Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
18311801 The abundant synovial expression of the RANK/RANKL/Osteoprotegerin system in peripheral sp 2008 Mar OBJECTIVE: Spondylarthritis (SpA) and rheumatoid arthritis (RA) have different patterns of bone damage, with more pronounced bone erosions in RA. The RANK/RANKL/osteoprotegerin (OPG) system plays a central role in bone resorption by promoting the maturation and activation of osteoclasts. To assess the potential role of this system in the distinct bone phenotype, we studied the synovial expression of these mediators in SpA and RA peripheral synovitis. METHODS: Synovial biopsy specimens were obtained from the actively inflamed peripheral joints of 35 patients with SpA and 19 patients with RA. Paired synovial biopsy samples were obtained from 24 patients with SpA after tumor necrosis factor alpha (TNFalpha) blockade. Synovial tissue sections were immunostained for RANKL, OPG, RANK, and TRAP and assessed by semiquantitative scoring and digital image analysis. RESULTS: After extensive validation of the reactivity and specificity of the antibodies, we demonstrated the abundant expression of RANKL and OPG in SpA synovitis. RANKL was expressed by both fibroblast-like synoviocytes and sublining T lymphocytes. RANK-positive osteoclast precursors but no mature TRAP-positive osteoclasts were present in the inflamed tissue. The expression of these mediators was not different between patients with nonpsoriatic SpA, patients with psoriatic SpA, and patients with RA, was not related to the degree of systemic or local inflammation, and was not significantly modulated by highly effective treatment with TNFalpha blockers. Only the subset of patients with the best systemic response to TNFalpha blockade had decreased RANKL expression in the intimal lining layer. CONCLUSION: The relative protection against bone erosions in SpA cannot be explained by qualitative or quantitative differences in the synovial expression of RANKL, OPG, and RANK. The abundant expression of these factors in SpA peripheral synovitis is largely disconnected from systemic and local inflammation.
17335371 Polymorphisms within the IL-1 gene cluster: effects on cytokine profiles in peripheral blo 2007 Mar BACKGROUND: Genetic polymorphisms of cytokines have been associated with the susceptibility, severity, and clinical outcome of inflammatory diseases, such as periodontitis and chronic arthritis. An important question to address is how interleukin (IL)-1 polymorphisms affect the cytokine profiles of patients with such diseases. METHODS: The study population consisted of Danish white adults, <35 years of age, who were diagnosed with localized aggressive periodontitis (LAgP, n = 18), generalized aggressive periodontitis (GAgP, n = 27), juvenile idiopathic arthritis (JIA, n = 10), and rheumatoid arthritis (RA, n = 23) and healthy individuals with no systemic or oral diseases (n = 25). Genotypes of IL-1A-889, IL-1A+4845, IL-1B-511, and IL-1B+3954 were determined by polymerase chain reaction (PCR)-restriction fragment length polymorphism, and IL-1RN variable number tandem repeat (VNTR) was detected by PCR amplification and fragment size analysis. Analysis of variance was used to evaluate the effects of IL-1 genotypes on the levels of IL-1alpha, -1beta, -1 receptor antagonist, -6, and -10; tumor necrosis factor-alpha (TNF-alpha); and lymphotoxin-alpha in peripheral blood (plasma) and in unstimulated and stimulated whole blood cell cultures from the same blood collection. RESULTS: The frequencies of IL-1 genotypes investigated did not differ significantly between diseased and control individuals. In LAgP patients, allele 2 of IL-1RN VNTR was associated with significantly higher levels of IL-1alpha, -6, and -10 and TNF-alpha, whereas allele 2 of IL-1B+3954 was associated with significantly lower levels of the same cytokines. In GAgP patients, a general lack of association was found. In JIA and RA patients, IL-1RN VNTR also influenced the cytokine levels. CONCLUSIONS: IL-1 genotypes were associated with cytokine levels in patients with aggressive periodontitis and chronic arthritis. No associations were observed in control individuals.
