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ID PMID Title PublicationDate abstract
19284164 Antibacterial antibodies for some enterobacteria in sera of patients with reactive arthrit 2008 Jan The presence of the specific antibodies for some enterobacteria--Yersinia, Salmonella and Shigella was investigated in patients hospitalized in the period 2000-2007 with reactive arthritis and other rheumatoid diseases. The antibacterial antibodies in the diagnosis titres were found in 172 out of 1102 (15.6%) patients. Increased antibodies levels to Yersinia were detected in the sera from 113 (65.7%) of the 172 patients, for Shigella in 47 (27.3%) and for Salmonella in 12 (7.0%) cases. From all serologically positive patients 126 (73.2 %) had clinical diagnosis of reactive arthritis and 46 (26.7%) other rheumatoid diseases (ankylosing spondilytis, Reiter's syndrome, sacroilitis). The most serologically positive cases (63.9%) were of middle-age (30-50 years). There were no significant differences between sexes among serologically positive cases.
16353132 Immunoglobulin VH genes in thymic MALT lymphoma are biased toward a restricted repertoire 2006 Feb Thymic MALT lymphoma shows certain distinctive features among MALT lymphomas, such as expression of IgA isotype, consistent lack of API2-MALT1 gene fusion, and very strong association with autoimmune disease, especially Sjogren's syndrome. To help clarify the nature of the clonal lymphoid infiltrates, we analysed the usage and somatic hypermutation of the Ig heavy chain variable region (V(H)) genes in nine different cases. The V(H) rearrangement was potentially functional in all cases and was restricted to the V(H)3 family. V(H) usage was biased toward V(H)3-30 (five cases) and V(H)3-23 (three cases) segments, which have both been frequently expressed by autoimmune B cells. Somatic hypermutation was absent in five cases. Fewer than the expected replacement mutations were found in the framework regions in two cases, indicating a negative antigen selection pressure. Ongoing mutation was absent in all cases. D segment usage was varied, whereas J(H) segment usage was restricted to J(H)4. The observed patterns of V(H) usage and mutations suggested that specific antigens may play a pathologically relevant role in the genesis or progression of thymic MALT lymphoma.
18307784 New classification of HLA-DRB1 alleles in rheumatoid arthritis susceptibility: a combined 2008 INTRODUCTION: Rheumatoid arthritis (RA) is a complex polygenic disease of unknown etiology. HLA-DRB1 alleles encoding the shared epitope (SE) (RAA amino acid pattern in positions 72 to 74 of the third hypervariable region of the DRbeta1 chain) are associated with RA susceptibility. A new classification of HLA-DRB1 SE alleles has been developed by Tezenas du Montcel and colleagues to refine the association between HLA-DRB1 and RA. In the present study, we used RA samples collected worldwide to investigate the relevance of this new HLA-DRB1 classification in terms of RA susceptibility across various Caucasoid and non-Caucasoid patients. METHODS: Eighteen subsamples were defined from a total number of 759 cases and 789 controls and grouped in 10 samples on the basis of their ethnic origin. HLA-DRB1 alleles were divided into five groups (S1, S2, S3D, S3P, and X) according to the new HLA-DRB1 allele classification. The whole analysis was performed by comparing carrier frequencies for the five HLA-DRB1 allele groups between RA patients and controls across the 10 Caucasoid and non-Caucasoid samples. The Mantel-Haenszel method of meta-analysis provided a global odds ratio (OR) estimate with 95% confidence interval (CI). RESULTS: A positive association with RA susceptibility was found for S2 allele carriers (OR 2.15, 95% CI 1.54 to 3.00; p < 10(-5)) and S3P allele carriers (OR 2.74, 95% CI 2.01 to 3.74; p < 10(-5)). A negative association was found for S1 alleles (OR 0.60, 95% CI 0.48 to 0.76; p < 10(-4)) and X alleles (OR 0.58, 95% CI 0.39 to 0.84; p = 4 x 10(-3)). No significant association was highlighted for the S3D group of alleles (OR 0.89, 95% CI 0.69 to 1.14; p = 0.89). The complementary genotype analysis fit with the genotype risk hierarchy previously reported in Caucasoid RA patients. CONCLUSION: So far, the present study is the first attempt to investigate the relevance of this new HLA-DRB1 classification in terms of RA susceptibility on both Caucasoid and non-Caucasoid samples. Our results support the hypothesis of a differential role played by different HLA-DRB1 allele groups in RA susceptibility across different ethnic backgrounds and confirm the interest of such an HLA-DRB1 classification in differentiating predisposing and protective alleles.
