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ID PMID Title PublicationDate abstract
17594840 [Gender differences in autoimmune diseases illustrated by rheumatoid arthritis]. 2007 Jun 18 Many autoimmune diseases like rheumatoid arthritis (RA) show gender differences. RA is triggered by an interaction between genetic, hormonal, environmental and behavioural factors. 75% of cases are women under the age of 60; lover the age 60 the gender ratio is 1:1. Different genotypes predispose for RA. Pregnancy often suppresses RA, as does oral contraception. Lactation, smoking (w), BMI > 30, heavy vibrations and certain dust particles (m) may trigger RA, while the effect of male hormones is uncertain. Future prevention should focus on environment, behavioural factors and genetic profiling.
16629448 [An autopsied case of a woman with rheumatoid arthritis attacked by multiple cerebral embo 2006 Mar A 45-year-old woman, who had had rheumatoid arthritis for 12 years, had three attacks of cerebral embolism over two months and died after the final attack. Intensive clinical laboratory investigations did not disclose any specific origins of emboli, but an autopsy revealed a nodule at the base of the aortic valve which was pathologically proved to be a rheumatoid nodule. The thrombi were present from the distal part of left internal carotid artery up to the proximal part of the left middle cerebral artery. They were rich in fiber, but poorly organized endothelial cell, raising the possibility that they originated from other parts and have recently reached there. On the top of the rheumatoid nodule, a thrombus was present. It was easily ablated and a small amount of fibrin stuck the nodule. Based on these results, we concluded that cerebral emboli were originally generated at the top of a rheumatoid nodule in the heart. In patients with RA, rheumatoid nodules are rarely seen in the heart. If present, they usually cause cardiac failure or atrioventricular block, and seldom result in cerebral infarction. This is the first case in which an autopsy proved rheumatoid nodule in the heart which had caused multiple cerebral emboli. We should consider the possibility of rheumatoid nodules in the heart as an origin of cerebral emboli in patients with rheumatoid arthritis.
17195357 [Follow-up studies of rheumatoid arthritis patients with the presence of antiphospholipid 2006 May The aim of the study was 2 years follow-up observation of clinical course in RA patients with the presence of anticardiolipin antibodies (aCL). METHODS: Among 395 patients with RA hospitalized in the Clinic of Rheumatology from January 2003 to December 2004 (2 years), in 39 patients with suspicion of antiphopspholipid syndrome the aCL antibodies were determined. In 7 cases we confirm the presence of aCL antibodies. Patients positive for antiphospholipid antibodies were invited to the Clinic on the beginning of 2006 (after 2 years from previous hospitalization) to analyze clinical course of disease and to perform laboratory examination. RESULTS: In the group of patients with RA positive for antiphospholipid antibodies, 3 had active RA with vascular changes. Aggressive therapy with disease modifying antirheumatic drugs (DMARDs) and corticosteroids caused conversion of anticardiolipin antibodies. Analogically antibiotic therapy in 2 patients with concomitant infections (urinary tract, respiratory system) caused conversion of aCL antibodies. 1 patient developed blastic coat cell lymphoma. 1 patient died because of cardiovascular complications. CONCLUSION: Presence of anticardiolipin antibodies can be the indicator of serious prognosis, it can predict vasculitis, persistent infections, cardiovascular complications or neoplasmatic disease. We suggest that antiphospholipid antibodies should be measure in patient with aggressive course of rheumatoid arthritis.
18756746 [The evaluation of the quality of life as a criterion of the efficiency of rehabilitating 2008 Under observation there were 120 patients with rheumatoid arthritis (RA), which were divided into basic (n = 80) and control group matched by gender, age and duration of the disease. The all patients received the similar drug and physiotherapeutic treatment. Furthermore additional sessions of structural resonance electromagnetic therapy (SREMT were performed) in patients from basic group. The comparative studies showed significant benefit of inclusion of SREMT in complex management of RA patients. The wide spectrum of therapeutic action of SREMT has positive influence on basic parameters of the quality of life of RA patients: the general indices of physical and role physical functioning, somatic pain, overall health, social and role emotional functioning. SREMT may be recommended for using in rheumatologic clinic as a method of increasing the efficacy of conducted treatment and therapeutic and rehabilitation measures in RA.
