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ID PMID Title PublicationDate abstract
16739782 Patient perceptions of stock footwear design features. 2006 Apr Patients with diseases which impact on foot health, for example diabetes and rheumatoid arthritis, are known to have some benefit from prescribed stock footwear with regards to clinical outcomes. Achieving this is not just about getting the footwear designed and fitted to meet the clinical needs, but it also requires that the patient wears the shoes. This means meeting the non-clinical needs or criteria of patients. The aim of this study was to compare perceptions of the same footwear between patients with diabetes and patients with rheumatoid arthritis (RA) with regard to specific design features. Fifty-four patients with RA and 40 patients with diabetes who required prescription footwear were asked to identify issues of importance, and to assess the features of five different pairs of stock footwear using a Likert scale scoring form. There was a difference between the RA and the diabetes groups with regards their overall requirements from the footwear with comfort being a priority in RA and style a priority for diabetes. Both groups rated the same footwear as overall best from the selection, but the scores suggest that there were features with the 'best' shoe which were not acceptable suggesting that even the 'best' shoe was a compromise This possibly indicates that existing footwear ranges do not meet all the patients' requirements. Patients have different perceptions with regard to what is important to them in terms of footwear with regards to the specific features of the footwear and one of the influences appears to be the underlying systemic disease. Patient-based criteria may be an important consideration in the design of the footwear.
15700117 Decrease in circulating endothelial cell adhesion molecule and thrombomodulin levels durin 2006 Feb OBJECTIVE: Rheumatoid arthritis is a chronic inflammatory autoimmune disease with proinflammatory cytokines involved in its pathogenesis. Recently in vitro as well as in vivo studies have shown that iloprost, a stable prostacyclin analogue, can reduce the release of these cytokines. This study was performed to further investigate the anti-inflammatory effects of iloprost by determining plasma adhesion molecules as markers of endothelial cell activation, and plasma thrombomodulin as a parameter of endothelial cell injury in patients with rheumatoid arthritis receiving oral iloprost therapy. METHODS: Plasma thrombomodulin levels and the values of the plasma adhesion molecules VCAM-1 (vascular cell adhesion molecule 1), E-selectin (CD62E), and ICAM-1 (intercellular adhesion molecule 1, CD 54) were measured by ELISA during a 7-day period of treatment with orally-administered iloprost in 14 patients with active rheumatoid arthritis. Finally, the same parameters were determined at the end of the observation period (1 week after the end of therapy). In addition, the disease activity was measured using the DAS (disease activity score) as well as the patients' self-assessed pain severity, and correlated with the changes of plasma adhesion molecule and thrombomodulin levels. RESULTS: The plasma levels of all three adhesion molecules as well as of thrombomodulin significantly decreased under therapy with oral iloprost. After 1 week (day 7 of therapy), the mean percent changes from day 0 were -20.1% for VCAM-1 (p = 0.008), -21.2 for ICAM-1 (p = 0.003), -24.6% for E-selectin (p = 0.001), and -21.7% for thrombomodulin (p = 0.003). This decrease lasted up to 1 week after the end of therapy in the case of VCAM-1 (p = 0.023) and ICAM-1 (p = 0.001). Further analysis of the results revealed additional significant correlations between different parameters of clinical disease activity, thrombomodulin and adhesion molecules. CONCLUSION: This study showed hints towards clinical effects in patients with rheumatoid arthritis receiving oral iloprost therapy. Pathophysiologically, the decrease of adhesion molecules points at an immunomodulating effect of iloprost. The observed thrombomodulin-lowering effect of iloprost may indicate stabilisation of endothelial cell function by diminishing endothelial cell injury.
17634923 [Treatment of septic arthritis of the shoulder and periprosthetic shoulder infections. Spe 2007 Aug Infections of the shoulder joint are rare but nevertheless carry a high risk of complications. Successful therapy is mostly operative and should be planned according to the causes, stage, and expansion of the infection and the expected spectrum of bacteria. Moreover, the patient's general condition and previous illnesses must be considered. Patients with rheumatoid arthritis and immunotherapy are especially at risk for complications and require special attention. Shoulder infections and periprosthetic infections can be treated with arthroscopy, with open debridement, or, in the case of periprosthetic infections, with one- or two-stage exchange procedures. In cases of noncontrollable infections, resection arthroplasty or arthrodesis can be performed as a last resort. Results and possible complications are described herein, including those based on our own results.