16192292 The potential role of human endogenous retrovirus K10 in the pathogenesis of rheumatoid ar 2006 May OBJECTIVE: To examine whether human endogenous retrovirus K10 is associated with autoimmune rheumatic disease. DESIGN: A novel multiplex reverse transcription polymerase chain reaction (RT-PCR) system was developed to investigate HERV-K10 mRNA expression in patients with rheumatoid arthritis. METHODS: 40 patients with rheumatoid arthritis, 17 with osteoarthritis, and 27 healthy individuals were recruited and total RNA was extracted from peripheral blood mononuclear cells (PBMCs) and analysed using multiplex RT-PCR for the level of HERV-K10 gag mRNA expression. Southern blot and DNA sequencing confirmed the authenticity of the PCR products. RESULTS: Using the histidyl tRNA synthetase (HtRNAS) gene as a housekeeping gene in the optimised multiplex RT-PCR, a significantly higher level of HERV-K10 gag mRNA expression was found in rheumatoid arthritis than in osteoarthritis (p = 0.01) or in the healthy controls (p = 0.02). CONCLUSION: There is enhanced mRNA expression of the HERV-K10 gag region in rheumatoid arthritis compared with osteoarthritis or healthy controls. This could contribute to the pathogenesis of rheumatoid arthritis.
17762450 Are patients with rheumatoid arthritis less physically active than the general population? 2007 Aug BACKGROUND: Although promoting physical activity (PA) and exercise among patients with rheumatoid arthritis (RA) is highly advocated nowadays, little is known about actual PA levels of these patients. In particular, the literature investigating how these PA levels are in proportion to the levels among the general population is scarce. OBJECTIVE: To compare the self-reported PA levels of patients with RA with those of the general Dutch population. METHODS: A sample of 400 RA patients were sent the Short QUestionnaire to ASsess Health-Enhancing PA comprising 10 questions about PA. From these data the proportions meeting the Dutch public health recommendation for PA (i.e., moderate PA for 30 minutes on > or = 5 days/wk) and the total number of minutes of PA per week were calculated. These data were compared with similar data from a representative sample of the general Dutch population. RESULTS: Two hundred fifty-two patients returned the questionnaire (response 63%). The proportions of RA patients meeting the PA recommendation were similar to those of the general population (57% in categories 45-64 years; 59% in categories > or = 65 years, and 58% in the total groups). The average number of minutes of PA per week was significantly lower in the RA population compared with the general population in the category 45 to 64 years (1836 vs. 2199, respectively, P = 0.001), whereas the difference in the category > or = 65 years was not significant (1115 vs. 1218 minutes, respectively, P = 0.33). CONCLUSIONS: The proportion of RA patients meeting the Dutch PA recommendation was similar to the general Dutch population. However, with respect to the average number of minutes of PA per week, the RA patients were less physically active. Because patients with RA have an increased risk of chronic conditions such as osteoporosis or cardiovascular diseases along with their arthritis, it remains a matter of utmost importance for health care professionals such as rheumatologists, physical therapists, and clinical nurse specialists to promote PA in daily clinical practice and guide patients in achieving and maintaining a healthy lifestyle.
17612045 Nitric oxide synthase and cyclooxygenase interactions in cartilage and meniscus: relations 2007 Rheumatoid arthritis and osteoarthritis are painful and debilitating diseases with complex pathophysiology. There is growing evidence that pro-inflammatory cytokines (e.g., interleukin-1 and tumor necrosis factor alpha) and mediators (e.g., prostaglandins, leukotrienes, and nitric oxide) play critical roles in the development and perpetuation of tissue inflammation and damage in joint tissues such as articular cartilage and meniscus. While earlier studies have generally focused on cells of the synovium (especially macrophages), there is increasing evidence that chondrocytes and meniscal cells actively contribute to inflammatory processes. In particular, it is now apparent that mechanical forces engendered by joint loading are transduced to biological signals at the cellular level and that these signals modulate gene expression and biochemical processes. Here we give an overview of the interplay of cytokines and mechanical stress in the production of cyclooxygenases and prostaglandins; lipoxygenases and leukotrienes; and nitric oxide synthases and nitric oxide in arthritis, with particular focus on the interactions of these pathways in articular cartilage and meniscus.
