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

ID PMID Title PublicationDate abstract
16732894 Reshaping Cinderella's slipper: the shared epitope hypothesis. 2006 This issue of Arthritis Research and Therapy contains a succinct and elegant paper by Michou and colleagues that advances our understanding of the genetic basis of rheumatoid arthritis (RA) by reclassifying the contribution of RA susceptibility alleles according to their structure. This line of research is potentially important in our conceptualization of the mechanism of disease in RA, in predicting disease course and severity, and as a model for further studies on this topic. The author's approach to reassessing the molecular structure of the shared epitope redirects attention to using the binding properties of the major histocompatibility complex molecules associated with susceptibility to search for the peptides driving the autoimmune process underlying rheumatoid arthritis.
17318275 Nasal tip necrosis--an unusual presentation of rheumatoid vasculitis. 2007 Nov We describe an unusual case of cutaneous necrosis of the nasal tip presenting to a facial reconstructive surgeon. The patient had developed this painless necrosis over a period of about 10 days. Her past medical history included rheumatoid arthritis. She described an exacerbation of her arthritic symptoms in the weeks preceding the development of the nasal tip necrosis. Her rheumatoid arthritis had been managed with corticosteroid and immunosuppressive therapy for more than 3 years. She had not previously experienced extra-articular manifestations (EAMs). A biopsy was taken and histological analysis identified a lymphocytic vasculitis. She was referred to her rheumatologist, and surgical management of her necrotic nasal tip commenced.
17915095 Antibodies to citrullinated proteins: pathogenic and diagnostic significance. 2007 Oct The recent demonstration of efficacy in the treatment of rheumatoid arthritis with B-cell-depleting therapy, along with the increasing understanding of the role of anticitrullinated protein antibodies (ACPA) have begun to provide new insights into the pathogenesis of this complex disease. This manuscript reviews the current understanding of ACPA with regard to clinical associations and pathogenic mechanisms in preclinical animal models. These data are synthesized into a model of the development of rheumatoid arthritis that refocuses attention on the role of B cells and immune complexes, returning in part to the origins of scientific investigation in this disease, and points to directions of research that are necessary to achieve the full therapeutic, diagnostic, and prognostic potential of the ACPA antigen-antibody system.
16997472 Higher levels of pain readiness to change and more positive affect reduce pain reports--a 2007 Feb The objective of the study was to analyze the relationships between Pain Readiness to Change, weekly measures of positive and negative affect and pain over eight subsequent weeks in patients with rheumatoid arthritis (RA). Factor analysis based on data from three different samples of patients with rheumatic diseases and other chronic pain conditions suggested a three factor solution for the Norwegian version of the Pain Stages of Change questionnaire (PSOCQ) representing Precontemplation, Contemplation, and Action/Maintenance (ACT) stages from the original Transtheoretical Model. Multilevel analyses on the weekly assessed data from a sub sample of 40 patients with RA revealed that higher levels of Pain Readiness to Change represented by high ACT scores were associated with more positive affect from week to week while no association was found between Readiness to Change and weekly pain. However, there was an interaction effect between Pain Readiness to Change and weekly positive affect on weekly pain, indicating that those persons having a higher level of Readiness to Change reported less pain in weeks when they also experienced increased positive affect. This may imply that a combination of cognitive factors and positive affect is most effective in relation to pain reduction. Results encourage continued investigation of apparent interactions between chronic pain, affect, and pain self-management.
16284769 Possible association of the X-ray cross complementing gene 1 (XRCC1) Arg280His polymorphis 2006 Jun Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by the invasion of synovial cells into cartilage and bone, exhibiting certain features of transformed cells. To examine whether retardation of DNA repair pathway of oxidative damage is a possible mechanism in altered phenotypes of these cells, we analyzed SNPs of the base excision repair (BER) protein, X-ray repair cross complementing gene 1 (XRCC1), among RA patients. Genomic DNA was extracted from blood cells of 40 RA patients and SNPs of the three allele of the XRCC1 coding region (codons 194, 280 and 399) were determined by PCR, followed by sequencing. Of the three polymorphisms, only the XRCC1 Arg280His allele was associated with increased RA risk (odds ratio 13; 95% confidence interval 1.1-147) after adjustment for smoking. These data provide evidence for the first time that BER, which is involved in the recovery from oxidative damage, may correlate with RA.
