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ID PMID Title PublicationDate abstract
19368280 [New risk factors for cardiovascular diseases in patients with rheumatoid arthritis]. 2008 Nov INTRODUCTION: In the last three decades numerous epidemiologic studies have shown the correlation between risk factors and cardiovascular diseases. Clinical research has proven that rheumatoid arthritis patients (RA) have higher prevalence of classical risk factors in relation to general population, and over the last few years there has been an emphasis on some new risk factors which can contribute to cardiovascular diseases (CVD). MATERIAL AND METHODS: This study examined risk factor values for CVD in 88 patients with RA treated at Rheumatology Department, Clinical Hospital Centre, Zemun. All patients have been thoroughly examined (clinical findings, laboratory and echocardiographic examination). Apart from classical factors, "new" risk factors have been examined in all patients: C-reactive proteine (CRP), high-sensitive C-reactive proteine (hs-CRP) and homocystein. RESULTS: It has been determined that RA patients have more frequent higher new risk factors in comparison to classical ones. 84.1% of patients had higher CRP values, 97.1% had hsCRP and 39.5% had homocystein. The mean CRP values, especially hsCRP have been higher in patients with positive rheumatoid factor finding. DISCUSSION: Rheumatoid arthritis patients may have worse "background atherosclerosis" than even subjects matched for classical cardiovascular risk factors. Continuous exposure to high grade systemic inflammation may be linked to accelerated atherosclerosis. CONCLUSIONS: Timely identification of patients with risk factors, particularly with new risk factors, enables adequate approach in prevention of and treatment for CVD in rheumatoid arthritis patients.
18503092 Therapeutic T-cell manipulation in rheumatoid arthritis: past, present and future. 2008 Oct Accumulating evidence suggests that RA is a T-cell-mediated autoimmune disease. Early attempts at disease modulation using strategies such as CD4 mAbs were severely hampered by a lack of biomarkers of autoreactivity. Recently, however, co-stimulation blockade has emerged as an effective treatment for RA. Alongside a greatly improved mechanistic understanding of immune regulation, this has rekindled hopes for authentic and robust immune programming. The final pieces of the jigsaw are not yet in place for RA but, in other disciplines, emerging treatment paradigms such as non-mitogenic anti-CD3 mAbs, autoantigenic peptides and even cellular therapies are providing hope for a future in which immunopathology can be specifically and vigorously curtailed.
17090565 Early functional disability predicts both all-cause and cardiovascular mortality in people 2007 Apr OBJECTIVE: To investigate the predictive value of early functional disability in patients with inflammatory polyarthritis (IP), for all-cause and cardiovascular disease (CVD) mortality. METHODS: 1010 subjects with new-onset IP from the Norfolk Arthritis Register were studied. All were seen at baseline and at 1 year. Health Assessment Questionnaire (HAQ) scores were obtained at both time points. Vital status at 10 years from registration was established through central records. Mortality (all-cause and CVD) per 1000 person-years were calculated by HAQ stratum (HAQ scores<1, 1-2 and>or=2). The predictive value of HAQ (per unit increase) at the two time points, adjusted for age at onset of symptom, sex and other factors found to predict mortality, was assessed using Cox regression models. The analysis was repeated for those who satisfied the 1987 American College of Rheumatology criteria for rheumatoid arthritis (RA) by 5 years. RESULTS: By 10 years, 171 (16.9%) subjects had died. 89 deaths (52%) were attributed to CVD. Mortality was greatest in the highest HAQ group at both time points. Following adjustment for other predictors, HAQ score at year 1 remained a significant predictor of all-cause mortality (HR 1.46; 95% CI 1.15 to 1.85) and CVD mortality (HR 1.49; 95% CI 1.12 to 1.97). The predictive value of HAQ at year 1 was similar in the RA subgroup. CONCLUSIONS: Our data show that at 1 year of follow-up, HAQ score is an important independent predictor of subsequent all-cause and CVD mortalities in people with IP and RA. Baseline HAQ scores are of less value.