17012421 Total knee replacement in morbidly obese patients. Results of a prospective, matched study 2006 Oct The results of 41 consecutive total knee replacements performed on morbidly obese patients with a body mass index > 40 kg/m(2), were compared with a matched group of 41 similar procedures carried out in non-obese patients (body mass index < 30 kg/m(2)). The groups were matched for age, gender, diagnosis, type of prosthesis, laterality and pre-operative Knee Society Score. We prospectively followed up the patients for a mean of 38.5 months (6 to 66). No patients were lost to follow-up. At less than four years after operation, the results were worse in the morbidly obese group compared with the non-obese, as demonstrated by inferior Knee Society Scores (mean knee score 85.7 and 90.5 respectively, p = 0.08; mean function score 75.6 and 83.4, p = 0.01), a higher incidence of radiolucent lines on post-operative radiographs (29% and 7%, respectively, p = 0.02), a higher rate of complications (32% and 0%, respectively, p = 0.001) and inferior survivorship using revision and pain as end-points (72.3% and 97.6%, respectively, p = 0.02). Patients with a body mass index > 40 kg/m(2) should be advised to lose weight prior to total knee replacement and to maintain weight reduction. They should also be counselled regarding the inferior results which may occur if they do not lose weight before surgery.
17216476 Factors affecting drug treatment compliance in patients with rheumatoid arthritis. 2007 Jun We prospectively examined 100 rheumatoid arthritis (RA) patients to calculate drug compliance rates, characteristics of compliant and non-compliant patients, and changes in compliance over time. Three assessments were obtained over a one-year follow-up. Detailed drug history of RA and for concomitant disease was queried. Sedimentation rate, C-reactive protein, and rheumatoid factor values, Ritchie articular index, morning stiffness, and health assessment questionnaire were evaluated. Twenty-six patients (30.2%) were consistently compliant and 10 patients (11.6%) were consistently non-compliant. Older age was associated with a greater likelihood of compliance. Comparison of compliant and non-compliant groups revealed no statistically significant difference in distribution of gender, disease duration, and total number of pills taken for RA and/or total number of pills taken for any reason. In conclusion, compliance to drugs in RA patients is a common problem. Clinical and laboratory activity of RA had less influence on drug compliance. Older age is associated with a greater likelihood of compliance.
17186727 [Comparative analysis via data mining on the clinical features of Western medicine and Chi 2006 Nov OBJECTIVE: To compare the clinical characteristics of traditional Chinese medicine (TCM) and Western medicine (WM) in diagnosing rheumatoid arthritis (RA). METHODS: A total of 85 clinical RA related messages were enacted and classified into 5 sets as pathological locations, quantitative diagnosis, symptomatic descriptions, general status and environment factors. The respective frequency of their presence in the TCM or WM data sets for RA diagnosis collected from MEDLINE and China National Knowledge Infrastructure (CNKI) were analyzed statistically by Chi-square test, and the relationship of some TCM diagnostic factors/conditions with the RA related biological factors was analyzed by co-occurrence-based literature approach of mining. RESULTS: There was significant difference between the diagnostic pattern of WM and TCM (P < 0.01). Compared with that of WM, TCM diagnosis on RA paid more attention to environmental factors and symptomatic descriptions, which showed definite association with the cytokines and neuro-endocrine factors in RA. CONCLUSION: Examination of environmental factors and symptomatic descriptions for RA diagnosis is one of the important characteristics of TCM treatment in accordance to syndrome differentiation, it has its potential biologic basis. A novel approach is proposed for exploring the characteristics of TCM in diagnosis and observation.
