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ID PMID Title PublicationDate abstract
17844981 Does the Comprehensive ICF Core Set for rheumatoid arthritis capture occupational therapy 2007 BACKGROUND: The ICF Core Sets for rheumatoid arthritis (RA) constitute an application of the International Classification of Functioning, Disability and Health (ICF). PURPOSE: To explore whether the ICF Core Sets for RA include the areas of functioning and environmental factors that are typically treated by occupational therapists in their clinical everyday practice with clients with RA. METHODS: In a three-round survey occupational therapists were asked about their intervention goals when treating clients with RA. The identified goals were grouped into goal classes that were then linked to the ICF. RESULTS: 41 occupational therapists in nine countries named 533 intervention goals that were grouped into 48 goal classes and then linked to ICF categories of all ICF components. The goal classes self-confidence, relaxation and psycho-social well-being are not represented in the Comprehensive ICF Core Set for RA. CONCLUSION: The validity of the ICF Core Set for RA from the perspective of occupational therapists was largely confirmed.
18519102 Alternative therapies for musculoskeletal conditions. 2008 Jun The use of complementary and alternative medicine is complex and nuanced. Patterns of use of complementary and alternative medicine differ among racially and ethnically different groups. Multivariate models of utilization indicate that ethnicity plays an independent role in the implementation of these modalities, in seeking practitioners and in health problems for which assistance is required. Moreover, there are many reasons why people use complementary and alternative medicine: conventional treatment may not be working as well as they would like; they want greater relief of symptoms and/or disability; they have issues with side-effects of pharmaceutical treatment; they wish to reduce some of the stress that comes from living with a chronic illness and want to cope better; they believe that complementary and alternative therapies are safer and 'natural'; and they are influenced by the widespread advertising and attractive claims that are made for many natural products. Although there are more than 150 different kinds of syndromes and conditions associated with arthritis, this review will focus on currently available evidence-based medicine for the two most common conditions diagnosed in Western countries - osteoarthritis and rheumatoid arthritis - for which people seek and then implement complementary and alternative medicine modalitites.
16806061 Imatinib mesylate inhibits platelet derived growth factor stimulated proliferation of rheu 2006 Aug 18 Synovial fibroblast is the key cell type in the growth of the pathological synovial tissue in arthritis. Here, we show that platelet-derived growth factor (PDGF) is a potent mitogen for synovial fibroblasts isolated from patients with rheumatoid arthritis. Inhibition of PDGF-receptor signalling by imatinib mesylate (1muM) completely abrogated the PDGF-stimulated proliferation and inhibited approximately 70% of serum-stimulated proliferation of synovial fibroblasts. Similar extent of inhibition was observed when PDGF was neutralized with anti-PDGF antibodies, suggesting that imatinib mesylate does not inhibit pathways other than those mediated by PDGF-receptors. No signs of apoptosis were detected in synovial fibroblasts cultured in the presence of imatinib. These results suggest that imatinib mesylate specifically inhibits PDGF-stimulated proliferation of synovial fibroblasts, and that inhibition of PDGF-receptors could represent a feasible target for novel antirheumatic therapies.
17973887 Cutaneous granulomas in rheumatoid arthritis. 2007 Nov A 57-year-old man with rheumatoid arthritis and myasthenia gravis developed an asymptomatic erythematous plaque on his nose and skin-colored nodules on the elbows. Histopathological examination was suggestive of palisaded neutrophilic granulomatous dermatitis (PNGD). PNGD is a rather uncommon cutaneous finding in different collagen vascular disorders that can manifest with a broad range of clinical symptoms and histological signs. Based on the case report of the patient described here, we briefly discuss what is currently known about this disease.
