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ID PMID Title PublicationDate abstract
18669223 Our experiences in treatment of patients suffering from rheumatoid arthritis. 2008 Rheumatoid arthritis is a chronic systematic inflammation illness characterized by progressive damage of joints. Treatment of rheumatoid arthritis is individual, programmed and complex and consists of general measures, application of adequate medication, physical procedures, balneotherapy and various surgical techniques as necessary. The objective of research is to show success of therapy in use of medication and other types of treatment for patients suffering from rheumatoid arthritis. The following were applied: non-steroid anti-inflammatory medications (NAIL), metotrexate, gold salts, corticosteroids, sulphasalzine, Chlorochin, cyclophosphamide and others. Metotrexate was often applied in our research and good results were achieved with it, but very good results were also achieved by combination of 2 or more immunodatulatory medications, including interarticular application of medication, physical, balneo and orthopedic therapy, as well as other alternative therapy. Success of therapy based on Richie index shows statistically significant improvement, meaning that there was movement from grade 3 and 4 into grades 1 and 2.
16949529 Hydroxyapatite augmentation for bone atrophy in total ankle replacement in rheumatoid arth 2006 Sep Although total ankle replacement is routinely used for rheumatoid arthritis of the ankle, it has been hampered by early implant failures such as loosening and subsidence of the tibial component due to poor bone quality. To prevent this complication, total ankle replacement augmented by a specially designed hydroxyapatite coating was used in 14 patients (16 feet). Patients were reviewed after an average follow-up of 23.1 months, and the mean clinical rating scale significantly improved from 30.7/100 points preoperatively to 65.9/100 at final follow-up, especially with respect to pain relief. Radiographs taken immediately postoperatively and at final follow-up were analyzed for the position and sinking of the tibial component. The position was evaluated by measurement of the alpha and beta angles, formed by the tibial long axis and tibial component on anteroposterior and lateral radiographs, respectively. The mean alpha and beta angles were 87.4 degrees and 79.3 degrees postoperatively and 87.7 degrees and 81.0 degrees at final follow-up, respectively. No significant change was noted in either angle between the immediate postoperative views and at final follow-up, and no significant subsidence was noted. Radiographs were also assessed for the presence of a lucent zone: 1 case demonstrated a clear zone between hydroxyapatite and bone, 9 cases between hydroxyapatite and the tibial component, and 6 cases between the tibial component and bone. These results suggest that hydroxyapatite helps to secure implant fixation firmly to the bone, making it a useful augmentation for tibial bone atrophy in total ankle replacement for rheumatoid arthritis.
16429237 Remission of rheumatoid arthritis after acute disseminated varicella-zoster infection. 2007 May A 65-year-old immunocompetent male presented with symmetric polyarthritis of 12 weeks and paresthesias in the distribution of the left median nerve distribution of 4 weeks duration. He had tender joint count of 20 and swollen joint count of 12. He was positive for rheumatoid factor and his erythrocyte sedimentation rate was 52 mm. Nerve conduction study demonstrated polyneuropathy. Radiographs showed severe juxta articular osteopenia at the wrist and the metacarpophalangeal joints. He received methotrexate of 10 mg/week and prednisolone of 0.15 mg/kg/day along with nonsteroidal antiinflammatory drugs (NSAIDs) with a diagnosis of seropositive rheumatoid arthritis (RA). Thirteen weeks after therapy, he presented to the outpatient clinic with disseminated vesicular eruptions all over his body with erythematous base and pneumonia involving the left upper lobe. Tzanck smear from the lesions and serology (IgG) for varicella-virus infection were positive. A diagnosis of acute disseminated varicella zoster with pneumonia was made. The patient improved on parenteral acyclovir and broad-spectrum antibiotics. With the improvement in rash and pneumonia after 2 weeks, the patient noticed a marked improvement in the joint symptoms. Arthritis remained in remission without the need for any disease-modifying drug or NSAID for next the 24 months and continued to be so until the last follow-up. Our case presents a unique phenomenon of RA remission after disseminated varicella-zoster infection in an immunocompetent individual.