16242974 Induction of MMP-13 expression by soluble human glucocorticoid-induced tumor necrosis fact 2006 Feb OBJECTIVE: We tested the hypothesis that human glucocorticoid-induced tumor necrosis factor receptor (hGITR/TR11) expressed on the surface of activated CD4(+) T cells is responsible for up-regulating the production of matrix metalloproteinase (MMP)-13 by fibroblast-like synoviocytes (FLSs). METHODS: The level of MMP-13 was measured by Western blot and reverse transcriptase polymerase chain reaction (RT-PCR). Expressions of hGITR ligand (hGITRL) on the surface of FLSs and hGITR on the surface of human CD4(+) T cells were analyzed by flow cytometry and RT-PCR. Neutralizing antibodies (Abs) were used to block hGITRL and hGITR on the surface of FLSs and human CD4(+) T cells, respectively. Human CD4(+) T cells were cocultured with FLSs to facilitate interaction between hGITR on CD4(+) T cells and hGITRL on FLSs. RESULTS: Soluble hGITR (shGITR) stimulated FLSs to produce MMP-13, and blockade of hGITRL reduced this effect. Direct contact between activated CD4(+) T and FLSs also induced the production of MMP-13, and neutralization of hGITR on activated CD4(+) T cells during coculture decreased the amount of MMP-13 produced by FLSs. CONCLUSION: shGITR stimulated FLSs to produce MMP-13 via a signal through hGITRL. Direct contact between activated CD4(+) T cells and FLSs facilitated hGITR-hGITRL interaction, and resulted in inducing MMP-13. This effect may increase tissue destruction in chronic inflammation such as rheumatoid arthritis (RA).
17141011 Sexual dimorphism in degenerative disorders of the spine. 2006 Oct Sexual dimorphism is evident during formation, growth, and development of the spine. Pregnancy alters spine physiology and is a risk factor for back pain. The processes of aging and spinal degeneration adversely affect men and women slightly differently. Although degenerative changes are observed at similar rates in both sexes, women seem to be more susceptible to degenerative changes leading to instability and malalignment, structural deterioration, such a stenosis or disc degeneration. Surgical satisfaction is greater in men, which has been attributed to poorer preoperative function secondary to more advanced disease at time of surgery and lower patient expectations for clinical improvement, both observed in women.
16859524 A novel approach to measure the contribution of matrix metalloproteinase in the overall ne 2006 Despite decades of research, only a very limited number of matrix metalloproteinase (MMP) inhibitors have been successful in clinical trials of arthritis. One of the central problems associated with this failure may be our inability to monitor the local activity of proteases in the joints since the integrity of the extracellular matrix results from an equilibrium between noncovalent, 1:1 stoichiometric binding of protease inhibitors to the catalytic site of the activated forms of the enzymes. In the present work, we have measured by flow cytometry the net proteolytic activity in synovial fluids (SF) collected from 95 patients with osteoarthritis and various forms of inflammatory arthritis, including rheumatoid arthritis, spondyloarthropathies, and chronic juvenile arthritis. We found that SF of patients with inflammatory arthritis had significantly higher levels of proteolytic activity than those of osteoarthritis patients. Moreover, the overall activity in inflammatory arthritis patients correlated positively with the number of infiltrated leukocytes and the serum level of C-reactive protein. No such correlations were found in osteoarthritis patients. Members of the MMP family contributed significantly to the proteolytic activity found in SF. Small-molecular-weight MMP inhibitors were indeed effective for inhibiting proteolytic activity in SF, but their effectiveness varied greatly among patients. Interestingly, the contribution of MMPs decreased in patients with very high proteolytic activity, and this was due both to a molar excess of tissue inhibitor of MMP-1 and to an increased contribution of other proteolytic enzymes. These results emphasize the diversity of the MMPs involved in arthritis and, from a clinical perspective, suggest an interesting alternative for testing the potential of new protease inhibitors for the treatment of arthritis.