18844117 [Mast cells and fibroblast-like synoviocytes co-culture increases interleukin-6 secretion 2008 Apr 29 OBJECTIVE: To explore the significance of mast cells-fibroblast like synoviocytes (FLS) interaction in the pathogenesis of rheumatoid arthritis (RA). METHODS: Frozen sections of RA synovia from 4 patients were made to observe the distribution of mast cells by immunochemistry. FLSs were isolated from 4 samples of RA synovia and co-cultured with the human mast cells of the line LAD-2 for 0, 12, 24, and 48 h, and 7 d. ELISA was used to detect the interleukin (IL)-6, an important proinflammatory cytokine. 4% formaldehyde was used to fix the FLS and LAD-2 cells and then detect the IL-6 levels in the supernatant. Other FLS and LAD-2 mast cells were put into the upper and lower chambers of Transwell system to be cocultured in isolate condition, an important proinflammatory cytokine. RESULTS: Microscopy showed that FLSs were adjacent to the mast cells. The IL-6 content of the FLS/LAD-2 cell co-culture supernatant was 7150 microg/L +/- 114 microg/L, significantly higher than that of the FLS supernatant (3019 microg/L +/- 57 microg/L, P < 0.01). LAD-2 cell number dose-dependently increased the IL-6 content in the supernatant. Almost no IL-6 secretion was found in the supernatant of the co-culture with fixed FLSs and non-fixe4d LAD-2 cells, and the IL-6 secretion in the supernatant of the co-culture with fixed LAD-2 cells and non-fixed FLSs was similar to that of the single FLS group and far lower than that of the FLS-LAD-2 co-culture group. Transwell system test showed that there was no significant difference in the IL-5 level between the direct mixture co-culture group and indirect mixture co-culture. CONCLUSION: Mast cell/FLS interaction increases the IL-6 secretion via soluble mediators, thus playing an important role in the pathogenesis of RA.
19104964 Variables related to posttraumatic growth in Turkish rheumatoid arthritis patients. 2008 Sep Rheumatoid arthritis (RA) is a chronic, deteriorative disease, which can cause great psychological distress. Although RA has negative psychological consequences, it may also lead to positive changes, which has been given relatively little attention in the research literature. The Posttraumatic Growth Inventory (PTGI) has been used to evaluate growth in survivor's thinking, feeling and/or behavior following the experiencing of traumatic or severely adverse life events. The purpose of the current study was to examine the domains of the PTGI and to identify variables related to Posttraumatic Growth (PTG) in 117 RA patients from Turkey, a secular, Islamic, non-western developing country. Results showed that the PTGI has three domains: relationship with others; philosophy of life; and self-perception. Regression analyses showed that problem-focused coping had significant contributions to the total PTG levels and PTGI domains of relationship with others and self-perception. Perceived social support appeared as a significant associate for the total PTG levels and for all three domains. In addition, age and perceived disease severity were found to be significantly related to some domains of PTG. Clinicians, aiming to increase positive experience of RA patients, may need to focus on and facilitate perceived social support and problem-focused coping to facilitate growth experiences.
17688046 [Primary total hip arthroplasty in patients with rheumatoid arthritis]. 2006 Total hip arthroplasty has become a successful way of treating the painful and destroyed hip joint in the patient with rheumatoid arthritis (RA). Two hundred twenty (135 cemented and 85 noncemented) total hip arthroplasties were performed in 180 patients with rheumatoid arthritis. The average age was 48.61 years and the average follow-up was 8.4 years. Clinical evaluation was based on a Harris hip score that showed significant improvement in pain and function preoperatively compared with pain and function at followup. There were two deep infections requiring removal of the prosthesis. Four cemented acetabular cups and one cemented femoral component were revised due to aseptic loosening. Three acetabular rings were revised due to aseptic loosening. The relatively inferior results of total hip arthroplasty among RA patients is due not only to fixation method, but also to the poorer bone quality and weakening musculature. The results in these patients suggest that cementless total hip arthroplasty might become a successful way of treating the destroyed hip joint in the patient with rheumatoid artritis.
