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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
16522674 The perception of rheumatoid arthritis core set measures by rheumatologists. Results of a 2006 Sep OBJECTIVE: To investigate the perception of values of individual core set measures by rheumatologists, and how it differs across measures and across physicians. METHODS: We designed a survey in which 44 international expert rheumatologists explicitly marked positions on the scales of seven core-set measures that in their opinion corresponded to cut-points between remission, low, moderate and high disease activity. The measures comprised swollen and tender joint counts (SJC, TJC), CRP, ESR, patient and evaluator global assessments of activity (PGA, EGA), and the Health Assessment Questionnaire Disability Index (HAQ). RESULTS: The interpretation of measures across physicians was most consistent for ESR and PGA, while for CRP and joint counts there was most variation. Joint counts and CRP implied active disease at lower relative values (using normalized scales) than did PGA, EGA or ESR (P < 0.01 for most comparisons; Bonferroni-adjusted Wilcoxon signed rank test), and most physicians tended to tolerate higher numbers of tender joints than swollen joints to define similar levels of disease activity. Given these cut-points, more RA patients in a typical cross-sectional cohort would be regarded as being in remission according to joint counts (SJC, 35%; TJC, 55%) than to global scores (PGA, 18%; EGA, 9%), and fewer patients would be regarded as being in remission by physician-derived or laboratory measures than by patient-derived ones. CONCLUSION: These data give insights into the integrative process of activity evaluation and will be informative for future survey designs, studies using physician opinion as the gold standard for criterion validity of disease activity, and allow 'activity mapping' of values on different scales based on expert opinion.
17286537 Exploratory analysis of four polymorphisms in human GGH and FPGS genes and their effect in 2007 Feb The enzyme folylpoly-gamma-glutamase synthethase (FPGS) plays an important role in the intracellular polyglutamation of the disease-modifying antirheumatic drug methotrexate (MTX) and the length of the polyglutamated MTX product correlates with the time that MTX resides in the cell. The glutamates are released from MTX by activity of the enzyme gamma-glutamyl-hydrolase (GGH), thereby allowing the efflux of MTX. GGH 452C>T has been associated with decreased catalytic activity and higher accumulation of long-chain MTX-polyglutamate. However, single nucleotide polymorphisms (SNPs) in FPGS and GGH genes have not yet been explored for association with MTX efficacy or toxicity. We selected for SNPs with frequencies higher than 10% or, in case of FPGS 114G>A, causing an amino acid change with no known frequencies. In this study, frequencies of two SNPs in FPGS (1994A>G and 114G>A, rs10106 and rs10760502, respectively) and GGH genes (452C>T and 16T>C, rs11545078 and rs1800909, respectively), were determined using a newly developed method in rheumatoid arthritis patients (n = 352) and in a group of healthy controls (n = 360). Next, the SNPs were associated with response to MTX in rheumatoid arthritis patients treated with MTX monotherapy. In rheumatoid arthritis patients, allele frequencies of FPGS 1994A>G were 0.534 (A) and 0.466 (G), and for FPGS 114G>A 0.714 (G) and 0.286 (A). Allele frequencies of GGH 16T>C were 0.737 (T) and 0.263 (C) and for GGH 452C>T 0.912 (C) and 0.088 (T). No significant differences in allele frequencies between rheumatoid arthritis patients and healthy controls were found. In addition, the SNPs were not associated with good clinical response to MTX. Only patients with the GGH 16C-allele and one or no copies of the GGH 452C-16T haplotype were associated with good clinical improvement at 3 months upon treatment with MTX. No associations with efficacy at 6 months and MTX-induced toxicity were found. Therefore we conclude that despite the positive association of the GGH 16C-allele and one or no copies of the GGH 452C-16T haplotype with good clinical improvement at 3 months upon treatment with MTX, the tested SNPs in GGH and FPGS genes are suggested not to be clinically important for MTX treatment outcome.