18537790 Radiographic scoring in rheumatoid arthritis: a short introduction to the methods. 2008 Several methods have been introduced for the scoring of plain radiographs in patients with rheumatoid arthritis. The first methods characterized global damage in hands and wrists in a qualitative rather than quantitative approach. The Sharp and the Larsen scoring methods were introduced in the 1970s. Modifications of these methods over time have resulted in contemporary scoring systems that are described herein.
17605944 Treatment and management of early RA: A primary care primer. 2007 Jul Rheumatoid arthritis (RA) is a complex disease to diagnose and manage. The classes of drugs that are used to treat RA are directed at the immune response that occurs during the disease process. Prompt initiation of pharmacologic treatment may delay or prevent disease progression. The primary care clinician is responsible for recognizing and diagnosing RA at its onset and for ensuring that patients receive prompt treatment to avoid debilitating and progressive joint damage. While a specialist in rheumatology will prescribe disease-modifying antirheumatic drugs for RA patients, the specialist and the primary care clinician share responsibility for monitoring patient progress, RA complications, and adverse effects of the drugs.
17694268 Posterior interosseous nerve palsy related to rheumatoid synovitis of the elbow. 2007 Posterior interosseous nerve palsy (PINP) is a rare complication of rheumatoid arthritis of the elbow. A 58-year-old woman with rheumatoid arthritis, who complained of an inability to extend her left fingers, was referred to our hospital. After a series of studies, extensor tendon ruptures were excluded, and PINP was diagnosed. By means of the Henry anterolateral approach, the radial nerve was exposed, which was compressed by swollen synovial membrane at the Frohse arcade. Elbow synovectomy was performed, and the arcade was opened to release the nerve. The PINP has been recovered completely within 2 weeks after surgery. Various examinations other than magnetic resonance imaging have been reported for the adjunctive diagnosis of PINP, but MR imaging was most useful as an adjunctive examination in this case.
19388592 [Anti-citrullinated peptide antibodies: novel markers for rheumatoid polyarthritis]. 2006 Rheumatoid arthritis is a multi-factorial autoimmune disease in which patho-physiological mechanisms have been partially elucidated these past few years. These recent advances have led to new and effective treatments that must be started early in the course of the disease. This review focuses on new serological markers, the anti citrullinated peptides antibodies which seem to be useful in early diagnosis and prognosis of rheumatoid arthritis and probably provide new insights in its pathogenesis.
18803141 [Constrictive pericarditis in the course of rheumatoid arthritis]. 2008 Aug We describe a case of a patient with advanced heart failure. On the basis of clinical status, echocardiography and the results of magnetic resonance, constrictive pericarditis was diagnosed. The seropositive rheumatoid arthritis was the cause of the constriction. Constrictive pericarditis should be considered in differential diagnosis in patients with rheumatoid arthritis and heart failure.
19005635 Limiting cardiovascular risk in Irish rheumatoid arthritis patients. 2009 Mar BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease and premature death. OBJECTIVES: Our aims were: (1) to assess how thoroughly RA patients were being screened for cardiovascular risk factors in our outpatient population and (2) to evaluate the benefit of introducing a shared care cardiovascular booklet. METHODS: We assessed 80 patients who attend our service with RA. Our initial audit revealed that 80% of patients had not been thoroughly assessed for basic cardiovascular risk. Based on these findings, we created a shared care booklet. RESULTS: On re-auditing our service, we found a significant improvement in the assessment of cardiovascular risks. CONCLUSION: There is currently a low level of screening for cardiovascular risks in busy outpatient clinics. We felt the introduction of a shared care booklet allowed an increased level of screening in our clinics and also acted as a tool for doctor and patient education.
