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ID PMID Title PublicationDate abstract
16735873 Lipopolysaccharide found in aseptic loosening of patients with inflammatory arthritis. 2006 Oct Aseptic loosening of orthopaedic implants occurs in the absence of clinical signs of infection. Nevertheless, bacterial endotoxins derived from subclinical infections, systemic sources, or the implant manufacturing process may contribute to aseptic loosening. Also, the rate of implant infection is greater in patients with inflammatory arthritis than in patients with osteoarthritis. We hypothesized that lipopolysaccharide, the classic endotoxin derived from gram-negative bacteria, is more prevalent in periprosthetic tissue surrounding aseptically loose implants in patients with inflammatory arthritis than in patients with osteoarthritis. To test this, we used a modified Limulus amebocyte assay not affected by beta-glucan-like molecules in mammalian tissues. Lipopolysaccharide rarely was detected in periprosthetic tissue from patients with osteoarthritis and aseptic loosening (one of six patients). In contrast, lipopolysaccharide was detected despite the absence of any clinical signs of infection in peri-prosthetic tissue from all four patients with inflammatory arthritis (rheumatoid arthritis, juvenile rheumatoid arthritis, and systemic lupus erythematosus). Lipopolysaccharide also was detected in two patients with gram-negative infections, who were included as positive control subjects. Endotoxins derived from low-grade or systemic bacteremia may be important contributors to aseptic loosening particularly in patients with autoimmune conditions such as inflammatory arthritis.
21614297 Role of radiosynovectomy in the treatment of rheumatoid arthritis and hemophilic arthropat 2007 Oct Radiosynovectomy is a novel method of treatment for several acute and chronic inflammatory joint disorders. A small amount of a beta-emitting radionuclide is injected into the affected joint delivering a radiation dose of 70 to 100 Gy to the synovia. The proliferative tissue is destroyed, secretion of fluid and accumulation of inflammation causing cellular compounds stops and the joint surfaces become fibrosed, providing long term symptom relief. The radionuclides are injected in colloidal form so that they remain in the synovium and are not transported by lymphatic vessels causing radiation exposure to other organs. Complete reduction of knee joint swelling has been seen in above 40% and pain relief in 88% of patients. Wrist, elbow, shoulder, ankle and hip joints showed significant improvement in 50-60% and restoration of normal function and long term pain relief has been achieved in about 70% of small finger joints. In hemophilic arthropathies complete cessation of bleeding in about 60% and improved mobility in 75% of patients has been reported.
18466494 Association mapping of susceptibility loci for rheumatoid arthritis. 2007 We analyzed a case-control data set for chromosome 18q from the Genetic Analysis Workshop 15 to detect susceptibility loci for rheumatoid arthritis (RA). A total number of 460 cases and 460 unaffected controls were genotyped on 2300 single-nucleotide polymorphisms (SNPs) by the North American Rheumatoid Arthritis Consortium. Using a multimarker approach for association mapping under the framework of the Malecot model and composite likelihood, we identified a region showing significant association with RA (p < 0.002) and the predicted disease locus was at a genomic location of 53,306 kb with a 95% confidence interval (CI) of 53,295-53,331 kb. A common haplotype in this region was protective against RA (p = 0.002). In another region showing nominal significant association (51,585 kb, 95% CI: 51,541-51,628 kb, p = 0.037), a haplotype was also protective (p = 0.002). We further demonstrated that reducing SNP density decreased power and accuracy of association mapping. SNP selection based on equal linkage disequilibrium (LD) distance generally produced higher accuracy than that based on equal kilobase distance or tagging.
19014513 Therapeutic efficacy of intra-articular adrenomedullin injection in antigen-induced arthri 2008 INTRODUCTION: Adrenomedullin is a potent vasodilatory and hypotensive peptide as well as an endogenous immunomodulatory factor with predominantly anti-inflammatory effects. The purpose of the present study was to evaluate the therapeutic effects of adrenomedullin in rabbits with antigen-induced arthritis, an experimental model of rheumatoid arthritis. METHODS: Following the induction of arthritis in both knee joints by ovalbumin injection into the joint spaces of pre-immunized rabbits, increasing daily doses of adrenomedullin were injected into the knee joint spaces or saline was injected into the contralateral knee joint spaces as the control. For time-course experiments, adrenomedullin and saline were injected into the knee joint spaces daily for 7 days and 20 days. The degree of joint swelling and the histological change in the knee joints injected with adrenomedullin were compared with the control knee joints. Histological evaluation of the infrapatellar fat pads and synovial tissue was performed. TNFalpha, IL-6, vascular endothelial growth factor and transforming growth factor-beta mRNA levels in the synovial tissue were measured using real-time quantitative PCR. RESULTS: Daily injections of adrenomedullin into the knee joint spaces of rabbits with antigen-induced arthritis decreased joint swelling. Histological examination revealed that adrenomedullin reduced edematous changes and the infiltration of inflammatory cells in the synovial tissues. Analysis of mRNA levels showed that adrenomedullin significantly reduced TNFalpha mRNA expression by 21% to 49% in a dose-dependent manner, and dose-dependently increased IL-6 mRNA expression by 45% to 121%. CONCLUSIONS: These results suggest that daily injections of adrenomedullin into the knee joint spaces of rabbits with antigen-induced arthritis ameliorated the inflammatory response in arthritic joints. Adrenomedullin may thus be useful as a treatment for rheumatoid arthritis; however, the effect of adrenomedullin on IL-6 production in the synovial tissue may be an undesirable adverse effect in rheumatoid arthritis therapy.