19096748 Underweight and obese states both associate with worse disease activity and physical funct 2009 Apr Obesity is characterised by low-grade inflammation and could potentially affect disease activity and severity in patients with rheumatoid arthritis (RA). Body mass index (BMI), body fat (BF), erythrocyte sedimentation rate, C-reactive protein, disease activity score 28, physical function (health assessment questionnaire) and presence of erosions and joint surgery were assessed in 294 (female=219) volunteers with established RA [age 63.3 (56.2-69.6); disease duration 13 (7-20) years]. Smoking status, rheumatoid factor and anti-cyclic citrullinated peptide positivity were also assessed. BMI and BF independently associated with disease characteristics. Compared to normal-weight patients, underweight and obese had higher C-reactive protein (p=0.046) and physical dysfunction (p=0.034). BMI or BF did not associate with presence of erosions or joint surgery. In patients with established RA, both very low and very high BMI and BF associate independently with increased disease activity and physical dysfunction; however, this does not seem to associate with presence of erosions or joint surgery. Further longitudinal studies are required to address this apparent dissociation.
17356144 GSB III total elbow replacement in rheumatoid arthritis. 2007 Mar Between 1993 and 2002, 58 GSB III total elbow replacements were implanted in 45 patients with rheumatoid arthritis by the same surgeon. At the most recent follow-up, five patients had died (five elbows) and six (nine elbows) had been lost to follow-up, leaving 44 total elbow replacements in 34 patients available for clinical and radiological review at a mean follow-up of 74 months (25 to 143). There were 26 women and eight men with a mean age at operation of 55.7 years (24 to 77). At the latest follow-up, 31 excellent (70%), six good (14%), three fair (7%) and four poor (9%) results were noted according to the Mayo elbow performance score. Five humeral (11%) and one ulnar (2%) component were loose according to radiological criteria (type III or type IV). Of the 44 prostheses, two (5%) had been revised, one for type-IV humeral loosening after follow-up for ten years and one for fracture of the ulnar component. Seven elbows had post-operative dysfunction of the ulnar nerve, which was transient in five and permanent in two. Despite an increased incidence of loosening with time, the GSB III prosthesis has given favourable mid-term results in patients with rheumatoid arthritis.
17661121 Prevalence and clinical significance of antibodies to citrullinated fibrinogen (ACF) in Ch 2007 Sep It has been reported that citrullinated fibrin(ogen) deposits in the inflamed joints played an important role in the pathogenesis of rheumatoid arthritis (RA). Although antibodies to citrullinated fibrinogen (ACF) have been detected in the sera of RA patients, the associations between ACF and RA remain unclear. In this study, human fibrinogen was citrullinated by peptidylarginine deiminase in vitro, and the ACF were detected by an enzyme-linked immunosorbent assay in rheumatic patients, including 183 RA, 121 systemic lupus erythematosus, 48 osteoarthritis, and 108 healthy controls. The prevalence of ACF was determined, and the associations between ACF and RA were evaluated. It was shown that the sensitivity and specificity of ACF in RA were 67.21 and 84.84%, respectively. There were significant correlations between ACF and erythrocyte sedimentation rate, anti-cyclic citrullinated peptide antibody, and anti-keratin antibodies (AKA). In radiographic progression, the RA patients with ACF had higher scores than those without ACF according to the Sharp-van der Heijde method. In addition, ACF was often positive in the RA patients who were IgM rheumatoid factor negative or AKA negative or anti-perinuclear factor negative. The results indicate that ACF assay is helpful for the diagnosis of RA.
16385494 A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared ep 2006 Jan OBJECTIVE: To investigate whether smoking and HLA-DR shared epitope (SE) genes may interact in triggering immune reactions to citrulline-modified proteins. METHODS: In a case-control study involving patients with recent-onset rheumatoid arthritis (RA), we studied interactions between a major environmental risk factor (smoking), major susceptibility genes included in the SE of HLA-DR, and the presence of the most specific autoimmunity known for RA (i.e., antibodies to proteins modified by citrullination). Immunostaining for citrullinated proteins in cells from bronchoalveolar lavage fluid was used to investigate whether smoking is associated with citrullination in the lungs. RESULTS: Previous smoking was dose-dependently associated with occurrence of anticitrulline antibodies in RA patients. The presence of SE genes was a risk factor only for anticitrulline-positive RA, and not for anticitrulline-negative RA. A major gene-environment interaction between smoking and HLA-DR SE genes was evident for anticitrulline-positive RA, but not for anticitrulline-negative RA, and the combination of smoking history and the presence of double copies of HLA-DR SE genes increased the risk for RA 21-fold compared with the risk among nonsmokers carrying no SE genes. Positive immunostaining for citrullinated proteins was recorded in bronchoalveolar lavage cells from smokers but not in those from nonsmokers. CONCLUSION: We identified an environmental factor, smoking, that in the context of HLA-DR SE genes may trigger RA-specific immune reactions to citrullinated proteins. These data thus suggest an etiology involving a specific genotype, an environmental provocation, and the induction of specific autoimmunity, all restricted to a distinct subset of RA.