16892136 [Diagnostic values of antibody to citrullinated human fibrinogen in rheumatoid arthritis]. 2006 Aug 18 OBJECTIVE: To study the prevalence of antibody to citrullinated human fibrinogen (ACF) in rheumatic diseases and the diagnostic values in rheumatoid arthritis. METHODS: Human fibrinogen was deiminated by the peptidylarginine deiminase (PAD) in the presence of Ca2+ in vitro. ACF was detected by ELISA in 352 patients with rheumatic diseases (183 RA, 121 SLE and 48 OA) and 108 healthy controls. The sensitivity and specificity in RA were calculated and the correlations between ACF and the clinical and laboratory parameters were analysed by SPSS statistical software. RESULTS: Compared with SLE (25.62%), OA (18.75%) and healthy control (2.78%) respectively, the patients with RA had a significantly higher level of ACF (67.21%, P<0.001). ACF had a sensitivity of 67.21% and a specificity of 84.84% for RA. In the investigated clinical and laboratory parameters of RA, the significant correlations were found between ACF and ESR (r=0.386, P<0.001), anti-CCP antibody (r=0.288, P<0.05) and AKA (r=0.288, P<0.05), respectively. Abnormalities in ESR, radiographic progression, IgM-RF, anti-CCP, AKA and APF were more often in ACF positive patients than in ACF negative patients. Moreover, ACF was positive in 38.00% of IgM-RF negative, 59.81% of AKA negative and 68.22% of APF negative patients, respectively. CONCLUSION: ACF is a sensitive and specific antibody in diagnosing RA. The ACF test is also very useful in diagnosing RA with other autoantibodies negative.
15948014 Intra-articular methotrexate in the treatment of rheumatoid arthritis and psoriatic arthri 2006 Mar The aim of our study was to evaluate the effects of intra-articular methotrexate (MTX) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Twenty-three consecutive patients, 10 with RA and 13 with PsA, with prevalent or unique arthritic involvement of one knee, were treated with intra-articular injections of MTX 10 mg every 7 days for 8 weeks. Before the beginning of the treatment and after 9 and 17 weeks, the patients underwent a clinical evaluation measuring maximal knee flexion angle, visual analog scale (VAS) and erythrocyte sedimentation rate (ESR). On the same days, an ultrasonographic examination of the involved knee was performed by two independent experienced operators. Synovial thickness in the suprapatellar bursa and the presence of joint effusion and Baker's cyst were assessed. An increase of the mean value of maximal knee flexion angle and a reduction of the mean values of ESR and VAS between T0, T9 and T17 were demonstrated. Ultrasonographic evaluation showed significant reduction of synovial thickness and joint effusion. No differences were detected for the presence of Baker's cyst. We may conclude that repeated intra-articular injections of MTX resulted in a decrease of local as well as systemic inflammatory signs. As far as we know, this is the first study that explores the effects of intra-articular MTX in RA and PsA both clinically and by ultrasonography.
16602015 Fibrous dysplasia localized to spine: a diagnostic dilemma. 2007 Jun Fibrous dysplasia of the spine is uncommon, especially in monostotic form. Isolated vertebral involvement in polyostotic form is very rare. We report a case of polyostotic fibrous dysplasia with lesions localized to dorso-lumbar spine in a 45-year-old rheumatoid arthritis patient. No associated appendicular lesions, cutaneous manifestations or endocrinopathies were seen. The extreme rarity of this type of lesion can pose a diagnostic dilemma, and biopsy is required for diagnosis. The association with rheumatoid arthritis in our case seems to be a chance occurrence.