17665482 Using the health assessment questionnaire to estimate preference-based single indices in p 2007 Aug 15 OBJECTIVE: To estimate the relationship between preference-based measures, EuroQol (EQ-5D) and SF-6D, and the Health Assessment Questionnaire (HAQ) disability index (DI) in patients with rheumatoid arthritis (RA), and to characterize components that are predictors of health utility. METHODS: Patients with RA participating in 2 studies in the UK (n = 151) and Canada (n = 319) completed the HAQ, EQ-5D, and Short Form 36 (SF-36). The SF-36, a generic measure of quality of life, was converted into the preference-based SF-6D. From these results we developed models of the relationship between the HAQ and SF-6D and EQ-5D using various regression analyses. RESULTS: The optimal model developed for the EQ-5D entered levels for each item as independent variables (model 5). A root mean square error (RMSE) of 0.18 suggested relatively good predictive ability. For the SF-6D, RMSEs were lower (0.09), suggesting better predictions than for the EQ-5D, but models with more explanatory variables did not improve results (model 2 or 4 optimal). The models were able to predict actual SF-6D and EQ-5D across the range of the HAQ DI. CONCLUSION: Our approach enabled calculations of quality-adjusted life years from existing trials where only the HAQ was measured. All aspects of the HAQ may not be reflected in the preference-based measures, and this method is suboptimal to direct measurement of health state utility in clinical trials. Given this limitation, our approach provides an alternative for researchers who need health-state utility values, but had not included a preference-based measure in their clinical study because of resource constraints or a desire to limit patient burden.
17330302 Development and validation of a German version of the joint protection behavior assessment 2007 Mar 15 OBJECTIVE: Joint protection (JP) is an important part of the treatment concept for patients with rheumatoid arthritis (RA). The Joint Protection Behavior Assessment short form (JPBA-S) assesses the use of hand JP methods by patients with RA while preparing a hot drink. The purpose of this study was to develop a German version of the JPBA-S (D-JPBA-S) and to test its validity and reliability. METHODS: A manual was developed through consensus with 8 occupational therapist (OT) experts as the reference for assessing patients' JP behavior. Twenty-four patients with RA and 10 healthy individuals were videotaped while performing 10 tasks reflecting the activity of preparing instant coffee. Recordings were repeated after 3 months for test-retest analysis. One rater assessed all available patient recordings (n = 23, recorded twice) for test-retest reliability. The video recordings of 10 randomly selected patients and all healthy individuals were independently assessed for interrater reliability by 6 OTs who were explicitly asked to follow the manual. Rasch analysis was performed to test construct validity and transform ordinal raw data into interval data for reliability calculations. RESULTS: Nine of the 10 tasks fit the Rasch model. The D-JPBA-S, consisting of 9 valid tasks, had an intraclass correlation coefficient of 0.77 for interrater reliability and 0.71 for test-retest reliability. CONCLUSION: The D-JPBA-S provides a valid and reliable instrument for assessing JP behavior of patients with RA and can be used in German-speaking countries.
16633927 Efficacy and safety of bucillamine, a D-penicillamine analogue, in patients with active rh 2006 Japanese rheumatologists consider bucillamine (Buc) to be a useful disease-modifying antirheumatic drug (DMARD) and often give Buc to patients with rheumatoid arthritis (RA) prior to administering methotrexate (MTX). However, no large studies on the efficacy and safety of Buc in RA patients have been published in English to date. We therefore investigated the clinical course of RA patients treated with Buc and compared the results with those for patients treated with MTX to evaluate and confirm the place of Buc in therapeutic strategies for RA in Japan. Our results suggested that Buc should be given to patients with moderately active RA either before or after the administration of MTX because its efficacy can be judged within 3 months and because serious adverse events are rare. Issues like the ability of Buc to prevent joint destruction and its efficacy and safety when combined with agents like etanercept require future study.
16249828 Severe rheumatoid valvular heart disease. 2006 Sep Rheumatoid arthritis (RA) is a systemic inflammatory disease in which extra-articular involvement is not uncommon. Cardiac compromise may be frequent, although most often, it is clinically silent. Herein, two cases of RA-related endocarditis, one of which required valve replacement, are described. Etanercept was useful in controlling the articular and extra-articular RA compromise in both cases.
18574755 Management of the basal joint of the thumb following interposition arthroplasty for pain a 2008 Jul Derangement of the carpometacarpal (CMC) joint of the thumb secondary to osteoarthritis (OA) or rheumatoid arthritis (RA) is a source of pain and disability in many postmenopausal women. If surgery becomes necessary, the goals of postsurgical management are directed to relief of pain, joint protection and rest, and restoration of functional activity. This article describes the successful postsurgical rehabilitation of two patients with CMC joint arthritis of differing etiologies, and medical complexity, OA and RA, respectively, and different levels of medical complexity. Basal joint protection, passive range of motion, and gentle active exercise resulted in rapid functional recovery for these two patients.