16461437 The relationship of medical, demographic and psychosocial factors to direct and indirect h 2006 Aug OBJECTIVES: Cost-effectiveness analysis (CEA) is essential for the comparison of treatments for rheumatoid arthritis (RA). CEA centres on accurate measurement of health utility (HU) preferences. Direct measures of HU in RA patients demonstrate weaker correlations with health status (functional disability and pain) than indirect measures. We examined whether demographic and psychosocial factors relate to HU in RA patients. METHODS: HU was measured for 142 RA patients (76% women; mean age 58.75 yr) directly through standard gamble (SG) and time trade-off (TTO), and indirectly on the EuroQol (EQ-5D). Current pain (100 mm visual analogue scale) and recent functional disability (Health Assessment Questionnaire; HAQ) were assessed. A subsample of 48 provided demographic and psychosocial information (education, employment, marital/family status, knowledge about RA, medication beliefs, desirable responding, social support, optimism, and the Hospital Anxiety and Depression Scale; HADS). RESULTS: Direct HU had higher means (SG = 0.88, TTO = 0.86) than indirect HU (EQ-5D = 0.52). HAQ functional disability correlated with SG (r = - 0.28), TTO (r = - 0.31) and EQ-5D (r = - 0.67). Current pain correlated with TTO (r = - 0.19) and EQ-5D (r = - 0.36). HADS depression correlated with TTO (r = - 0.35) and EQ-5D (r = - 0.64); HADS anxiety also correlated with EQ-5D (r = - 0.46). CONCLUSIONS: Demographic and psychosocial factors cannot completely explain either the significant differences between direct and indirect HUs in RA patients or the moderate correlations of direct HUs with health status. Characteristics of the SG and TTO may make them inappropriate for HU assessment and CEA among RA patients.
18713769 'I just thought it was normal aches and pains': a qualitative study of decision-making pro 2008 Oct OBJECTIVE: Effective treatment can only be given during the early stages of RA if patients are seen early. However, many patients delay for prolonged periods before seeking medical advice. This study explores factors influencing the decision to seek medical advice in RA patients. METHODS: In-depth, semi-structured interviews were carried out with 24 patients. Purposive sampling ensured a cross-section in terms of time to presentation, gender, age and ethnic background. Interview transcripts were analysed and themes identified using established methods. RESULTS: Four main themes influenced the decision to seek medical advice: (i) symptom experience: the severity of symptoms and their impact on functional ability; (ii) symptom evaluation: the patient's explanation for their symptoms and recognition of their significance; (iii) knowledge of RA and available therapies; and (iv) experience of and attitudes towards health care providers. A significant and rapid impact of the disease on functional ability characterized those presenting early. Many developed an explanation for their symptoms that related to preceding activities. Recognition that this explanation was inadequate to explain symptom progression frequently prompted a consultation. Only one patient sought advice because she thought that she might have RA. CONCLUSIONS: Symptom evaluation is a key factor influencing how quickly medical advice is sought in other diseases. In contrast to the situation with many cancers where there is widespread association of symptoms and signs with the eventual diagnosis, this was not the case in RA. Our findings should inform strategies to reduce delays in help-seeking in people with early RA.
16635056 Edaravone inhibits the disease activity in rheumatoid arthritis. 2006 Apr A male patient with rheumatoid arthritis (RA) developed acute stroke and was treated with the free radical scavenger, edaravone. Polyarthralgia improved with a reduction in serum C-reactive protein concentration soon after the start of edaravone administration. The disease activity score 28 (DAS28) also decreased. Edaravone appears to be effective for the control of RA. The usefulness of this potentially novel therapeutic agent should be tested in a well designed randomized controlled trial.
