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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
16881123 Possession of assistive devices is related to improved psychological well-being in patient 2006 Aug OBJECTIVE: To investigate the relationship between the possession of assistive devices and psychological well-being in patients with rheumatic conditions. METHODS: Patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) were selected from rheumatology outpatient clinics in 2 adjacent regions in The Netherlands and Germany. A total of 142 patients completed a questionnaire on the possession of assistive devices and psychological well-being. Questions on sociodemographics, clinical status, and health status were included. Hierarchical multiple linear regression analysis was used to determine the unique association between the number of assistive devices per patient and psychological well-being, controlling for confounding variables. RESULTS: Univariately, the number of assistive devices per patient was negatively associated with psychological well-being. Multivariately, the number of assistive devices per patient was positively associated with psychological well-being. Functional status was a negative confounder of the relationship between the possession of assistive devices and psychological well-being. CONCLUSIONl The possession of assistive devices was positively related to psychological well-being of patients with rheumatic diseases, after controlling for differences in functional status.
17530671 Use of accommodations for valued life activities: prevalence and effects on disability sco 2007 Jun 15 OBJECTIVE: To describe the prevalence of using 4 specific behavioral accommodations (assistive devices, personal assistance, limits on the amount or kind of activities, and taking more time to perform activities) in the performance of valued life activities (VLAs), and to examine the impact of accounting for these accommodations on VLA disability scores. METHODS: Data were from a panel study of 467 individuals with rheumatoid arthritis (RA) interviewed annually by telephone. VLA disability was assessed using a 29-item scale, rating difficulty performing each activity and asking whether the 4 types of accommodations were used. An unadjusted difficulty score based solely on difficulty ratings was calculated, as well as 3 adjusted scores accounting for use of assistance or devices, use of assistance, devices, or limitations in activities, and use of all 4 accommodations. RESULTS: Accommodations were widely used by individuals with RA to perform daily activities. Limits and more time were used for more activities than assistance and devices. Adjustment for accommodations produced substantial increases in disability scores (e.g., the mean total VLA difficulty score increased by 84% after adjustment for all 4 accommodations). CONCLUSION: The accommodations included on the Health Assessment Questionnaire, the most commonly used measure of functioning for RA, include only assistive devices and personal assistance, which were not the accommodations most frequently used in our sample. If assessments are intended to estimate total disease burden, they should include use of a broader range of accommodations to develop a more complete picture of how daily function is affected.
17894002 Preclinical impairment of coronary flow reserve in patients with rheumatoid arthritis. 2007 Jun Cardiovascular involvement in rheumatoid arthritis (RA) is common, although the true prevalence of cardiac abnormalities is difficult to measure, as much disease remains clinically silent. The pathogenesis of cardiac lesions in RA is related to the primary disorder of microcirculation with diffuse arteriolar and capillary lesions. Previous studies demonstrated that coronary flow reserve (CFR) is impaired in patients with connective tissue diseases (CTD). This review focuses on transthoracic Doppler echocardiography as a noninvasive method used to assess CFR in RA patients. CFR is early reduced in RA patients without clinical evidence of heart disease as a result of impaired microcirculation. CFR seems a useful technique able to follow-up and to assess effects of new drugs on RA patients.
16875130 [Optimization of laboratory assessment of the activity of an inflammatory process in patie 2006 Jun The paper proposes to measure the serum content of medium-weight molecules as a simple and available means of rapidly and adequately assessing the total activity of an inflammatory process (including the minimal one) in patients with rheumatoid arthritis. The method may be performed at any powered clinical diagnostic laboratories; it does not require expensive reagents and equipment, and special staff training.
16504820 The pharmacoeconomics of newer therapeutics for rheumatic diseases. 2006 Feb Rheumatic diseases are common, serious conditions characterized by alterations in normal immune homeostasis with resultant end-organ injury. Although diverse in clinical expression and pathophysiologic basis, therapeutic approaches for these conditions frequently overlap. Over the past decade, several important new therapies have been introduced into the clinic for the treatment of many rheumatic conditions. Although these agents have proven highly effective, their higher costs have raised questions concerning their most appropriate use in the clinic. This issue has been analyzed in greatest detail in rheumatoid arthritis. Increasing data suggest that newer therapeutics may be cost-effective for rheumatoid arthritis and other rheumatic diseases.
