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ID PMID Title PublicationDate abstract
18507184 [Effect of physical rehabilitation on endothelial dysfunction in chronic inflammatory join 2008 Mar The purpose of the study was to determine the degree of influence of physical exercises on endothelial dysfunction in patients with chronic articulation inflammatory diseases on the example of rheumatoid arthritis (RA) and osteoarthritis (OA). 41 patients with chronic articulation inflammatory diseases were examined. Endothelial dysfunction was detected in 37% OA patients and 77% RA patients. The results of the study show significantly higher degree of influence of physical exercises on endothelial dysfunction in comparison with drug therapy.
18709990 [False-positive reaction of urinary ketone bodies caused by bucillamine]. 2008 Jul In many patients taking bucillamine, an anti-rheumatic drug, urinary examinations show false-positive findings for ketone on urine dipsticks, because of the SH radicals in bucillamine. Our group examined the frequency of false-positive ketone testing and the causative factors in 179 outpatients being treated by the Department of Rheumatology in our hospital. The samples that remained purple even after boiling were determined to be false-positives, because boiling volatilizes urinary ketones while leaving bucillamine unchanged. Forty-six of 49 patients taking bucillamine tested false-positive for ketone, whereas there were no false-positive reactions among patients not receiving bucillamine. The patients showing false-positive reactions had significantly lower serum albumin levels, higher specific gravity of urine and more acidic urine. Moreover, we could predict whether the reaction was true-positive or bucillamine-induced false-positive by observing differences between the colors and levels of discoloration of the urine test paper. In the evaluation of ketone findings on urinary dipstick, the physician must ascertain whether the patient is taking bucillamine.
17611972 Guiding optimal therapy with the use of disease activity and functional instruments: lesso 2007 Jul Proper assessment and aggressive treatment of patients with rheumatoid arthritis (RA) are the key to improved longterm outcomes. The most important diagnostic and monitoring principles for RA include the assessment of inflammation, disease activity, collateral damage from comorbid diseases, and the improvement of patient function and quality of life. A number of different assessment tools are available for physicians to use during routine examination of patients with RA; these instruments will be detailed with suggestions based on proceedings from a satellite symposium at the American College of Rheumatology (ACR) 2006 Annual Meeting. Audience Response System questions and answers for this topic, which may help other clinicians decide which assessment tools to use in their practices, are included.
18946676 [Rheumatological rehabilitation today. Exemplified by two case reports]. 2008 Nov Today, medical rehabilitation of patients with rheumatic diseases is based on the International Classification of Functioning, Disability and Health (ICF). In addition to the biomedical view, rehabilitation includes the individuals' activities and participation in society; the ICF integrates personal and environmental factors. Disability due to rheumatic disease results from the health condition itself and its structural and functional limitations as well as individual personal and environmental contextual factors. Two case reports--a patient with early rheumatoid arthritis and a patient with advanced ankylosing spondylitis--illustrate interdisciplinary treatment in medical rehabilitation that is based on the ICF.
17611975 Disease modifiers: making the right therapeutic choices for our patients. 2007 Jul Patients with rheumatoid arthritis (RA) who suffer an inadequate response to disease modifying antirheumatic drugs and biologic therapies represent a large segment of the RA population, so treating these patients is a major issue for physicians. The 4 case studies discussed in this article were presented at an American College of Rheumatology 2006 Annual Meeting Satellite Symposium and highlight some of the key issues for patients who are not responding adequately to current therapies. These issues include which therapy to consider next for maintaining tight control and maximizing outcomes in patients, and what is the rightful place of newly approved therapies within the current RA treatment armamentarium. Included here are the Audience Response System (ARS) results from the symposium, which will allow readers to compare their answers with that of the audience; this may help physicians in the decision-making process for their patients.
16886694 [Diagnostic image (282). A woman with invalidating hip complaints]. 2006 Jul 15 A 40-year-old woman with a five-year history of rheumatoid arthritis experienced progressive pain of the left hip due to protrusio acetabuli.
