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ID PMID Title PublicationDate abstract
18421416 Iliopsoas bursitis-associated femoral neuropathy exacerbated after internal fixation of an 2008 We present the case of a 63-year-old woman with a six-year history of rheumatoid arthritis (RA) and a left iliopsoas bursitis. Radiography had detected destructive changes in her hip joint associated with her bursitis, and she had reported some paresthesia along the left anterior distal thigh. Her pain and numbness remained tolerable, and her disease activity was well controlled until she accidentally fell on the floor, which resulted in an unstable intertrochanteric fracture of left femur with displacement of the proximal portion. The fracture was successfully treated with open reduction and internal fixation, but after the surgery, her femoral nerve palsy worsened. She subsequently underwent bursa excision after the failure of conservative treatment. Accordingly, after bursa excision, the postoperative course was uneventful, and her neurological symptoms gradually disappeared. We would recommend that bursa excision be considered even in cases of iliopsoas bursitis associated with mild femoral neuropathy when destructive changes in the hip joint are also present.
18817971 Synthesis, characterization, and in vivo diagnostic applications of hyaluronic acid immobi 2008 Dec Herein we describe a new class of multifunctional gold nanoprobes for ultra-sensitive optical detection of reactive oxygen species (ROS) and hyaluronidase (HAdase). The nanoprobes were fabricated by end-immobilizing near-infrared fluorescence (NIRF) dye labeled hyaluronic acid (HA) onto the surface of gold nanoparticles (AuNPs). The nanoprobes effectively induced nanoparticle surface energy transfer (NSET) between NIRF dyes and AuNPs. When the surface immobilized HA was cleaved by ROS and HAdase, strong fluorescence recovery signals were attained with extreme sensitivity. In live animal models of rheumatoid arthritis (RA) and metastatic tumor, local arthritic inflammation and tumor sites were clearly identified upon systemic injection of the nanoprobes. These results suggest that the gold nanoprobes can be exploited not only as in vitro molecular and cellular imaging sensors for ROS and HAdase, but also as in vivo optical imaging agents for detection of local HA degrading diseases such as RA and tumor.
17609401 Improvement of ACTH response to insulin tolerance test in female patients with rheumatoid 2007 Jul OBJECTIVE: The hypothalamic-pituitary-adrenal (HPA) axis evaluation has been conflicting in rheumatoid arthritis (RA) patients. Our aim was to evaluate the HPA axis response to the insulin tolerance test (ITT) in premenopausal female patients with RA before and after anti-tumor necrosis factor therapy (anti-TNF therapy). DESIGN: A comparative cross-sectional analysis. SUBJECTS AND METHODS: Ten females with RA and without previous anti-TNF therapy were included. Five healthy females were included as controls. An ITT was performed before first dose of anti-TNF therapy and then after week 12. Anti-TNF therapy was applied every 14 days for 12 weeks. Cortisol and ACTH levels were measured at 0, 30, 45, and 65 min. Prolactin was measured at 0, 30, 45, 90, 120, and 150 min. RESULTS: The ACTH basal plasma levels at weeks 0 and 12 did not show statistical differences, at 1.26 (0.41-2.12) vs 1.54 (0.60-2.49) respectively (P = 0.68). The controls demonstrated a higher ACTH response than in the RA patients at week 0 before the anti-TNF therapy (349.12 area under curve (AUC)), (P = 0.004) and a similar ACTH response to ITT to those of RA patients at week 12 after the use of the anti-TNF therapy (1087.42 AUC). Serum cortisol levels did not show significant changes when the ITT was performed before and after the anti-TNF therapy. CONCLUSIONS: Our findings support a role for the TNF on the pituitary gland in premenopausal female patients with RA. An adequate control of RA in early stages of the disease diminishing TNF levels improves ACTH response to stress situations.
17065118 NeuFlex compared with Sutter prostheses: a blind, prospective, randomised comparison of Si 2006 Forty patients (156 metacarpophalangeal joints) with mutilating rheumatoid arthritis were randomly allocated in a blinded manner to have either NeuFlex or Sutter implants. Indications for operation were pain and severe deformity. Thirty-nine patients were followed up postoperatively for one year. An independent physiotherapist and occupational therapist examined each one. Grip strength, range of motion, and pain during activity and at rest were measured. The Canadian Occupational Performance Measure (COPM) assessed the patients' evaluation of their occupational performance. Both groups had overall good results, but it seems that though patients' mobility and grip strength improve considerably, pain seems to do so only relatively. Most patients seem to be satisfied with the operation and their functional gain. Five out of 78 Sutter and two out of 78 NeuFlex implants broke. We found no major differences between the two designs, but the patients in the NeuFlex group seemed to be more satisfied with their occupational performance (COPM performance) (p=0.05).