16758512 The frequency and distribution of minocycline induced hyperpigmentation in a rheumatoid ar 2006 Jul OBJECTIVE: Minocycline is particularly useful in patients with rheumatoid arthritis (RA) with previous major sepsis, where anti-tumor necrosis factor is relatively contraindicated. Pigmentation is a documented side effect, but predisposing factors in an RA population have not been established. We investigated minocycline induced pigmentation in a population with RA to determine whether skin type and eye color influence predisposition to this side effect. METHODS: Patients with RA attending a rheumatology unit who had received minocycline were contacted by telephone and some were also interviewed in the clinic. Those receiving therapy for more than 3 months were assessed. Hair color, eye color, tendency to burn in the sun, and dose and duration of therapy were documented. The frequency, type, and distribution of pigmentation were established. RESULTS: Of 37 patients identified, 10 were excluded because the duration of therapy was less than 3 months. Of the remaining 27 patients, 85% were female, with median age 64 years (range 44-88) and median disease duration 23.5 years (range 4-51). Eleven patients (41%) developed pigmentation after a median of 12 months. Four of the 11 stopped their minocycline due to pigmentation. Hair color, eye color, and tendency to burn in the sun did not predict patients who developed pigmentation. CONCLUSION: Pigmentation is a common side effect in patients receiving minocycline therapy for more than 3 months. Most patients do not stop therapy due to pigmentation. Those who stop are more likely to be female, less than 70 years of age, and have facial pigmentation.
18240604 [Successful treatment of cystoid macular edema with etanercept in a patient with rheumatoi 2008 Jan BACKGROUND: The anti-tumor necrosis factor (TNF)-alpha agent has been shown to be effective for the treatment of various inflammatory diseases, including rheumatoid arthritis and inflammatory disorders of the colon. It also appears to be effective for treatment of macular edema secondary to uveitis. CASE: A 57-year-old woman complained of blurred vision in both eyes. Inflammatory cells in the anterior chamber, vitreous opacity, and cystoid macular edema (CME) were detected in both eyes. Her corrected visual acuity was 0.1 OD and 0.3 OS. Macular thickness measured by optical coherence tomography was 784 and 714 microm for the right and left eyes, respectively. She had active rheumatoid arthritis, and treatment with etanercept was started. The extent of CME decreased gradually after the treatment was begun, with the macular thickness having decreased to 204 and 190 microm in the right and left eyes, respectively, and visual acuity having improved to 0.9 OD and 1.2 OS by 4 months after the beginning of treatment. CONCLUSION: These results suggest that etanercept may be effective for the treatment of CME secondary to uveitis, and they implicate TNF-a in the pathogenesis of uveitic CME.
18321234 The future of the IL-1 receptor antagonist anakinra: from rheumatoid arthritis to adult-on 2008 Mar BACKGROUND: IL-1 receptor antagonist (IL-1Ra) is a naturally occurring IL-1RI-binding molecule that blocks the biologic effects of the proinflammatory cytokine IL-1. A recombinant form of human IL-1Ra, anakinra (Kineret), has been approved for use in rheumatology initially to manage rheumatoid arthritis (RA) patients that are refractory to more conventional forms of treatment. OBJECTIVE: This review summarizes the experience with anakinra in the treatment of patients with rheumatic diseases emphasizing its beneficial effects in novel applications. METHODS: English-language trials of anakinra were searched using MEDLINE and abstracts from rheumatology scientific meetings. RESULTS/CONCLUSIONS: In the treatment of patients with RA anakinra is effective but inferior to TNF-alpha blocking agents. Over the last few years it has become increasingly evident that anakinra is highly effective and safe in patients with systemic-onset juvenile idiopathic arthritis, adult-onset Still's disease, hereditary autoinflammatory syndromes, Schnitzler's syndrome and recently in gouty attacks.