17350542 Early rheumatoid arthritis: strategies for prevention and management. 2007 Feb The treatment of rheumatoid arthritis (RA) has changed considerably in the past few years since new tools and new concepts have been developed and validated highlighting the need for guidelines focused on early RA. The treatment goal should now be to achieve clinical remission, in order to prevent structural damage and long-term disability. A very early use of effective disease-modifying anti-rheumatic drugs (DMARDs) is a key point in patients at risk of developing persistent and erosive arthritis. Intensive treatment such as combination DMARDs plus steroids or biological therapies can induce a high rate of remission, control of radiological progression and provide better outcome than DMARD monotherapy in early RA and should be considered in at risk patients. Regarding the risk:benefit ratio and the cost-effectiveness of these strategies, a reasonable course of action in early RA should be initial DMARD monotherapy such as methotrexate. However, a close monitoring of disease activity and radiographic progression is mandatory in order to change DMARD therapy and strategy if necessary. Systemic glucocorticoids are effective in the short-term relief of pain and swelling and should be considered, but mainly as a temporary therapy part of the DMARD strategy. Information and education for patients, as well as some non-pharmacological interventions, can be proposed as treatment adjuncts. Finally, the reduction or stopping of smoking, which could prevent the development and progression of early RA, is the only prevention tool currently available.
16671950 Interleukin-18 promoter polymorphism in patients with rheumatoid arthritis. 2006 May Rheumatoid arthritis (RA) is a chronic inflammatory disease in which interleukin (IL)-18 plays an important role. However, there are controversial reports on IL-18 promoter polymorphism as an independent marker of RA susceptibility. The aim of present study was to examine the IL-18 promoter polymorphism in patients with RA, and its association with disease susceptibility, activity and severity. We examined 309 patients with RA from a Polish population diagnosed according to the criteria of American College of Rheumatology. An allele-specific polymerase chain reaction was used for analysis of the polymorphisms in positions - 137 and - 607 in promoter region of IL-18 gene. A significantly decreased number of subjects with AC/AC and AG/AG diplotypes was observed among RA patients as compared with healthy controls (OR - 0.51, 95%CI 0.28-0.95, P = 0.045) and (OR - 0.12, 95% CI 0.02-0.97, P = 0.042), respectively. Nevertheless, there was no significant association with disease activity, joint erosions, extra-articular manifestations, rheumatoid factor. Above results suggest that IL-18-137 and - 607 promoter polymorphisms are not the significant factors influencing RA course and severity in a Polish population.
19024474 [A clinical study on the diagnosis of early rheumatoid arthritis using bone imaging with 9 2008 Oct This study aimed to explore the usefulness of 99mTechnetium methylenediphosphonate (99mTc-MDP) bone imaging in diagnosticating rheumatoid arthritis (RA). In 66 patients with RA, 99mTc-MDP whole body bone imaging, feet and hands regional bone imaging and ROI were performed. And from each patient, X-ray film, rheumatoid factor (RF), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were taken for examination. By the use of 99mTc-MDP, abnormal bone images were observed in 55 cases of RA; the total positive rate of incidence (83.3%) was significantly higher than those by use of X-ray (45.5%), RF (51.5%), CRP (63.6%) and ESR (69.7%); the positive rates of imaging with 99mTc-MDP in the 55 cases of RA (divided into 4 groups according to the course of disease; namely, < 1,1-, 5- and >10-year groups) were 75.0%, 88.9%, 92.3% and 100.0% respectively, whereas the positive rates of those year-groups by use of X-ray were 10.7%, 33.3%, 84.6%, 100.0% respectively; comparison of the two methods, showed statistically significant difference: P<0.01 (< 5-year group); P >0.05 (> 5-year group). In 177 joint lesions detected by bone images, 144 lesions (81.4%) were symmetric, and 33 lesions (18.6%) were single. The most frequently detected lesions were at metacarpophalangeal joints or interphalangeal and wrist joints, metatarsophalangeal or ankle joints, and knee joints. We have noticed that 99mTc-MDP bone imaging can elevate the detectability at the early stage of RA, so it is of value for the treatment of RA.