17950198 One-year results of use of poly-L/D-lactic acid joint scaffolds and bone packing in revisi 2007 Aug Revision metacarpophalangeal arthroplasty after silicone implant arthroplasty is frequently complicated by severe bone loss, osteolysis and diaphyseal perforations. Impacted, morselised allografts are frequently used to treat bone loss in revision surgery. A new method of treatment using bioreconstructive poly-L/D-lactic acid (PLDLA) joint scaffold and allograft bone packing, after complete removal of the original silicone implants, allows recovery of bony deficiencies, correction of malalignment and improves function of the hand. This article presents the one-year results of a prospective, non-randomised clinical and radiographic follow-up study of 21 patients with 52 revision metacarpophalangeal arthroplasties using the PLDLA implants and allograft bone packing.
18590406 Rheumatoid arthritis as a risk factor for a narrow C-2 pedicle: 3D analysis of the C-2 ped 2008 Jul OBJECT: Vertebral artery (VA) injury is a potentially serious complication of C-2 pedicle screw (PS) fixation. Although this surgery is frequently performed in patients with rheumatoid arthritis (RA), few studies have compared the risk of VA injury in patients with and without RA. In this study, the authors compare the morphological risk of VA injury relating to C-2 PS fixation in patients with and without RA. METHODS: A total of 110 3D CT images of the cervical spine including the axis were evaluated. Fifty patients with RA and 60 patients without RA were included in the study. The maximum PS diameter (MPSD) that could be used at C-2 without breaching the cortex was measured in 3D using a computer-assisted navigation system. A narrow-pedicle carrier was defined as a patient with an MPSD of 4 mm or less. RESULTS: In the RA group, 42 of 100 MPSDs were < or = 4 mm, and 30 of 50 patients (60%) were narrow-pedicle carriers. In the non-RA group, 10 of 120 MPSDs (8%) were < or = 4 mm, and 8 of 60 (13%) patients were narrow-pedicle carriers. The MPSD, the anteroposterior (AP) diameter of C-3, and the ratio of MPSD to the AP diameter of C-3 were significantly smaller in the RA group than in the non-RA group. Multiple logistic regression analysis showed that RA and narrow C-3 AP diameter were significant risk factors for a narrow-pedicle carrier. CONCLUSIONS: Rheumatoid arthritis is a significant risk factor for a narrow C-2 pedicle. When performing PS placement at C-2, particularly in patients with RA, thorough preoperative evaluation of the bone architecture is very important for avoiding inadvertent injury to the VA.
16947773 Function of interleukin-20 as a proinflammatory molecule in rheumatoid and experimental ar 2006 Sep OBJECTIVE: The pathogenesis of rheumatoid arthritis (RA) reflects an ongoing imbalance between proinflammatory and antiinflammatory cytokines. Interleukin-20 (IL-20) has proinflammatory properties for keratinocytes. In this study, we sought to determine whether IL-20 is involved in RA. METHODS: We analyzed IL-20 levels in synovial fluid from RA patients. IL-20 and its receptors were detected in RA synovial fibroblasts (RASFs), using immunohistochemical staining. The effect of IL-20 on endothelial cells, neutrophils, and RASFs was investigated using MTT and migration assays. The expression of IL-20 and its receptors in healthy rats and in rats with collagen-induced arthritis (CIA) was also analyzed. Soluble IL-20 receptor type I (sIL-20RI) or sIL-20RII was administered to rats with CIA by intramuscular electroporation, and the severity of arthritis was monitored. RESULTS: RA patients expressed significantly higher levels of synovial fluid IL-20 than did the rheumatic disease controls. IL-20 and its receptors were expressed in the synovial membranes and RASFs. IL-20 induced RASFs to secrete monocyte chemoattractant protein 1, IL-6, and IL-8, and it promoted neutrophil chemotaxis, RASF migration, and endothelial cell proliferation. Both IL-20 and IL-20RI were up-regulated in the rat CIA model. In vivo, electroporated sIL-20RI plasmid DNA decreased the severity of arthritis in the rats with CIA. CONCLUSION: IL-20 was up-regulated in the synovial fluid of RA patients and acted as a chemokine that attracted the migration of neutrophils and RASFs in vitro. The rat CIA model demonstrated that IL-20 was involved in the pathogenesis of arthritis, because sIL-20RI significantly reduced arthritis in rats with CIA. Thus, IL-20 may modulate the incidence and severity of arthritis and play important roles at local sites of inflammation.