19060682 Arthroscopic synovectomy of the metacarpophalangeal and proximal interphalangeal joints. 2008 Dec Few reports about clinical experience in arthroscopy of finger joints exist. Furthermore, little attention has been given to arthroscopic synovectomy of rheumatoid fingers. Herein, we describe our experience with arthroscopic synovectomy of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in patients with rheumatoid arthritis.Arthroscopic synovectomy was performed in 45 finger joints (18 MCP joints, 26 PIP joints, and 1 interphalangeal thumb joint) of 23 patients with rheumatoid arthritis. All procedures were performed on an outpatient basis under regional anesthesia. The diameter of the arthroscope for small joints was 1.5 mm, and a mini shaver system with a 2.5-mm cutter was used for synovectomy. We developed new portals for PIP joints that were established on the dorsolateral aspect at a position more lateral than previously reported portals.Intraarticular structures of finger joints were well visualized, and magnified observation of the articular cartilage and synovial membrane was possible. Because insertion of the instruments into the palmar cavity was not possible without causing damage to the articular surfaces, synovectomy of the palmar capsule could not be performed. However, arthroscopic synovectomy of the dorsal capsule under visual control could be safely performed using the 2-portal technique. None of the patients experienced postprocedural complications. Swelling of each joint disappeared after the procedure and did not return in many cases for a long period. Furthermore, no joints required reoperation.We conclude that arthroscopy of MCP and PIP joints is useful not only for the assessment of articular cartilage and synovium but also for synovectomy in rheumatoid arthritis.
18424014 Proteasome inhibition as a novel therapy in treating rheumatoid arthritis. 2008 Rheumatoid arthritis (RA) is an erosive joint disease affecting about 1% of the population. The joint destruction is primarily mediated by special cells called fibroblast-like synoviocytes (FLS), which undergo an expansion forming a pannus that destroys the joint. Apoptosis has been rarely detected in the synovial lining. This has lead to the identification of pro-survival factors that are expressed in FLS at the sites of the pannus including mutant p53, hrd1, sentrin, and NF-kappaB. Current anti-inflammatory modalities only bring upon temporary relief and do not treat the pannus. Therefore, the FLS remain intact, joint destruction proceeds, patients relapse and eventually become resistant to all forms of therapy. To date, surgical removal of the pannus remains the only option to help delay further joint destruction. Therefore, we believe the future should hold a less invasive approach using a class of novel drugs called proteasome inhibitors to attenuate the growth of the FLS. We suggest the use of a novel proteasome inhibitor PS-341 to treat RA patients. PS-341 has been shown to induce apoptosis in many cancer cell lines and has lead to successful outcomes in phase II and III clinical trials of multiple myeloma. Moreover, PS-341 has been shown to sensitize a variety of cell lines to chemotherapeutic drugs, some of which are used as conventional therapy in RA. We hypothesize that PS-341 alone and/or in combination with conventional RA therapies could induce apoptosis in FLS in vitro and in vivo thereby treating the pannus. Prior to clinical use extensive research examining the effects of PS-341 in animal models of arthritis would be essential in order to understand the effects proteasome inhibition in disease biology. Overall, the purpose of our hypothesis is to suggest a realistic and alternative treatment for patients with refractory and non-refractory arthritic disease.
17906290 Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheuma 2007 Dec Conclusions based on systematic reviews of randomized controlled trials are considered to provide the highest level of evidence about the effectiveness of an intervention. This overview summarizes the available evidence from systematic reviews on the effects of nonpharmacological and nonsurgical interventions for rheumatoid arthritis (RA). Systematic reviews of studies of patients with RA (aged >18 years) published between 2000 and 2007 were identified by comprehensive literature searches. Methodological quality was independently assessed by 2 authors, and the quality of evidence was summarized by explicit methods. Pain, function, and patient global assessment were considered primary outcomes of interest. Twenty-eight systematic reviews were included in this overview. High-quality evidence was found for beneficial effects of joint protection and patient education, moderate-quality evidence was found for beneficial effects of herbal therapy (gamma-linolenic acid) and low-level laser therapy, and low-quality evidence was found for the effectiveness of the other interventions. The quality of evidence for the effectiveness of most nonpharmacological and nonsurgical interventions in RA is moderate to low.