17075598 Strategies to control disease in rheumatoid arthritis with tumor necrosis factor antagonis 2006 Nov Recent data have shown that disability and joint destruction in rheumatoid arthritis (RA) occur early on in the course of the disease and progress rapidly. It has been shown that in the early stages of RA, disability is attributed to increased disease activity, whereas later in the course of the disease, disability results from irreversible joint damage. These findings support the need to develop treatment strategies that will rapidly bring the disease under control, with the ultimate goal of alleviating symptoms and halting progressive joint damage. A number of such strategies have been evaluated, including the early administration of a biologic agent alone or in combination with high-dose methotrexate. Other, more recent treatment strategies include the tight control of disease activity by targeting specific outcomes necessary for decision making; the use of biologic agents for the treatment of moderate disease; and the induction of remission with a biologic agent early in the course of disease, followed by maintenance therapy using a conventional disease-modifying antirheumatic drug. The substantial positive effect these strategies have on patient outcomes supports the concept that the optimal management of RA involves aggressive early therapy combined with close monitoring of disease progression and modification of ineffective therapeutic strategies.
18511729 Medicaid prescription formulary restrictions and arthritis treatment costs. 2008 Jul OBJECTIVES: We used the Arizona Medicaid program as a model to examine the consequences of the relative restrictiveness of nonsteroidal anti-inflammatory drug (NSAID)-preferred drug lists on health care use and costs for Medicaid enrollees with arthritis. METHODS: In a retrospective, cross-sectional study of Medicaid enrollees with rheumatoid arthritis or osteoarthritis, we used data from the Arizona HealthQuery database and generalized linear regression models to estimate the effect of the restrictiveness of formularies on the association between number of NSAID drugs covered and the number of emergency department visits, ambulatory physician visits, hospital stays, and total health expenditures. RESULTS: For plans with NSAID formularies that were more restrictive, enrollees with rheumatoid arthritis experienced 22% fewer ambulatory visits and 29% more hospitalizations, and enrollees with osteoarthritis experienced 38% fewer ambulatory visits and 52% more hospitalizations. These plans spent an additional $935 for medical care and prescription drugs annually per enrollee with rheumatoid arthritis. CONCLUSIONS: Formularies that are more restrictive significantly change the patterns of health care and prescription drug use and may have unintended consequences in terms of more frequent and, for those with rheumatoid arthritis, more expensive medical care.
17076589 Gender-specific pharmacology: implications for therapy. 2006 Aug Historically, research into drugs and diseases has assumed that beyond the reproductive system, gender differences did not exist or were not relevant. Interest in recognizing the importance of gender-based differences in pharmacology and disease has been fueled in recent years by an increasing amount of data revealing variations in drug efficacy and side effect profiles between the genders as well as differences in disease prevalence.
17407244 Repair in rheumatoid arthritis, current status. Report of a workshop at OMERACT 8. 2007 Apr Repair of structural damage in rheumatoid arthritis has drawn much attention with newly available effective treatments. A workshop was held at OMERACT 8 to update current knowledge on the validity of the concept of repair and on the assessment of repair. In preparation for the workshop several studies were performed and the results were presented. This was followed by a discussion and voting on statements on various aspects of repair. A majority of participants agreed that results of the new studies strengthen the validity of the concept of repair, and that repair can be assessed on radiographs. There was less agreement on the best means of measurement and there was a plea for more extensive reporting of data, i.e., not limited to sum scores of all joints together. The conclusions of the workshop mean a big step forward in the acceptance and assessment of repair.
17881508 Serum reactivity against Borrelia burgdorferi OspA in patients with rheumatoid arthritis. 2007 Nov Lyme arthritis and rheumatoid arthritis share common clinical features and synovial histology. It is unclear whether they also share similar pathogenesis. Previous studies have shown that the severity and duration of Lyme arthritis correlate directly with serum concentrations of antibody against outer surface protein A (OspA) of the causative pathogen Borrelia burgdorferi. We tested the sera of 68 subjects with rheumatoid arthritis, 147 subjects with other autoimmune diseases, and 44 healthy subjects who had never had Lyme disease, as well as sera of 16 patients who had Lyme disease, for reactivity against the B. burgdorferi OspA protein. The sera of about a quarter of the rheumatoid arthritis patients and a 10th of the autoimmune disease and Lyme disease patients reacted against OspA antigen. Of 50 rheumatoid arthritis patients who could be evaluated for disease severity, a 28-joint count disease activity score of >2.6 was noted for 11 of 15 (73%) patients whose sera reacted against OspA antigen and 13 of 35 (37%; P < 0.05) whose sera were nonreactive. Serum reactivity against OspA antigen is associated with the pathogenesis of rheumatoid arthritis.