16611864 Cigarette smoking and the risk of systemic lupus erythematosus and rheumatoid arthritis. 2006 May Smoking may affect the disease course in SLE and patients should be counselled to stop
16691188 High-density SNP analysis of 642 Caucasian families with rheumatoid arthritis identifies t 2006 Jun We have completed a genome wide linkage scan using >5700 informative single-nucleotide polymorphism (SNP) markers (Illumina IV SNP linkage panel) in 642 Caucasian families containing affected sibling pairs with rheumatoid arthritis (RA), ascertained by the North American Rheumatoid Arthritis Consortium. The results show striking new evidence of linkage at chromosomes 2q33 and 11p12 with logarithm of odds (LOD) scores of 3.52 and 3.09, respectively. In addition to a strong and broad linkage interval surrounding the major histocompatibility complex (LOD>16), regions with LOD>2.5 were observed on chromosomes 5 and 10. Additional linkage evidence (LOD scores between 1.46 and 2.35) was also observed on chromosomes 4, 7, 12, 16 and 18. This new evidence for multiple regions of genetic linkage is partly explained by the significantly increased information content of the Illumina IV SNP linkage panel (75.6%) compared with a standard microsatellite linkage panel utilized previously (mean 52.6%). Stratified analyses according to whether or not the sibling pair members showed elevated anticyclic citrullinated peptide titers indicates significant variation in evidence for linkage among strata on chromosomes 4, 5, 6 and 7. Overall, these new linkage data should reinvigorate efforts to utilize positional information to identify susceptibility genes for RA.
17225293 The comparative efficacy and safety of biologics for the treatment of rheumatoid arthritis 2006 Dec OBJECTIVE: Biologics are an important therapeutic option for treating patients with rheumatoid arthritis (RA). However, they are associated with rare but severe adverse events such as serious infections, lymphoma, or chronic heart failure. In addition, dosing regimens and routes of administration differ substantially among biologics. In a systematic review, we assessed the comparative efficacy and safety of biologic agents for RA. METHODS: We searched electronic databases up to May 2006. We limited evidence to controlled trials for efficacy but included observational evidence for safety. Outcomes of interest were clinical response, radiographic progression, and quality of life. Given the paucity of head-to-head evidence, we conducted adjusted, indirect comparisons of placebo-controlled trials. RESULTS: Twenty-six controlled trials provided efficacy data; 18 additional studies assessed safety. The only evidence directly comparing 2 biologic agents was a nonrandomized, open-label trial that found no differences in effectiveness and safety between etanercept and infliximab. Adjusted indirect comparisons indicate no significant differences in efficacy between anti-tumor necrosis factor (TNF) drugs. However, anti-TNF drugs appear to be more efficacious than anakinra, although not all comparisons reached statistical significance. Because of the lack of sound longterm safety data, evidence is insufficient to draw firm conclusions about the comparative safety of biologics. CONCLUSION: Anti-TNF drugs appear to be more efficacious than anakinra but do not differ significantly among each other. Clinical considerations such as comorbidities, route of administration, dosing regimens, and specific side effect profiles may guide the choice of an anti-TNF drug.
17170054 Validation of the ABILHAND questionnaire as a measure of manual ability in patients with r 2007 Aug OBJECTIVE: Hand and upper limb involvement is common in patients with rheumatoid arthritis (RA). However, its impact on manual activities of daily life has not been fully evaluated. A measure of manual ability was developed, through the Rasch measurement model, by adapting and validating the ABILHAND questionnaire, which measures the patient's perceived difficulty in performing everyday manual activities. METHODS: 112 patients with RA were evaluated. The following tests were performed: the ABILHAND questionnaire, the Health Assessment Questionnaire (HAQ), the Jamar grip and key pinch strength tests, the Box and Block dexterity test and the Purdue pegboard dexterity test. In total, 35 patients were reassessed to determine the test-retest reliability of the ABILHAND, and 6 patients were studied before and after therapy with tumour necrosis factor (TNF) blockers to address sensitivity to change. RESULTS: The Rasch refinement of the ABILHAND led to a selection of 27 items rated on a 3-point scale. The resulting ability scale was targeted to the ability of the patients. The item-difficulty hierarchy was stable across demographic and clinical subgroups and over time. Grip and key pinch strength and manual and digital dexterity on both hands were significantly, though moderately, correlated with the ABILHAND measures. Manual ability was also significantly related to the number of affected hands, disease duration, tender and swollen joint counts on upper limbs, disease activity and the HAQ. Sensitivity to change was demonstrated in patients treated with TNF blockers, commensurate with their clinical improvement. CONCLUSION: The ABILHAND questionnaire is a clinically valid person-centred measure of manual ability that could be useful in longitudinal RA studies.
