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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
18313405 Lipid, protein, DNA oxidation and antioxidant status in rheumatoid arthritis. 2008 May OBJECTIVES: To investigate lipid, protein, DNA oxidation and antioxidant status in blood and synovial fluid of rheumatoid arthritis (RA) patients and to determine the importance of oxidative stress parameters in reflecting disease activity. DESIGN AND METHODS: 20 RA patients and 15 healthy controls were included. Lipid peroxidation (thiobarbituric acid reactive substances (TBARS), lipid hydroperoxide, and conjugated diene), protein oxidation (carbonyl and thiol), DNA oxidation (8-OHdG) and antioxidant status markers (glutathione (GSH), glutathione peroxidase (GSH Px), superoxide dismutase (CuZn SOD), and catalase) were determined in blood and synovial fluid. RESULTS: TBARS (p<0.001), lipid hydroperoxide (p<0.001), conjugated diene (p<0.001), carbonyl (p<0.001) and 8-OHdG (p<0.01) levels were significantly higher; thiol (p<0.01) and GSH levels (p<0.01) and GSH Px (p<0.001) and CuZn SOD (p<0.01) activities were significantly lower in blood of RA patients. TBARS (p<0.001), lipid hydroperoxide (p<0.001), conjugated diene (p<0.01), carbonyl (p<0.001) and 8-OHdG (p<0.05) levels were significantly higher, catalase activity (p<0.001) significantly lower in synovial fluid of RA patients. CONCLUSIONS: Increased lipid, protein and DNA oxidation markers and impaired antioxidant status confirm the role of oxidative stress in the pathogenesis of RA. Lipid peroxidation markers can serve as surrogate markers for disease activity.
17304656 Differences in clinical status measures in different ethnic/racial groups with early rheum 2007 Feb OBJECTIVE: Studies have documented differences in health status, disease prevalence, treatment outcomes, and healthcare utilization among different ethnic groups. We compared patients with early rheumatoid arthritis (RA) of different ethnic/racial groups according to disease activity measures, to identify possible differences in patterns of severity of clinical status. METHODS: An early RA treatment evaluation registry (ERATER) with more than 500 patients with less than 3 years of RA was established; 118 ERATER patients are followed in Brooklyn, NY, USA. At each visit, all patients complete a multidimensional Health Assessment Questionnaire (MDHAQ), including functional status, pain, fatigue, global assessment on a 10 cm visual analog scale, psychological distress, and duration of morning stiffness. Clinical evaluation includes tender and swollen joint counts and erythrocyte sedimentation rate (ESR). Baseline measures were collected before patients started any treatments. Clinical status measures in 3 ethnic/racial groups were compared. RESULTS: Hispanic patients with RA scored worst in all self-report measures compared to Caucasians and African Americans, with statistically significant differences in MHAQ functional score, psychological distress, and morning stiffness. The groups were not statistically significantly different in joint counts, ESR, or physician global assessment. CONCLUSION: Our findings indicate differences between ethnic/racial groups in patient derived measures in patients with early RA at presentation. Cultural differences and possible ethnic influences on disease activity measures in clinical trials and clinical care may be important in interpreting differences in prognosis and outcomes of patients with RA.
17888209 Radiographic progression of rheumatoid arthritis in patients from the Czech National Regis 2007 Jul OBJECTIVE: To evaluate the clinical status and radiographic progression in patients with rheumatoid arthritis (RA) being followed by the Czech National Registry of biological treatments. METHODS: Patients who failed at least two disease-modifying antirheumatic drugs and had high disease activity (DAS28 > 5.1) were treated with infliximab. Radiographic progression was measured with a modified version of the Sharp score (TSS) after 54 weeks of treatment. RESULTS: Ninety-nine patients with an average disease duration of 13.7 years were enrolled. The DAS28 dropped from 6.66 to 4.07 (p < 0.001). Before treatment the mean TSS was 90.1 and the mean estimated yearly disease progression was 8.56. After 54 weeks of infliximab, radiographic progression was 4.15 times slower than the estimated rate before treatment and 63 patients did not show any radiographic progression at all. In the remaining 36 patients, the progression rate slowed to 3.8 +/- 0.9 from the estimated TSS of 10.9 +/- 6.9 before the initiation of treatment (p = 0.011). CONCLUSION: Data derived from the Czech National Registry, which reflect general clinical practice, show a significant retardation of radiographic progression in patients treated with anti-TNF and the magnitude of the improvement seen is similar to results from clinical trials.