17453717 The association between HLA genes and radiological erosions in Malaysian patients with rhe 2007 May OBJECTIVE: To assess the relationship between the HLA-DRB1 genes with disease severity as assessed by radiological erosions in Malaysian patients with rheumatoid arthritis (RA). METHODS: In this cross-sectional study, we studied 61 RA patients who fulfilled the ACR criteria for the diagnosis of RA. HLA-DRB1 genotyping was performed by sequence specific primer (SSP) - PCR. Radiological grading and erosive score of the hands and wrists was calculated according to the Larsen-Dale method. Demographic data and treatment given to the patients were obtained from their case records. RESULTS: Fifty-six females and five males were studied from three ethnic groups. In 57 patients with erosions, rheumatoid factor was detected in 80%, HLA-DR4 in 40%, HLA-DRB1*0405 in 24% and shared epitope (SE) in 31%. The median delay in starting DMARDs was 24 months. The presence of rheumatoid factor, HLA-DR4 and HLA-DRB1*0405 were not significantly associated with a worse erosive score. Patients who possessed the SE had a higher erosive scores, compared to those who did not (p = 0.05). Concurrently, a delay in starting DMARD was associated with a high erosive score (p = 0.023, r = 0.348). However, after adjustment for the delay in starting DMARD, SE was no longer significantly associated with the erosive score. CONCLUSIONS: In these patients, the delay in starting DMARDs had a greater influence on the erosive score than SE alone. Whilst we cannot discount the contribution of the SE presence, we would advocate early usage of DMARDs in every RA patient to reduce joint erosions and future disability.
16551663 Inferring causal relationships among intermediate phenotypes and biomarkers: a case study 2006 Jun 15 MOTIVATION: Genetic association analysis is based on statistical correlations which do not assign any cause-to-effect arrows between the two correlated variables. Normally, such assignment of cause and effect label is not necessary in genetic analysis since genes are always the cause and phenotypes are always the effect. However, among intermediate phenotypes and biomarkers, assigning cause and effect becomes meaningful, and causal inference can be useful. RESULTS: We show that causal inference is possible by an example in a study of rheumatoid arthritis. With the help of genotypic information, the shared epitope, the causal relationship between two biomarkers related to the disease, anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) has been established. We emphasize the fact that third variable must be a genotype to be able to resolve potential ambiguities in causal inference. Two non-trivial conclusions have been reached by the causal inference: (1) anti-CCP is a cause of RF and (2) it is unlikely that a third confounding factor contributes to both anti-CCP and RF.
18341711 Rheumatologists, take heart! We may be doing something right. 2008 In the present issue of Arthritis Research & Therapy data are presented suggesting that antirheumatic therapies decrease the risk of cardiovascular disease in patients with rheumatoid arthritis. The QUEST-RA group, a large international collaboration, analyzed data on 4,363 patients in a cross-sectional manner. Traditional risk factors were all significantly associated with cardiovascular events, and the presence of extraarticular disease significantly increased the risk, confirming a previous publication. The most interesting analysis in this study suggests that effective antirheumatic treatment, with traditional disease-modifying antirheumatic drugs (DMARDs), glucocorticoids, or anti-TNF biologics, reduces the risk of cardiovascular disease in rheumatoid arthritis. Some methodological issues are discussed, however, and confirmatory studies are suggested.