17643186 Significance of anti-cell membrane-associated DNA (mDNA) antibodies in systemic lupus eryt 2008 Feb The aim of this study was to evaluate the value of anti-cell membrane-associated DNA (mDNA) antibodies in the diagnosis of systemic lupus erythematosus (SLE). Antibodies against mDNA were detected with indirect immunofluorescence assay in 207 SLE, 167 other rheumatic diseases, and 82 healthy controls. Association of clinical features and anti-mDNA antibodies was analyzed. The prevalence of anti-mDNA antibodies was 73.3% in SLE, 8.3% in Sjögren's syndrome, and 4.8% in rheumatoid arthritis. The incidences of anti-mDNA antibodies in SLE lacking antideoxyribonucleoprotein, antihistone antibodies, antinuclesome antibodies, anti-dsDNA, and anti-Sm antibodies were 73.8, 62.7, 65.3, 57.8 and 51.6%, respectively. Skin rash, alopecia, oral ulcer, and joint pain are more common in patients with anti-mDNA antibodies. The anti-mDNA antibody is one of the most valuable markers in SLE. It is also informative in some SLE patients lacking other autoantibodies.
17454938 Methotrexate-related lymphomatoid granulomatosis: a case report of spontaneous regression 2007 Jan We describe a 54-year-old female patient with rheumatoid arthritis (RA) and Sjögren's syndrome (SS) who presented with right chest pain and a large mass visible in the upper right field of a chest X-ray. Computed tomography (CT) showed multiple tumours in both lungs, the liver, and the spleen. The right lung tumour was 8 cm in diameter with a cavity. Biopsy of the lung and liver revealed lymphomatoid granulomatosis (LG) and diffuse large B-cell lymphoma (DLBCL). These lesions spontaneously regressed after withdrawal of methotrexate without any therapy for the lymphoma. This is the first report of self-limiting LG in a patient, complicated with methotrexate-treated RA.
18512783 The rheumatoid arthritis-associated allele HLA-DR10 (DRB1*1001) shares part of its reperto 2008 Jun OBJECTIVE: To identify the peptide anchor motif for the rheumatoid arthritis (RA)-related HLA allele, DR10, and find shared natural ligands or sequence similarities with the other disease-associated alleles, DR1 and DR4. METHODS: The HLA-DR10-associated peptides were purified, and a proportion of these natural ligands were de novo sequenced by mass spectrometry. Based on crystallographic structures, the complexes formed by peptide influenza virus hemagglutinin HA306-318 with DR1, DR4, and DR10 were modeled, and binding scores were obtained. RESULTS: A total of 238 peptides were sequenced, and the anchor motif of the HLA-DR10 peptide repertoire was defined. A large proportion of the DR10-associated peptides had the structural features to bind DR1 and DR4 but were theoretical nonbinders to the negatively associated alleles DR15 and DR7. Among the sequenced ligands, 10 had been reported as ligands to other RA-associated alleles. Modeling data showed that peptide HA306-318 can bind DR1, DR4, and DR10 with similar affinities. CONCLUSION: The data show the presence of common peptides in the repertoires of RA-associated HLA alleles. The combination of the shared epitope present in DR1, DR4, and DR10 together with common putative arthritogenic peptide(s) could influence disease onset or outcome.
16831656 Long-term results with the Kudo type 3 total elbow arthroplasty. 2006 Jul From 1992 to 1993, 17 elbows were replaced with the unlinked Kudo type 3 total elbow arthroplasty in 16 patients with arthritic joint destruction. Of these elbows, 8 were available for clinical examination after a mean of 9.5 years. Of the 17 elbow implants, 5 were revised: 2 because of loosening of the ulnar component, 1 because of dislocation, 1 because of a periprosthetic fracture, and 1 because of a late deep infection. At 9.5 years' follow-up, 67.9% of the prostheses had survived, and the mean survival of the implant was 8.7 years (95% confidence interval, 7.5-10 years). In this study, we observed high rates of progressive valgus tilting of the ulnar component. This valgus tilting is of major concern because it provides more stress to a smaller area on the polyethylene. It may, therefore, cause an increased degree of polyethylene wear and, thereby, reduce the final implant survival rate.