16778982 [Rheumatoid leptomeningitis: a case report and literature review]. 2006 Jun 18 To report the clinical, radiological and neuropathological findings of a patient with rheumatoid meningitis. The patient was a 71-year-old Chinese man with a two-year history of rheumatoid arthritis and no other significant medical history, who presented to our hospital recurrent weakness of his left extremities, dysarthria and a continuous bilateral hand tremor. Cerebrospinal fluid (CSF) and serum examinations were normal apart from a mildly raised serum perinuclear antineutrophil cytoplasmic autoantibody (p-ANCA). Brain magnetic resonance imaging (MRI) showed leptomeningeal enhancement in both frontal and parietal lobes, in addition to several old white matter infarcts. Meningeal biopsy showed numerous infiltrating macrophages and lymphocytes within the leptomeninges. The patient responded clinically and radiologically to corticosteroid and cyclophosphamide therapy. The patient subsequently developed herpes zoster over his left chest as a complication of his immunosuppressive treatment. His cyclophosphamide was ceased and intravenous immunoglobulin (IVIG) therapy was commenced, with good clinical response to both the herpes zoster and meningitis. According to the result of the biopsy, aseptic meningitis was considered the MRI results and the patient's clinical history were given, and a diagnosis of rheumatoid meningitis was made. The patient was p-ANCA positive. Although there was no evidence for cerebral vasculitis on biopsy, it remains a possibility that the patient's recurrent minor cerebral infarcts visible on MRI were vasculitic in nature.
17682494 [Quality of life of Saratov region residents with rheumatoid arthritis]. 2007 The aim of the study was to evaluate quality of life (QL) of patients with rheumatoid arthritis (RA) in Saratov region. The study was conducted within the framework of the program MCSQL (multi-center study of quality of life). The work presents the results of an investigation of the center of Saratov. The subjects were 139 patients (117 women; 22 men) with a valid diagnosis of RA. Deteriorated QL indices were revealed in all the patients; these indices correlated with the duration and activity of the disease as well as with gender and age.
17392347 Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arth 2007 Sep OBJECTIVES: To describe a novel scoring system for the assessment of tenosynovitis by magnetic resonance imaging (MRI) in patients with rheumatoid arthritis, and assess its intra- and inter-reader reliability in a multireader, longitudinal setting. METHODS: Flexor and extensor tenosynovitis were evaluated at the level of the wrist in 10 different anatomical areas, graded semi-quantitatively from grade 0 to 3 (total score 0-30), based on the maximum width of post-contrast enhancement within each anatomical area on axial T1-weighted MR images. Ten sets of baseline and 1-year follow-up MR images of the wrists of patients with rheumatoid arthritis with early and established disease were scored independently by four readers twice on 2 consecutive days. Intra- and inter-reader agreements were evaluated. RESULTS: The intrareader intraclass correlation coefficients (ICCs) were high for status scores (median ICCs 0.84-0.88) and slightly lower for change score (0.74). The smallest detectable difference (SDD) in % of the maximum score was 11.2-11.5% for status scores and 13.3% for change scores. Inter-reader single-measure ICCs were acceptable for both status scores (median 0.73-0.74) and change scores (0.67), while average-measures ICCs were very high for both status and change score (all > or =0.94). The median scoring time per patient (baseline and follow-up images) was 7 min (range 3-10). CONCLUSIONS: The introduced tenosynovitis scoring system demonstrates a high degree of multireader reliability, is feasible, and may be used as an adjuvant to the existing OMERACT RAMRIS score, allowing improved quantification of inflammatory soft tissue changes in patients with rheumatoid arthritis.