19010978 Mast cell chymase contributes to the antibody response and the severity of autoimmune arth 2009 Mar Mast cells are implicated in rheumatoid arthritis, but the mechanism by which they contribute to disease progression is not clarified. Here we investigated whether mouse mast cell protease-4 (mMCP-4), a chymase present in the mast cell secretory granule, contributes to experimental arthritis. Two models of arthritis were investigated in mMCP-4(+/+) and mMCP-4(-/-) DBA/1 mice: collagen-induced arthritis (CIA) was induced by immunization with collagen II (CII) in Freund's complete adjuvant, and a passive model of arthritis was induced by administration of anti-CII antibodies. The clinical scores were significantly reduced in the mMCP-4(-/-) animals as compared to mMCP-4(+/+) controls in both arthritis models. In CIA, the number of affected paws was lower in the CII-immunized mMCP-4(-/-) mice, with less cartilage destruction, pannus formation, and mononuclear cell and mast cell influx in the mMCP-4(-/-) joints. Interestingly, the lower clinical scores in the CII-immunized mMCP-4(-/-) mice coincided with lower serum levels of immunoglobulin G anti-CII antibodies. Our findings identify a pathogenic role of mMCP-4 in autoimmune arthritis.
17920231 Effect of Cervus korean TEMMINCK var. mantchuricus Swinhoe on protease activities, antioxi 2008 Feb The effect of deer antler extracts (DAA) of Cervus korean TEMMINCK var. mantchuricus Swinhoe on protease activities, oxidant and free radical damages in synovial fluid from rheumatoid arthritis in rats was studied. Rats were i.p. administered with DAA. We have compared (using the same series of experimental samples) the levels of activity of a comprehensive range of cytoplasmic, lysosomal and matrix protease types, together with the levels of free radical induced protein damage (determined as protein carbonyl derivative) and total antioxidant in synovial fluid from rheumatoid arthritis (RA) and DAA-treated rats. Many proteases activities were shown to be significantly increased in RA compared to normal rats. Protease activities (including those enzyme types putatively involved in the immune response, such as dipeptidyl aminopeptidase IV) in plasma were not significantly different between RA and normal rats. DAA treatment at dose of 100 microg/kg suppressed the production of the proteases of cytoplasmic, lysosomal and matrix protease types. The level of free radical induced damage to synovial fluid proteins was approximately 2-fold lower in DAA rats compared to RA rats, although there was no significant difference in total antioxidant status in synovial fluid or plasma between RA and DAA rats. It was concluded that DAA treatment reduces the activation of proteolytic enzymes and free radicals, which are likely to be of equal potential importance as protein damaging agents in the pathogenesis of RA.
17616555 A modification of the Omeract RA MRI score for erosions for use with an extremity MRI syst 2007 Dec OBJECTIVES: To develop and test the reliability of a modified version of the OMERACT rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for erosions using extremity MRI (eMRI) with reduced field of view (RAMRIS-RV). METHODS: Using a MagneVu 0.2 T machine, the preliminary RAMRIS-RV assessed erosions in metacarpophalangeal (MCP) joints 2-3, bases of metacarpal (MC) 2-5, and all wrist bones excluding base MC 1, pisiform and trapezium. T1 weighted images of >/=500 MCP and wrist bony sites from a mixed severity RA and control cohort were evaluated. An inter-reader reliability study evaluating 300 wrist and 160 MCP bony sites was then performed. RESULTS: Mean per cent exact (and close) agreement results were as follows: MCP proximal sites 83.5 (96.2), MCP distal 54.4 (77.2), bases MC 2-4 85.2 (96.7), carpal bones 79.0 (92.1), distal radius/ulna 66.4 (87.8). The base of MCP 5 was visualised in
17851302 Pain relief in osteoarthritis and rheumatoid arthritis: TENS. 2007 Aug Pain is a common symptom experienced by people with osteoarthritis and rheumatoid arthritis and impacts upon mobility and quality of life. This article reviews the limited evidence relating to TENS for pain relief which suggests that it is beneficial for some patients and does no harm. More research is needed to clarify optimal treatments regimes and its cost-effectiveness compared to conventional analgesia.