16087381 Cartilage breakdown in rheumatoid arthritis. 2006 Jan Rheumatoid arthritis (RA) is a connective tissue disease characterized by destruction of the joint cartilage and subsequently of the underlying bone. Cartilage destruction is due to proteolysis by enzymes called metalloproteinases (MMPs), whose production and expression are regulated by numerous local mediators such as cytokines, growth factors, prostaglandins, oxygen species, and neuropeptides. MMP activation is largely due to a stimulatory effect of cytokines including IL-1beta and TNFalpha. When these cytokines bind to their membrane receptor, they set off signaling cascades, with activation of TGFbeta-activating kinase (TAK-1), of NF-kappaB by Ikappa-B kinase, of mitogen-activated protein kinases (MAP kinases), and finally of activator protein-1 (AP-1). Tissue inhibitors of MMPs (TIMPs) specifically inhibit MMPs. The interrelations between joint inflammation and joint destruction remain poorly understood. Experimental data suggest that IL-1 may be involved chiefly in joint destruction and TNF in joint inflammation. However, TNF antagonists are potent inhibitors of joint destruction in clinical practice. These results suggest that the mediators function as a network and that inhibition of a single mediator can affect the entire web. Insights gained into the innermost mechanisms of cartilage breakdown in patients with RA have led to major therapeutic breakthroughs. Thus, TNF antagonists have proved highly effective in RA. Future progress will no doubt stem from new knowledge about the extracellular mediators and intracellular signaling pathways that lead to the production and activation of enzymes responsible for cartilage degradation.
16724377 The role of anti-cyclic citrullinated peptide antibodies in predicting progression of pali 2006 Jul OBJECTIVE: To determine whether the presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies at presentation is of prognostic value in patients with palindromic arthritis. METHODS: Stored sera, taken around the time of presentation from patients with palindromic arthritis, where available, were assessed for anti-CCP antibodies, and results were correlated with subsequent clinical outcome. RESULTS: Twenty-nine of 61 patients had progressed to rheumatoid arthritis after a mean followup of 5.4 years; 83% of these had had anti-CCP antibodies in their baseline sera. CONCLUSION: The sensitivity/specificity and likelihood ratios for CCP antibodies were better than rheumatoid factor in predicting outcome.
17304655 Independent association of increased trunk fat with increased arterial stiffening in postm 2007 Feb OBJECTIVE: We recently reported increased arterial thickening and stiffening in patients with rheumatoid arthritis (RA) to which inflammation and increased bone resorption contributed. The current study examined the possible involvement of trunk fat in increased arterial stiffening in postmenopausal patients with RA. METHODS: RA patients (n = 30) and healthy controls (n = 30), all postmenopausal women, were examined for body adiposity and brachial-ankle pulse wave velocity (baPWV) by dual-energy x-ray absorptiometry and waveform analyzer, respectively. Subjects having other diseases and predisposed to atherosclerosis were excluded. Trunk:peripheral fat ratio was calculated as the fat mass of the trunk divided by the sum of the fat mass of arms and legs. Bone mineral density (BMD) at ultradistal radius was measured by peripheral quantitative computed tomography. Inflammation markers and bone resorption markers were also measured. RESULTS: Age, body mass index, and systolic blood pressure (BP) of RA patients were 60.8 +/- 9.8 years, 22.5 +/- 3.3, and 129.6 +/- 20.8 mm Hg, respectively, which did not differ from data from healthy controls. Duration of RA was 10.4 years with mean daily dose of prednisolone 3.02 +/- 3.85 mg. RA patients exhibited a significantly greater trunk:peripheral fat ratio (1.041 +/- 0.253 vs 0.839 +/- 0.223; p < 0.001) and baPWV value (1544.7 +/- 304.9 vs 1373.8 +/- 256.1; p < 0.005) than healthy controls. In RA patients, age (r = 0.588, p < 0.001), systolic BP (r = 0.553, p < 0.005), trabecular BMD at ultradistal radius (r = -0.346, p = 0.061), and trunk:peripheral fat ratio (r = 0.366, p = 0.046) were correlated with baPWV. Trunk:peripheral fat ratio did not differ significantly between RA patients with and those without prednisolone treatment. In multiple regression analysis that included age, systolic BP, and trunk:peripheral fat ratio as independent variables, the trunk:peripheral fat ratio emerged as an independent factor significantly associated with baPWV in RA patients. When trabecular BMD at ultradistal radius was inserted in place of trunk:peripheral fat ratio, it emerged as a factor that was significantly associated with baPWV. CONCLUSION: We showed that increased trunk fat was significantly and independently associated with increased arterial stiffening in postmenopausal patients with RA.
