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ID PMID Title PublicationDate abstract
17922624 The anti-inflammatory effect of A3 adenosine receptor agonists: a novel targeted therapy f 2007 Oct Targeting the A(3) adenosine receptor (A(3)AR) to combat inflammation is a new concept based on two findings. First, A(3)AR is highly expressed in inflammatory cells, whereas low expression is found in normal tissues. This receptor was also found to be overexpressed in peripheral blood mononuclear cells, reflecting receptor status in the remote inflammatory process. Second, A(3)AR activation with a specific agonist induces de-regulation of the NF-kappaB signaling pathway in inflammatory cells, as well as initiation of immunomodulatory effects. The A(3)AR agonist CF-101 (known generically as IB-MECA) induces anti-inflammatory effects in experimental animal models of collagen- and adjuvant-induced arthritis. Combined therapy with CF-101 and methotrexate in adjuvant-induced arthritis rats yielded an additive anti-inflammatory effect. Methotrexate induced upregulation of A(3)AR, rendering the inflammatory cells more susceptible to CF-101. In Phase I and in Phase IIa human studies, CF-101 was safe, well tolerated and showed strong evidence of an anti-inflammatory effect in rheumatoid arthritis patients. In peripheral blood mononuclear cells withdrawn from the patients at base line, a statistically significant correlation between A(3)AR expression level and response to the drug was noted. It is suggested that A(3)AR may serve as a biologic marker to predict patient response to the drug. Taken together, this information suggests that A(3)AR agonists may be a new family of orally bioavailable drugs to be developed as potent inhibitors of autoimmune-inflammatory diseases.
17330409 [Referral and patient satisfaction after an rheumatological interdisciplinary pain assessm 2007 Feb 7 The aim of this quality assessment was to evaluate the specific satisfaction issues of the referring physician and of the patient after the rheumatological interdisciplinary pain assessment (RIPA). The prevalence of chronic pain disorders appear to grow worldwide. In the daily routine we are confronted with the problem, that the waiting list for such assessments is increasing. Our opinion is that the RIPA could be helpful for a second opinion, to improve the therapeutic alliance and the management of the patient. The study population was analysed in a longitudinal cross-sectional design with a follow up at three months after an interdisciplinary assessment (rheumatologist, physiotherapist, occupational therapist and psychologist). On the average reported the patients acceptable satisfaction values. The feedback of the referrers after RIPA was positive. It was remarkable that most of the referrers would recommend this kind of interdisciplinary assessment to other colleagues. From the clinicians perspective seems that such triages might be advantageous in order to achieve an effective patient-management.
16541203 The frequency of thyroid antibodies in fibromyalgia patients and their relationship with s 2007 Jan We determined the frequency of thyroid autoantibodies in fibromyalgia (FM) patients and the relationship between FM symptoms and these antibodies. Euthyroid 128 FM patients, 64 rheumatoid arthritis (RA) patients, and 64 healthy control subjects were included in the study. The sociodemographic features and the clinical features of FM patients were determined. By using a visual analog scale, patients were questioned about the severity of FM-related symptoms. All patients were administered with Duke-Anxiety Depression (Duke-AD) scale, the physical function items of the fibromyalgia impact questionnaire scale. Thyroid autoimmunity was defined as the presence of detectable antithyroglobulin (TgAb) and/or antithyroid peroxidase (TPOAb) antibodies by the immunometric methods. Patients with a connective tissue disorder, hypo- or hyperthyroidism, and patients who had psychiatric treatment within the last 6 months were not included into the study. The frequencies of thyroid autoimmunity in FM (34.4%) and RA (29.7%) patients were significantly higher than controls (18.8%) (p<0.05). Twenty-six (20.3%) FM patients had positive TgAb and 31 (24.2%) had positive TPOAb. When patients with thyroid autoimmunity were compared to others, it was seen that the mean age, the percentage of postmenopausal patients, the frequency of dryness of the mouth, and the percentage of patients with a previous psychiatric treatment were higher in this group (p<0.05). FM patients had thyroid autoimmunity similar to the frequency in RA and higher than controls. Age and postmenopausal status seemed to be associated with thyroid autoimmunity in FM patients. The presence of thyroid autoimmunity had no relationship with the depression scores of FM patients.