18239749 Glucocorticoids in early rheumatoid arthritis. 2008 Jan This series of articles facilitated by the Australian Cochrane Musculoskeletal Group (CMSG), aims to place the findings of recent Cochrane musculoskeletal reviews in a context immediately relevant to general practitioners. This article considers treating patients in the first 2 years of rheumatoid arthritis with low dose of oral corticosteroids.
18219461 [Outcome of a patient with rheumatoid arthritis treated with homeopathic drugs without DMA 2008 Jan 15 CASE REPORT: The case of a 34-year-old female patient with rheumatoid arthritis (RA) is reported, who was treated with homeopathic medicine without DMARD (disease-modifying antirheumatic drugs) therapy for 13 years. She required bilateral knee replacement surgery. Her arthritis was highly active. On X-ray analysis, her wrists, metacarpophalangeal and proximal interphalangeal joints displayed marked structural damage. CONCLUSION: There are very few controlled clinical trials investigating the efficacy of homeopathic remedies in RA, and none of them has shown a significant benefit for the patients. This lack of efficacy is underscored by the case presented here. It is medical malpractice to treat patients with homeopathic drugs while withholding an effective DMARD therapy.
18638687 Dietary omega-3 fats for treatment of inflammatory joint disease: efficacy and utility. 2008 May There is high level evidence (meta-analysis of randomized, controlled trials) for symptomatic benefits from fish oil use in rheumatoid arthritis, and there is biologic plausibility for its clinical effects. Fish oil also has safety advantages in reducing cardiovascular risk via direct cardiovascular effects and via nonsteroidal anti-inflammatory drug-sparing. This is an important aspect of fish oil use, given the increased cardiovascular risk in rheumatoid arthritis. Perceived barriers to clinical use are readily addressed.
17998095 Labeling of autologous monocytes with 99mTc-HMPAO at very high specific radioactivity. 2007 Nov Rheumatoid arthritis of joints involves the accumulation of monocyte-derived macrophages in the affected synovial tissue. This process of cell migration can be portrayed scintigraphically in order to monitor noninvasive effects of therapy on the progress of the disease. Scintigraphic detection of inflammation by means of technetium 99m-hexamethylpropylene amine oxime (99mTc-HMPAO)-labeled leukocytes provides a classic example. Present state-of-the-art methods in cell biology allow the isolation of cells like lymphocytes or monocytes, which are less abundant than main blood constituents but, instead, harbor particular functions like specific homing properties. To facilitate scintigraphic imaging of the cell functions involved, the relatively small population of cells must be labeled to radioactive yields as high as possible. We demonstrate that autologous monocytes isolated from 100 ml of peripheral blood can be radiolabeled to a yield of 10 (instead of 1) Bq per cell, allowing scintigraphic analysis of rheumatoid arthritis up to 20 h post injection of patients. The method is based on the instantaneous distribution of lipophilic 99mTc-HMPAO between the hydrophobic inside of cells and the hydrophilic (aqueous) surrounding of cells, followed by decomposition of the radiopharmaceutical into compounds that are unable to cross the cellular membrane. The procedure provides a method of choice for cell-mediated scintigraphy at low availability of cells with the correct homing properties.
17520867 Antirheumatic drugs and gene signatures. 2007 May Rheumatoid arthritis is a chronic autoimmune disease involving progressive destruction of the joints. Although a variety of antirheumatic drugs are in use, they usually only slow, and not halt, disease progression, or reverse the damage to cartilage and bone. Furthermore, treatment has to be discontinued in some cases due to toxicity and/or lack of response. By analyzing the whole transcriptome of a cell or tissue with microarray technology, a newo way of identifying treatments and discovering more about the mechanisms of known drugs has become available. This review discusses the strengths and weaknesses of microarray technology and gives an overview of gene expression studies currently performed in the field of antiheumatic therapies.