16365685 Disease activity and functional changes of RA patients receiving different DMARDs in clini 2006 Sep The aim of this study was to compare the effectiveness of different disease-modifying anti-rheumatic drugs (DMARDs) in improving disease activity and functional status in patients with rheumatoid arthritis (RA). One hundred and fifty-two Thai RA patients treated with at least one DMARD were enrolled in this 1-year cohort. Demographic characteristics, baseline and end-of-study data on disease activity and Health Assessment Questionnaire (HAQ) Disability Index of the subjects were compared among different DMARD options. Predictors of HAQ score were investigated using regression analysis. The results showed that the studied patients had established RA with mild to moderate activity. More than 85% were prescribed methotrexate (MTX) as single or combined DMARDs. At 1 year, improvement in most activity measures was experienced. However, all patients had functional declines. Patients taking antimalarial agents had the maximal rate of functional deterioration. Patients taking MTX-based DMARDs had significantly lower rate of functional decline than patients taking DMARDs without MTX (p=0.018). Only patients receiving MTX-based DMARDs had clinically meaningful improvement in HAQ score. The predictors of HAQ score at 1 year included baseline HAQ score and patient global assessment at end of study. In conclusion, although DMARD treatment was shown to improve disease activity in RA patients, functional deterioration was evident in our cohort. Thus, measures of functional status are more appropriate than measures of disease activity to evaluate treatment effects of DMARDs in established RA in clinical practice. MTX-based DMARDs should be prescribed where possible in RA patients with persisting activity due to their ability to delay functional deterioration.
16946997 Occurrence of sacroiliitis in patients with seronegative oligoarthritis. 2007 May The aim of this study was to investigate sacroiliitis in patients with seronegative oligoarthritis. Thirty consecutive patients with seronegative oligoarthritis and no other signs of spondylarthropathy were included. Sacroiliac (SI) joints were investigated by both radiography and magnetic resonance imaging. HLA B27 antigen was studied and family history was reexamined in 2006. Five patients had sacroiliitis. Additionally, 15 patients had HLA B27 antigen or family history of either psoriasis or ankylosing spondylitis. Our conclusion is that during the first decade of seronegative oligoarthritis, HLA B27 antigen, family history, and especially imaging of SI joints reveal in two thirds of the patients the spondylarthritic nature of their disease.
18487724 A simple method for heuristic modeling of expert knowledge in chronic disease: identificat 2008 Identification of prognostic subgroups is of key clinical interest at the early stages of chronic disease. The aim of this study is to examine whether representation of physicians' expert knowledge in a simple heuristic model can improve data mining methods in prognostic assessments of patients with rheumatoid arthritis (RA). Five rheumatology consultants' experiences of clinical data patterns among RA patients, as distinguished from healthy reference populations, were formally represented in a simple heuristic model. The model was used in K-mean-clustering to determine prognostic subgroups. Cross-sectional validation using physician's global assessment scores indicated that the simple heuristic model performed better than crude data made in identification of prognostic subgroups of RA patients. A simple heuristic model of experts' knowledge was found useful for semi-automatic data mining in the chronic disease setting. Further studies using categorical baseline data and prospective outcome variables are warranted and will be examined in the Swedish TIRA-program.
17404489 [RANKL as a target molecule for treatment of joint destruction]. 2007 Apr Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized progressive joint destruction. Recent studies have revealed an essential role of receptor activator of NF-kappaB ligand (RANKL) in bone destruction in RA, and therapeutics targeting RANKL has been attracting a great deal of attention.