18563794 Optimum treatment allocation rules under a variance heterogeneity model. 2008 Sep 30 We provide optimal treatment allocation schemes when the outcome variance varies across the treatment groups and our objectives are to estimate treatment effects with equal or unequal interest. Unlike other optimal designs, such as A-optimal designs, the proposed designs can be found without an iterative scheme. We evaluate robustness properties of the optimal designs to mis-specification in the expected variance from each group and identify situations when popular allocation schemes have poor efficiencies. An application to design a randomized rheumatoid arthritis trial is discussed, along with a potential application to design a cancer screening trial when the main outcome is a continuous variable.
18809639 How do you feel? Self-esteem predicts affect, stress, social interaction, and symptom seve 2008 Oct Self-esteem has been demonstrated to predict health and well-being in a number of samples and domains using retrospective reports, but little is known about the effect of self-esteem in daily life. A community sample with asthma (n = 97) or rheumatoid arthritis (n = 31) completed a self-esteem measure and collected Ecological Momentary Assessment (EMA) data 5x/day for one week using a palmtop computer. Low self-esteem predicted more negative affect, less positive affect, greater stress severity, and greater symptom severity in daily life. Naturalistic exploration of mechanisms relating self-esteem to physiological and/or psychological components in illness may clarify causal relationships and inform theoretical models of self-care, well-being, and disease management.
18653811 Tocilizumab: the first interleukin-6-receptor inhibitor. 2008 Aug 1 PURPOSE: The pharmacology, pharmacokinetics, clinical efficacy, safety, and role of tocilizumab in rheumatoid arthritis (RA) are reviewed. SUMMARY: Tocilizumab is a novel monoclonal antibody that competitively inhibits the binding of interleukin-6 (IL-6) to its receptor (IL-6R). Inhibiting the entire receptor complex prevents IL-6 signal transduction to inflammatory mediators that summon B and T cells. Tocilizumab has a nonlinear pharmacokinetic profile. The hypothesis that targeting and inhibiting IL-6R with tocilizumab can result in significant improvement of the signs and symptoms of RA appears to have been substantiated in one Phase III and two Phase II clinical trials, which have demonstrated a marked reduction in disease activity and the acute-phase response. The results of these studies indicate that tocilizumab treatment, both as a combination with methotrexate and as monotherapy, has a safety profile consistent with that of other biological and immunosuppressive therapies. In general, tocilizumab as monotherapy and in combination with methotrexate appears to be well tolerated. Adverse events were not dose dependent and were of similar frequency in all groups. Tocilizumab appears to provide an additional option for those patients who do not respond sufficiently to methotrexate. Since IL-6R inhibition has a distinct mechanism of action, some patients who do not respond to antitumor necrosis factor agents or who have a partial response may respond to tocilizumab. CONCLUSION: Tocilizumab, a novel IL-6R inhibitor, may be beneficial for the treatment of RA in patients who do not respond to methotrexate or disease-modifying antirheumatic drugs. A large clinical trial is needed to confirm tocilizumab's clinical efficacy and safety.
17978556 [Need for pharmaceutical skill in using displacement of protein binding]. 2007 Nov In pharmacotherapy, to alleviate pains of patients and to provide comforts to patients, pharmacists should improve their pharmaceutical skills of their clinical sense involving pharmaceutical investigational outcomes. Without pharmaceutical skills, pharmacists cannot apply the essence of drug therapies for patients in the most urgent 24 hours treatment. To cope with these drug therapies, we have developed search methods which easily identify the diachronic change of protein binding and the factors in serum (=a new pharmaceutical distribution diagnostic method). This method can speculate diachronic change factors in serum, by monitoring diachronically binding capacities of drug binding sites on human serum albumin (HSA) and alpha(1)-acid glycoprotein (AGP) molecules in patient sera (add each site probe to each patient serum, and measure the free level of each probe by using TDX/FLX analyzer and HPLC detector), and considering the binding capacities and values of HSA, AGP, free fatty acids, bilirubin (Bil) and blood urea nitrogen (BUN) associating with the amounts of uremic toxins laboratory tests. In addition, the diagnostic method could attempt effective administration by using the protein binding displacement of drugs that have a high protein binding capacity and small distribution volume, or high targeting (=the pharmaceutical skill of protein binding displacement). We have practiced pain control of patients with rheumatoid arthritis by the pharmaceutical skill. It is important for pharmacists to master the pharmaceutical skill in pharmacotherapy.