17429638 Predicting factors for severity of rheumatoid arthritis: a prospective multicenter cohort 2007 Sep Rheumatoid arthritis may take an unfavourable course leading to rapid functional decline in a certain percentage of patients. Early identification of these patients is desirable. The aim of this study was to evaluate clinical and laboratory parameters for their value in the prediction of bad outcome. A total of 172 patients with early arthritis were followed for 3 years. Higher initial values for erythrocyte sedimentation rate, IgG and IgM rheumatoid factor, serum concentration of cartilage oligomeric matrix protein, Health Assessment Questionnaire score, Larsen score of feet, disease activity score, and swollen and tender joint count predicted worse outcome. An association with the presence of IgA rheumatoid factor or anti-cyclic-citrullinated peptide could not be established. We conclude that prognosis in an individual with rheumatoid arthritis depends on many factors. The determination of independent prognostic factors for progression of rheumatoid arthritis is a valuable tool in early arthritis to select patients for more aggressive therapy.
17525852 [A gene defect in the promoter of the endothelial NO synthase as a risk factor for rheumat 2007 Jul The risk to develop rheumatoid arthritis (RA) includes environmental as well as genetic factors. Moreover, RA, being an inflammatory disease, is itself considered to be a risk factor for coronary artery disease, as it - or its treatment - may lead to endothelial dysfunction. Likewise, a single nucleotide polymorphism in the promoter of the endothelial NO synthase ((-786)C/T) leads to endothelial dysfunction in (-786)CC homozygous individuals. This genetic defect occurs in significantly higher frequencies in patients with RA, and therefore must be regarded as a genetic risk factor for RA.
17586864 Non-drug care for RA--is the era of evidence-based practice approaching? 2007 Sep Non-pharmacological treatment modalities are often recommended, prescribed and used in addition to drug treatment in patients with rheumatoid arthritis (RA). This article provides a review of the literature on their effectiveness. Currently, a considerable number of systematic reviews summarising the available studies for non-drug care interventions in RA are available. The evidence of effectiveness varies among the different non-pharmacological modalities, with relatively strong support for exercise and self-management interventions, and modest support for joint protection programmes, specific orthoses and comprehensive care interventions. Overall, the evidence for effectiveness of massage and electro-physical modalities is absent or weak. In general, few studies in patients with early RA, studies comparing different attributes of non-pharmacological modalities or comprehensive care models and economic evaluations have been performed, so that the optimal timing, intensity, duration and mode of delivery often remain unclear. The results of this review indicate a need for further investigation into the most clinically and cost-effective strategies to deliver individual non-pharmacological treatment modalities as well as comprehensive arthritis service delivery models for RA patients in different stages of the disease.
17604284 Characteristics and survival of 26 patients with paraneoplastic arthritis. 2008 Feb OBJECTIVE: To date, only a few series of patients with paraneoplastic arthritis have been published. The charts of patients with cancer-associated arthritis were collected in order to describe characteristics of this rheumatism. METHODS: A questionnaire was created for this study and validated by experts based on specific criteria of inclusion and exclusion. Histology of neoplasia was included. RESULTS: In all, 16 males and 10 females with a mean (range) age of 57.5 years (28-85) were recruited from 17 nationwide centres in France. Patients presented with symmetric polyarthritis involving wrists and hands (85%) and extra-articular symptoms were frequent (84%). There was no specific biologic or radiographic feature. The mean (range) delay between the diagnosis of rheumatism and neoplasia was 3.6 months (0-21.2). Tumours were usually diagnosed after articular symptoms occurred (88.5%). Twenty patients had a solid cancer, and six a haematological malignancy. Adenocarcinoma of the lungs was the most frequent type of solid cancer (60%). Tumours were diagnosed at an early stage, which may explain the good median survival of 1.21 years (range 0.64-present) with a mean follow-up of 1.9 years (range 0.16-10). The percentage of articular symptoms resolution was significantly higher in patients with solid tumours, as compared to patients with haemopathy (p = 0.007). In cases of tumour relapse, rheumatic symptoms did not recur for 75% of patients. CONCLUSIONS: Underlying neoplasia should be considered in male patients with new onset polyarthritis, smokers, and particularly in patients chronically ill. Additional investigations should then be performed to diagnose cancer at an early stage.