17471545 Tolerance and effectiveness of anti-tumor necrosis factor alpha therapies in elderly patie 2007 May 15 OBJECTIVE: Limited data have been published on tolerance to and efficacy of classic or biologic disease-modifying antirheumatic drugs in elderly patients with rheumatoid arthritis (RA). The goal of the present study was to evaluate the tolerance to and effectiveness of anti-tumor necrosis factor (anti-TNF) agents in elderly patients (> or =65 years old) with RA (ERA) in comparison with younger patients (YRA). METHODS: The Swiss Clinical Quality Management program for RA is a longitudinal population-based cohort. All patients who had received at least 1 dose of anti-TNF agents between January 1997 and November 2005 were included and categorized according to their age. Tolerance was assessed by analyzing discontinuation rates of anti-TNF agents. Effectiveness of these agents was assessed by analyzing RA disease activity (Disease Activity Score in 28 joints [DAS28]) and functional disability (Health Assessment Questionnaire [HAQ]) after anti-TNF initiation. RESULTS: Among 1,571 patients with RA treated with anti-TNF agents, 344 were > or =65 years of age at treatment initiation. Drug discontinuation rates (median time 3 years) and mean change in DAS28 scores at 2 years (-0.65 versus -0.58) were identical in ERA and YRA. However, HAQ score improved significantly less in ERA (-0.02) than in YRA (-0.1) and a subsequent analysis revealed that this finding was essentially due to patients >75 years of age. CONCLUSION: Age in itself should not interfere with the decision to treat elderly patients with RA with anti-TNF agents. In a subset of patients ages >75 years, no functional improvement according to HAQ should be expected despite improvements in disease activity.
16291813 Most visits of most patients with rheumatoid arthritis to most rheumatologists do not incl 2006 Jun OBJECTIVE: To ask rheumatologists about the likelihood of performing a formal joint count at each visit of a patient with rheumatoid arthritis (RA) in standard clinical care. METHOD: Direct query of rheumatologists at an international meeting of about 600 rheumatologists from 17 European countries. RESULTS: Overall, 14% of rheumatologists reported performing a formal joint count at each visit of each patient, and 44% of rheumatologists reported performing a formal joint count at more than 50% of visits of patients with RA. Therefore, 56% of rheumatologists reported performing a joint count at fewer than 50% of visits, including 45% at fewer than 25% of visits. One in eight rheumatologists (13%) reported never performing a formal joint count. CONCLUSION: Although the joint count remains the most specific measure for RA, most visits of most patients with RA to most rheumatologists do not include a formal quantitative joint count.
16466625 Skin involvement and outcome measures in systemic autoimmune diseases. 2006 Jan This paper focuses on skin manifestations that can be observed in autoimmune diseases such as rheumatoid arthritis (RA), Sjögren syndrome (SS), dermatomyositis (DM) and Behçet syndrome (BS). In RA the most widely recognized skin lesion is the rheumatoid nodule. Other cutaneous manifestations can be observed either non-specific or related to the disease itself and/or to the commonly used drugs. Cutaneous manifestations are considered one of the most typical extraglandular features of primary SS, generally they are distinguished in vasculitic and non vasculitic lesions. Among non-vasculitc lesions, skin dryness (xerosis) has been shown to be very common in pSS while vasculitis lesions include typically flat and palpable purpura and urticarial vasculits. In DM the skin manifestations are also frequent and include a heliotrope rash (blue-purple discoloration) on the upper eyelids with edema, a flat red rash on the face and upper trunk, and erythema of the knuckles with a raised violaceous scaly eruption (Gottron rash). The most frequent mucocutaneous finding in BS is aphthous stomatitis which can not usually be differentiated from idiopatic reccurrent aphthous stomatitis on clinical grounds. The most typical skin manifestations are nodular lesions, which are commonly seen in BS and may be due to panniculitis [erythema nodosum (EN)-like lesions] or superficial thrombophlebitis.