17404486 [Clinical benefits of anti-human IL-6 receptor antibody therapy]. 2007 Apr Interleukin-6 (IL-6) plays pathological roles in promoting autoimmune reactions and chronic inflammation as well as destruction of bone and cartilage in rheumatoid arthritis (RA). Humanized anti-human IL-6 receptor antibody, tocilizumab, specifically recognizes human IL-6 receptor and inhibits IL-6 actions. Tocilizumab has been shown to ameliorate the disease activity of RA in the clinical trials. Tocilizuamb can be a new therapy based on the pathology of RA.
17294063 [Cooperation between primary care physicians and rheumatologists in Lower Saxony. Results 2007 Mar AIM: Between 2000 and 2003 the collaborative arthritis center Hanover implemented a quality management program for patients with rheumatoid arthritis (RA). Fourteen rheumatologists in private practice participated in this model project. One of the aims of the project was to improve the cooperation between primary care physicians and rheumatologists. A survey of the primary care physicians was conducted to evaluate rheumatological care. METHODS: A total of 340 patients with RA were included in the study. All primary care physicians of these patients were informed about the goals of the project and asked to answer a questionnaire on cooperation with rheumatologists. The questionnaire contained 14 questions and was sent to 270 primary care physicians. RESULTS: Of the primary care physicians, 83% returned the questionnaire, and 81% percent of these were family practitioners. The primary care physicians treated a mean of 19 patients with RA, of whom 14 were attended in cooperation with rheumatologists. High mean values were found for satisfaction with different aspects of rheumatological patient care on a numerical rating scale from 0 (not satisfied at all) to 10 (completely satisfied). Mean values for satisfaction: diagnosis 7.9, therapy recommendations 7.6, follow-up 7.2,and usefulness of medical report 7.7. A total of 70% of primary care physicians reported difficulties in realizing the recommendations of the rheumatologists. Of the respondents, 90% saw a need for improvement in cooperation with rheumatologists, the most frequently mentioned being the difficulty of consultation with appointments. CONCLUSION: This survey of primary care physicians of patients with RA reveals a positive assessment of the cooperation with rheumatologists. The problems which exist mainly concern the realization of recommendations. There is a great requirement for further improvement in the cooperation between primary care physicians and rheumatologists.
17195530 [Clinical and laboratory assessment of endogenic intoxication syndrome in patients with rh 2006 AIM: To detect endogenic intoxication syndrome (EIS) and to assess its severity depending on clinical manifestations of rheumatoid arthritis (RA) using laboratory tests. MATERIAL AND METHODS: Laboratory tests including analysis of synovial fluid, blood count with estimation of leucocytic intoxication index, urinalysis, total protein and protein fractions, seromucoid, syalic acids, peroxide-antioxidant balance, metabolism of proteoglycanes, immunological tests were made in 162 patients with documented RA and 86 healthy controls. Content of middle mass molecules served as an integral biochemical EIS marker. RESULTS: Inflammatory destructive processes in the affected tissues of RA patients lead to marked systemic metabolic and immune disorders accompanied with EIS. Severe EIS are associated with severe metabolic disorders. A significantl rise (p < 0.05) in content of middle mass molecules in the serum was found in all RA patients including in the disease onset and in minimal activity of inflammation and presence of only mono-olygoarthritis of the knee joints. CONCLUSION: RA patients develop EIS the severity of which depends on the activity and distribution of the inflammatory process but not on the disease stage. Metabolic disorders in RA patients can be assessed with an effective method--blood serum middle mass molecule assay.
17926481 [The clinical significance of cyclic citrullinated peptide antibodies: new data]. 2007 Early diagnosis of rheumatoid arthritis (RA) is a challenge due to an insufficient specificity of its clinical signs and a low sensitivity of presently used clinico-laboratory criteria. Cyclic citrullinated peptide antibodies (CCPA) are nowadays considered the most promising diagnostic and prognostic RA marker. A heterogeneous group of citrullinated peptides are the target for CCPA. The sensitivity of CCPA is comparable to that of the rheumatoid factor (RF), while its specificity for this disease is much higher. CCPA detection may be very useful for diagnostics of early sero-negative RA, differential diagnosis between RA and other rheumatic diseases, and for the prognosis of severe erosive articular lesion. Simultaneous detection of RF and CCPA allow for early RA diagnostics, which is important for timely administration of a more aggressive basic antirheumatic therapy.