18397956 Expression of IL-19 and its receptors in RA: potential role for synovial hyperplasia forma 2008 Jun OBJECTIVE: IL-19 is a novel cytokine of the IL-10 family. In this study, we sought to examine whether IL-19 plays a role in the pathogenesis of RA. METHODS: Expression of IL-19, IL-20 receptor 1 (IL-20R1) and IL-20R2 was examined by RT-PCR and immunohistochemical analysis in rheumatoid synovium. The effects of IL-19 on synovial cells established from rheumatoid synovium (RASCs), with regard to IL-6 production and signal transducers and activators of transcription3 (STAT3) activation, were examined by ELISA and western blot analysis, respectively. The effect of IL-19 on RASC apoptosis was examined by Hoechst staining, flow cytometry analysis of annexin V binding and caspase-3 activity. RESULTS: IL-19, IL-20R1 and IL-20R2 mRNA were detected by RT-PCR in synovial tissues from RA patients. Immunohistochemical analysis showed IL-19 was predominantly expressed in the hyperplastic lining layers of RA synovial tissues. The majority of IL-19-positive cells were vimentin-positive and CD68-positive synovial cells, serving as markers of fibroblasts and macrophages, respectively. IL-20R1 and IL-20R2 (IL-20Rs) were expressed in both the lining and sublining layers of RA synovium. In RASC, IL-19 was induced by lipopolysaccharide stimulation and constitutive expression of IL-20Rs was observed, suggesting IL-19 has an autocrine action. In terms of this function, IL-19 induced STAT3 activation and increased IL-6 production by RASC above the medium control. Moreover, IL-19 significantly reduced RASC apoptosis induced by serum starvation. CONCLUSIONS: These data suggest that IL-19, produced by synovial cells, promotes joint inflammation in RA by inducing IL-6 production and decreasing synovial cell apoptosis.
18490140 Consumption of hydrolyzable tannins-rich pomegranate extract suppresses inflammation and j 2008 Jul OBJECTIVE: Although consumption of dietary supplements containing pomegranate extract (POMx) by patients with arthritis is on the rise, the efficacy of such preparations in suppressing joint inflammation and damage is not known. The present study was designed to evaluate a standardized preparation of POMx using collagen-induced arthritis (CIA) in mice, a widely used animal model of rheumatoid arthritis. METHODS: CIA-susceptible DBA/1 mice were fed POMx by gavage before and after immunization with chicken type II collagen. Severity of clinical arthritis was scored using a visual scoring system. Arthritic joints were analyzed by histopathology and graded. Lysates were generated from mouse joints and levels of anti-type II collagen immunoglobulin G and inflammatory cytokines interleukin (IL)-1beta, IL-6, and tumor necrosis factor-alpha were quantified by enzyme-linked immunosorbent assay. The effect of POMx on lipopolysaccharide-induced nitric oxide production was determined by Griess reaction and mitogen-activated protein kinase activation was studied by western immunoblotting in mouse macrophages. RESULTS: Consumption of POMx potently delayed the onset and reduced the incidence of CIA in mice. Severity of arthritis was also significantly lower in POMx-fed animals. Histopathology of the arthritic joints from POMx-fed mice demonstrated reduced joint infiltration by the inflammatory cells, and the destruction of bone and cartilage were alleviated. Levels of IL-6 were significantly decreased in the joints of POMx-fed mice with CIA. In mouse macrophages, POMx abrogated multiple signal transduction pathways and downstream mediators implicated in the pathogenesis of rheumatoid arthritis. CONCLUSION: Our studies suggest that inhibition of a spectrum of signal transduction pathways and the downstream pathogenic cellular response by POMx or compounds derived from it may be a useful approach for the prevention of the onset and severity of inflammatory arthritis.
