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ID PMID Title PublicationDate abstract
18276745 C4b-binding protein (C4BP) inhibits development of experimental arthritis in mice. 2009 Jan OBJECTIVES: To assess the human complement inhibitor C4b-binding protein (C4BP) for treatment of arthritis. METHODS: We have used two mouse models of rheumatoid arthritis (RA) to assess the therapeutic effect of C4BP on different phases of arthritis, the collagen antibody-induced arthritis (CAIA), an acute antibody-induced disease and the collagen-induced arthritis (CIA), which carries the full complexity of arthritis. RESULTS: Purified human C4BP injected intraperitoneally alleviated CAIA significantly in a manner similar to cobra venom factor that depletes complement due to massive activation. Furthermore, C4BP was injected before and after the disease development into CIA mice. In the former case, the disease onset was delayed and in the latter, the severity of the disease was reduced in animals treated with C4BP. However, C4BP did not affect the anti-CII antibody synthesis. C4BP present in mouse sera decreased activity of the classical but not the alternative pathway of the complement system when these were assessed in a fluid phase. However, C4BP was efficiently inhibiting the alternative pathway when present on the activating surface. Taken together, the disease ameliorating effect of C4BP appears to be related to inhibition of both pathways of complement. CONCLUSIONS: Although human C4BP was cleared relatively fast from the circulation and was only moderately affecting complement activity, its effect on the disease severity was substantial, suggesting that minor alterations in complement activity can have significant therapeutic value in RA.
18720701 Development of systemic lupus erythematosus in a patient with rheumatoid arthritis followi 2008 Aug Systemic lupus erythematosus (SLE)-like syndromes and the development of lupus-related autoantibodies are known to occur during treatment with certain medications. Here a case of complete SLE conversion in a patient with rheumatoid arthritis following sequential treatment with infliximab and adalimumab is reported. Potential mechanisms for development of SLE with this treatment regimen are discussed, as well as the need for further exploration into autoimmune phenomenon with the use of immunobiologic agents.
18240256 Development and validation of a patient-based disease activity score in rheumatoid arthrit 2008 Feb 15 OBJECTIVE: Assessor-based disease activity measures such as the Disease Activity Score in 28 joints (DAS28), although widely used in rheumatoid arthritis (RA), have high interobserver variability. We developed and validated a patient-based disease activity score (PDAS) as an alternative assessment. METHODS: Patients' assessments of swollen or tender joints, visual analog scales for pain and general health, the Health Assessment Questionnaire, and erythrocyte sedimentation rate (ESR) were used to develop the PDAS. In a developmental cohort (204 patients), regression analyses determined the best fit with the DAS28. A validation cohort (322 patients) subsequently evaluated criterion and construct validity against a range of outcome measures, including the Nottingham Health Profile (NHP) and Short Form 36 (SF-36). Sensitivity to change was assessed in 56 patients after 6 months of treatment with disease-modifying antirheumatic drugs or biologics. RESULTS: In the developmental cohort, the PDAS with ESR (PDAS1) and without ESR (PDAS2) achieved excellent fit with the DAS28 (r = 0.88 and 0.74, respectively). In the validation cohort, the PDAS showed high criterion validity by correlation with the DAS28 (PDAS1: r = 0.89, PDAS2: r = 0.76). Construct validity was demonstrated by high correlations with a range of disease activity measures (r > or = 0.45), whereas low correlations (r < 0.45) with mental and social components of the SF-36 and NHP indicated divergent validity. The PDAS and DAS28 had similar sensitivity to change, determined using effect sizes (DAS28 = 1.03, PDAS1 = 1.02, PDAS2 = 0.77) or standardized response means (DAS28 = 0.79, PDAS1 = 0.77, PDAS2 = 0.73). CONCLUSION: The PDAS1 and PDAS2 are valid and sensitive tools to assess disease activity in RA. They appear suitable for clinical decision making, epidemiologic research, and clinical trials.