17118041 Effectiveness of non-pharmacological interventions for fatigue in adults with multiple scl 2006 Dec AIM: This paper reports a systematic review of non-pharmacological interventions for fatigue in adults with three common autoimmune conditions. BACKGROUND: A considerable proportion of people with multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus experience compromised quality of life due to fatigue. Recent reviews of pharmacotherapies for fatigue in these conditions remain inconclusive, and systematic evidence for effectiveness of non-pharmacological interventions was unavailable. Our paper addresses this gap. METHODS: The literature search used the key words fatigue, energy, multiple sclerosis, rheumatoid arthritis and systemic lupus. It included 19 electronic databases and libraries, three evidence-based journals, two internet search engines, was dated 1987-2006, and limited to English. Non-pharmacological experimental studies about fatigue comprising more than five adults were included. Meta-analysis was not possible due to diverse interventions and outcome measures, therefore studies were analysed by types of interventions used to reduce fatigue. RESULTS: Of 653 hits, 162 papers were reviewed, and 36 met the inclusion criteria. Thirty-three primary studies reported 14 randomized controlled trials and 19 quasi-experimental designs. Most interventions were tested with people with multiple sclerosis. Exercise, behavioural, nutritional and physiological interventions were associated with statistically significant reductions in fatigue. Aerobic exercise was effective, appropriate and feasible for reducing fatigue among adults with chronic autoimmune conditions. Electromagnetic field devices showed promise. The diversity of interventions, designs, and using 24 different instruments to measure fatigue, limited comparisons. CONCLUSION: Low impact aerobic exercise gradually increasing in intensity, duration and frequency may be an effective strategy in reducing fatigue in some adults with chronic auto-immune conditions. However, fatigue is a variable and personal experience and a range of behavioural interventions may be required. Well-designed studies testing these promising strategies and consensus on outcome fatigue measures are needed.
20887431 Occupational performance modification and personal change among clients receiving rehabili 2008 Mar BACKGROUND:   A client's personal process of change is recognised as an important element in the rehabilitation process that may affect the acceptance and outcome of recommended occupational therapy self-management interventions. Recent research has examined the transformative process of changing underlying values, beliefs, feelings and knowledge, collectively known as meaning perspectives, in clients receiving rehabilitation for various chronic conditions. AIM/METHODS:   This article presents the findings of a Grounded Theory Qualitative retrospective study of 10 adults diagnosed with rheumatoid arthritis receiving occupational therapy to modify their daily living environment and activities to maximise the quality of life and occupational performance. They were interviewed twice in a semidirected manner. RESULTS:   Two personal change processes were identified for two different courses of the illness: progressive adaptation during a course of gradual steady development of symptoms without remission, and complex adaptation that led to transformation during a course of acute development of symptoms with periods of remission. CONCLUSION:   Implications for more effective and efficient occupational therapy interventions are suggested.
18178765 Tophaceous gout in a patient with rheumatoid arthritis. 2007 Dec Chronic gout and rheumatoid arthritis are common medical manifestations with debilitating effects on patients. However, these conditions are not typically identified concomitantly and can be hard to distinguish from one another. We report a rare case of a 50-year-old white woman with a history of chronic gout and rheumatoid arthritis who presented with intradermal tophaceous gout. Physical examination and laboratory results are described.
16785804 F-18 FDG whole-body PET for the assessment of disease activity in patients with rheumatoid 2006 Jul PURPOSE OF REPORT: F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used to image synovitis in patients with rheumatoid arthritis (RA). The aim of this study was to evaluate if a simple scoring system based on visual assessment of FDG joint uptake correlates with the clinical assessment of patients with RA undergoing antiinflammatory treatment. MATERIALS AND METHODS: Seven patients with active RA underwent whole-body FDG PET and clinical assessment before and after treatment with the antitumor necrosis factor alpha antibody (infliximab). A PET total joint score, ie, the sum of all scores based on FDG uptake intensity between zero and 4 in 28 joints, was correlated with a total joint score based on the clinical disease activity in the same joints using a Spearman rank correlation. RESULTS: The PET based total joint score was similarly high before onset as was the clinical total joint score. The decrease of FDG joint uptake in the follow-up PET scans correlated significantly with the clinical assessment. Additionally, synovial FDG uptake was found in extraarticular sites such as tendon sheaths and bursae. CONCLUSIONS: Visual assessment of FDG uptake shows a significant correlation with clinical evaluation of disease activity in patients with RA undergoing antiinflammatory treatment.