17195213 Reduced expression and proteolytic susceptibility of lubricin/superficial zone protein may 2007 Jan OBJECTIVE: To investigate the effect of arthritis development and progression on the integrity and function of lubricin and the relationship of lubricin to cartilage damage in a rat antigen-induced arthritis model. METHODS: Arthritis was induced in the right knee joints, using methylated bovine serum albumin and Freund's complete adjuvant. Whole joint friction measurements were performed ex vivo with a modified Stanton pendulum configuration, and coefficients of friction (mu) were determined. Levels of messenger RNA (mRNA) for lubricin, cathepsin B, and interleukin-1beta (IL-1beta) in synovial tissue from control and affected joints were determined by quantitative polymerase chain reaction. Lubricin staining in cartilage was performed using a lubricin-specific monoclonal antibody. RESULTS: The mu values in excised right joints following arthritis induction were significantly (P < 0.001) higher than those in excised left joints. Lubricin mRNA expression levels in synovial tissue on days 4 and 7 after arthritis induction were significantly (P < 0.001) lower in the right joints compared with the left joints, whereas levels of cathepsin B and IL-1beta mRNA expression on days 4, 7, and 14 were significantly (P < 0.001) higher in the right joints than the left joints. Lubricin staining was diminished in cartilage from the right joints compared with the left joints. CONCLUSION: Elevated coefficients of friction in arthritic joints occur concurrently with enhanced proteolytic degradation by up-regulated cathepsin B and other proteases, as well as decreased lubricin synthesis by synovial fibroblasts and superficial zone chondrocytes. Loss of joint lubrication is an early event in inflammatory arthropathy. Restoring chondroprotection and preventing potential wear-induced cartilage degradation may require lubricin supplementation in synovial fluid.
16356189 Analysis of Fcgamma receptor haplotypes in rheumatoid arthritis: FCGR3A remains a major su 2006 The Fcgamma receptors play important roles in the initiation and regulation of many immunological and inflammatory processes, and genetic variants (FCGR) have been associated with numerous autoimmune and infectious diseases. The data in rheumatoid arthritis (RA) are conflicting and we previously demonstrated an association between FCGR3A and RA. In view of the close molecular proximity with FCGR2A, FCGR2B and FCGR3B, additional polymorphisms within these genes and FCGR haplotypes were examined to refine the extent of association with RA. Biallelic polymorphisms in FCGR2A, FCGR2B and FCGR3B were examined for association with RA in two well characterized UK Caucasian and North Indian/Pakistani cohorts, in which FCGR3A genotyping had previously been undertaken. Haplotype frequencies and linkage disequilibrium were estimated across the FCGR locus and a model-free analysis was performed to determine association with RA. This was followed by regression analysis, allowing for phase uncertainty, to identify the particular haplotype(s) that influences disease risk. Our results reveal that FCGR2A, FCGR2B and FCGR3B were not associated with RA. The haplotype with the strongest association with RA susceptibility was the FCGR3A-FCGR3B 158V-NA2 haplotype (odds ratio 3.18, 95% confidence interval 1.13-8.92 [P = 0.03] for homozygotes compared with all genotypes). The association was stronger in the presence of nodules (odds ratio 5.03, 95% confidence interval 1.44-17.56; P = 0.01). This haplotype was also more common in North Indian/Pakistani RA patients than in control individuals, but not significantly so. Logistic regression analyses suggested that FCGR3A remained the most significant gene at this locus. The increased association with an FCGR3A-FCGR3B haplotype suggests that other polymorphic variants within FCGR3A or FCGR3B, or in linkage disequilibrium with this haplotype, may additionally contribute to disease pathogenesis.