17117592 Drug evaluation: VX-702, a MAP kinase inhibitor for rheumatoid arthritis and acute coronar 2006 Nov Vertex Pharmaceuticals Inc, in collaboration with Kissei Pharmaceutical Co Ltd, is developing VX-702, one of a series of second-generation, orally active p38 MAP kinase inhibitors, for the potential treatment of inflammation, rheumatoid arthritis and cardiovascular diseases. In June 2005, a phase II clinical trial of VX-702 was initiated in rheumatoid arthritis. In July 2006, Vertex was planning to file an IND in the second half of 2006.
18836893 Improvement in diagnosis and management of musculoskeletal conditions with one-stop clinic 2009 We evaluated the impact of clinic-based musculoskeletal ultrasonography (MSUS) on diagnosis and management of cases as seen in day-to-day rheumatology practice. Data were retrieved for demography, background condition, clinical findings, indications, regions scanned, and outcomes of MSUS, and categorised as: new-patients and follow-up. New-patient records were analysed as to whether MSUS had helped to confirm or change clinical diagnosis or was of no additional help. In follow-ups, we determined whether MSUS had helped in disease assessment, detection of co-existing problems or revision of diagnosis. Its impact on treatment decisions was noted. A total of 237 patients (146 women; mean age 55.9+/-17.2 years) had 264 regions scanned; hands,50.7%. In 78/237 (32.9%) there was disagreement between clinical and MSUS findings. Amongst new-patients (72), 13/39 (33.3%) referred with inflammatory arthritis had no MSUS evidence of inflammation in or around joints. In 76.3% it helped in confirming or changing diagnosis. Of the follow-ups (165), in 78.7%, 13.9% and 7.2% it helped in assessment, detection of co-existing problems and revision of diagnosis, respectively. MSUS influenced treatment in 45/165 (27.27%) cases. In 60/67 (89.55%) cases of rheumatoid arthritis (RA), it was done for disease assessment; in 31/60 (51.66%) it influenced treatment. MSUS, as a clinic-based service in rheumatology, has significant impact on the diagnosis and treatment of patients. This has potential to reduce diagnostic uncertainty and follow-up visits and ensure better outcomes.
16107513 Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence an 2006 Mar Adverse effects of glucocorticoids have been abundantly reported. Published reports on low dose glucocorticoid treatment show that few of the commonly held beliefs about their incidence, prevalence, and impact are supported by clear scientific evidence. Safety data from recent randomised controlled clinical trials of low dose glucocorticoid treatment in RA suggest that adverse effects associated with this drug are modest, and often not statistically different from those of placebo.
19132154 Efficacy and safety of anti-TNF agents in the Lombardy rheumatoid arthritis network (LORHE 2008 Oct Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic synovitis and bone damages, which consist of joint destruction. Clinical trials have shown that anti-tumour necrosis factor (TNF) drugs are effective in patients with rheumatoid arthritis (RA) refractory to disease-modifying antirheumatic drugs (DMARDs). At about the same time as the European approval of the third anti-TNF agent for treating rheumatoid arthritis (RA) patients, the Italian Society of Rheumatology (Società Italiana di Reumatologia [SIR]) started a database for the registration and active follow-up of patients with RA treated with biological response modifiers. Since 1999, all patients with RA (ACR criteria) and treated with at least one dose of an anti-TNF agent at four Rheumatology Centres in Lombardy (northwest Italy) have been included in the Lombardy Rheumatology Network (LORHEN) registry in order to track the efficacy and safety of the three available TNF inhibitors during the first three years of treatment.
18758424 Differentiating subscapular tendon and glenohumeral joint on anterior shoulder sonography. 2008 Sep BACKGROUND: Anterior sonography of the glenohumeral joint has been suggested as a useful method of assessing inflammatory joint disease. The proximity of the subscapular tendon (SSC) to the glenohumeral joint (GHJ) in the shoulder might require differentiating between these two structures. CASE REPORTS: Anterior shoulder sonographic evaluation (Sonosite-Titan) was carried out on four patients: active rheumatoid arthritis (1), osteoarthritis (1), healthy young man (1), silent crystal induced joint disease (1). The shoulder was in a position of supination and external rotation. SSC and GHJ were compared with the transducer located just medial to the biceps tendon (for SSC) and just lateral to the coracoid process (for GHJ). The structural and location differences between the subscapular tendon and the glenohumeral joint on anterior shoulder sonography were discerned. A transverse view of SSC with the transducer located just medial to the biceps tendon (BT) shows the following distinguishing features of the SSC: minor tuberositas, concave surface of the lower surgical neck, fibrillar structure of SSC, continuation of the lower bone margin without demonstration of the thickness of the labrum. A longitudinal view of GHJ with the transducer located just lateral to the coracoid process indicates a rate of GHJ synovial distension, convex, round humeral head with termination of its lower margin and labrum thickening, lack of fibrillar structure of GHJ, and convex round shape of the GHJ capsule. CONCLUSIONS: Differentiating SSC and GHJ on anterior shoulder sonography with above mentioned sonographic features misinterpretation of US data might be minimized.