19062459 Measures of outcome in patients with inflammatory arthritis. 2008 Sep 11 BACKGROUND: Musculoskeletal disorders account for 15-20% of general practitioner (GP) consultations and cause significant morbidity and disability. Although rheumatology nursing is regarded as a partnership between the practitioner and patient, it remains a relatively tough task to generate a letter summarizing the outcome of clinical assessment and decisions made regarding the patients' management. OBJECTIVE: To assess the validity of a developed pro forma letter that summarizes the outcome measures of patients suffering from inflammatory arthritis, as assessed in secondary care, and to assess the comprehensibility of this new model. METHODS: The outcome measures of 184 patients with rheumatoid arthritis (99), as well as seronegative inflammatory arthritis (85) were reviewed. A pro forma was designed to summarize the outcome of the clinical assessment. RESULTS: Fifty-five males (29.9%) and 129 (70.1%) females were included with a mean age of 44.3 years and standard deviation of 14.5 (age range 22-81 years); duration of illness was variable and ranged between 4 months and 28 years. The pro forma showed a strong validity when compared to patients' data records (range 0.89-0.97). All GPs rated it as comprehensible (comprehensibility rate 80.8%). CONCLUSION: The pro forma is a valid instrument that can be used in clinical practice. It offers an option that is well accepted by rheumatology nurses, rheumatologists, as well as GPs. The letter was found to be a significantly better tool for informing GPs about patients' medical condition, possible risks and management plan.
18037319 Recommendations of the French Society for Rheumatology regarding TNFalpha antagonist thera 2007 Dec OBJECTIVES: To update French Society for Rheumatology guidelines regarding the use of TNFalpha antagonists for treating patients with rheumatoid arthritis (RA). METHODS: Existing guidelines were updated using the AGREE instrument. Items that required updating were selected by a task force, the relevant literature was critically appraised, and new wording was suggested by a limited committee of experts then validated by the task force and subsequently by a panel of external reviewers. The three-topic structure of the recommendations (indication, initiation, and adjustment) and the final algorithm format were maintained. RESULTS: Of the 12 items, five were selected for updating; one pertained to the indication for treatment with TNFalpha antagonists, two to treatment initiation, and two to treatment adjustment. Of the four initially recommended criteria for determining that TNFalpha antagonist therapy is indicated, the first three were left unchanged (confirmed diagnosis of RA; active disease for more than 1month with objective evidence of inflammation or progressive structural damage, or dependency on glucocorticoid therapy, or progressive radiographic damage; and failure to respond adequately to methotrexate - or another agent when methotrexate is contraindicated - in the optimal tolerated dosage). The fourth and last criterion was modified as follows: co-morbidities should be evaluated in order to distinguish absolute contraindications from relative contraindications that require referral to a specialist. Of the four initial recommendations about TNFalpha antagonist initiation, the first and fourth were left unchanged (a workup should be performed prior to treatment initiation, and the patient should receive regular standardized follow-up); the second and third recommendations were modified as follows: there is no evidence that one TNFalpha antagonist is more effective than the others, and concomitant methotrexate therapy is generally advisable, regardless of the TNFalpha antagonist used. Of the four recommendations about treatment adjustment, the first two were modified as follows: the goal of treatment is to achieve the EULAR response criteria or better; and in non-responders, the dosage or dosing interval can be modified when infliximab is used, methotrexate should be added when the TNFalpha antagonist is used alone, and in all other situations the patient should be switched to a different TNFalpha antagonist. The other two recommendations about treatment adjustment were left unchanged (patients who fail to tolerate one TNFalpha antagonist can be switched to another TNFalpha antagonist if allowed by the nature of the adverse event; and when a remission is achieved, reduction or discontinuation of symptomatic drugs - most notably glucocorticoids - is appropriate, followed in the event of a prolonged remission by changes in the dosage and/or dosing interval of the TNFalpha antagonist or concomitant disease-modifying drug). CONCLUSION: These recommendations are designed to help practitioners optimize the use of TNFalpha antagonists in patients with RA seen in everyday practice. They do not constitute regulations.