17530677 Cost-utility analysis of a multidisciplinary job retention vocational rehabilitation progr 2007 Jun 15 OBJECTIVE: To estimate from a societal perspective the cost-utility of a multidisciplinary job retention vocational rehabilitation program compared with usual care in patients with chronic rheumatic diseases at risk of job loss. METHODS: Patients (n = 121) were randomly assigned to either the vocational rehabilitation program or usual outpatient care initiated by the treating rheumatologist. Followup lasted for 2 years. Program costs were estimated using time registrations and other societal costs using quarterly cost questionnaires filled out by the patients. To estimate quality-adjusted life years, utility was assessed using the EuroQol classification system, EuroQol rating scale, Short Form 6D, and Time Trade-Off. RESULTS: As part of the vocational rehabilitation program, patients on average had a total of 7.1 consultations and the total time spent by the multidisciplinary team was 12.7 hours per patient. Program costs were estimated at euro1,426, of which approximately 20% were time and travel costs incurred by the patients. No significant differences were found in other health care consumption, productivity, or quality-adjusted life years. Program costs were outweighed by total savings on other health care and nonhealth care costs, but not significantly. CONCLUSION: From a societal perspective, it remains unclear whether the program reduces or increases total costs. Further research on effective vocational rehabilitation is warranted, with special attention to early detection of work problems and the collaboration between health care and vocational rehabilitation services.
17228803 [A case of follicular bronchiolitis preceding rheumatoid arthritis]. 2006 Feb A 52-year-old woman was admitted to Yame General Hospital because of persistent cough, wheeze, and shortness of breath at age 48. Chest X-ray and computed tomography (CT) showed bilateral centrilobular shadows. Pulmonary function test revealed obstructive dysfunction. She also had chronic sinusitis. Initially, diffuse panbronchiolitis was diagnosed and she was given macrolides, but no improvement was observed. Thus video-assisted thoracoscopic lung biopsy (VATS) was performed in order to establish a definitive diagnosis. Histopathological findings were compatible with a diagnosis of follicular bronchiolitis. Treatment with corticosteroid (oral prednisolone, 50 mg/day) improved her condition. However, on reducing the steroid doze, her symptoms and chest X-ray film/CT findings became exacerbated. In addition, polyarthritis appeared. Further investigations revealed a diagnosis of rheumatoid arthritis. Only 2 cases of follicular bronchiolitis preceding rheumatoid arthritis have been reported in Japan.
18264553 The arthritic, cuff-deficient shoulder--when is hemiarthroplasty enough? 2007 Dec This article outlines the role of hemiarthroplasty in the treatment of cuff-tear arthropathy. Rotator cuff tear arthropathy, kinematics, and classification are reviewed.
17216677 Prognosis of 5-year radiographic erosions of the wrist according to early, late, and persi 2007 Jan OBJECTIVE: To determine whether early inflammatory activity in the first year of disease compared to persistent or later occurrence of swelling or tenderness in the wrist joints is associated with 5-year erosions in the same joint in patients with early rheumatoid arthritis (RA). METHODS: A cohort of 195 patients with early active RA was enrolled in the Finnish RA Combination Trial. Swelling and tenderness of wrists were assessed at baseline and at 3, 6, 12, 24, 36, and 48 months. Radiographs of the wrists were taken at the baseline and at 5 years. The 237 wrist joints of 125 patients without erosions at baseline were classified according to wrist swelling, i.e., I: never swollen; II: swollen during first year only; III: swollen during the second to fourth year only; and IV: swollen during the first year and followup, and similarly according to tenderness. RESULTS: Thirty percent of the wrists were never swollen in all clinical examinations; 43% were swollen only during the first year; 11% were not swollen in the first year, but were swollen at some time during 24-48 months; and 16% of wrists were swollen during the first year and at some time during 24-48 months. At 5 years, 64% of 237 wrists remained free of erosions. Erosions developed in 82% of wrists that were swollen during both the first year and 24-48 months, versus 56% of wrists that were not swollen at first year but were swollen during 24-48 months, 31% of wrists that were swollen during the first year only, and 11% of wrists that were never swollen. Similar results were seen for joint tenderness. CONCLUSION: Wrist swelling during the first year only is associated with less future wrist radiographic damage than persistent swelling or swelling only during the followup. Our results emphasize the value of early and continuous suppression of inflammatory activity in early RA.