17985847 Detection of six single-nucleotide polymorphisms associated with rheumatoid arthritis by a 2007 Dec 15 An electrochemical DNA chip using an electrochemically active intercalator and DNA probe immobilized on a gold electrode has been developed for genetic analysis. In this study, the six polymorphisms associated with rheumatoid arthritis (RA), N-acetyltransferase2 (NAT2) gene polymorphisms T341C, G590A, and G857A, methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms C677T and A1298C, and serum amyloid A1 (SAA1) gene promoter polymorphism C-13T were simultaneously detected by the electrochemical DNA chip and the loop-mediated isothermal amplification (LAMP) method, which is a novel technique for DNA amplification. Human genomic DNAs were extracted from blood, and the targets containing the six polymorphisms were amplified by the LAMP method. A sample containing the six LAMP products was reacted with the electrochemical DNA chip using a DNA detection system that controls hybridization reaction, washing, electrochemical detection, and data analysis automatically. A total of 31 samples were genotyped by this method, and the results were completely consistent with those determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis or the PCR direct sequence analysis. The time required for this method was only 2 h, and operations were very simple. Therefore, this method is expected to contribute to personalized medicine based on genotype.
17311887 Validation of the comprehensive international classification of functioning, disability an 2007 Apr BACKGROUND AND PURPOSE: The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Rheumatoid Arthritis (RA) represents the typical spectrum of problems in the functioning of patients with RA. The objective of this study was to validate this ICF Core Set from the perspective of physical therapists. METHODS: Physical therapists were asked about their intervention goals in a 3-round Delphi survey. Intervention goals were compiled, and the physical therapists were asked whether they considered the goal classes to be relevant. The goal classes then were linked to the ICF. RESULTS: A total of 82 physical therapists in 12 countries named 562 intervention goals. A total of 45 goal classes covering all ICF components were identified. The goal classes addressing muscle tone, balance and coordination, and psychological distress were not represented in the ICF Core Set for RA. DISCUSSION AND CONCLUSION: The validity of the ICF Core Set for RA was largely supported. However, some categories currently not covered by the ICF Core Set for RA will need to be investigated further.
17471544 Comparison of energy expenditure from lifestyle physical activities between patients with 2007 May 15 OBJECTIVE: Low energy expenditure is a risk for cardiovascular morbidity. The goals of this study were to compare energy expenditure between patients with rheumatoid arthritis (RA) and healthy controls. METHODS: A total of 121 RA patients and 120 healthy controls in New York City completed the Paffenbarger Physical Activity and Exercise Index at time of enrollment (1999-2000) and 1 year later to measure energy expenditure from walking, climbing stairs, and exercise/sports. Analyses were adjusted for age, sex, education, pain, social support, and depressive symptoms and were compared with recommended thresholds of energy expenditure. RESULTS: Participants' mean age was 49 years, and 87% were women. Patients with RA expended fewer kilocalories per week than controls (mean +/- SD 1,474 +/- 1,198 versus 1,958 +/- 1,940, P = 0.003), with most of this difference from less walking as opposed to high-intensity activities. Although similar percents of RA patients and controls met national recommendations for total weekly energy expenditure (56% versus 64% for the lower [> or =1,000 kilocalories per week] threshold; P = 0.14, and 41% versus 48% for the higher [> or =1,400 kilocalories per week] threshold; P = 0.17), fewer RA patients met the recommendations (> or =700 kilocalories per week) for walking (32% versus 48%; P = 0.01). The strongest predictor of more energy expenditure at 1 year for both groups was more energy expenditure at enrollment. CONCLUSION: Most of the difference in energy expenditure between RA patients and healthy controls was due to less walking. Given that walking is an effective and relatively safe lifestyle activity, increasing walking should be a priority to improve cardiovascular risk in RA.