16467055 What determines the possession of assistive devices among patients with rheumatic diseases 2006 Feb 28 PURPOSE: To identify the determinants of the possession of assistive devices among patients with various rheumatic conditions. In order to determine the influence of the country-related health care system, patients from two different countries were studied. METHOD: Patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) were selected from rheumatology outpatient clinics in two adjacent regions in The Netherlands and Germany. A total of 142 patients completed a self-administered questionnaire. Information on the possession of assistive devices and data on socio-demographics, clinical status and health status were obtained. Logistic regression analyses were used to identify determinants of the possession of assistive devices. RESULTS: The majority (78%) of the patients possessed at least one or more assistive devices. Obviously, functional status was the most important determinant, followed by the country where the patient resided. More assistive devices were found in increasingly disabled patients as well as in patients living in The Netherlands. CONCLUSION: Functional status and the patient's country are the most important determinants of the possession of assistive devices among patients with rheumatic conditions. We hypothesize that the most likely explanation for the differences in possession rates between countries are differences in societal systems for the prescription and reimbursement of assistive devices.
18956205 [Relevance of the gene variant PTPN22 620W for rheumatology]. 2008 Nov PTPN22 620W is regarded as the second most important risk factor for type 1 diabetes and rheumatoid arthritis. Here we describe aspects of the molecular biology of the enzyme and its function, the geographical distribution of the 620W variant, as well as its importance in less frequent rheumatic diseases.
20306665 Psychiatric morbidity associated with some cytokines (IL-1beta, IL-12, IL-18 and TNF-alpha 2008 Psychiatric morbidity is common in rheumatoid arthritis (RA) patients and may affect disease activity and immunological markers. We studied the relationship of the psychiatric morbidity and immunological factors; the serum levels of Interleukin-1beta (IL-1beta), Tumor Necrosis Factor Alpha (TNF-alpha), Interleukin-18 (IL-18) and its inducer interleukin-12 (IL-12), and their impact on RA disease activity. Forty-two RA patients and 20 apparently healthy individuals as a control group were included in this study. Psychiatric morbidity was identified according to the International Classification of Disease, tenth version criteria (ICD-10). The Hospital Anxiety and Depression Scale (HADS) and the mental health Short Form 36 (SF-36) were applied for further analysis. Serum IL-1beta, IL-12, IL-18 and the TNF-a were measured using Enzyme-Amplified Sensitivity Immunoassays (EASIA) and were correlated with psychiatric morbidity and disease activity as measured by Health Assessment Questionnaire and Overall Status. Psychiatric morbidity was found in 40.48% of the studied patients, the most common psychiatric disorders among RA patients were depressive disorders and anxiety disorders. The SF-36 score was closely correlated to the anxiety and depression score (P < 0.001). RA patients showed high levels of IL-1beta, IL-12, IL-18 and TNF-alpha than the control group. There was a significant correlation between psychiatric morbidity, serum levels of IL-1beta, IL-12, IL-18, TNF-alpha and disease activity measurements. We have to view rheumatoid arthritis as a psycho-immumological disorder rather than an autoimmune disease. Furthermore, the studied cytokines may be a novel target for therapeutic intervention of rheumatoid arthritis and its psychiatric morbidity.