16988848 [Comorbidity in rheumatoid arthritis of early onset. Effects on outcome parameters]. 2006 Oct Three-year follow-up data of 1,032 patients with recent onset rheumatoid arthritis (RA) were analyzed regarding the frequency of 21 common comorbid chronic conditions and their impact on health outcome (i.e., pain, functional capacity, disease activity, and radiographic joint damage). Multivariate logistic regression analyses were used to calculate age- and gender-adjusted odds ratios for each chronic condition on severe functional capacity (<60% of full function). Comorbidity was already common at the onset of RA, with 72% of the patients having at least one comorbid condition and almost 50% having at least two. Common comorbidities were associated with significantly worse baseline measures in at least three of seven investigated outcome parameters. The more of these conditions patients had, the worse their 3-year outcome. Functional capacity was most sensitive to comorbid conditions. In logistic regression, obesity, hypercholesterolemia, type II diabetes, and osteoporosis resulted in a twofold risk of severe functional limitation (<60% of full function), independent of each other and of age and gender. The impact of comorbidity on measures of disease severity should be considered when used to compare outcome parameters of different RA samples.
17787044 Myocardial dysfunction in rheumatoid arthritis: a controlled tissue-Doppler echocardiograp 2007 Oct OBJECTIVE: To determine the sensitivity and accuracy of tissue-Doppler echocardiography (TDE) to assess myocardial contractility. Heart failure is one of the determinants of the excess in mortality in patients with rheumatoid arthritis (RA). METHODS: Consecutive RA patients with normal clinical cardiac examination were prospectively included and compared to 27 controls. All underwent conventional echocardiography, and systolic and diastolic strain rate (SR) were determined by TDE. RESULTS: Twenty-seven patients with RA were included (mean age 50 +/- 10 yrs, disease duration 8 +/-6 yrs). Mean disease activity score was 4.3 +/- 1.6, C-reactive protein 23 +/- 32 mg/l. When compared to controls (50 +/- 9 yrs), patients with RA had increased left ventricular mass (99 +/- 24 vs 80 +/- 25 g/m2, p = 0.009), and there was a trend for left atrial enlargement (31 +/- 3 vs 29 +/- 6 mm, p = 0.06). Fractional shortening and systolic SR did not differ between groups. Diastolic function, as estimated by the E/A Doppler velocity ratio was similar in both groups (p = 0.18). However, diastolic SR was strikingly reduced in patients with RA versus controls (3.7 +/- 1.3 vs 5.5 +/- 1.1s-1, p < 0.001) with 18/27 patients with RA having marked reduced diastolic SR (SR < 4s-1). None of the RA characteristics was associated with significant differences in TDE measurements. CONCLUSION: TDE identifies impaired diastolic function in patients with RA that may not be detected by conventional measurements.
18454843 Molecular discrimination of responders and nonresponders to anti-TNF alpha therapy in rheu 2008 INTRODUCTION: About 30% of rheumatoid arthritis patients fail to respond adequately to TNFalpha-blocking therapy. There is a medical and socioeconomic need to identify molecular markers for an early prediction of responders and nonresponders. METHODS: RNA was extracted from peripheral blood mononuclear cells of 19 rheumatoid arthritis patients before the first application of the TNFalpha blocker etanercept as well as after 72 hours. Clinical response was assessed over 3 months using the 28-joint-count Disease Activity Score and X-ray scans. Supervised learning methods were applied to Affymetrix Human Genome U133 microarray data analysis to determine highly selective discriminatory gene pairs or triplets with prognostic relevance for the clinical outcome evinced by a decline of the 28-joint-count Disease Activity Score by 1.2. RESULTS: Early downregulation of expression levels secondary to TNFalpha neutralization was associated with good clinical responses, as shown by a decline in overall disease activity 3 months after the start of treatment. Informative gene sets include genes (for example, NFKBIA, CCL4, IL8, IL1B, TNFAIP3, PDE4B, PPP1R15A and ADM) involved in different pathways and cellular processes such as TNFalpha signalling via NFkappaB, NFkappaB-independent signalling via cAMP, and the regulation of cellular and oxidative stress response. Pairs and triplets within these genes were found to have a high prognostic value, reflected by prediction accuracies of over 89% for seven selected gene pairs and of 95% for 10 specific gene triplets. CONCLUSION: Our data underline that early gene expression profiling is instrumental in identifying candidate biomarkers to predict therapeutic outcomes of anti-TNFalpha treatment regimes.