17165003 Acute destruction of the hip joints and rapid resorption of femoral head in patients with 2006 We report three rheumatoid arthritis (RA) cases with acute destruction of hip joint and rapid resorption of femoral head. The condition occurred in less than 6 months and closely resembled rapid destructive coxarthrosis. All three patients were postmenopausal women with active RA who had been taking steroids. Two of the patients were taking prednisolone (PSL) of over 20 mg as maximum dose per day, and all patients were resistant to disease-modifying anti-rheumatic drugs (DMARDs). Other than the problems of their hip joints, one had a giant bursitis around the pathological side of the hip joint, another had multiple rheumatoid nodules and skin infarction, and the other suffered from insufficiency fracture of the contralateral femoral subcapital lesion. As a result, all of them had total hip arthroplasty. We recommend taking repetitive radiographs for RA patients with continuing severe hip pain.
16758056 Dermatitis herpetiformis and rheumatoid arthritis. 2006 Jun Dermatitis herpetiformis DH is a rare, intensely pruritic, chronic, recurrent, papulovesicular disease. The disease can be clearly distinguished from the other subepidermal blistering eruptions by histologic, immunologic, and gastrointestinal criteria. Most patients have an associated gluten-sensitive enteropathy GSE that is usually asymptomatic. Both enteropathy and the dermatologic findings disappear with a gluten-free diet, therefore, DH is thought to be the specific dermatologic finding of celiac disease CD. An association between CD and autoimmune disease has been documented in several studies. Similar associations have been reported in DH. We report a 46-year-old man with DH diagnosed more than 10 years previously who developed GSE, pernicious anemia, and rheumatoid arthritis in the following years.
18450270 Comparative analysis of seronegative and seropositive rheumatoid arthritis regarding some 2007 Classifying patients into two subsets of the disease--seronegative RA and seropositive RA--has been the subject of many studies which aim to clarify this phenomenon--without any conclusive or acceptable answer so far. The aim of this prospective study was to establish a scientific comparative analysis between seronegative and seropositive rheumatoid arthritis (RA) regarding some epidemiological and anamnestic characteristics. The studied group consisted of seronegative patients with titers lower than 1:64 as defined by Rose-Waaler test, while the control group consisted of seropositive patients with titers of 1:64 or higher. All patients belonged to 2nd and 3rd functional class according to the ARA criteria, were between 25-60 years of age (Xb=49.96), with disease duration between 1-27 years (Xb=6.41). Education, residence, economic and living conditions did not show any significant statistical difference regarding serostatus. Familial clustering of RA confirmed higher susceptibility in the seropositive group (chi2=7.02; p<0.01). In both subsets banal diseases, psychic and physical trauma, weakness, and numbness of hands and legs dominated, without any statistical differenceregarding serostatus. Some differences between groups regarding sex were noticed, but were not statistically significant, except regarding physical trauma, which was more present in seronegative females (chi2=8.05; p<0.01).
17708742 Monitoring response to treatment in rheumatoid arthritis--which tool is best suited for ro 2007 Rheumatoid arthritis treatment is a fast changing and advancing area. Current drugs are now better utilized and new medications continue to be developed. The main challenge is to identify which patients are responding to treatment and to objectively quantify their response or nonresponse. There is a need for more rheumatologists to pursue use of an objective assessment tool in routine clinical care. Therefore, knowledge of the various tools available to rheumatologists in clinical trials and routine care and their practical differences is important to progress in patient evaluation and management. The tool that is easiest for both the patient and the physician to use and that still provides important treatment response and prognostic information has the best chance to be consistently and successfully applied by busy clinicians.
17924607 Decrease of disease activity under ineffective therapy in DMARD-naive patients with early 2007 Oct OBJECTIVE: To evaluate whether the baseline presence of rheumatoid arthritis (RA)-associated biomarkers could define subgroups of patients that are more prone to show a spontaneous decrease of RA disease activity. In a previous placebo-controlled phase II trial that failed to show any superiority of the experimental compound versus placebo, a remarkable decrease of such disease activity was observed despite the lack of effective treatment. METHODS: A subgroup of 83 disease modifying antirheumatic drug-naive RA patients with disease duration < 3 years was analyzed. Rheumatoid factor (RF), anti-citrullinated protein/peptide antibodies (ACPA), and HLA shared epitope (SE) were determined at baseline. RESULTS: RF-positive patients tended to have higher levels of disease activity at baseline compared to RF-negative patients [Disease Activity Score (DAS) 6.12 vs 5.65, p = 0.02 at screening], but the decrease in disease activity was similar in both subgroups (DAS -1.23 vs -1.07). In contrast, ACPA-positive patients showed similar baseline disease activity scores compared to ACPA-negative patients, but tended to show a smaller decrease of disease activity than patients without ACPA (Delta DAS -1.53 vs -0.79, p = 0.013). Presence of the HLA-SE seemed not to have any effect on the baseline DAS or on the spontaneous decrease of DAS. CONCLUSION: The predictive value of baseline RA-associated biomarkers for spontaneous decrease of disease activity under placebo or ineffective treatment is limited. Yet the data analyzed here might be useful for the design of future placebo-controlled trials in RA.