17236298 Correlation between different components of synovial fluid and pathogenesis of rheumatic d 2006 Biochemical analysis of synovial fluid is important in orientating the diagnosis of joint effusions. Its composition reflects the metabolic status of synovial tissue correlated with different rheumatic pathologies. The aim of this study was to compare the information provided by usual biochemical tests and proton magnetic resonance spectroscopy (MRS) analysis of synovial fluid, in order to detect potential characteristics of joint effusion correlated to the pathogenesis of arthritis. PATIENTS AND METHODS: This study included 99 synovial fluid samples obtained from patients with different etiology of arthritis--rheumatoid arthritis (RA), osteoarthritis (OA), gout, seronegative spondylarthropathies and septic arthritis, which underwent routine laboratory tests available in the Department of Rheumatology, Cantacuzino Clinical Hospital, Bucharest. Patients were admitted in the hospital between January 2003 and June 2005. Synovial samples were examined in parallel using MRS determination. Spectra have been recorded on a Bruker Avance DRX 400 MHz spectrometer. RESULTS: We obtained a good correlation between biochemical analysis and MRS determination. RA samples have offered the most important information regarding the complex composition of pathological synovial fluid. In addition to the markedly elevated lactate (p < 0.009) and diminished glucose concentration (p < 0.02) in RA samples vs. OA, MRS analysis provides evidence for reduced mean chain length of very-low-density-lipoprotein (VLDL)-associated triacylglycerols (p < 0.05), high levels of ketone bodies (p < 0.05), ceramide (p < 0.02) and citrulline (p < 0.04). OA samples have shown a characteristically increased level of N-glucosamine (p < 0.04) and creatine (p < 0.04). For the other pathologies, there are no characteristic markers detected, except for the extremely increased level of lactate and the decreased concentration of glucose in septic arthritis. CONCLUSIONS: This study gave us the possibility to provide a complex exploration of the biochemical environment of synovial fluid using the MRS method, that offers us the opportunity to understand more about the pathogenesis of rheumatic diseases, to provide information regarding the degree of inflammation, immune infiltration and apoptosis in RA, cartilage degradation and muscular secondary atrophy in OA. The most valuable information is focused on the possibility to have a simultaneous detection of more than 26 different metabolites in synovial fluid samples.
18665325 Abatacept and serious respiratory infections in patients with previous lung disease. 2008 Dec Abatacept is a biologic agent used in the treatment of rheumatoid arthritis, for which underlying chronic obstructive lung disease is listed as a precaution to its use due to concern for increased risk of respiratory adverse events. We describe two cases of severe respiratory complications affecting rheumatoid arthritis patients undergoing treatment with abatacept who had been previously diagnosed with underlying lung disease.
19418969 Doppler sonographic analysis of synovial vascularization in a patient with rheumatoid arth 2008 Dec Synovial vascularization in metacarpophalangeal joints of a patient with rheumatoid arthritis treated with leukocytapheresis (LCAP) was evaluated by Doppler sonography. After the treatment with LCAP, evaluation with American College of Rheumatology core set showed improvement, and the levels of C-reactive protein and serum amyloid A protein decreased. Power Doppler sonography demonstrated a reduction of color flow signals of the joints, and spectral Doppler sonography demonstrated an increase in vascular resistant, indicating a reduction of vessel's permeability. This is the first report evaluating a synovial vascularization and blood flow of the joints by Doppler sonography before and after LCAP therapy. Doppler sonography might be one of the useful methods for evaluating the therapeutic response of LCAP.
