to several modifications of the operative procedure over time. Today we are able to achieve high primary stability of the wrist fusion by using a special plate and covering it with soft tissues to avoid internal decubitus. Because of this, patients usually do not need any cast immobilisation, thus making this procedure much more comfortable for these multimorbid patients.
16972685 [Bone disease related to rheumatoid arthritis]. 2006 Sep Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by progressive bone destruction, in which proinflammatory cytokines such as tumor necrosis factor-alpha play essential roles. Recent studies have revealed an important involvement of osteoclasts in bone destruction of RA. In this review, I would like to explain the molecular mechanism of osteoclast development in RA, and propose the possibility of anti-osteoclast therapy to the disease.
19024274 [Monitoring disease activity, adjustment of conventional treatment and prognosis in rheuma 2008 In the past decade treatment strategies for patients with rheumatoid arthritis have changed dramatically. Patients are being treated earlier and more aggressively than in the past, and far more therapeutic options are available, which has increased the complexity of the management of patients with rheumatoid arthritis. The processes have had an influence on the outcome of patients with RA and on the way they are being evaluated. Disease course should regularly be evaluated with both process (i.e. erythrocyte sedimentation rate, joint counts) and outcome measures (i.e. radiological progression). For the evaluation of interventions, 'core sets' of valid measures to assess disease activity and outcome and specific criteria for improvement should be used. "Tight control" of patients with rheumatoid arthritis will enable us to adjust the therapy and to achieve the ultimate goals, remission and less disability.
18157732 The burden of rheumatoid arthritis and access to treatment: health burden and costs. 2008 Jan As part of the study "The burden of rheumatoid arthritis and patient access to treatment", this paper reviews evidence on the health burden of rheumatoid arthritis (RA) in terms of morbidity (DALYs), mortality (% of deaths attributable to RA) and quality of life (utility and loss of QALYs), as well as the economic impact on society. Based on available literature on the prevalence and the cost of RA, combined with economic indicators, the annual cost per patient as well as the total national cost is estimated for Europe and North America (Canada and the United States), as well as Australia, Turkey, the Russian Federation and South Africa. Total costs to society were estimated at 45.3 billion in Europe and at 41.6 billion in the United States. Utility scores were found to be amongst the lowest compared to other diseases.
18080699 [The new serological markers of rheumatoid arthritis]. 2007 Sep Rheumatoid arthritis (RA) is the most frequent human chronic inflammatory autoimmune disease. Its etiology is up to date not known. RA has been proven to be an antigen-specific lymphocyte T driven process. Many exo- and endogenous antigens having a possible potential to induce and maintain autoimmunologic reaction have been described. In this report RA associated autoantibodies, especially novel, most specific serological marker--anti-cyclic citrullinated peptide antibodies (aCCP) are presented.
17404488 [Effect of CTLA4-Ig on radiographic outcome of patients with rheumatoid arthritis]. 2007 Apr CTLA4-Ig (abatacept) is a recombinant fusion protein containing components of immunoglobulin G (IgG) and cytotoxic T-lymphocyte-associated protein-4 that inhibit costimulatory signal from antigen presenting cells and prevent activation of T cells. Abatacept significantly ameliorated signs and symptoms and improved physical function of patients with rheumatoid arthritis (RA) who had shown inadequate response to methotrexate (MTX) or TNF antagonists. Abatacept also retarded the radiological progression of structural damage of affected joints in MTX-resistant patients. This article briefly discussed the mechanism of action and the results of clinical trials of abatacept.
16891925 Recurrent postpartum episodic rheumatoid arthritis. 2006 Aug It is well known that rheumatoid arthritis improves in the majority of patients during pregnancy and that aggravation of disease symptoms occurs within the first 6 months postpartum. We report a female patient who had 4 postpartum episodes of transient polyarthritis typical of rheumatoid arthritis with positive serum rheumatoid factor and anti-CCP antibodies. All bouts resolved within 4 to 10 weeks after onset without any symptoms in between the episodes.