16924693 Serum autoantibodies that bind citrullinated fibrinogen are frequently found in patients w 2006 Nov OBJECTIVE: Autoantibodies that bind citrullinated antigens are a sensitive and specific marker for rheumatoid arthritis (RA). While synthetic cyclic citrullinated peptides (CCP) are typically used to identify these antibodies, little is known about antibody reactivity to the predominant citrullinated protein found in the inflamed synovium, citrullinated fibrinogen (CitFib). We assessed the prevalence of anti-CitFib antibodies in patients with various rheumatic diseases. METHODS: In total, 65 patients with established RA and 63 patients with other rheumatic diseases were tested for serum IgM rheumatoid factor (RF), IgG anti-CCP2, and IgG anti-CitFib antibodies. This cohort was used to determine optimal positive cutoff values for antibody reactivity to CitFib through receiver operating characteristic curve analysis. The specificity of these assays was confirmed with sera from 49 patients with psoriatic arthritis. RESULTS: Antibodies to both citrullinated antigens were identified in the majority of RA patients tested. The overall sensitivity and specificity of the assays were: CCP 82%, 96%, CitFib 75%, 98%, and IgM RF 80%, 64%, respectively. All but one patient that was positive for CitFib was also positive for CCP2, and close to half the RF-negative RA patients were positive for CitFib and CCP2. CONCLUSION: These results suggest that autoimmunity to CitFib is common in patients with RA and may play a role in disease pathogenesis.
17122779 Slc11a1 (formerly NRAMP1) gene modulates both acute inflammatory reactions and pristane-in 2007 Jan Mice selected for the maximum acute inflammatory reaction (AIRmax) are highly susceptible to pristane-induced arthritis (PIA), whereas mice selected for the minimum response (AIRmin) are resistant. These lines show distinct patterns of leukocyte infiltration and R and S allele frequency disequilibrium of the solute carrier family 11a member 1 (Slc11a1) gene. In order to study the interactions of the Slc11a1 R and S alleles with the inflammation modulating Quantitative Trait Loci (QTL) during PIA development, homozygous AIRmax(RR), AIRmax(SS), AIRmin(RR) and AIRmin(SS) lines were produced by genotype-assisted breedings. These mice received two intraperitoneal injections of 0.5 ml pristane at 60-day intervals, and the subsequent development of arthritis was assessed for 210 days. Cytokine-secreting cell profiles were investigated using enzyme-linked immunospot. Arthritis incidence in AIRmax(RR) mice reached 29%, whereas PIA incidence in AIRmax(SS) mice was 70% by day 180. AIRmin(RR) mice were resistant, whereas 13.3% of AIRmin(SS) mice became arthritic. The presence of the defective S allele also increased arthritis severity, although acute inflammation was higher in mice bearing the R allele. A predominant Th0/Th2-type response in Slc11a1(SS) mice was observed. These results indicate that Slc11a1 is a strong candidate for the QTL modulating acute inflammation and for PIA.