16845710 Using predicted disease outcome to provide differentiated treatment of early rheumatoid ar 2006 Sep OBJECTIVE: To determine the usefulness of a prediction model for making treatment decisions in early rheumatoid arthritis (RA). METHODS: In 152 patients with early RA, progression of radiological damage during the first year [Sharp-van der Heijde (SH) score > 0] was assessed and used to define actual disease outcome. Available variables at baseline were entered in a multivariate regression analysis with progression score as dependent variable. This model was used to predict disease outcome in every patient. Using the standard deviations of the predicted disease outcome, patients were divided into 3 groups: (1) severe disease: high probability (> or = 0.8) for progression > 0, (2) mild disease: high probability (> or =0.8) for progression < or = 0, and (3) not classified: no high probability for either option. It was determined how many patients could be classified by using this model. RESULTS: One hundred nine patients (71.7%) showed joint damage progression during the first year. Baseline variables available were: age, sex, duration of symptoms, duration of morning stiffness, patient's global assessment of disease activity, Health Assessment Questionnaire score, swollen and painful joint count, bilateral compression pain in metatarsophalangeals, rheumatoid factor positivity, erythrocyte sedimentation rate, shared epitope positivity, SH-score, and the presence of erosions. The R2 value (approximately variation explained) of the prediction model was 0.36. By using this model 46.3% of patients could be classified as having severe disease, 0% as having mild disease, and 53.7% could not be classified. CONCLUSION: To be able to make treatment decisions in early RA based on predicted disease outcome, a better prediction of disease outcome is needed, making the search for better prognostic variables urgent.
16429239 Carpal collapse in patients with rheumatoid arthritis. 2006 Nov The inflammation of the wrist and carpal collapse play an important role in the deformity of the rheumatoid hand and leads to functional limitation. The aim of this study was to evaluate carpal collapse and related clinical variables in patients with rheumatoid arthritis (RA). Carpal height ratio (CHR) indicating the degree of carpal collapse was measured in 33 female RA patients with a mean age of 41.9+/-10.3 years and 30 female healthy control subjects with a mean age of 40.5+/-9.2 years. The normal range of the carpal collapse was defined in our study population and the incidence of carpal collapse was determined. The correlation between carpal collapse and clinical and laboratory variables including pain by visual analog scale, Ritchie articular index, erythrocyte sedimentation rate, C-reactive protein, health assessment questionnaire indicating functional status, and Larsen roentgenological evaluation were determined. Subgroup analyses were also performed in patients with and without carpal collapse. The mean disease duration of the patients was 12.4+/-5.5 years. The mean CHR index of the patients was significantly lower than in the control group (0.47+/-4.3 and 0.54+/-1.4 respectively). CHR <0.48 was defined as carpal collapse in our study group. Seventeen patients (51.5%) had carpal collapse in the patient group. None of the clinical or laboratory variables except levels of disease duration and Larsen score was correlated with carpal collapse as represented by CHR. The best related clinical variable with carpal collapse was found as duration of disease. The mean duration of disease and the Larsen score were significantly higher in patients with carpal collapse than those without collapse. Other clinical parameters and functional status were similar between patients with and without carpal collapse. In conclusion, although various clinical parameters and functional disability in patients with RA may not be correlated with radiological malalignment, the carpal collapse may be more common in RA than is generally recognized.
18159201 [Diagnostic performance of anti-cyclic citrullinated antibodies and IgM rheumatoid factor 2007 Oct The presence of IgM class rheumatoid factor RF-M in the serum is one of the ACR criteria for the classification of rheumatoid arthritis RA . OBJECTIVES: To compare the sensitivity and specificity of two diagnostic markers for RA in Portuguese patients the 2nd generation anti-cyclic citrullinated peptide antibodies anti-CCP2 and the RF-M. METHODS: Serum samples from 56 patients with established RA 44 women and 12 men mean disease duration 9 5 -8 5 years were evaluated for the presence of anti-CCP2 and RF-M. Results were compared with 93 samples from a control group with identical demographic characteristics 43 from patients with spondylarthropaties and 50 from healthy blood donors . The determination of anti-CCP2 antibodies was performed by enzymatic fluroimunoassay and RF-M was measured by microElisa. RESULTS: Anti-CCP2 antibodies were positive in 40 patients with RA 71 4 at a mean antibody concentration of 350 5 UA ml range 11-1670 UA ml and negative in all controls. The RF-M was positive in 34 patients with RA 60 7 in 4 patients with spondylarthropaties 9 3 and in one blood donor 2 . The sensitivity specificity positive predictive value and negative predictive value for RF-M was 60 7 90 7 89 5 and 63 9 and for anti-CCP2 was 71 4 100 100 and 72 9 respectively. CONCLUSIONS: The anti-CCP2 assay showed an excellent specificity and a global performance superior to that of the RF-M test in this population with established RA.