19292267 Quadriparesis due to acute collapse of a seemingly stabilized C5/6 segment in a patient wi 2008 Apr Rheumatoid arthritis often involves the cervical spine, especially the atlantoaxial joint. Although any cervical lesion can induce myelopathy in patients with rheumatoid arthritis, it is difficult to precisely predict if the lesion will progress and produce the myelopathy in a prospective fashion. The diagnostic imaging studies including plain radiographs, computed tomography, and magnetic resonance imaging are not always of sufficient quality to identify and predict the instability in the cervical spine in an rheumatoid arthritis patient. This article presents a patient with rheumatoid arthritis who had an acute collapse of a seemingly stabilized C5-6 segment, followed by severe quadriparesis resulting in death.
18087761 Anticitrulline peptide antibodies (CCP3) in leprosy sera: a negative association. 2008 Apr Anticyclic citrullinated peptide antibodies (anti-CCP) have been described almost exclusively in patients with rheumatoid arthritis. Recently, these autoantibodies have been found in patients with active tuberculosis. Leprosy is another mycobacterial disease where the presence of autoantibodies has been described by several authors. In this study, 64 patients with leprosy (32 paucibacillary and 32 multibacillary forms of the disease) were evaluated and only 2 patients were positive for the presence of anti-CCP. The low frequency of anti-CCP in leprosy sera demonstrated in our study illustrates the high specificity of anti-CCP for the diagnosis of rheumatoid arthritis.
18094000 Clinical identification and treatment of a rapidly progressing disease state in patients w 2008 Apr Inflammation is the major factor driving the progression of structural damage in rheumatoid arthritis (RA); therefore, it is critical to achieve rapid suppression of inflammation to maximize disease control. The severity of inflammation and progression of joint damage varies from patient to patient. Some patients have the propensity to change slowly over time and then progress in a more rapid and dynamic fashion. In those where inflammation is more severe, extensive damage can occur within only a few years of disease onset. The progress of joint destruction, as assessed radiographically, results in a decline in functional capacity and quality of life. Consequently, the challenge for clinicians is to identify and treat those patients who develop rapid, progressive disease. Several biological markers and clinical indicators have been identified to help predict or establish which of the patients have rapidly progressing disease or who are at most risk for rapid progression. Early diagnosis of patients with rapidly progressing RA enables immediate and intensive intervention (e.g. with biologic therapy) and a greater opportunity to change the course of disease.
18843784 Circulating dickkopf-1 and radiological progression in patients with early rheumatoid arth 2008 Dec OBJECTIVE: Dickkopf-1 (Dkk-1) regulates bone remodeling in animal models of inflammatory arthritis, but its role in patients with rheumatoid arthritis (RA) remains unclear. METHODS: Baseline circulating Dkk-1 was measured in 113 patients with RA (< 3 yrs) who received etanercept (10 or 25 mg twice/week, n = 63) or methotrexate alone (n = 40) for 1 year. Progression was assessed by changes in radiological Sharp score. RESULTS: Increased Dkk-1 was associated with a higher risk of progression of bone erosion, independently of age, sex, baseline radiological damage, C-reactive protein, and disease activity in patients treated with etanercept. CONCLUSION: Dkk-1 may be an important mediator of bone erosion in patients with RA.
18807254 Induction of remission in rheumatoid arthritis: criteria and opportunities. 2008 Dec The concept of remission in rheumatology is complicated by the lack of a single gold standard measurement, spontaneous remissions and the usage of several sets of remission criteria. Feasibility is reduced by traditional clinical practice, which does not include remission criteria monitoring. The "window of opportunity" to prevent joint damage with DMARD therapy lasts only a few months. The perspective of the physician and patient differ, as the former gives importance to signs of disease activity, whereas the latter to disability and quality of life. All patients with rheumatoid arthritis are candidates for combination DMARD-based therapy, which should be instituted without delay. Remission is important to prevent joint destruction, preserve adequate quality of life and prevent disability. The introduction of biological agents has made this objective feasible, but the failure rate is still high (about 50%), on account of lack of response, contraindications and intolerance.