17435254 Relationship between synovial fluid and plasma manganese, arginase, and nitric oxide in pa 2007 Feb Nitric oxide (NO) participates in the pathogenesis of inflammatory reactions in many autoimmune diseases such as rheumatoid arthritis (RA). There is a reciprocal pathway between arginase and nitric oxide synthase (NOS) for NO production, and Mn is required for arginase activity and stability. To investigate whether NO production related with the arginine-nitric oxide pathway in patients with RA, we measured synovial fluid and plasma nitrite (NOx) levels, arginase activities, and its cofactor manganese (Mn) concentrations in 21 RA patients and 13 healthy control subjects. Plasma albumin levels were measured as an index of nutritional status. NOx levels were determined after the reduction of nitrates to nitrites using the Griess reaction. Whereas, synovial fluid arginase activities and Mn levels were found to be significantly lower (p<0.001, p<0.001, respectively), plasma arginase activities and Mn levels were similar in patients with RA when compared to the control subjects. Plasma and synovial fluid NO levels were similar in patients with RA and in healthy subjects (p>0.05, p>0.05, respectively). There were significantly positive correlations between synovial fluid and plasma arginase activities vs Mn content (r=0.543, p=0.011; r=0.516, p=0.017, respectively) and significantly negative correlations between synovial fluid and plasma NO levels vs arginase activities (r=-0.497, p=0.022; r=-0.508, p=0.019 respectively) in the patients group. Our results indicate that the lower concentration of synovial fluid Mn could cause lower arginase activity and this could also upregulate NO production by increasing L-arginine content in patients with RA.
17570481 New therapies for treatment of rheumatoid arthritis. 2007 Dec 1 Rheumatoid arthritis is characterised by pain, swelling, and destruction of joints, with resultant disability. Only disease-modifying antirheumatic drugs can interfere with the disease process. In the past few years, biological agents, especially inhibitors of tumour necrosis factor, have allowed for hitherto unseen therapeutic benefit, although even with these drugs the frequency and degree of responses are restricted. Therefore, new agents are needed, and three novel biological compounds for treatment of rheumatoid arthritis have already been used in practice or are on the horizon: rituximab (anti-CD20), abatacept (cytotoxic T-lymphocyte antigen 4 immunoglobulin), and tocilizumab (anti-interleukin 6 receptor). We discuss the targets of these drugs, the roles of these targets in the pathogenesis of rheumatoid arthritis, and the efficacy and adverse effects of these agents from clinical trial data. Novel therapeutic strategies in conjunction with optimised disease assessment for better treatment of rheumatoid arthritis and an outlook into potential future targets are also presented.
18198196 Cigarette smoking, disease severity and autoantibody expression in African Americans with 2008 Nov OBJECTIVE: To examine the association of smoking with clinical and serological features in African Americans with recent-onset rheumatoid arthritis (RA) and to explore whether this association is dependent on the presence of the HLA-DRB1 shared epitope (SE). METHODS: In African Americans with recent-onset RA (n = 300), we examined the association of cigarette smoking (current versus past versus never and pack-years of exposure) with anti-cyclic citrullinated peptide antibody, rheumatoid factor (RF) (IgM and IgA), rheumatoid nodules and baseline radiographic erosions using logistic and cumulative logistic regression (adjusting for SE status). We also examined for evidence of interaction between smoking status and SE for all outcomes. RESULTS: Although there was no association with RF-IgA seropositivity, current smokers were approximately twice as likely as never smokers to have higher IgA-RF concentrations (based on tertiles; OR = 1.74; 95% CI 1.05 to 2.88) and nodules (OR = 2.43; 95% CI 1.13 to 5.22). These associations were most pronounced in those with more than 20 pack-years of exposure. There was no association of smoking status or cumulative tobacco exposure with anti-cyclic citrullinated peptide antibody, IgM-RF or radiographic erosions. There was also no evidence of a biological or statistical SE-smoking interaction for any of the outcomes examined. CONCLUSIONS: This is the first study to systematically examine the association of cigarette smoking with RA-related features in African Americans. Cigarette smoking is associated with both subcutaneous nodules and higher serum concentrations of IgA-RF in African Americans with RA, associations that may have important implications for long-term outcomes in this population.