19024272 [Rheumatoid arthritis--new imaging methods]. 2008 The radiology imaging in musculoskeletal system with a point on rheumatoid arthritis and modern methods such as magnetic resonance, power ultrasound, and color Doppler are described. Tomosynthesis, a new method for analysis of trabecular bone and bone density, which is important in rheumatoid arthritis, is described too.
17915096 B-cell inhibitors as therapy for rheumatoid arthritis: an update. 2007 Oct A revolution in the treatment of rheumatoid arthritis has occurred in recent years. This holds particularly true for B-cell-directed therapies for rheumatoid arthritis. The approval of rituximab for the treatment of rheumatoid arthritis has not only expanded the armamentarium of therapies for rheumatologists, but it has also led the way to better understanding of the biologic sequelae of these treatments as well as the potential to better understand the etiology of autoimmune diseases. This review updates the latest B-cell therapies in rheumatoid arthritis.
16362443 Severity of rheumatoid arthritis: the SEVERA study. 2006 Sep This study aims to assess the severity of rheumatoid arthritis (RA) in rheumatology practice in our population. All outpatients and inpatients with RA seen by registered rheumatologists over a 1-year period were included. Severity was measured using the Larsen score for hands and wrists and the Modified Health Assessment Questionnaire (M-HAQ). Two hundred ninety-eight RA cases were included. Mean age was 51.5 years. Among them, 261 (87.6%) were females. Disease duration was less than a year in 26 subjects (8.7%) and 10 years and above in 108 (36.2%) with a mean of 8.9. There were 220 (73.8%) subjects who had M-HAQ score <1. In 61 (20.5%) subjects, M-HAQ score was > or =1 and <2, and 17 (5.7%) had M- HAQ score > or =2. In relation with disease duration, M-HAQ starts with an average (SD) value of 0.7 (0.6) during the first year, decreases to 0.4 (0.4) at 5-year disease duration and increases after 10 years of disease progression to an average of 0.9 (0.8). Mean (SD) Larsen score was 51.9 (29.5) and median was 45. A total of 25% had a Larsen score > or =50% of maximum. Larsen score increased significantly (p<0.0001) with disease duration, starting at an average (SD) of 36.1 (14.9) during the first year, rising to 42.5 (15.8) around 5 years and reaching 73.9 (36.9) after 10 years. RA severity in our practice is comparable to that reported in Western populations in terms of radiological damage; however, functional status differs, possibly reflecting cultural differences.
17038464 More relevant, precise, and efficient items for assessment of physical function and disabi 2006 Nov OBJECTIVES: Patient reported outcomes (PROs) have become standard study endpoints. However, little attention has been given to using item improvement to advance PRO performance which could improve precision, clarity, patient relevance, and information content of "physical function/disability" items and thus the performance of resulting instruments. METHODS: The present study included 1860 physical function/disability items from 165 instruments. Item formulations were assessed by frequency of use, modified Delphi consensus, respondent judgement of clarity and importance, and item response theory (IRT). Data from 1100 rheumatoid arthritis, osteoarthritis, and normal ageing subjects, using qualitative item review, focus groups, cognitive interviews, and patient survey were used to achieve a unique item pool that was clear, reliable, sensitive to change, readily translatable, devoid of floor and ceiling limitations, contained unidimensional subdomains, and had maximal information content. RESULTS: A "present tense" time frame was used most frequently, better understood, more readily translated, and more directly estimated the latent trait of disability. Items in the "past tense" had 80-90% false negatives (p<0.001). The best items were brief, clear, and contained a single construct. Responses with four to five options were preferred by both experts and respondents. The term physical function may be preferable to the term disability because of fewer floor effects. IRT analyses of "disability" suggest four independent subdomains (mobility, dexterity, axial, and compound) with factor loadings of 0.81-0.99. CONCLUSIONS: Major improvement in performance of items and instruments is possible, and may have the effect of substantially reducing sample size requirements for clinical trials.