17414531 Rheumatoid arthritis patients' experiences of night pain. 2007 Apr BACKGROUND: Night pain is a significant problem for many patients with rheumatoid arthritis (RA), but clinicians often overlook it. This study aimed to explore the issue of night pain among patients with RA both at home and in the hospital setting. METHODS: This was a qualitative study involving in-depth interviews among 8 hospital inpatients with established RA. Each interview was recorded, transcribed, and underwent framework analysis. RESULTS: The following themes were identified: Night pain in RA is a significant problem both at home and in hospital. All patients had established routines that they used in the home setting when disturbed by night pain. This often included getting out of bed and walking around, making hot drinks, and/or taking extra painkillers. These activities were often curtailed in the hospital setting for fear of disturbing other patients or the nurses. The effect of disturbed sleep and night pain on other people, be it partners or family members at home or patients and nurses in the hospital, was raised by all interviewees. CONCLUSION: Night pain in particular appears harder to control in the hospital setting than at home, and some of this may stem from lack of a tailored routine and fears of disturbing others. Information could be provided when patients are first admitted to the ward. This could describe or orient patients to the facilities available, which may be beneficial in the management of night pain. Further work on identifying influences upon night pain needs to be undertaken.
17440729 Cost effectiveness analysis of disease modifying antirheumatic drugs in rheumatoid arthrit 2007 Sep The objective was to assess the cost-effectiveness of various DMARDs compared with antimalarials (AM) for rheumatoid arthritis (RA) treatment. The data on disease activity, functional status and societal costs were collected from a 1-year cohort of 152 patients with RA receiving at least one DMARD for > or = 6 months. Incremental cost effectiveness ratio (ICER) was calculated from the societal costs of DMARD treatment compared with AM per one unit of HAQ improvement. All costs were presented in 2001 US dollars. Mean (SD) societal cost of AM treatment was US$ 2,285 (1,154) per patient per year. MTX + AM was less costly and more effective than AM, as the ICER of this combination would save US$ 834 per 1 U of HAQ improvement. MTX + SSZ, leflunomide, and triple therapy (AM + MTX + SSZ) were more effective than AM with additional costs. RA treatment with non MTX-based DMARDs was not cost-effective.
17264092 What's in season for rheumatoid arthritis patients? Seasonal fluctuations in disease activ 2007 May OBJECTIVES: To examine whether a seasonal fluctuation exists with rheumatoid arthritis (RA) activity and to analyse seasonal effects of varying components that express disease activity in RA patients. METHODS: A group of 1665 RA patients (mean age 57.2 yrs, mean disease duration 9.9 yrs) whose data were available for 10 consecutive phases from a large observational cohort study conducted at our institution from October 2000 to April 2005, bi-annually, were evaluated. Ten criteria were analysed to assess RA disease activity. RESULTS: All criteria revealed decrease in disease activity during fall and increase in disease activity during spring, except for the physician's global assessment of disease activity in which significant differences were not observed between the two seasons. CONCLUSIONS: We found definite seasonal differences in RA patients, both subjectively and objectively. RA disease activity was higher in spring and lower during fall. Seasonal changes may play an important role in evaluating disease activity of RA patients and should be taken into account when examining these patients.