18274640 Administration of PDE4 inhibitors suppressed the pannus-like inflammation by inhibition of 2007 A marked proliferation of synovial fibroblasts in joints leads to pannus formation in rheumatoid arthritis (RA). Various kinds of cytokines are produced in the pannus. The purpose of this study is to elucidate the effects of phosphodiesterase 4 (PDE4) inhibitors in a new animal model for the evaluation of pannus formation and cytokine production in the pannus. Mice sensitized with methylated bovine serum albumin (mBSA) were challenged by subcutaneous implantation of a membrane filter soaked in mBSA solution in the back of the mice. Drugs were orally administered for 10 days. The granuloma formed around the filter was collected on day 11. It was chopped into pieces and cultured in vitro for 24 hr. The cytokines were measured in the supernatants. The type of cytokines produced in the granuloma was quite similar to those produced in pannus in RA. Both PDE4 inhibitors, KF66490 and SB207499, suppressed the production of IL-1beta, TNF-alpha, and IL-12, and the increase in myeloperoxidase activity, a marker enzyme for neutrophils and hydroxyproline content. Compared to leflunomide, PDE4 inhibitors more strongly suppressed IL-12 production and the increase in myeloperoxidase activity. PDE4 inhibitors also inhibited lipopolysaccharide-induced TNF-alpha and IL-12 production from thioglycolate-induced murine peritoneal macrophages and the proliferation of rat synovial fibroblasts. These results indicate this model makes it easy to evaluate the effect of drugs on various cytokine productions in a granuloma without any purification step and may be a relevant model for evaluating novel antirheumatic drugs on pannus formation in RA. PDE4 inhibitors could have therapeutic effects on pannus formation in RA by inhibition of cytokine production by macrophages and synovial fibroblast proliferation.
18597398 A high interleukin 1 receptor antagonist/IL-1beta ratio occurs naturally in knee osteoarth 2008 Aug OBJECTIVE: To assess the interleukin 1 receptor antagonist (IL-1Ra)/IL-1beta ratio in synovial fluid (SF) of patients with knee osteoarthritis (OA) or rheumatoid arthritis (RA) to determine a possible relation between cytokine level and disease activity. METHODS: IL-1beta and IL-1Ra concentrations were measured by ELISA in knee SF from patients with OA (n = 42) or RA (n = 11). For OA patients, pain and disability were assessed by a visual analog scale (VAS) and the Lequesne index. RA disease activity was assessed using the Disease Activity Score 28 Joint Count (DAS28). RESULTS: Patients with OA showed lower median levels of IL-1beta and IL-1Ra in SF than patients with RA (p < 0.001) but a higher IL-1Ra/IL-1beta ratio: 1793 (584-6221) versus 773.5 (187.64-1570.5) (p = 0.05). For patients with OA, the IL-1Ra/IL-1beta ratio was not associated with pain or disability. For patients with RA, the IL-1Ra/IL-1beta ratio and IL-1Ra and IL-1beta levels were related to SF white blood cell count. CONCLUSION: High endogenous IL-1Ra/IL-1beta ratio occurs in SF from knee OA and does not correlate with pain or Lequesne index. Our results suggest that intraarticular injection of IL-1Ra might be self-limited in patients with knee OA and a naturally high SF ratio.
16898079 Pharmacokinetics of IL-18 binding protein in healthy volunteers and subjects with rheumato 2006 Apr IL-18 binding protein (BP) neutralizes the activity of IL-18, a cytokine implicated in psoriasis and rheumatoid arthritis (RA). We investigated the pharmacokinetics, pharmacodynamics and safety of recombinant human IL-18 BP (r-hIL-18 BP) in healthy volunteers and subjects with psoriasis or RA in four phase I studies. A) Healthy volunteers (n = 24) were randomised to receive a single subcutaneous (sc) injection of r-hIL-18 BP (20, 70, 210 or 350 mg) or placebo. B) Healthy volunteers (n = 10) were randomised to receive six sc injections of r-hIL-18 BP (35 or 175 mg, 48 h between injections) or placebo. C) Subjects with moderate-to-severe plaque psoriasis (n = 35) were randomised to receive r-hIL-18 BP (20, 160 or 320 mg, sc tiw) or placebo for 6 weeks. D) Subjects with active, moderate-to-severe RA (n = 36) were randomised to receive r-hIL-18 BP (20, 80, 160 mg, sc tiw) or placebo for 6 weeks. Pharmacokinetics, pharmacodynamics and safety were assessed in all four studies. r-hIL-18 BP showed a dose-dependent pharmacokinetic profile, with a peak serum concentration of 6-48 hours. With repeated sc injections tiw, a steady state was achieved in 1-2 weeks among subjects with psoriasis or RA. The majority of adverse events were mild or moderate in severity. Injection site reactions were the most frequently reported event in subjects with psoriasis or RA. r-hIL-18 BP displays dose-dependent pharmacokinetics, has a favourable safety profile and is well-tolerated in healthy volunteers and in subjects with moderate-to-severe plaque psoriasis or active, moderate-to-severe RA.