18726549 Assistive devices: usage in patients with rheumatoid arthritis. 2009 Feb We describe the usage of various assistive devices and identify factors associated with usage in patients with rheumatoid arthritis (RA). A cross-sectional, multicentre study was performed in three outpatient rheumatology clinics in the Netherlands. Two hundred forty patients with RA participated in the study. The main measures were questionnaires and a semi-structured interview regarding the possession and usage of 21 common assistive devices in the ISO9999 categories orthopaedic footwear, personal care, mobility, household and adaptations for housing. Potential factors associated with usage included sociodemographic variables, health status, quality of life, coping strategies, self-efficacy, outcome expectations and satisfaction. Out of 240 patients, 213 (89%) had one or more assistive devices in possession (median number of devices 3.0, interquartile range 3.0). The proportions of patients never using a device in possession varied between 8% for orthopaedic insoles and 23% for grab bars. The main factors related to usage varied among categories, but common determinants were a specific impairment or disability, satisfaction with the device or related services, self-efficacy and the number of devices in possession. In conclusion, in patients with RA, possession rates are high, with 23% or less of the devices in possession being abandoned. Overall, satisfaction rates were high. Factors associated with usage varied among categories and comprised, apart from the number of devices in possession and variables related to health status, also aspects of satisfaction with the device or related services or self-efficacy. The latter findings underline the need for a systematic evaluation of the outcomes of assistive devices by prescribing health professionals or suppliers in every individual case.
15933856 Association between dynamic exercise therapy and IGF-1 and IGFBP-3 concentrations in the p 2006 Feb We aimed to evaluate the relationship between short-term dynamic exercise therapy and insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in rheumatoid arthritis (RA) patients. Forty RA patients were assigned into dynamic or range of motion (ROM) exercise groups. Also control group carried out the same dynamic exercise protocol. Morning stiffness, pain (VAS), Health assessment questionnaire (HAQ) and Ritchie articular index (RAI) were evaluated and erythrocyte sedimentation rate, serum C-reactive protein, IGF-1 and IGFBP-3 levels of the participants were recorded. The assessments were determined before, at the 7th and 15th days of treatment. VAS and RAI scores were significantly improved by the dynamic exercises in RA patients. There were increases on IGF-1 in dynamic exercise group, although IGF-1 levels showed a decrease in ROM exercise and control groups. Also no significant changes were observed on IGFBP-3 in three groups. Our results suggest that short-term dynamic exercise therapy increases serum IGF-1 in RA patients. The manipulation of serum IGF-1 levels by dynamic exercise therapy may indicate the beneficial effects of dynamic exercise in RA patients.
18395847 Restoring the balance: harnessing regulatory T cells for therapy in rheumatoid arthritis. 2008 Apr Treg play a vital role in the maintenance of tolerance to self antigens, thereby preventing disease through the active suppression of proliferation and pro-inflammatory cytokine production by autoreactive T cells. Here we discuss strategies aimed at enhancing Treg function in patients with rheumatoid arthritis with the ultimate aim of restoring lasting tolerance but without increasing the risk of infections or cancer.
18711765 Symptom combinations assessed in traditional Chinese medicine and its predictive role in A 2008 The predictive roles of symptom combination traditionally evaluated in traditional Chinese medicine (TCM) in the treatment of rheumatoid arthritis (RA) were explored. Three hundred and ninety six patients were randomly divided into 197 subjects receiving Western medicine therapy (WM) and 199 subjects receiving TCM therapy (TCM). A complete physical examination and 18 clinical manifestations typically assessed in TCM were recorded before the randomization. The ACR responses were used for efficacy evaluation. ACR20 and 50 responses with WM treatment were higher than in the TCM group. The 18 symptoms in RA could be clustered into 4 symptom combinations with factor analysis, which represent joint symptoms, cold pattern, deficiency pattern and hot pattern in TCM respectively. TCM would be more effective in patients with weak-symptom combination 3 (deficiency pattern in TCM), and WM would be more effective in patients with symptom combination 2 (cold pattern in TCM). Symptom combinations judged with TCM may have influence on the efficacy of therapy in the treatment of RA.
17404475 [Histopathological features of joint destruction in rheumatoid arthritis (RA)]. 2007 Apr Recent technologies proceed the remarkable development of genetical and protein analysis. However, we are apt to lose opportunities to observe about the disease as a whole feature. In this article, we describe the inflammatory process from synovial inflammation to cartilage and bone destruction. We notice that there are many problems to be solved in rheumatoid arthritis (RA) from the point of inflammatory process. It is often needed for us to stand still and look over the whole features of disease.