17918786 Bone edema determined by magnetic resonance imaging reflects severe disease status in pati 2007 Nov OBJECTIVE: To determine the significance of bone edema, detected by magnetic resonance imaging (MRI), in early-stage rheumatoid arthritis (RA). METHODS: We simultaneously examined serologic variables, MRI of wrist sites and finger joints of both hands, clinical disease activity score (DAS), and HLA-DR typing at entry in 80 patients with early-stage RA. RESULTS: The number of bones scored as positive for bone edema correlated with the number of sites scored as positive for MRI synovitis and MRI bone erosion, rate of enhancement (E-rate), and serum C-reactive protein (CRP), matrix metalloproteinase 3 (MMP-3), and interleukin 6 (IL-6). Findings for MRI synovitis and MRI bone erosion, E-rate, CRP, MMP-3, IL-6, seropositivity, and titer of anti-cyclic citrullinated peptide antibody (anti-CCP antibody), DAS28-CRP and HLA-DRB1*0405 allele carriership, were significantly higher in the positive versus the negative bone edema group. CONCLUSION: Bone edema based on our scoring system may reflect severe disease status in patients with early-stage RA. However, its clinical value at entry in prognostication of RA should be examined through prospective clinical followup studies.
16715223 [Sonography of synovial and erosive inflammatory changes]. 2006 May High-frequency sonography enables excellent detection of early erosions and synovial proliferations. Power Doppler sonography (PDUS) allows for an improved characterization of articular and peritendinous augmented volume, because detection of hypervascularity correlates with inflammatory activity and further is helpful in differentiation from effusion and inactive pannus. The use of contrast media improves the sensitivity of vascularity detection, because they allow for a delineation of vessels at the microvascular level. This is of increased interest, as the development of new therapeutic options targeting the microvascular level calls for earlier diagnosis and optimal assessment of disease activity. Because of good availability, cost effectiveness, and patient acceptance, sonography facilitates early diagnosis of synovial proliferations and erosions as well as therapy follow-up.
18034251 [Early rheumatoid arthritis--rapid help is double help]. 2007 Dec Early diagnosis and therapy of persisting (or chronic) polyarthritis is essential for preventing permanent damage. The guidelines of the German Society for Rheumatology recommend referral to a rheumatologist 6 weeks (at the latest) after symptom onset. DMARD therapy should be initiated within 12 weeks. Even earlier, high titer rheumatoid factor, detectable antibodies to CCP, or early erosion, constitute firm arguments for initiating DMARD therapy in patients with arthritis. At this time point, fast acting combination therapy frequently achieves remission or at least low disease activity. Since TNF blockers are not commonly available for first line therapy, corticosteroids should accompany DMARD initiation. Sufficient capacity in early consultation at arthritis clinics, optimized communication with primary care physicians and sensibilisation of the entire population are essential to prevent permanent damage in as many patients as possible.
17183622 Prevalent rheumatoid arthritis and diabetes among NHANES III participants aged 60 and olde 2007 Mar OBJECTIVE: This study examines the cross-sectional association between prevalent rheumatoid arthritis (RA) and diabetes among noninstitutionalized US civilians aged >or= 60 years between 1988 and 1994. METHODS: Using National Health and Nutrition Examination Survey III data from the National Center for Health Statistics, RA and diabetes were identified using several classification schemes. In total, 5302 survey participants aged >or= 60 years were included in logistic regression analyses taking survey weights into account. We also conducted sensitivity analyses restricting the study population to participants not recently prescribed glucocorticoids and fasting at least 8 hours prior to blood draw, as well as data incorporated from the Multiple Imputation Project. RESULTS: Among the 5302 participants aged >or= 60, 144 participants had RA and 24 of these also were found to have prevalent diabetes. The adjusted odds ratios for the cross-sectional association between RA and diabetes ranged from 1.1 to 1.5, but did not reach statistical significance. CONCLUSION: While this study cannot definitively rule out a modest non-null association, we can conclude that there is no evidence of a strong cross-sectional association between prevalent RA and diabetes in subjects aged >or= 60 years. Future longitudinal studies with more participants with RA are required to further evaluate a possible association between RA and the incidence of diabetes.