18727667 Hydroxychloroquine-induced hyperpigmentation: the staining pattern. 2008 Dec We report two cases of hydroxychloroquine-induced hyperpigmentation presenting in a 50-year-old Caucasian female (case 1) and a 78-year-old female (case 2), both receiving 400 mg per day. Case 1 had an arthritis predominant undifferentiated connective tissue disease, which was treated with hydroxychloroquine for 4-5 years. She presented with a mottled, reticulated macular gray pigmentation involving the upper back and shoulders. Case 2 had a history of systemic lupus erythematosus and rheumatoid arthritis, treated with hydroxychloroquine for 1.5 years. She presented to the hospital for treatment of constrictive cardiomyopathy and was noted to have a blue macular pigmentation involving the right temple. The biopsies from both patients showed superficial dermal, yellow-brown, non-refractile and coarsely granular pigment deposition. A Fontana-Masson stain highlighted some of these granules, while the Perl's iron stain was negative. Rare, previous reports of hyperpigmentation indicate the presence of both melanin and hemosiderin in patients being treated with antimalarial medication. To our knowledge, this staining pattern for hydroxychloroquine has not been previously reported in the literature and supports that hydroxychloroquine, in addition to chloroquine, binds to melanin.
18464312 A novel predictor of clinical response to methotrexate in patients with rheumatoid arthrit 2008 Jun OBJECTIVE: Methotrexate (MTX) is an important drug for treatment of rheumatoid arthritis; however, there is variation in the clinical response. MTX inhibits T cell cytokine production, with significant interindividual variability in the dose required. We investigated if the variability in clinical response was related to variability in the in vitro assay. METHODS: Patients with disease modifying antirheumatic drug-naive, active RA [1982 American College of Rheumatology (ACR) criteria] seen from September 2005 through January 2006 were enrolled. MTX was started at 10 mg/week and increased monthly by 2.5 mg/week. Baseline whole-blood cultures were set up with anti-CD3, anti-CD28, and increasing doses of MTX. Supernatants were harvested at 96 hours and tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and interleukin 10 (IL-10) concentrations were estimated by ELISA. The dose of MTX (ID50) required for 50% suppression of production of cytokines and the change in Disease Activity Score-28 (DeltaDAS) at 4 months were noted. RESULTS: T cell stimulation resulted in significant increase in cytokine release, and addition of MTX led to a dose-dependent suppression of all 3 cytokines. There was significant negative correlation of DeltaDAS with ID50 values for TNF-alpha (R = -0.62, p < 0.01) and IFN-gamma (R = -0.43, p = 0.04). At 4 months, EULAR moderate and ACR 20% responses were achieved by 13 and 16 patients, respectively. EULAR moderate response could be predicted using ROC curves for TNF-alpha (sensitivity 93%, specificity 86%) and IFN-gamma (60% specificity, 71% sensitivity). ACR response was correctly predicted in 14 of 16 ACR 20% responders and in all ACR 50% and ACR 70% responders. CONCLUSION: An in vitro TNF-alpha suppression assay may help predict clinical response to MTX in RA.
16443118 Trigger digits: principles, management, and complications. 2006 Jan Stenosing tenosynovitis, or trigger finger, is an entity seen commonly by hand surgeons. This problem generally is caused by a size mismatch between the flexor tendon and the first annular (A-1) pulley. Conservative management includes splinting, corticosteroid injection, and other adjuvant modalities. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Complications are rare but include bowstringing, digital nerve injury, and continued triggering. Some patients require more extensive procedures to reduce the size of the flexor tendon. Comorbid conditions affect how trigger finger is treated. Patients with rheumatoid arthritis require tenosynovectomy instead of A-1 pulley release. In children trigger thumb resolves reliably with A-1 pulley release but other digits may require more extensive surgery. In diabetic patients trigger finger often is less responsive to conservative measures. An understanding of the pathomechanics, risk factors, and varied treatments for trigger finger is essential for appropriate care.