17399962 Automated segmentation and quantification of inflammatory tissue of the hand in rheumatoid 2007 Jun OBJECTIVES: The aim of this paper is the development of an automated method for the segmentation and quantification of inflammatory tissue of the hand in patients suffering form rheumatoid arthritis using contrast enhanced T1-weighted magnetic resonance images. METHODS AND MATERIALS: The proposed automatic method consists of four stages: (a) preprocessing of images, (b) identification of the number of clusters, by minimizing the appropriate validity index, (c) segmentation using the fuzzy C-means algorithm employing four features which are related to intensity and the location of pixels and (d) postprocessing, where defuzzification is performed and small objects and vessels are eliminated and quantification takes place. RESULTS: The proposed method is evaluated using a dataset of image sequences obtained from 25 patients suffering from rheumatoid arthritis. For 17 of them we have obtained follow-up images after 1 year treatment. The obtained sensitivity and positive predictive rate is 97.71% and 83.35%, respectively. In addition, quantification of inflammation before and after treatment, as well as, comparison with manual segmentation is carried out. CONCLUSIONS: The proposed method performs very well and results in high detection and quantification accuracy. However, the reduction of false positives and the identification of old inflammation must be addressed.
17304654 Determining the minimal clinically important differences in activity, fatigue, and sleep q 2007 Feb OBJECTIVE: To determine the minimal clinically important differences (MCID) in the patient-reported outcomes of activity (0-30, number of days of limitation), fatigue (0 = none, 100 = complete), and sleep quality (0 = no problems, 100 = worst case) for patients with rheumatoid arthritis (RA). METHODS: Two randomized controlled trials comparing abatacept to placebo in RA patients were considered: ATTAIN (n = 391) and AIM (n = 652). An internal anchor-based approach was used to derive the MCID using the Health Assessment Questionnaire, patient global assessment, and pain as anchors. Minimal important change in activity, fatigue, and sleep were determined by estimating mean changes in these outcomes in patients showing change in a narrow range about the MCID of the internal anchor. Correlation analysis was used to determine the consistency of the changes in the outcomes and anchors, and a Delphi process was used to determine the final MCID values. RESULTS: For the 2 trials, consistent patterns of change for activity, fatigue, and sleep and the internal anchors were found with correlations in the range of 0.5, 0.7, and 0.4, respectively. The mean changes for activity, fatigue, and sleep in a narrow range about the MCID of the 3 internal anchors corresponding to the 2 trials were: 3.4 to 4.3 for activity; 6.7 to 17.0 for fatigue; and 4.1 to 7.3 for sleep. Following the Delphi process the MCID determined were 4 for activity, 10 for fatigue, and 6 for sleep. CONCLUSION: These MCID for activity limitation, fatigue, and sleep problems can be used in designing clinical trials and providing benchmarks in assessing patient improvement.
19337555 Effect of conjugated linoleic acid, vitamin E and their combination on lipid profiles and 2008 The aim of this study was to assess the impact of conjugated linoleic acids (CLAs), vitamin E, and combination of these nutrients on serum lipid profiles and blood pressure (BP) in patients with active rheumatoid arthritis (RA). In a randomized, double-blind, placebo-controlled trial, 87 patients with active RA were divided into four groups receiving one of the following daily supplements for three months: Group C: CLAs 2.5 g equivalent to 2 g mixture of cis 9-trans 11 and trans 10-cis12 CLAs in a rate of 50/50; Group E: vitamin E: 400 mg; Group CE: CLAs and vitamin E at above doses: Group P: placebo. After supplementation, SBP levels decreased significantly in the group C in comparison with groups E and P and mean arterial pressure reduced significantly in groups C and CE. There weren't significant differences in the levels of prostaglandin E2 (PGE2), triglycerides, cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), LDL/HDL, cholesterol/HDL, fasting blood sugar, C-reactive protein (CRP), arylestrase activity, platelet count and body mass index between groups. CRP dropped nonsignificantly in groups P, C, E and CE (19%, 24%, 55%, and 39%, respectively). Erythrocytes sedimentation rate levels decreased in groups C, E and CE (P < or = 0.05, P < or = 0.05, P < or = 0.001, respectively). It is concluded that supplementation of CLAs decreased BP and vitamin E decreased CRP. Therefore co-supplementation of CLAs and vitamin E might be profitable for heart disease prevention in RA patients.