18077778 A randomized clinical trial of elk velvet antler in rheumatoid arthritis. 2008 Jan This article examines the effects of elk velvet antler on joint pain and swelling, patient/physician global assessment of disease activity, functional ability, quality of life, blood levels of C-reactive protein, and adverse events in persons with stage 2 to 3 rheumatoid arthritis experiencing residual symptoms after standard treatment. Patients (N=168) were enrolled in a 6-month randomized, triple-blind, placebo-controlled clinical trial. Instruments included the Arthritis Impact Measurement Scale, the Health Assessment Questionnaire, tender and swollen joint counts, and 100 mm-length visual analogue scales, along with blood tests. There were no significant differences between groups on any measures. The pattern of change of the measures across time points was essentially the same for both groups. Although some patients reported clinical improvements in their symptoms, there were no statistically significant differences between groups. Overall, elk velvet antler does not effectively manage residual symptoms in patients with rheumatoid arthritis.
16465652 Course of patient-reported health outcomes in rheumatoid arthritis: comparison of longitud 2006 Feb OBJECTIVE: To describe health outcomes reported by patients with rheumatoid arthritis (RA), i.e., pain, disability and health-related quality of life, as a function of disease duration in a longitudinal approach, and to compare the course of patient-reported health outcomes by a longitudinal versus a cross-sectional approach. METHODS: Data were collected with 4 series of questionnaires between 1997 and 2002 among patients with RA (maximum number = 882) of varying disease duration. The course of patient-reported health outcomes as a function of disease duration was evaluated using both longitudinal data and cross-sectional data of the first series. RESULTS: The course of RA shows a different pattern for various health outcomes. We observed similar trends in health outcomes in this large patient sample using the longitudinal and the cross-sectional approach. CONCLUSION: Although longterm consequences of RA are preferably assessed in longer duration followup studies, cross-sectional studies, including patients with a broad range of disease durations, seem to provide fairly reliable estimates of the course of health outcomes.
17504821 Effectiveness of adalimumab for rheumatoid arthritis in patients with a history of TNF-ant 2007 Jul OBJECTIVE: To evaluate the effectiveness and safety of adalimumab in patients with rheumatoid arthritis (RA) who previously discontinued tumour necrosis factor (TNF) antagonists for any reason in clinical practice. METHODS: ReAct (Research in Active Rheumatoid Arthritis) was a large, open-label trial that enrolled adults with active RA who had previously been treated with traditional disease-modifying anti-rheumatic drugs or biological response modifiers. Patients self-administered adalimumab 40 mg subcutaneously every other week for 12 weeks and were allowed to enter an optional long-term extension phase. Measures of adalimumab effectiveness included American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) response criteria, Disease Activity Score 28 (DAS28) and the Health Assessment Questionnaire Disability Index (HAQ DI). RESULTS: Of 6610 patients, 899 had a history of etanercept and/or infliximab therapy; these patients experienced substantial clinical benefit from adalimumab treatment. At week 12, 60% of patients had an ACR20 and 33% had an ACR50 response; 76% had a moderate and 23% had a good EULAR response. In addition, 12% achieved a DAS28 < 2.6, indicating clinical remission, and 13% achieved a HAQ DI score <0.5. The allergic adverse event rate, regardless of relationship to adalimumab, was 6.5/100-patient-years (PYs) in previously TNF-antagonist-exposed patients and 4.3/100-PYs in TNF-antagonist-naive patients. A multiple regression analysis indicated no statistically significantly increased risk of serious infections in patients who received prior TNF antagonists compared with TNF-antagonist-naive patients. CONCLUSION: In typical clinical practice, adalimumab was effective and well-tolerated in patients with RA previously treated with etanercept and/or infliximab.
19227308 [Relationship between blood lipid spectrum and activity of the disease in patients with rh 2008 Patients with rheumatoid arthritis (RA) are at risk of cardiovascular disorders. Pathogenesis of rapidly developing atherosclerosis in RA remains to be elucidated. The aim of this study was to compare cholesterol content in serum lipoprotein subfractions in patients with RA and healthy subjects and to establish relationship between lipid profile variations, severity of the disease, and plasma levels of anti-inflammatory cytokines. The study included 15 patients with active RA and 120 healthy subjects of comparable sex and age. RA was found to be associated with a significant decrease of cholesterol of high density (HDL2) and intermediate density (IDL) lipoproteins and its elevation in low density lipoproteins (LDL1-3). There was negative correlation between the latter parameter and disease activity index. No relationship between lipoprotein cholesterol and serum interleukins (IL-6, IL-8) TNF-alpha, and IFN-gamma) was documented. It is concluded that patients with RA exhibit proatherogenic changes of cholesterol content in different lipoprotein subfractions related to the severity of the disease. Further studies are needed to elucidate molecular mechanisms of dyslipidemia in RA and to ensure the choice of optimal targets for therapeutic modalities reducing the risk of cardiovascular disorders.