17164997 The therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy in the 2006 The purpose of the present study was to retrospectively evaluate the therapeutic outcome of minimally invasive synovectomy assisted with arthroscopy (MISAA). From 1995 to 2003, MISAA was performed on 30 knees of 18 rheumatoid arthritis patients. The mean follow-up period was 74.4 months. Radiographic assessment according to Larsen's radiological classification, the conversion ratio to total knee arthroplasty (TKA), and postoperative change of the range of flexion were evaluated retrospectively. There were 10 knees in grade I, 14 knees in grade II, and 6 knees in grade III, preoperatively. All the knees in grade I and 8 of 14 knees in grade II maintained the same grade until the latest follow-up. The other 6 knees in grade II and all the knees in grade III deteriorated to grade IV and were converted to TKA after MISAA. The mean range of flexion significantly increased postoperatively except the knees that were converted to TKA. MISAA is effective for rheumatoid knees in grade I or II, and improves range of flexion.
18409278 [Chosen determinants of smoking among persons with rheumatoid arthritis]. 2007 Rheumatoid arthritis (RA) is a chronic connective tissue disease with characteristic symmetric joints infibulations leading to disability. Due to progressive character of the disease, with periods of worsening and remission, the treatment should be complex and focused on the inhibition of the progress of the changes. The aim of the study was opinion of effect of smoking for functionality in person with rheumatoid arthritis. Material consists of 23 persons with RA. HAQ Disability Score were used. Additionally the questionnaire for estimation of health attitudes was used. Results of investigations prove lack of connections between smoking and correct functionality in persons with rheumatoid arthritis.
17221251 [Tendon ruptures in rheumatic patients]. 2007 Feb In the course of rheumatoid arthritis, changes to tendons occur in different areas. This can lead to rupture if not prevented at an early stage. In particular, regions with extreme joint thickness, high mechanical wear and tear and narrow regions present a higher risk of synovitis. This primarily affects the tendons of the hand, where the extensor digitorum minimus tendon and the extensor and flexor pollicis tendons are most at risk. There is a high possibility of rotator cuff lesion in the shoulder area during the course of a secondary synovitis dependent raised shoulder, or by bursitis or tendonitis. A rupture of the biceps tendon is also increased by omarthritis or synovitis in the sulcus. For the foot, the posterior tibial tendon is most commonly effected, which if primarily or secondarily damaged can lead to a rheumatic flat foot. In addition, there can be partial or complete destruction in the Achilles tendon area, which is definitely pathognomonic. The narrow syndrome in the flexor hallucis and the extensor digitorum tendons are less common.
17878684 Pulmonary findings without the influence of therapy in a patient with rheumatoid arthritis 2007 Aug We report the autopsy findings of a 40- year- old woman with lung complications of rheumatoid arthritis. She has been suffering from rheumatoid arthritis and interstitial pneumonia without satisfactory therapies because of her poor compliance. At autopsy, diffuse pleural adhesions and many protruding cysts were observed. The cut surfaces had rich fibrous changes and honey-comb like appearances dominantly in the left lower lobe. Microscopically, remarkable fibrous changes were observed with destruction of the alveolar structure. These fibroses were temporally homogeneous and lacked prominent fibroblastic foci. The histological pattern was consistent with fibrous non- specific interstitial pneumonia. In peripheral pulmonary arterioles, some thrombi were detected with much recanalization. Systemic amyloidosis was observed in the submandibular gland, thyroid, heart, and arterioles of the lung, kidney, and digestive tract. In the left pulmonary artery, a large embolus was detected. This embolism was the direct cause of death. Her pulmonary findings, except for the embolism, were considered sober states of lung complications of rheumatoid arthritis without the influence of therapy.