17414538 Successful rituximab therapy of acquired factor VIII inhibitor in a patient with rheumatoi 2007 Apr Acquired factor VIII deficiency due to antibody inhibition can result in life-threatening hemorrhage. Rarely such antibody inhibition of factor VIII can be associated with other autoimmune disorders including rheumatoid arthritis. We present the first case of a patient with active rheumatoid arthritis and refractory bleeding diatheses due to a factor VIII inhibitor who was successfully treated with rituximab. A 61-year-old Caucasian female with rheumatoid arthritis unresponsive to multiple therapies developed an acute hematoma while having a peripheral catheter placed. Her aPTT was prolonged at 61.4 with low factor VIII activity and an inhibitor level for factor VIII of 2.0 Bethesda Units. She received rituximab 375 mg/m in 4 weekly doses. Normalization of the aPTT and resolution of the bleeding occurred in 2 weeks. After 45 days, the levels of factor VIII inhibitor and factor VIII activity were <0.4 BU/mL and 130%, respectively. After 1 year, the aPTT remained normal and there was no further bleeding. An added benefit was the substantial improvement in her rheumatoid arthritis. Treatment of acquired factor VIII inhibitors in rheumatoid arthritis should be guided by the levels of the inhibitor. Patients with low levels of the inhibitor may respond to rituximab monotherapy, whereas higher levels may necessitate combination therapies. The dual benefit of RA disease control and resolution of bleeding makes rituximab therapy compelling in the rare patient who presents with these 2 disorders.
16839511 Vasculitis associated with connective tissue disorders. 2006 Aug Vasculitis associated with connective tissue disorders is an important cause of secondary vasculitis about which little is written. When vasculitis occurs in the setting of a preexisting connective tissue disorder, it often correlates with disease severity and portends a poorer prognosis. It may involve virtually any organ system and present in a myriad of ways. Prompt recognition and treatment of vasculitis can dramatically improve the outcome for the patient. This review focuses on recent insights into the clinical presentation and pathogenic mechanisms that may be involved.
17965118 Identification of disease activity and health status cut-off points for the symptom state 2008 Jul BACKGROUND: Established thresholds for low levels of disease activity need to be examined from a patients' perspective. OBJECTIVE: To identify new cut-off points for patients' perception of satisfactory condition (patient acceptable symptom state (PASS)) in composite indices and patient-reported outcomes, and to examine the agreement between the new PASS cut-off points for composite indices and existing thresholds for remission, low and moderate disease activity. METHODS: Patients with rheumatoid arthritis from a treatment register (n = 1496, 72.1% women, mean (SD) age 53.9 (13.5) years, disease duration 7.6 (9.1) years, 28-joint Disease Activity Score (DAS28) 4.98 (1.36)) responded during follow-up (12, 24 and 52 weeks) to a global dichotomised question on satisfactory condition (PASS). New PASS cut-off points were identified with the 75th centile estimation and receiver operating characteristic analyses for a variety of outcome measures, and cut-off points for composite indices were examined for agreement with the low disease activity threshold (1.625) of the Patient Activity Scale (PAS) and thresholds for remission, low and moderate disease activity in DAS28, Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI). RESULTS: New PASS cut-off points for DAS28, SDAI and CDAI were in the moderate range of disease activity, and the cut-off point was 3.56 for PAS. Agreement between thresholds for disease activity levels and the PASS cut-off points was best for low disease activity (accuracy 64.5-74.6), and better for moderate disease activity (accuracy 61.3-67.2) than for remission (accuracy 30.7-45.8). CONCLUSION: The current PASS concept seems to be in the range of moderate disease activity.
17280795 Treatment of rheumatoid arthritis and other related conditions by provoking a mild infecti 2007 When rheumatoid arthritis presents, the immune system overcompensates and acts attacking the joints and the body in general, the same thing occurs with other autoimmune diseases; the immunological mechanisms that manifest in these diseases have been identified, but there is still no explanation as to why this occurs. This article will present a hypothesis that is based on provoking a mild infection in patients with rheumatoid arthritis, and other related autoimmune diseases, an infection that does not result in serious consequences to the health of the patients, but does generate an immunological response, in this manner, the immune system itself, which is overcompensating, will fight the provoked infection instead of causing damage to the body itself.