18663623 Polymorphisms of the endothelin-1 gene associate with hypertension in patients with rheuma 2008 Jul Rheumatoid arthritis (RA) associates with excess cardiovascular (CV) morbidity and mortality. Hypertension, a highly prevalent entity in RA, has been associated with the endothelin-1 (ET-1) gene locus (EDN1) in some groups, such as Afro-Caribbean, the obese, and in low-renin states, but not in the general population as a whole. High levels of plasma ET-1 have been observed in RA. This study evaluated the potential association of EDN1 gene locus and serum ET-1 levels with hypertension in patients with RA. Genomic DNA and serum samples were collected from 397 well-characterized RA patients; DNA was also available from 401 local general population controls without RA. To explore the overall relevance of EDN1, two suitable single-nucleotide polymorphisms (SNPs), rs1800541 and rs5370, were selected and haplotype analysis was performed. Both SNPs were identified using real-time polymerase chain reaction (PCR) and melting curve analysis. Genetic analysis was related to hypertension as dichotomous trait and to blood pressure indices as continuous variables. Serum endothelin levels were also assessed in the RA patients. No genotype or haplotype differences were observed between RA and control subjects. Within RA, logistic regression analysis of each SNP separately revealed a threefold increase in the adjusted odds of being hypertensive of rs5370 TT homozygotes compared to GG homozygotes (OR = 2.89, 95%CI: 1.02 to 8.19). After adjustment for multiple potential confounders, haplotype analysis revealed an additive effect of the rs1800541-rs5370 T-T haplotype on hypertension (OR = 2.96, 95%CI: 1.28 to 6.86; p = .011), systolic blood pressure (SBP) (beta = 6.75 +/- 2.57 mm Hg; p = .009), and pulse pressure (PP) (beta = 4.37 +/- 2.12 mm Hg; p = .040). There was an increased prevalence of raised ET-1 levels amongst hypertensive RA patients, whereas a similar trend was observed for T-T haplotype carriers. RA patients who carry the rs1800541-rs5370 T-T EDN1 haplotype appear more likely to be hypertensive with an increased SBP and PP. These findings, if replicated in future studies, could be used as a screening tool for RA patients at increased hypertension, and thus cardiovascular, risk.
16572449 Evaluation of classical complement pathway activation in rheumatoid arthritis: measurement 2006 Apr OBJECTIVE: Novel activation products that are stable and minimally susceptible to in vitro artefacts have recently been described in the classical complement pathway. The present study assessed circulating levels of these products, i.e., covalent complexes between the recognition molecule of the classical pathway (C1q) and activated C4, in plasma samples from patients with rheumatoid arthritis (RA) to establish the relationship between these levels and the clinical and immunologic parameters in these patients. METHODS: C1q-C4 levels were measured in plasma samples from 41 patients with active RA and 43 patients with inactive RA. These levels were related to other complement activation products and to disease activity according to the Disease Activity Score in 28 joints (DAS28), using Spearman's rank correlations. RESULTS: C1q-C4 plasma levels were significantly higher in patients with active RA as compared with patients with RA in clinical remission (median 3.3 arbitrary units [AU], range 0.4-13.4 versus 1.7 AU, range 0.2-5.5; P=0.0001), suggesting that activation of the classical complement pathway reflects disease activity. This was supported by a significant correlation between C1q-C4 levels and the DAS28 (r=0.398, P=0.0002). Levels of other complement activation products, such as activated C4 (C4b/c), were also significantly elevated in patients with active disease compared with patients with inactive disease (P=0.03), and were correlated with C1q-C4 levels (r=0.329, P=0.002). Levels of C1q-C4 complexes were higher in synovial fluid samples than in plasma samples from the 4 patients tested. CONCLUSION: Systemic complement activation via the classical pathway in patients with RA correlates with disease activity. These results indicate that C1q-C4 complexes may be used as a biomarker for RA.