17609389 TNF-induced structural joint damage is mediated by IL-1. 2007 Jul 10 Blocking TNF effectively inhibits inflammation and structural damage in human rheumatoid arthritis (RA). However, so far it is unclear whether the effect of TNF is a direct one or indirect on up-regulation of other mediators. IL-1 may be one of these candidates because it has a central role in animal models of arthritis, and inhibition of IL-1 is used as a therapy of human RA. We removed the effects of IL-1 from a TNF-mediated inflammatory joint disease by crossing IL-1alpha and beta-deficient mice (IL-1-/-) with arthritic human TNF-transgenic (hTNFtg) mice. Development of synovial inflammation was almost unaffected on IL-1 deficiency, but bone erosion and osteoclast formation were significantly reduced in IL-1-/-hTNFtg mice, compared with hTNFtg mice based on an intrinsic differentiation defect of IL-1-deficient monocytes. Most dramatically, however, cartilage damage was absent in IL-1-/-hTNFtg mice. Chimera studies revealed that protection of cartilage is based on the loss of IL-1 on hematopoietic, but not mesenchymal, cells, leading to decreased expression of ADAMTS-5 and MMP-3. These data show that TNF-mediated cartilage damage is completely and TNF-mediated bone damage is partially dependent on IL-1, suggesting that IL-1 is a crucial mediator for inflammatory cartilage and bone degradation.
16622905 Socioeconomic status and risk of rheumatoid arthritis: a Danish case-control study. 2006 Jun OBJECTIVE: To examine whether markers of socioeconomic status (SES) are associated with risk of rheumatoid arthritis (RA), and if so, whether selected lifestyle-related factors could explain this association. METHODS: We conducted a frequency matched case-control study; subjects comprised 515 patients (participation rate 83%) attending rheumatology and internal medicine departments in Denmark, with recently diagnosed RA according to the American College of Rheumatology (ACR) 1987 classification criteria for RA (mean disease duration 2.3 yrs), and 769 frequency-matched population controls (participation rate 64%). Information about SES and environmental exposure was obtained by structured telephone interview. Logistic regression analyses evaluated the role of markers of SES. RESULTS: Level of education was significantly inversely associated with risk of RA, with a 2-fold lower risk of RA among those with the longest formal education compared with those having the lowest level of education (multivariate odds ratio = 0.43, 95% confidence interval 0.24-0.76, p trend = 0.001). None of a series of studied lifestyle factors could explain this finding in multivariate logistic regression analyses. When dividing the RA cases into clinical subgroups, the inverse association with level of education was found to apply predominantly to rheumatoid factor (RF)-positive RA. CONCLUSION: The inverse association between level of education and risk of RF-positive RA was not explained by any of the examined lifestyle factors. RF-positive and RF-negative RA may be 2 distinct diseases with different etiologies, with unmeasured factors related to educational level predominantly associated with the risk of RF-positive RA. However, because mechanisms underlying referral to a hospital might be linked to educational level, our observation based on hospital-referred RA patients should be evaluated cautiously. The study stresses the importance of taking SES measures into account in studies that aim at identifying environmental risk factors for RA.
17544962 Rheumatoid nodule. 2007 Jun Rheumatoid nodules are the most common extra-articular manifestation of rheumatoid arthritis. Dermatologist may be concerned with the diagnosis and management of rheumatoid nodules, although most patients will probably be under the care of a rheumatologist. This article focuses in clinical, pathogenic, diagnostic, and therapeutic aspects of rheumatoid nodules. Classic rheumatoid nodules commonly occur in genetically predisposed patients with severe, seropositive arthritis. However, they may appear in other clinical settings. Accelerated rheumatoid nodulosis, especially involving the hands, has been reported in patients receiving methotrexate, antitumor necrosis factor alpha biologic drugs or leflunomide therapy for rheumatoid arthritis. Rheumatoid nodulosis is characterized by multiple rheumatoid nodules, recurrent joint symptoms with minimal clinical or radiologic involvement, and a benign clinical course. Pseudorheumatoid nodules have been reported in healthy children. Although histologically almost indistinguishable from true rheumatoid nodules, some consider these lesions to be a form of deep granuloma annulare.