17606463 Functional variants of interleukin-23 receptor gene confer risk for rheumatoid arthritis b 2008 Feb OBJECTIVES: Recently, an association was found between Crohn's disease and the interleukin-23 receptor (IL-23R) gene. Since the IL-23/IL-17 pathway is known to associate with other autoimmune diseases, including rheumatoid arthritis (RA) and systemic sclerosis (SSc), we hypothesised that IL-23R could be a shared susceptibility gene. METHODS: Groups of patients with rheumatoid arthritis (n = 412), systemic sclerosis (n = 224), Crohn's disease (n = 190) and healthy controls (n = 220) were genotyped for rs10889677 (exon-3'UTR C2370A), rs2201841, and rs1884444 variants; the first two have been shown to confer risk for Crohn's disease. RESULTS: We observed an increased prevalence of the homozygous rs10889677 AA and homozygous rs2201841 CC genotypes both in the Crohn's disease and in the RA groups as compared to the controls (12.1%, 11.9% vs 5.91%, p<0.05; and 13.2%, 13.1% vs 5.91%, p<0.05), but not in the SSc patients. Logistic regression analysis revealed that bearing these alleles represent risk for the development of rheumatoid arthritis (chi(2) = 5.58, p = 0.018, OR = 2.15, 95% CI 1.14-4.06 for rs10889677; and chi(2) = 7.45, p = 0.006, OR = 2.40, 95% CI 1.28-4.51 for rs2201841). The rs1884444 allele, which has been previously reported as neutral for development of Crohn's disease, was also found neutral for all studied groups in the present study. CONCLUSIONS: The data reported here provide direct evidence that some allelic variants or haplogroups of IL-23R represent independent risk factors for rheumatoid arthritis as well as Crohn's disease, but not for scleroderma.
17265481 Vaccination with selected synovial T cells in rheumatoid arthritis. 2007 Feb OBJECTIVE: This pilot clinical study was undertaken to investigate the role of T cell vaccination in the induction of regulatory immune responses in patients with rheumatoid arthritis (RA). METHODS: Autologous synovial T cells were selected for pathologic relevance, rendered inactive by irradiation, and used for vaccination. Fifteen patients received T cell vaccination via 6 subcutaneous inoculations over a period of 12 months. RESULTS: T cell vaccination led to induction of CD4+ Tregs and CD8+ cytotoxic T cells specific for T cell vaccine. There was selective expansion of CD4+,V(beta)2+ Tregs that produced interleukin-10 (IL-10) and expressed a high level of transcription factor Foxp3, which coincided with depletion of overexpressed BV14+ T cells in treated patients. CD4+ IL-10-secreting Tregs induced by T cell vaccination were found to react specifically with peptides derived from IL-2 receptor alpha-chain. The expression level of Foxp3 in CD4+ T cells and increased inhibitory activity of CD4+,CD25+ Tregs were significantly elevated following T cell vaccination. The observed regulatory immune responses collectively correlated with clinical improvement in treated patients. In an intent-to-treat analysis, a substantial response, defined as meeting the American College of Rheumatology 50% improvement criteria, was shown in 10 of the 15 patients (66.7%) and was accompanied by a marked improvement in RA-related laboratory parameters. CONCLUSION: These findings suggest that T cell vaccination induces regulatory immune responses that are associated with improved clinical and laboratory variables in RA patients.