18030927 Mind-body hypnotic imagery in the treatment of auto-immune disorders. 2007 Oct For many years Western Medicine has considered the immune system to be separate and independent from the central nervous system. However, significant scientific advances and research discoveries that occurred during the past 50 years have presented additional facts that the immune system does interact with the central nervous system with mutual influence. This article provides a systematic review of the literature on the connection between the brain and the immune system and its clinical implications. It then provides a rational foundation for the role of using hypnosis and imagery to therapeutically influence the immune system. Five case examples are provided with illustrated instructions for clinicians on how hypnosis and imagery may be utilized in the treatment of patients with auto-immune disorders. Suggestions for future research in this field are included.
17263587 Tumor necrosis factor receptor pre-ligand assembly domain is an important therapeutic targ 2007 Tumor necrosis factor (TNF)-alpha is an important proinflammatory cytokine and plays a crucial role in pathogenesis of inflammatory arthritis, such as rheumatoid and septic arthritis. TNFalpha exerts its effect by binding to the extracellular domain of TNF receptor (TNFR) 1 and 2. The amino-terminal portion of the TNFR extracellular domain, known as cysteine rich domain 1 (CRD1), or the pre-ligand binding assembly domain (PLAD), plays an important role in the TNFR signaling pathway. TNFR1 PLAD and TNFR2 PLAD proteins block the actions of TNFalpha by interfering with assembly of the receptor complex required for TNFalpha binding. The TNFR1 PLAD protein have been shown to significantly inhibit inflammatory arthritis, such as arthritis induced by TNFalpha, bacterial DNA, lipopolysaccharide, and collagen. The TNFR1 PLAD protein inhibit nuclear factor (NF)-kappaB activation and osteoclastogenesis triggered by TNFalpha was able to inhibit expression of receptor activator of NF-kappaB (RANK), RANK ligand, matrix metalloproteinase and inducible nitric oxide synthase in collagen-induced arthritis. The TNFR1 PLAD protein could therefore be useful in treatment of inflammatory arthritis.
17517530 TNF-alpha antagonists and the prevention of hospitalisation for chronic obstructive pulmon 2008 BACKGROUND: TNF-alpha may be important in the pathogenesis of COPD. Consequently, the use of TNF-alpha antagonists has been advocated for its treatment. METHODS: We conducted an observational study to evaluate the effectiveness of TNF-alpha antagonists in preventing COPD hospitalisations in a cohort of patients diagnosed with both RA and COPD identified from a health claims database. A nested case-control approach was used to match each case hospitalised to 10 controls on age and cohort entry date. Data on prescribed medications during the year prior to the index date were obtained. Rate ratios (RR) of COPD hospitalisation were estimated by conditional logistic regression, after adjustment for COPD severity and concomitant RA medication use. RESULTS: The cohort included 15,771 subjects with both RA and COPD, of which 1205 were hospitalised for COPD during follow-up. The adjusted RR of COPD hospitalisation associated with the use of TNF-alpha antagonists was 0.62 (95% confidence interval (CI) 0.43-0.89). This rate reduction was due to etanercept (RR 0.49, 95% CI 0.29-0.82) but not infliximab (RR 0.95, 95% CI 0.59-1.52). CONCLUSION: Our finding of a halving in the rate of COPD hospitalisation associated with the use of etanercept corroborates the potential importance of TNF-alpha in the pathogenesis of COPD. This study supports the initiation of randomised controlled trials of this TNF-alpha antagonist among COPD patients at high risk of severe exacerbations.