16652437 Adalimumab for treating rheumatoid arthritis. 2006 Jun OBJECTIVE: To assess the efficacy and safety of adalimumab in the treatment of rheumatoid arthritis (RA). METHODS: A Cochrane systematic review was performed. The literature search, selection and assessment of the methodological quality of the studies, and the data extraction were performed according to the standard methodology of the Cochrane reviews. Outcome measures included American College of Rheumatology (ACR) and European League Against Rheumatism responses, Disease Activity Score 28 and components of the ACR response, and radiographic and safety data. Weighted mean difference and relative risk were used for reporting continuous and dichotomous data, respectively. Number needed to treat (NNT) or to harm (NNH) were estimated when appropriate. When significant heterogeneity was not found, data were pooled. RESULTS: Six studies with 2,390 patients were included in this review. With adalimumab 40 mg every other week (eow) + methotrexate versus placebo + methotrexate, the absolute risk differences to achieve an ACR20, ACR50, and ACR70 response at 52 weeks were 35%, 32%, and 19% with NNT of 2.9, 3.1, and 5.3, respectively. At 52 weeks, adalimumab 40 mg eow and 20 mg every week (ew) significantly slowed the radiological progression. With adalimumab 40 mg eow versus placebo, the absolute risk differences to achieve an ACR20, ACR50, and ACR70 response at 24/26 weeks were 23.64%, 15.31%, and 12.22% with NNT of 5.0, 7.0, and 9.0, respectively. In most of the analyzed studies and comparisons, there were no significant differences in safety outcomes between adalimumab and control groups. CONCLUSION: On the basis of studies reviewed here, adalimumab is efficacious in the treatment of RA. No serious adverse effects occurred.
17137624 Simultaneous diagnosis of CD3+ T-cell large granular lymphocyte leukaemia and true thymic 2007 Jul CD3+ T-cell large granular lymphocyte (LGL) leukaemia is a mature T-cell neoplasm of cytotoxic T-lymphocytes. Neutropenia represents the most frequent peripheral blood cytopenia associated with CD3+ T-cell LGL leukaemia. A wide variety of diseases associated with LGL leukaemia have been reported, both autoimmune and neoplastic. We describe for the first time the association of true thymic hyperplasia with CD3+ T-cell line LGL leukaemia. The patient presented with severe symptomatic neutropenia. Complete and persistent haematological and molecular remission was induced with an association of low-dose methotrexate and cyclosporin A, followed by thymectomy.
17057566 The validity and reliability of the graphic rating scale and verbal rating scale for measu 2006 Nov OBJECTIVE: To compare the validity and reliability of a graphic rating scale (GRS) and a verbal rating scale (VRS) for measuring pain intensity in young female Egyptian and Dutch patients with rheumatoid arthritis (RA). METHODS: Data were obtained in a cross-cultural study of 42 Egyptian and 30 Dutch female outpatients with stable RA. Construct validity was assessed by correlating the scales with other core measures of disease activity in RA. Test-retest reliability was assessed over a 1-week interval. RESULTS: The GRS and the VRS were strongly intercorrelated in the total study cohort and in the Egyptian and Dutch subgroups. In the individual subgroups, only the GRS demonstrated the expected pattern of correlations with other disease activity measures. Test-retest reliability of the GRS was adequate in both Egyptian and Dutch patients (intraclass correlation coefficient 0.78 vs. 0.83, respectively), whereas reliability of the VRS was unsatisfactory in the Egyptian subgroup (weighted kappa 0.60 vs. 0.82 in the Netherlands). DISCUSSION: The study confirmed that the GRS and VRS were reliable and valid in the total study cohort. Within the individual countries, the GRS seemed to perform better than the VRS.