16447241 Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associat 2006 Feb OBJECTIVE: Pneumonia is a major cause of mortality and morbidity in rheumatoid arthritis (RA). This study was undertaken to determine the rate and predictors of hospitalization for pneumonia and the extent to which specific RA treatments increase pneumonia risk. METHODS: RA patients (n = 16,788) were assessed semiannually for 3.5 years. Pneumonia was confirmed by medical records or detailed patient interview. Covariates included RA severity measures, diabetes, pulmonary disease, and myocardial infarction. Cox proportional hazards regression was used to determine the multivariable risk associated with RA treatments. RESULTS: After adjustment for covariates, prednisone use increased the risk of pneumonia hospitalization (hazard ratio [HR] 1.7 [95% confidence interval 1.5-2.0]), including a dose-related increase in risk (< or = 5 mg/day HR 1.4 [95% confidence interval 1.1-1.6], > 5-10 mg/day HR 2.1 [95% confidence interval 1.7-2.7], > 10 mg/day HR 2.3 [95% confidence interval 1.6-3.2]). Leflunomide also increased the risk (HR 1.2 [95% confidence interval 1.0-1.5]). HRs for etanercept (0.8 [95% confidence interval 0.6-110]) and sulfasalazine (0.7 [95% confidence interval 0.5-1.0]) did not reflect an increased risk of pneumonia. HRs for infliximab, adalimumab, and methotrexate were not significantly different from zero. CONCLUSION: There is a dose-related relationship between prednisone use and pneumonia risk in RA. No increase in risk was found for anti-tumor necrosis factor therapy or methotrexate. These data call into question the belief that low-dose prednisone is safe. Because corticosteroid use is common in RA, the results of this study suggest that prednisone exposure may have important public health consequences.
16222409 MRI appearance of retrocalcaneal bursitis and rheumatoid nodule in a patient with rheumato 2006 Sep Rheumatoid arthritis is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and sometimes multisystem involvement. Rheumatoid nodules have been reported in as many as 20-30% of patients with rheumatoid arthritis; however, they are not commonly seen in the feet. We present magnetic resonance (MR) findings of a rarely seen case of rheumatoid bursitis in the retrocalcaneal bursa associated with a subcutaneous rheumatoid nodule inferior to the calcaneus which histologically confirmed the rheumatoid arthritis. To the best of our knowledge, this is the first case that rheumatoid bursitis in the retrocalcaneal bursa associated with the rheumatoid nodule in the foot was revealed by MR imaging.
17184535 The impact of rheumatoid arthritis on foot function in the early stages of disease: a clin 2006 Dec 21 BACKGROUND: Foot involvement occurs early in rheumatoid arthritis but the extent to which this impacts on the structure and function leading to impairment and foot related disability is unknown. The purpose of this study was to compare clinical disease activity, impairment, disability, and foot function in normal and early rheumatoid arthritis (RA) feet using standardised clinical measures and 3D gait analysis. METHODS: Twelve RA patients with disease duration < or =2 years and 12 able-bodied adults matched for age and sex underwent 3D gait analysis to measure foot function. Disease impact was measured using the Leeds Foot impact Scale (LFIS) along with standard clinical measures of disease activity, pain and foot deformity. For this small sample, the mean differences between the groups and associated confidence intervals were calculated using the t distribution RESULTS: Moderate-to-high foot impairment and related disability were detected amongst the RA patients. In comparison with age- and sex-matched controls, the patients with early RA walked slower (1.05 m/s Vs 1.30 m/s) and had a longer double-support phase (19.3% Vs 15.8%). In terminal stance, the heel rise angle was reduced in the patients in comparison with normal (-78.9 degrees Vs -85.7 degrees). Medial arch height was lower and peak eversion in stance greater in the RA patients. The peak ankle plantarflexion power profile was lower in the patients in comparison with the controls (3.4 W/kg Vs 4.6 W/kg). Pressure analysis indicated that the RA patients had a reduced lesser toe contact area (7.6 cm2 Vs 8.1 cm2), elevated peak forefoot pressure (672 kPa Vs 553 kPa) and a larger mid-foot contact area (24.6 cm2 Vs 19.4 cm2). CONCLUSION: Analysis detected small but clinically important changes in foot function in a small cohort of RA patients with disease duration <2 years. These were accompanied by active joint disease and impairment and disability.