18393373 Which patients with IBD need psychological interventions? A controlled study. 2008 Sep BACKGROUND: Psychological distress is frequent in inflammatory bowel disease (IBD). Whether there is a need for psychological interventions is unknown. This study investigated the quantity and quality of the need for psychological interventions in IBD as compared to rheumatoid arthritis (RA). METHODS: In all, 302 patients with IBD and 109 patients with RA answered the ADAPT questionnaire, assessing the need for psychosomatic support (physicians support) and for psychotherapy, the hospital anxiety and depression scale, the SF-36, a questionnaire on social support (SOZU-K22), and the Rating Form of IBD Patient Concerns (IBD patients only). Detailed biomedical data were also assessed. RESULTS: Ninety-three patients with IBD (31%) expressed a need for psychological intervention compared to 14 patients with RA (13%; P < 0.001). Stepwise logistic regression analysis revealed that anxiety (odds ratio [OR] 3.6; 95% confidence interval [CI] 2.2-6.0; P < 0.001), age < or =44 years (OR 2.6; 95% CI 1.5-4.3; P < 0.001) and impaired social support (SOZU-K22 <4.20) (OR 2.0; 95% CI 1.2-3.3; P = 0.009) accounted for this difference. In IBD the need for psychosomatic (physicians) support was associated with worries and concerns about IBD and the need for psychotherapy was associated with worries and concerns about IBD, anxiety, impaired "social functioning" (SF-36), and short disease duration. CONCLUSIONS: Patients with IBD express a higher need for psychological interventions than patients with RA due to greater psychosocial restrictions inherent in IBD. The need for psychological interventions was characterized by psychological factors, mainly worries about the disease and anxiety, rather than by medical variables
17134787 The impact of cost sharing of prescription drug expenditures on health care utilization by 2007 Aug PURPOSE: To estimate healthcare demand elasticity and evaluate the impact of deductible/co-payment policy changes for prescription drugs on the use of drugs and physician visits among seniors with rheumatoid arthritis (RA) in British Columbia (BC), Canada. METHODS: According to the BC drug insurance program, prior to 2002, seniors co-paid the dispensing fee of each prescription to an annual maximum of CAN$ 200 (plan A). Starting in 2002, this plan was split into plan A and plan A1 (Premium Assistance) such that the co-payment amount equaled a maximum of CAN$ 25 and CAN$ 10 per prescription to an annual maximum of CAN$ 275 and CAN$ 200, respectively. Because of the endogeneity of the beneficiary price in the presence of a non-linear price schedule resulting from the cost-sharing policy, we implemented the method of instrumental variables to estimate price elasticities. The instrument was based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. RESULTS: A total of 8017 patients were included. The estimated own-price elasticity of demand for prescription drugs and the cross-price elasticity of demand for physician visits were found to be negative and positive, respectively. The implications of our findings were that when cost sharing for prescription drugs increased, the demand for prescription drugs decreased and the demand for physician visits increased. CONCLUSIONS: In a predominantly publicly funded health care system, the selective introduction of market driven cost containment concepts such as patient cost-sharing might have the unintended impact of increasing overall health utilization for seniors with RA.
16981287 Hypertrophic pachymeningitis in rheumatoid arthritis after adalimumab administration. 2006 Nov Tumor necrosis factor-a (TNF-a) inhibition, used in the treatment of rheumatoid arthritis (RA), is associated with central nervous system (CNS) events including new onset and/or exacerbations of pre-existing demyelinating neurological diseases. We describe a patient with refractory RA where adalimumab, a fully humanized IgG1 monoclonal antibody against TNF-a, may have contributed to the development of meningoencephalitis, with brain biopsy suggestive of hypertrophic pachymeningitis, a rare complication of this disease. The patient had recurrence of neurological symptoms upon repeated administration of adalimumab, and resolution of symptoms after withdrawal.
16543723 The active form of leflunomide, HMR1726, facilitates TNF-alpha and IL-17 induced MMP-1 and 2006 BACKGROUND/AIMS: To elucidate the influence and mode of action of HMR1726 (the active metabolite of leflunomide) on TNF-alpha and IL-17 activated metalloproteinases expression in synoviocytes. METHODS: Synovial fibroblasts from RA and OA patients were stimulated with both cytokines and altered gene expression in the presence or absence of leflunomide was detected by microarray analyses and quantitative RT-PCR. Protein expression was detected by western blotting and commercial ELISAs. RESULTS: Microarray analyses revealed that the addition of HMR1726 (50 microM) to TNF-alpha and IL-17- stimulated synoviocytes induced gene expression of metallo-proteinases, especially MMP-1 and -3 in comparison to activated synoviocytes in the absence of leflunomide. To confirm these data, we examined the influence of different concentrations of HMR1726 in synoviocytes from further 5 OA and 7 RA patients by quantitative PCR. HMR1726 gradually induced MMP-1 and MMP-3 gene expression in a dose-dosedependent manner. Similar results were observed on protein levels. Examination of signal transduction pathways participating in the regulation of leflunomideinduced MMPs expression showed that the mechanism underlying activation of MMP-1 is in part p38- and activation of MMP-3 was MEK1/2- dependent. CONCLUSION: Leflunomide was not able to abolish expression of metallo-proteinases in synoviocytes activated with TNF-a and IL-17.