17447069 Diagnostic performances of anti-cyclic citrullinated peptide antibodies in rheumatoid arth 2007 Oct To evaluate the rheumatoid arthritis (RA) diagnostic performances of anti-cyclic citrullinated peptide antibodies (anti-CCP). Anti-CCP was detected by an enzyme linked immunosorbent assay in 164 patients with RA and 343 controls. In addition, anti-CCP predictive value for radiological damage were investigated in 37 recent-onset RA patients followed up prospectively for 2 years. Radiological damages were assessed by Sharp method modified by van der Heijde. The sensitivity of anti-CCP was 78.7% and the specificity was 95.6%. The positive predictive value and the negative predictive value were 90.2% and 90.3%, respectively. Anti-CCP were detected in sera of 79.3% of patients with recent onset RA and 78.3% of patients with long disease duration. In univariate and multivariate analyses, anti-CCP were not predictive for radiological damage. Our study confirms the high diagnostic performances of anti-CCP in RA. They are very useful to aid the diagnostic of RA in clinical practice.
16550339 Joint inflammation and cytokine inhibition in rheumatoid arthritis. 2006 Mar The hallmark of rheumatoid arthritis (RA) is chronic synovial inflammation resulting in progressive joint damage. Cytokines are key mediators of inflammation and can be found in abundance both in the joint and blood of patients with active disease. They are responsible not only for the destructive synovitis but also for some of the systemic features. Research over the last 2 decades has highlighted the important role of cytokines such as tumour necrosis factor alpha (TNF-alpha) and interleukins (IL) 1, 6 and 15 in the pathogenesis of RA and these are potential therapeutic targets. Inhibitors of TNF-alpha and IL-1 are already licensed treatments for RA. Novel biologic agents targeting IL-6 and -15 are currently being developed and showed promise in early clinical trials. This article reviews the role of various cytokines in the pathogenesis of RA and the therapeutic effect of inhibiting these cytokines.
18237535 [Gene expression profile of the peripheral CD4(+)T cells in patients with RF(+) and RF(-) 2008 Feb AIM: To explore the differences of the gene expression of CD4(+) lymphocytes between the RF(+) and RF(-) patients with rheumatoid arthritis. METHODS: mRNA of all the CD4(+) lymphocytes samples were extracted and identified. Then they were labeled and hybridized to microarrays. RESULTS: Hierarchical clustering analysis showed there were 55 differential expression genes between the RF(+) and RF(-) patients with rheumatoid arthritis. CONCLUSION: There are differential expression genes between the RF(+) and RF(-) patients and these genes are related to immunoresponse.
17083766 Remission as the treatment goal--the FIN-RACo trial. 2006 Nov The Finnish Rheumatoid Arthritis Combination Therapy (FIN-RACo) trial is the first rheumatoid arthritis (RA) clinical trial in which remission served as the primary outcome measure. This chapter reviews the philosophical background, study design, and results of the FIN-RACo trial. The study showed that a third of patients with active early RA may achieve remission with a combination of methotrexate (MTX), sulfasalazine (SSZ), hydroxychloroquine (HCQ), and prednisolone.