16868535 New radiopharmaceuticals for imaging rheumatoid arthritis. 2006 Sep Rheumatoid arthritis (RA) is an incapacitating chronic inflammatory disease of the joints that, because of frequent relapses, requires life-long treatment. In patients affected with RA an important treatment objective is to achieve specific immune suppression in order to extinguish the immune process and arrest the disease, thus preventing or delaying complications and avoiding disease recurrence. The side effects of anti-inflammatory drugs given to improve the quality of life of these patients can be reduced with the use of specific immune therapies that block, as selectively as possible, the pathologic mechanism responsible for the disease. New therapeutic options for specific, targeted therapies for treating RA are being developed, and trials to assess the efficacy and safety of these approaches are underway. However, these therapies rely primarily on clinical assessment to evaluate treatment efficacy. It would be useful, therefore, to have an objective and reliable method that directly highlights the immune processes underlying the disease. Currently available radiopharmaceuticals for imaging RA, with a special emphasis on recently developed agents and their use in therapy decision-making and follow-up are the focus of this article.
18613033 Pharmacokinetics of dexamethasone in a rat model of rheumatoid arthritis. 2008 Sep Dexamethasone (DEX) is often given for the treatment of rheumatoid arthritis and clinical dosing regimens of DEX have often been based empirically. This study tests whether the inflammation processes in a rat model of rheumatoid arthritis alters the clearance and volume of distribution of DEX when compared with healthy controls. Groups of healthy and arthritic male Lewis rats received either a low (0.225 mg/kg) or high (2.25 mg/kg) intramuscular dose of DEX. Arthritis was induced by intradermal injection of type II porcine collagen in incomplete Freund's adjuvant emulsion at the base of the tail. DEX was dosed in the arthritic animals 22 days post arthritis induction. Plasma DEX concentrations were determined by HPLC. Plasma concentration versus time data were analysed by non-compartmental analysis and pharmacokinetic model fitting using the population pharmacokinetic software NONMEM V. A linear bi-exponential pharmacokinetic model with extravascular input described the data for both healthy and arthritic animals. Clearance was the only parameter determined statistically different between both groups (healthy=1.05 l/h/kg, arthritic=1.19 l/h/kg). The steady-state volume of distribution for both groups was 4.85 l/kg. The slight difference in clearance was visibly undetectable and unlikely to produce meaningful changes in DEX disposition in arthritic rats.
17585360 Expression of CD22 on peripheral B cells in patients with rheumatoid arthritis: relation t 2007 Oct B cells in patients with rheumatoid arthritis (RA) are hyperactivated. Although B cell receptor signal transduction may be affected by various response regulators, CD22 plays an important role as a response regulator of B cells. Therefore, we investigated and examined CD22 expression on peripheral blood B cells of patients with RA. Thirty-two RA patients and 16 controls were enrolled in this study, and CD22 expressions on B cells were analyzed by flow cytometry. In patients with RA, CD22(+) B cells significantly decreased in comparison to the controls (ratio: P < 0.05). However, there was no correlation between this decrease and the clinical data. Interestingly, CD5(+) CD22(-) B cells significantly increased in RA patients. The decrease in CD22(+) B cells and increased in CD5(+)CD22(-) B cells play critical roles in the pathogenesis of RA mediated by the activation of B cells.
19037225 Issues in the design of new clinical trials for rheumatoid arthritis therapeutics. 2008 Dec Rheumatoid arthritis (RA) is a chronic, heterogeneous disease, for which there has traditionally been few reliable prognostic indicators or simple clinical outcome measures with which to adequately assess disease status or clinical improvement. These challenges have hindered the assessment of new therapeutic agents. Investigators in rheumatology have, therefore, attempted over the past two decades to develop new approaches and scoring systems to facilitate the study and development of therapies. As a result of these efforts, the efficacy of almost all new agents tested in clinical trials are now assessed with widely accepted scoring systems that measure improvement in three important areas. First, changes in patient signs and symptoms are measured via composite indices of both clinical and laboratory parameters. Second, the progression of structural damage is assessed by radiographic imaging. Finally, long-term improvement in patient function is measured via patient-reported outcomes. These changes to clinical trial design have been adopted by health authorities around the world. Further challenges, however, must be overcome in order for progress to continue.