17160529 Unusual cause of painful shoulder in an elderly woman with rheumatoid arthritis. 2007 Sep The painful shoulder is a very common condition encountered in the rheumatology clinic with rotator cuff disorders, glenohumeral disorders, acromioclavicular joint disease and referred neck pain being the most common causes. Other rare causes have to be considered in the presence of "red flag" indicators. We describe a case of a patient with mild rheumatoid arthritis and a past medical history of stage 2C epithelial ovarian carcinoma who presented to the rheumatology clinic with a painful shoulder and who was initially diagnosed with rotator cuff tendinopathy. When seen 3 months later she was found to have a 15 x 10-cm firm, non-tender soft tissue mass over the right scapula and X-rays showed a large lytic mass destroying much of the upper border of the scapula, suggestive of metastasis. Bone metastases in patients with ovarian carcinoma are very rare; they occur in about 2% of cases and are invariably predictors of poor prognosis. To our knowledge, this is the first case of ovarian cancer metastasised to the scapula. We suggest that rheumatologists should be aware of the differential diagnosis of painful shoulder and look for "red flag" indicators in patients with known rheumatic conditions.
21132065 Personal mastery predicts pain, stress, fatigue, and blood pressure in adults with rheumat 2008 Among individuals with rheumatoid arthritis (RA), stress-associated disease flare can severely impact well-being. Psychological factors such as personal mastery may buffer an individual from the negative effects of those flares. We tested the hypothesis that a high sense of personal mastery would prospectively predict stress reactivity. Measures of pain,perceived stress, fatigue, and mean arterial pressure (MAP) were collected before, during, and after two interpersonal stressors conducted on 73 individuals with RA. Factor analysis of the personal mastery scale yielded two independent factors: a 5-item "fatalism" component and a 2-item "control" component. Individuals with high fatalism scores reported overall greater joint pain at baseline and those scoring high on control exhibited lower MAP, and reported less stress and fatigue at baseline. After controlling for baseline differences, those high in control exhibited greater MAP increase during stress, and less drop in pain when compared to those low in control. These results suggest that individuals high in control may be more susceptible to the effects of acute stress; however, the overall beneficial aspects of high control outweigh the acute negative effects. Personal mastery may play a role in the experience of pain, stress, and fatigue for people with RA.
17992379 Influence of overall and abdominal adiposity on C-reactive protein levels in elderly women 2007 Oct OBJECTIVE: To investigate how overall and abdominal adiposity, measured by waist circumference (WC), body mass index (BMI), and sum of skinfolds (sigmaSK), affect plasma C-reactive protein levels (CRP) in elderly women. METHODS: Study sample consisted of 387 women older than 60 years (mean age 68.9; standard deviation 5.9 years). BMI, WC, sigmaSK, and CRP levels were all measured. One-way ANOVA was performed to detect differences in study variables among the CRP levels investigated. Logistic regression analysis was used to determine the influence of body fat measurements on CRP levels. The significance level was set at p < 0.05. RESULTS: The analysis of variance showed that mean WC was lower in women with normal CRP levels, as compared to those with high CRP levels. Logistic regression analysis examined the influence of BMI, WC, and sigmaSK quartiles on CRP levels, yielding the following results: only WC was predictive of elevated CRP levels, its highest quartile (cut-off point of 94.0 cm) showing levels nearly two times higher than its lowest quartile (odds ratio = 2.23; 95% confidence interval = 1.92-4.18; p = 0.012). CONCLUSION: The results of this study indicate that abdominal adiposity is a strong predictor of elevated CRP levels.