16652418 Safety of infliximab used in combination with leflunomide or azathioprine in daily clinica 2006 May OBJECTIVE: To investigate the safety of infliximab (INF) combination therapy with leflunomide (LEF) or azathioprine (AZA) in patients with rheumatoid arthritis (RA). METHOD: A standardized questionnaire on the use of INF in combination with LEF or AZA was mailed to hospital physicians and collected over a 2 month period. Adverse events (AE) and the reasons for withdrawal of combination therapy were analyzed. RESULTS: Data on 225 patients with RA were collected retrospectively. INF was used in combination with LEF in 171 patients and with AZA in 54. The duration of INF exposure was similar in both groups (mean 8.8 mo). AE were reported in 75 patients (33.3%), 60 LEF/INF (35%) and 15 AZA/INF combinations (27.8%) (p=nonsignificant). No unexpected AE were observed. The main AE were infections (6.2%), cytopenia (5.8%), hepatotoxicity (5.8%), reactions to infusion (5.3%), and skin reactions (4%). At the time the questionnaires were sent out, 161 patients were continuing combination therapies. The main reasons for drug withdrawal were AE (53 patients, 23.5%), inefficacy (10 patients, 4%), and one temporary discontinuation for surgery. CONCLUSION: Our study suggests that INF used in combination with LEF or AZA could be an alternative to methotrexate/INF combinations.
16969427 Combined cannabinoid therapy via an oromucosal spray. 2006 Aug Extensive basic science research has identified the potential therapeutic benefits of active compounds extracted from the Cannabis sativa L. plant (the cannabinoids). It is recognized that a significant proportion of patients suffering with the debilitating symptoms of pain and spasticity in multiple sclerosis or other conditions smoke cannabis despite the legal implications and stigma associated with this controlled substance. GW Pharmaceuticals have developed Sativex (GW- 1,000-02), a combined cannabinoid medicine that delivers and maintains therapeutic levels of two principal cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), via an oromucosal pump spray, that aims to minimize psychotropic side effects. Sativex has proved to be well tolerated and successfully self-administered and self-titrated in both healthy volunteers and patient cohorts. Clinical assessment of this combined cannabinoid medicine has demonstrated efficacy in patients with intractable pain (chronic neuropathic pain, pain due to brachial plexus nerve injury, allodynic peripheral neuropathic pain and advanced cancer pain), rheumatoid arthritis and multiple sclerosis (bladder problems, spasticity and central pain), with no significant intoxication-like symptoms, tolerance or withdrawal syndrome.
17236388 Awake intubation using fast-track laryngeal mask airway as an alternative to fiberoptic br 2006 Dec Patients with rheumatoid arthritis (RA) pose a unique challenge to the anesthetist. The manifestations of RA may include cervical spine instability, limited range of motion, and temperomandibular joint involvement limiting mouth opening. Therefore, securing the airway while maintaining the head and neck in a neutral position is of particular concern to the anesthetist. While this is most commonly accomplished using an awake fiberoptic technique, the following case is presented as a safe and efficient initial alternative to the primary use of fiberoptic bronchoscopy in the appropriate patient population.
17381830 Impact of cytokines and T lymphocytes upon osteoclast differentiation and function. 2007 Historically, the osteoblast has been considered the master cell in the control of osteoclast development and, therefore, bone resorption. Now the interactions between cells of the immune system and bone cells have redefined our thinking on the regulation of bone resorption. Moreover, the crosstalk between these cell types has special significance in inflammatory conditions such as rheumatoid arthritis. This report highlights the contribution that T lymphocytes make in regulating osteoclast formation and bone resorption.
16697964 Immunoglobulin variable-region gene mutational lineage tree analysis: application to autoi 2006 Apr Lineage trees have frequently been drawn to illustrate diversification, via somatic hypermutation (SHM), of immunoglobulin variable-region (IGV) genes. In order to extract more information from IGV sequences, we developed a novel mathematical method for analyzing the graphical properties of IgV gene lineage trees, allowing quantification of the differences between the dynamics of SHM and antigen-driven selection in different lymphoid tissues, species, and disease situations. Here, we investigated trees generated from published IGV sequence data from B cell clones participating in autoimmune responses in patients with Myasthenia Gravis (MG), Rheumatoid Arthritis (RA), and Sjögren's Syndrome (SS). At present, as no standards exist for cell sampling and sequence extraction methods, data obtained by different research groups from two studies of the same disease often vary considerably. Nevertheless, based on comparisons of data groups within individual studies, we show here that lineage trees from different individual patients are often similar and can be grouped together, as can trees from two different tissues in the same patient, and even from IgG- and IgA-expressing B cell clones. Additionally, lineage trees from most studies reflect the chronic character of autoimmune diseases.