17289757 Redefining overweight and obesity in rheumatoid arthritis patients. 2007 Oct OBJECTIVES: To assess whether body mass index (BMI) and body fat (BF) differ between rheumatoid arthritis (RA) patients, patients with non-inflammatory arthritis (osteoarthritis, OA) and healthy individuals, and whether disease specific measures of adiposity are required to accurately reflect BF in these groups. METHODS: 641 individuals were assessed for BMI (kg/m(2)) and BF (bioelectrical impedance). Of them, 299 (174 RA, 43 OA and 82 healthy controls (HC)) formed the observation group and 342 (all RA) the validation group. RA disease characteristics were collected. RESULTS: ANOVA revealed significant differences between disease groups for BMI (p<0.05) and BF (p<0.001). ANCOVA showed that age accounted for the differences in BMI (F(1,294) = 5.10, p<0.05); age (F(1,293) = 22.43, p<0.001), sex (F(1,293) = 380.90, p<0.001) and disease (F(2, 293) = 18.7, p<0.001) accounted for the differences in BF. For a given BF, patients with RA exhibited BMI levels reduced by 1.83 kg/m(2) (p<0.001) compared to HC; there were no significant differences between OA and HC. A predictive model for BF was developed (R(2) = 0.769, p<0.001) and validated using limits of agreement Analysis against measured BF in the validation group (95%LIM(AG) = 6.17; CV = 8.94). CONCLUSIONS: In individuals with RA, BMI cut-off points should be reduced by 2 kg/m(2) (that is, to 23 kg/m(2) for overweight and 28 kg/m(2) for obesity). The equation developed can be used to accurately predict BF from BMI in RA patients. These findings may be important in the context of the cardiovascular comorbidity of RA.
18321947 Disease Activity Score 28-ESR bears a similar relationship to treatment decisions across d 2008 Apr OBJECTIVES: To determine whether physician factors are associated with disease activity status in RA, independently of 28-joint disease activity score (DAS28)-ESR and to re-evaluate DAS28-ESR misclassification rates for identifying active disease in usual practice. METHODS: A prospective observational study of outpatients with RA seen by 17 rheumatologists across New Zealand. Active disease was defined by an increase in therapy together with a reason of 'active disease'; very low disease activity was defined by a decrease in therapy together with a reason of 'patient well'. The independent physician effect was assessed using logistic regression. Sensitivity and specificity of current DAS28-ESR thresholds were calculated. RESULTS: In 511 patients, 178 had active disease, 220 had low disease activity, 37 had very low disease activity and 76 had uncertain disease activity status. There was no independent effect of physician upon active disease status (P = 0.16) with DAS28-ESR [(OR) 3.7] explaining around 50% of the variability in active disease status. There was a trend towards an independent effect of physician upon very low disease activity status (P = 0.06) and greater variability in the distribution of DAS28-ESR for patients in very low disease activity. DAS28-ESR thresholds showed a significant risk of misclassification for active disease. CONCLUSIONS: DAS28-ESR discriminates satisfactorily between groups of patients with active and non-active disease, with no evidence of additional physician-specific factors to explain disease activity status. However, DAS28-ESR is not as good for discriminating remission from non-remission status. There are appreciable probabilities of misclassification error, which make DAS28-ESR inappropriate as a sole guide for treatment decisions.