16989407 [Immunologic laboratory testing in clinical practice for rheumatoid arthritis]. 2006 Aug The recent clinical practices for rheumatoid arthritis have changed greatly. First, biologic agents such as tumor necrosis factor blocker have been developed as well as disease-modifying antirheumatic drugs, with great efficacy in intractable RA. On the other hand, the importance of early effective therapeutic intervention has been recognized since early treatment prevents the progression of joint damage. However, early diagnosis of RA is not so easy because of the lack of appropriate diagnostic criteria. New laboratory tests have appeared for the diagnosis and prognostic prediction of RA. Among them, anticyclic citrullinated peptide antibodies (anti-CCP), which bind epitopes containing citrulline, seem to be attracting the most attention. Although rheumatoid factor (RF) is the only serologic marker among the seven classification criteria of the American College of Rheumatology (ACR) for RA, variability of the RF assay within laboratories and/or between laboratories, and quality assurance has not been established. We must address the standardization of RF assay as soon as possible.
16511906 Anti-cyclic citrullinated protein antibodies as a predictor of response to anti-tumor necr 2006 Mar OBJECTIVE: . The treatment of rheumatoid arthritis (RA) has changed dramatically with the introduction of anti-tumor necrosis factor (TNF) agents. Unfortunately, a subset of patients have partial or no response. No measurements were found to predict the efficacy of this therapy. Anti-cyclic citrullinated protein antibodies (anti-CCP) are highly specific and sensitive for RA, and their titer correlates with erosive disease. We investigated the correlation between the efficacy of infliximab therapy and the titer of anti-CCP. METHODS: Thirty consecutive seropositive patients with RA were treated with infusion of 3 mg/kg infliximab on Weeks 0, 2, 6, and 14. Clinical assessment and blood withdrawal were done before each treatment, i.e., at the minimal concentration of the drug. Disease activity was assessed by DAS28 score and by interleukin 6 (IL-6) level. Anti-CCP titer was measured by a commercial ELISA at Week 0 and Week 14. RESULTS: At baseline, 24 patients were positive for anti-CCP antibodies. In most patients there was a significant correlation between clinical response to therapy and anti-CCP titer. The results were especially noteworthy in those patients who showed a sustained and significant decrease in IL-6 levels through the entire period. CONCLUSION: Anti-CCP titer and IL-6 levels might be early predictors of the efficacy of anti-TNF therapy in patients with RA.
17472993 Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year 2007 Nov OBJECTIVES: To examine priorities for health status improvement in patients with active rheumatoid arthritis (RA) during anti-tumour necrosis factor (TNF) treatment. METHODS: Data were used from 173 patients with RA starting treatment with TNF-blocking agents. Outcome measures included assessment of health status with the Arthritis Impact Measurement Scales 2 (AIMS2) at baseline and after 3 and 12 months. The AIMS2 contains a priority list from which patients are asked to select from 12 areas of health the 3 in which they would most like to see improvement. RESULTS: After 1 year of treatment, 10 out of 12 areas of health on the AIMS2 were significantly improved. The most commonly selected priorities for improvement at baseline were pain (88%), hand and finger function (57%), walking and bending (42%), mobility (33%), and work (29%). At group level, this priority ranking remained largely unchanged during treatment. After adjustment for multiple comparisons, only pain was selected significantly less often at 3 and 12 months (71% at both assessments). Within individual patients, however, priorities often changed. Changes in the priority of pain were related to the achieved level of patient-perceived pain and disease activity. CONCLUSIONS: This study shows that, at the group level, patients' priorities for improvement are fairly stable during 12 months of anti-TNF therapy, despite major improvements in health status. Although pain reduction becomes somewhat less important, it remains the most commonly selected priority. In contrast, individual patient priorities are not stable over the course of treatment and appear to be associated with differences in disease state.
18985308 [Rheumatoid arthritis today]. 2008 Dec Advances in the therapy of rheumatoid arthritis with disease modifying antirheumatic drugs (DMARD) such as methotrexate and biological response modifiers in particular, have turned a chronic progressive disease with significant invalidity and mortality into one that can be well controlled. To prevent irreversible damage, early diagnosis is essential. DMARD therapy needs to be instituted within three months after symptom onset - a clinical and organisational challenge. Long term DMARD therapy is monitored using standardized scores and modified whenever not sufficiently successful. Analgesia, physiotherapy and occupational therapy as well as orthopaedic surgery play important roles in the management of rheumatoid arthritis. Consequent multimodal therapy can decisively influence the course of the disease and prevent or at least minimize damage.