18983693 Targeting histone deacetylase activity in rheumatoid arthritis and asthma as prototypes of 2008 Cellular activation, proliferation and survival in chronic inflammatory diseases is regulated not only by engagement of signal trans-duction pathways that modulate transcription factors required for these processes, but also by epigenetic regulation of transcription factor access to gene promoter regions. Histone acetyl transferases coordinate the recruitment and activation of transcription factors with conformational changes in histones that allow gene promoter exposure. Histone deacetylases (HDACs) counteract histone acetyl transferase activity through the targeting of both histones as well as nonhistone signal transduction proteins important in inflammation. Numerous studies have indicated that depressed HDAC activity in patients with inflammatory airway diseases may contribute to local proinflammatory cytokine production and diminish patient responses to corticosteroid treatment. Recent observations that HDAC activity is depressed in rheumatoid arthritis patient synovial tissue have predicted that strategies restoring HDAC function may be therapeutic in this disease as well. Pharmacological inhibitors of HDAC activity, however, have demonstrated potent therapeutic effects in animal models of arthritis and other chronic inflammatory diseases. In the present review we assess and reconcile these outwardly paradoxical study results to provide a working model for how alterations in HDAC activity may contribute to pathology in rheumatoid arthritis, and highlight key questions to be answered in the preclinical evaluation of compounds modulating these enzymes.
17953280 Definition of adult-onset rheumatoid arthritis from elderly-onset rheumatoid arthritis by 2007 Jul AIMS: The study of the distribution of T-lymphocyte sub-populations has revealed some immune characteristics of rheumatoid arthritis (RA) as well as polymyalgia rheumatica (PMR). There is much evidence that the subsets of T-lymphocyte subpopulations are well correlated with the age of the patient and the precise diagnosis of RA and PMR. The aims of the study were to evaluate the absolute number and percentage of T-lymphocyte subpopulation subsets in peripheral blood and their soluble receptors and serum soluble receptors of interleukin-2. MATERIAL AND METHODS: Thirty-six patients with RA were divided into 21 adult-onset RA (AoRA) and 15 elderly-onsets RA (EoRA) patients. They were compared with 48 PMR patients, 21 normal subjects under 45 years and 17 healthy elderly subjects over 65 years. T-lymphocyte subsets were studied by FACSCAN with double stained specific monoclonal antibodies. The EL ISA method was used to determine soluble receptors of CD4+ and CD8+ and IL-2. RESULTS: The AoRA patients had a significant alteration of T-lymphocyte sub-populations as well as their specific soluble receptors compared to EoRA patients. On the other hand, distribution of T-lymphocyte sub-populations in EoRA patients was quite similar to that in PMR patients. CONCLUSIONS: This method is probably not applicable for daily routine clinical practice but provides some interesting data for differential diagnosis between RA and PMR.
18071707 The role of cytokines in inflammatory response after total knee arthroplasty in patients w 2008 May Surgery and trauma is accompanied by changes in blood levels of certain cytokines and chemokines including interleukin-6 (IL-6) and interleukin-8 (IL-8). However, there is little data on correlations between local and systemic levels of these mediators during orthopedic surgeries in rheumatoid arthritis (RA) patients who already show increased levels of proinflammatory cytokines due to their disease. We aimed to measure dynamics of blood and drainage fluid levels of IL-6 and IL-8 in postoperative period in rheumatoid arthritis patients undergoing knee replacement surgery and correlate these changes with blood levels of C-reactive protein (CRP), body temperature and pain. We report that blood and drainage fluid levels of IL-6 and IL-8 showed significantly increasing trend during the 36-h period after the surgery. Drainage fluid levels of both cytokines were significantly higher in comparison with blood, indicating their local production in the operated joint. In contrast, levels of CRP were higher in blood than in drainage fluid. Despite the fact that the levels of tested cytokines had already been high in RA patients before surgery, we conclude that after surgery their levels were being much significantly enough high in drainage fluid to reflect dominated local inflammatory reaction to surgical stress and trauma.