18660510 The value of synovial cytokine expression in predicting the clinical response to TNF antag 2008 Oct OBJECTIVES: Clinical response to TNF-alpha blockade in the treatment of RA is heterogeneous. The study aims were to determine whether pre-treatment synovial cytokine expression predicted infliximab response and whether synovial changes after therapy correlated with response. METHODS: Fifty-one patients had arthroscopic biopsies of the knee joint prior to infliximab (3 mg/kg) treatment. Synovial tissue cell numbers (CD68 and CD3 positive) and cytokine expression (TNF-alpha, lymphotoxin-alpha, IL-1alpha, -beta and receptor antagonist, and IL-6) pre-treatment was assessed using semi-quantitative immunohistochemistry. Changes in these parameters were assessed 16 weeks after infliximab in 32 patients who underwent repeat arthroscopic biopsy. RESULTS: Of the total patients, 47% (n = 24) achieved an ACR20 response; 53% (n = 27) did not. Baseline synovial TNF-alpha, IL-1alpha and -beta expression did not differ between the two groups. No differences in baseline TNF-alpha levels were observed with ACR levels of response (ACR20 and ACR50/70 groups). Post-treatment biopsies (17 ACR responders, 15 ACR non-responders) revealed significant reductions in sub-lining layer TNF-alpha expression in both response and non-response groups with significant reduction in vascularity and membrane proliferation scores. The worst ACR non-responders (<20% CRP suppression) demonstrated no reduction in any of the parameters. CONCLUSION: Pre-treatment synovial TNF-alpha or IL-1 expression does not predict TNF blockade response. Both ACR response and non-response was associated with reduction in synovial TNF-alpha-level expression. Suppression in TNF-alpha levels was not observed in the worst non-responders. The improvements (including in vascularity), independent of ACR clinical response, are compatible with the reduced structural damage documented in all groups of patients independent of response.
17498050 Mast cells in the pathogenesis of rheumatic diseases and as potential targets for anti-rhe 2007 Jun Increasing evidence suggests that mast cells (MCs), in addition to acute allergic reactions, are involved in the pathogenesis of chronic inflammatory diseases and in particular in rheumatoid arthritis (RA). MCs reside in connective tissues and in synovial tissue of joints. They produce an array of proinflammatory mediators, tissue destructive proteases, and cytokines, most prominently tumor necrosis factor-alpha, which is one of the key cytokines in the pathogenesis of RA. MCs may also participate in the development of secondary or amyloid A amyloidosis, as the partial degradation of the serum amyloid A (SAA) protein by MCs leads to the generation of a highly amyloidogenic N-terminal fragment of SAA. MCs may contribute to the pathogenesis of connective tissue diseases, scleroderma, vasculitic syndromes, and systemic lupus erythematosus, although the data available are limited. Inhibition of the most important growth factor receptor of human MCs, c-Kit, by the selective tyrosine kinase inhibitor imatinib mesylate, induces apoptosis of synovial tissue MCs. As MCs are long-lived cells, induction of their apoptosis could be a feasible approach to inhibit their functions. Preliminary findings suggest that a drug that inhibits c-Kit could have anti-rheumatic activity in the treatment of patients with RA and spondyloarthropathies.
16868018 Rheumatoid factor seropositivity is inversely associated with oral contraceptive use in wo 2007 Feb OBJECTIVES: To examine whether oral contraceptive use is associated with the presence of serum rheumatoid factor in women of reproductive age without rheumatoid arthritis. METHODS: 304 women selected from parents of children who were at increased risk of developing type 1 diabetes were studied, because they were enriched with the human leucocyte antigen-DR4 allele, a susceptibility marker for both type 1 diabetes and rheumatoid arthritis. Participants visited a clinic where blood was drawn for rheumatoid factor testing, and exposure data were collected via questionnaires. A medical history and joint examination were performed to rule out rheumatoid arthritis. Participants and examiners were unaware of the participants' rheumatoid factor status at the time of examination and questionnaire. RESULTS: Use of oral contraceptives at any time was inversely associated with rheumatoid factor positivity (adjusted odds ratio (OR) 0.2, 95% confidence interval (CI) 0.07 to 0.52) independent of age, education and smoking. Smoking > or = 20 pack-years was also associated with rheumatoid factor positivity (adjusted OR 56.38, 95% CI 4.31 to 736.98) compared with never smoking. Smoking 1-19 pack-years was not associated with a positive rheumatoid factor. CONCLUSIONS: Our results suggest that oral contraceptive use, and possibly cigarette smoking, act early in the development of the immune dysregulation that occurs in rheumatoid arthritis.