17526155 [From the bath- and massage to the sports clinic--the Rheumatological Department of Bispeb 2006 At the turn of the previous century, the number of inhabitants in the City of Copenhagen increased greatly. A new large hospital, Bispebjerg Hospital, stood ready in 1913. At the time, access to light, fresh air, and open spaces was considered to be important factors in the battle against disease. Physical treatment such as different forms of bathing, massage, exercise, electricity and radioactivity were also much relied upon, and a large building for this treatment in the form of a Roman thermal bath was built at the clinic of physical medicine. The first head of the clinic, Hans Jansen (1875-1933), was a specialist in internal medicine who studied physical treatments for a wide range of diseases, including phototherapy, as a collaborator of the Nobel Prize laureate Niels Finsen. Later, Jansen focused on the treatment of rheumatoid arthritis. It was left to the internal medicine ward at Bispebjerg Hospital to introduce the first effective treatment with the gold compound Sanocrysin during the 1930's. In 1918, physical therapy, physiatry (in Danish, fysiurgi), was established as a medical speciality in Denmark. The next head of the clinic, from 1933 Knud Aage Rasmussen (1897-1976), a specialist in fysiurgi, focused on the treatment of regional and general rheumatic pain syndromes. The rehabilitation of patients with different diseases by gymnastic exercises had been in use from the start of the clinic, but in the late 1940's more emphasis was put on this treatment under the influence of impulses from the USA, and as a response to demographic change with an increased number of older individuals with physical challenges in the City of Copenhagen. A rehabilitation ward was established and together with the clinic of physiotherapy formed a new department in 1968 under the leadership of Lone Gjørup (1923-2005). At the same time, interest in the treatment of inflammatory rheumatic diseases rose after the discovery of glucocorticoids as potent anti-inflammatory compounds. The department at Bispebjerg Hospital followed this dual course of treatment of inflammatory diseases with new drugs and rehabilitation. Recent new technology and interest in sports medicine promoted research in physical training in the clinic and eventually gave rise to a separate research and development unit devoted to sports medicine.
18767434 Putting pain in perspective. 2008 Aug 20 Cognitive behavioural therapy is improving the quality of life of people with rheumatoid arthritis.
17497027 Insights to clinical use of serial determination in titers of cyclic citrullinated peptide 2007 Anti-cyclic citrullinated peptide (CCP) antibody is a useful marker for the diagnosis and prognosis of rheumatoid arthritis (RA). Recently, clinical significance of follow-up in anti-CCP antibody titer has been pointed out. Thus, we investigated the serial determination in anti-CCP antibodies titer in RA patients. Six patients with RA, who were followed up for longer than 5 years, were assessed in anti-CCP antibodies and radiographs (Larsen score). Anti-CCP antibodies in frozen sera were measured using ELISA. As a result, 6 patients with RA were divided into two groups: one possessed high titers without variation, and the other was without high titers. Joint damage progressed during observation in 2 out of 3 patients with high anti-CCP titers in a retrospective assessment. In contrast, the RA patient, whose anti-CCP titer decreases although it had been high titer at baseline, did not show increase in the Larsen score. These findings suggest that it might be necessary to analyze changes in anti-CCP to predict the prognosis of joint destruction.
17598422 Anti-citrullinated antibodies, radiological joint damages and their correlations with dise 2007 Mar Determination of anti-citrullinated peptides (anti-CCP) specificity as a predictor of joint erosive changes, correlation between their serum level and radiological damages as well as disease activity score (DAS28). A trial has been conducted on a 211 patient sample fulfilling ACR criteria for rheumatoid arthritis (RA). There was assigned anti-CCP serum level, disease activity score by the formula for DAS28(3)-CRP and assessed radiological changes degree after Steinbrocker score. In 132 patient (62.559%) the serum anti-CCP concentration was positive for RA. Specificity of the test was 100% and sensitivity 65% (Z = 0.731, p = 0.465). There is a medium intensity correlation between variables representing anti-CCP and Steinbrocker score. Pearson's coefficient was 0.479 and Spearman's rank correlation coefficient was 0.614, i.e. statistically significant (p = 0.000). There is no statistically significant correlation between variables representing anti-CCP and DAS28(3)-CRP Anti-CCP are good RA predictor and their concentration correlate with radiological damages degree.