17996860 Rapid and sensitive detection of autoantibody in rheumatoid arthritis patients by heat-med 2008 Jan OBJECTIVE: Heat-mediated ELISA (HELISA) technique has been reported to shorten ELISA timings and has major clinical implications in diagnostic field [Bora U, Kannan K, Nahar P. Heat mediated enzyme linked immunosorbent assay. J Immunol Methods 2004; 293: 43-50]. Objective of this study is to find out whether anti-MBL autoantibody can be detected rapidly by HELISA technique. DESIGN AND METHODS: Activated polystyrene microtiter plate was prepared by a photolinker in a photochemical reaction carried out over a period of 10 min. Lectin was covalently immobilized onto the activated plate at 50 degrees C in 45 min. Antigenicity of the immobilized lectin was checked by HELISA carried out at elevated temperature (50 degrees C). The result was further compared with that obtained by conventional ELISA method carried out on an untreated plate over an incubation period of 18 h. RESULTS: Autoantibody detection carried out by HELISA method (intra- and inter-assay CVs were <9.8%) in 2 h 45 min gives absorbance value comparable to that of conventional ELISA (intra- and inter-assay CVs were <12%) carried out in 18 h in RA patients and healthy controls (n=100). HELISA on a photoactivated surface showed 1.5-fold higher absorbance than those obtained on untreated surface (p=0.00019). The HELISA method is more sensitive (AUC=0.967, 95% CI=0.948-0.987) and can be used to detect autoantibody even at higher dilution than by conventional assay. Excellent correlation was observed when autoantibodies were detected by HELISA and conventional ELISA (R=0.9706). CONCLUSION: The present method provides rapid and sensitive detection of autoantibody in rheumatoid arthritis patients. The method is precise and reliable similar to method currently used in diagnostics and could be potentially useful for other immunoassays.
16572443 Efficacy and toxicity of methotrexate in early rheumatoid arthritis are associated with si 2006 Apr OBJECTIVE: To determine associations of methotrexate (MTX) efficacy and toxicity with single-nucleotide polymorphisms (SNPs) in genes coding for folate pathway enzymes in patients with early rheumatoid arthritis (RA). METHODS: Patients (n=205) with active RA received MTX at an initial dosage of 7.5 mg/week, which was increased to 15 mg/week and combined with folic acid (1 mg/day) after 4 weeks. If the Disease Activity Score in 44 joints (DAS44) was >2.4 at 3 months, MTX was increased to 25 mg/week. MTX efficacy was evaluated at 3 and 6 months and compared for genotypes in 3 analyses: patients with and without good response (DAS441.2), and patients with and without moderate improvement (DeltaDAS44>0.6). The association between MTX-related adverse drug events (ADEs) and genotype was evaluated by comparing genotypes between patients with and without ADEs, specifically pneumonitis, gastrointestinal ADEs, skin and mucosal ADEs, and elevated liver enzyme levels. The following SNPs were analyzed: methylenetetrahydrofolate reductase (MTHFR) 677C>T, MTHFR 1298A>C, dihydrofolate reductase (DHFR) -473G>A, DHFR 35289G>A, and reduced folate carrier 80G>A. In case of significant differences, odds ratios (ORs) were calculated. RESULTS: At 6 months, MTHFR 1298AA was associated with good improvement relative to 1298C (OR 2.3, 95% confidence interval [95% CI] 1.18-4.41), which increased with increased copies of the MTHFR 677CC haplotype. In contrast, MTHFR 1298C allele carriers developed more ADEs (OR 2.5, 95% CI 1.32-4.72). CONCLUSION: Patients with MTHFR 1298AA and MTHFR 677CC showed greater clinical improvement with MTX, whereas only the MTHFR 1298C allele was associated with toxicity. In the future, MTHFR genotypes may help determine which patients will benefit most from MTX treatment.