16971972 Emerging therapeutic strategies for chronic inflammatory diseases. 2006 Jul The 6th edition of the "Days of Molecular Medicine" conference was held at the Karolinska Institute in Stockholm, Sweden, May 24-27, 2006, and focused on the role of inflammation in chronic disease. The meeting, organized by The Nature Publishing Group, the Massachusetts General Hospital and the Karolinska Institute, brought together an international panel of speakers who discussed recent advances in the molecular pathology of chronic inflammatory diseases. This congress report summarizes the most relevant presentations highlighting novel targets for therapeutic intervention.
16219644 Significance of SAA1.3 allele genotype in Japanese patients with amyloidosis secondary to 2006 Jan OBJECTIVE: To clarify the clinical significance of the SAA1.3 allele in the development and outcome of AA amyloidosis in Japanese patients with rheumatoid arthritis (RA). METHODS: One hundred and twenty RA patients (60 alive and 60 dead) fulfilling the 1987 ACR criteria and 62 RA patients with biopsy-confirmed amyloid A (AA) amyloidosis (36 alive and 26 dead) were enrolled. The SAA1 genotypes were determined by PCR-based restriction fragment length polymorphism. To predict the clinical outcome of AA amyloidosis, we investigated characteristics and survival, focusing on the SAA1.3 allele retrospectively. RESULTS: The SAA1.3 allele genotype was not only a risk factor for the association of AA amyloidosis but also a poor prognostic factor for the development of AA amyloidosis (P=0.015). Both the association of AA amyloidosis arising early in the RA disease course and symptomatic variety and severity were found in amyloidotic patients with the SAA1.3 allele. The presenting factors adversely influenced were age (P=0.001), lowered serum albumin (P=0.001) and creatinine concentration (P=2.14 x 10(-5)). Renal involvement was associated with poor survival in patients with AA amyloidosis (P=0.011) and the presence of cardiac involvement was likely to be a risk factor for survival (P=0.062). The rate of the causes of death in respect to the category of infection, gastrointestinal diseases, and renal failure was higher in patients with AA amyloidosis than in those without amyloidosis, gastrointestinal diseases and renal failure. Cyclophosphamide was found to be superior to methotrexate in the management of RA patients with AA amyloidosis. CONCLUSION: Our data support the fact that homozygosity for the SAA1.3 allele is a univariate predictor of survival in addition to a risk factor for the association of AA amyloidosis adversely influencing the outcome in Japanese RA patients. Renal involvement is a pivotal clinical manifestation in the development of AA amyloidosis, as is likely to be cardiac involvement in AA amyloidosis secondary to RA.
16669206 Benefits of patient pathways in rheumatoid arthritis care. 2006 Apr 18 Rheumatoid arthritis is a painful, inflammatory, chronic condition that often results in irreversible joint damage. This article uses the condition to highlight the benefits of patient pathways and illustrate how they can be developed.
18344921 Multiple factors determine the increased prevalence of atherosclerosis in rheumatoid arthr 2008 Jan Rheumatoid arthritis (RA) is a systemic inflammatory disease that presents not only involvement of joints but also endothelial dysfunction, dyslipidemia, and premature atherosclerosis. The death rate in RA is known to be higher than in the general population and clinical cardiovascular events secondary to atherosclerosis are responsible for the excessive death rate. A better understanding of the mechanisms that take part in the pathogenesis of atherosclerosis in RA patients is needed. Thus, the authors review the role of several factors involved in RA atherosclerosis, including disease activity, new cardiovascular risk factors, dyslipidemia and the association of atherosclerosis with the use of anti-rheumatic drugs, glucocorticoids and anti-tumor necrosis factor (TNF) agents. The role of humoral autoimmunity, namely autoantibodies against heat shock proteins, cardiolipin and beta2-glycoprotein I, and its link with atherosclerosis is also discussed. It is likely that the elucidation of the key mechanisms of atherogenesis in RA may determine a positive impact by reducing cardiovascular morbidity and mortality of these patients.