18430326 Spontaneous bilateral olecranon fractures in a rheumatoid patient. 2008 Apr A case is described of a patient sustaining bilateral spontaneous olecranon fractures while undergoing rehabilitation following surgery for a hip fracture. The patient's underlying rheumatoid arthritis disease process most likely caused erosions and subchondral cysts formation in the mid-trochlear notch region. This area, in turn, acts as a pivot point in elbow extension/flexion movements. During rehabilitation, the patient became dependent on her upper limbs for mobilisation. This led to significant forces being put through this already weakened region, causing spontaneous bilateral olecranon fractures. Rheumatoid patients after lower limb surgery should be careful during rehabilitation, and avoid undue strains through their upper limbs.
17209445 [The functional condition of the left ventricle in patients suffering from rheumatoid arth 2006 The purpose of the study was to evaluate the systolic and diastolic left ventricular (LV) function in patients with the system form of rheumatoid arthritis (RA) with subcutaneous rheumatoid nodules (SRN). The subjects, 105 patients with proved RA, were divided into two groups. The main group consisted of 40 patients suffering from system RA with SRN. The comparison groups included 40 patients suffering from the articular-and-visceral form of RA without SRN, and 25 patients with the articular form of RA. The systolic LV function was evaluated in all the 105 RA patients using M-mode Echo CG. In 20 patients with SRN systolic and diastolic LV function was evaluated with radionuclide ventriculography (RVG). The hemodynamic parameters obtained with Echo CG and RVG were processed according to variation statistics rules, presenting the data in groups as a mean and the standard error (M +/- m); the results were compared between the patients and between the patients and healthy controls. The significance was estimated using Student criterion (p < 0.05). In the group of RA patients with SRN, Echo CG and RVG found a significant decrease in LV systolic function parameters vs. patients without SRN and healthy controls. RVG revealed LV diastolic dysfunction in RA patients with SRN. Systolodiastolic LV dysfunction in these patients suggests myocardial involvement. Present-day instrumental methods of the evaluation of functional heart condition may be used to evaluate systolic and diastolic LV function in RA patients, especially during the dynamic observation of the effectiveness of RA treatment with modern anti-rheumatic preparations.
16421640 [Pneumocystis jiroveci pneumonia (PcP) in patients with rheumatic diseases: case report an 2006 Feb A 74-year-old female patient with rheumatoid arthritis was diagnosed with Pneumocystis jiroveci pneumonia (PcP) following therapy with methotrexate and prednisone. Although bactrim treatment was initiated and PcP was not detected by a control bronchoalveolar lavage, the patient died. The precise cause of death remains unknown. As this case illustrates, PcP must be considered as a differential diagnosis in immunocompromised patients with rheumatic disease. The typical course, diagnosis, prophylaxis and treatment of PcP in this patient group are discussed.
18822481 [Combination of modern physiotherapeutic methods in rehabilitation of patients with osteoa 2008 Jul Duration of the rehabilitation period after arthroscopic surgery on the knee joint was reduced by the use of a combination of two modern physiotherapeutic modalities, local cryo-aerotherapy and electrostimulation of smooth muscle components of vascular walls using a Lymphavision apparatus (5-7 sessions). This treatment was given to 55 patients with osteoarthrosis following arthroscopic meniscal resection and abrasive chondropasty and to 20 ones with rheumatoid arthritis after arthroscopic total synovectomy. All patients reported alleviation of pain and oedema in the affected joint. The rehabilitation period was 2-5 days shorter than after the traditional treatment.