16750964 Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women. 2006 Jun BACKGROUND: Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid factor (RF) seropositive versus seronegative RA are still unclear. METHODS: We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses' Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors. RESULTS: The RR of RA was significantly elevated among current (RR 1.43 [95% confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence interval 1.23-1.76]), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation. CONCLUSIONS: In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation.
16926650 Interstitial lung disease in rheumatoid arthritis: recent advances. 2006 Sep PURPOSE OF REVIEW: Subsequent to the ATS/ERS consensus classification of idiopathic interstitial pneumonia, non-specific interstitial pneumonia pattern was the dominant pattern in many collagen vascular diseases, which may explain the better prognosis of interstitial pneumonia associated with collagen disease than idiopathic pulmonary fibrosis. Recent papers on rheumatoid arthritis suggest that this is not the same in all collagen diseases, and this paper will review previous data and discuss recent papers. RECENT FINDINGS: In contrast to other collagen diseases, the usual interstitial pneumonia pattern seems to be more common, or at least as common in rheumatoid arthritis. This pathological observation was supported by high-resolution computed tomography findings. In addition to the usual interstitial pneumonia pattern, several types of small airway involvements were frequently observed in rheumatoid arthritis-associated interstitial pneumonia, the prognosis of which is also variable. SUMMARY: Because the usual interstitial pneumonia pattern may be more frequent in rheumatoid arthritis and some data suggest a poor prognosis for rheumatoid arthritis-associated interstitial pneumonia, further studies are required on the prognosis of collagen vascular disease-associated interstitial pneumonia, especially in relation to the pathological pattern. Drug-related interstitial pneumonia should also be considered in rheumatoid arthritis patients on methotrexate or newer drugs such as leflunomide.
18455687 Novel approaches for the treatment of rheumatoid arthritis: lessons from the evaluation of 2008 Apr The analysis of synovial biomarkers is increasingly used in the context of innovative trial design in rheumatoid arthritis (RA). This approach, which is generally well tolerated by patients, has been used to provide insight into the pathogenesis of RA and the mechanism of action of therapy, as well as for screening purposes during early drug development.
18184543 [Principal factor analysis of symptoms of rheumatoid arthritis and their correlations with 2008 Jan OBJECTIVE: To explore the correlations between symptom-based principal factors of rheumatoid arthritis (RA) and the effect of traditional Chinese medicine or Western medicine on RA after factor analysis of RA symptoms. METHODS: Four hundred and thirteen RA patients from 9 clinical centers were included in the clinical trial. They were randomly divided into Western medicine (WM) treated group with 204 cases and traditional Chinese medicine (CM) treated group with 209 cases. A complete physical examination and 18 common clinical manifestations were recorded before the randomization and after the treatment. The WM therapy included voltaren extended action tablet, methotrexate and sulfasalazine. The CM therapy included glucosidorum Tripterygll totorum tablet and Yishen Juanbi Tablet. The American College of Rheumatology 20 (ACR20) was used for efficacy evaluation. All data were analyzed on SAS 8.2 statistical package. Eighteen symptoms in the RA patients were analyzed by factor analysis and the relationships between the factors and effects were analyzed with Chi-Square test. RESULTS: Four principal factors were obtained from the analysis results of the 18 symptoms. The factors could represent the symptoms related to joints, cold-syndrome, deficiency syndrome and heat-syndrome in traditional Chinese medicine (TCM), respectively. The effect of WM therapy was better than CM therapy. After 12 weeks of treatment, the effect of CM on patients without deficiency-syndrome was better than the patients with deficiency-syndrome. After 24 weeks of treatment, WM therapy showed better effect on patients with cold syndrome than patients without cold syndrome. CONCLUSION: The results based on the factor analysis of RA symptoms are similar to the results of syndrome differentiation of TCM, and the factor-related different categories of symptoms are associated with the curative effect, thus further research on the symptoms is necessary.