27144962 Arthritis -The Complete Guide to Relief Using Methods that Really Work Klein Arthur C Arth 2006 Jul 26 This guide for people living with rheumatoid arthritis or osteoarthritis aims to share with the reader what help people have accessed and what aspects of management, including conventional and complementary treatment, they have found beneficial or unhelpful.
17252261 Systemic onset juvenile rheumatoid arthritis presenting with absence of B lymphocytes. 2007 Aug Juvenile rheumatoid arthritis (JRA) is a complex disease involving the interactions of several cell populations with different mediators. Herein, we report a five-year-old girl with systemic-onset JRA. At admission, peripheral blood flowcytometric analysis showed the percentages of CD19(+) and CD20(+) B cells were <1%. These values returned to normal on the tenth day of steroid treatment. This is the first report of JRA presented with absence of B lymphocytes in the literature and suggested that lymphocytes subset analysis could change with treatment in patients with JRA. Different clinical signs and symptoms reflecting aspects of JRA are critical for the etiology of the disease and to identify new strategies for treatment.
16703818 Use of the faces pain scale to evaluate pain of a pediatric patient with pauciarticular ju 2006 Apr The Faces Pain Scale developed by Wong and Baker is a common assessment tool that uses cartoon-like faces to assess self reported pain in children. The purpose of this case report is to explore the appropriateness of the Faces Pain Scale as an outcome measure for a young child with pauciarticular juvenile rheumatoid arthritis. The patient was a four-year-old boy who had undergone a synovectomy on his right knee secondary to pauciarticular JRA. Each session the patient was asked to rate his pain using the Faces Pain Scale. The patient gainedfull knee range of motion and his functional mobility improved compared to initial visit. His subjective pain rating remained constant at "no hurt" throughout three weeks of visits. His functional mobility did not match his subjective rating of pain via the Faces Pain Scale. Further research is needed to determine the relationship of pain, stiffness, and function in children with rheumatic diseases.
17884528 A method of treating the patient with postpubescent juvenile rheumatoid arthritis. 2007 Oct PURPOSE: Juvenile rheumatoid arthritis (JRA) is a perplexing and devastating disease for which establishment of a treatment protocol is difficult. The relatively low incidence and unknown cause of this disorder have made it difficult to establish when and how to intervene. Treatment protocols for the prepubescent patient (<12 years for girls and 14 years for boys), as well as for the adult, have been established. A protocol for postpubescence (ages 12 through 18 years) has yet to be established. This pilot study attempts to establish another treatment protocol for this particular subgroup of patients. PATIENTS AND METHODS: Five girls between the ages of 14 and 18 years with common facial deformities who were given a diagnosis of juvenile rheumatoid arthritis were reconstructed by orthognathic surgery and costochondral rib grafts. All underwent surgery performed by the first author and were followed for 4 to 14 years. Patients were in disease remission at the time of surgery, and all presented with the same skeletal/dental deformity and condylar destruction. RESULTS: Serial cephalograms were taken immediately presurgically (T1), immediately postsurgically (T2), and at latest recall (T3). Tracings were done by the same orthodontist with the use of Quick Ceph Image Pro software (Quick Ceph Systems, San Diego, CA). Mandibular position as it related to the success of costochondral and orthognathic surgery was assessed by gnathion position relative to nasion-basion at the cranial center, as described by Rickett's facial analysis. Patient long-term follow-up lasted from 4 to 14 years and had a mean duration of 9.6 years. The average increase in anterior/posterior direction (T1 to T2) was 22.7 mm with an average relapse (T2 to T3) of 1.5 mm. Four of 5 patients had a stable Class I occlusion on follow-up, and 1 developed a 3-mm open bite postoperatively. CONCLUSION: This pilot study offers a treatment protocol for the postpubescent juvenile patient with rheumatoid arthritis (aged 12 to 18 years) that is based on a single surgery with relative postoperative stability.
18604580 Efficacy of methylprednisolone pulse therapy in children with rheumatoid arthritis. 2008 Nov Pulse therapy is one of the most well-known methods used in the treatment of juvenile rheumatoid arthritis. This study assessed the outcome of methylprednisolone pulse therapy, its rate of efficacy, and its associated complications in patients with juvenile rheumatoid arthritis (JRA). This cross-sectional study was performed on 120 children with JRA who attended the Pediatric Ward of Imam Khomeini Hospital from 1994 to 2004 and who had undergone around 500 cycles of methylprednisolone pulse therapies. Clinical signs, including signs of improvement, complications, or recurrence of disease, were noted. SPSS version 11.5 and paired t test were used to compare the variables prior to and after treatment. Clinical signs observed included: feeling of weakness (100%), malaise (98.3%), loss of appetite (93.3%), fever (88.3%), skin rash (28%), lymphadenopathy (18.3%), serositis (4.2%), splenomegaly (3.3%), and hepatomegaly (1.7%); however, none of these findings were present after pulse therapy. The number of swollen and tender joints, duration of morning stiffness, erythrocyte sedimentation rate, C-reactive protein, and hemoglobin levels showed significant improvement after pulse therapy. Complications of pulse therapy included tachycardia (n = 16, 13.3%), hypertension (n = 10, 8.3%), headache (n = 2, 1.7%), and flashing (n = 2, 1.7%). The mean duration of remission was 3.3 +/- 0.7 months.
18195473 Triptolide inhibits CCR5 expressed in synovial tissue of rat adjuvant-induced arthritis. 2007 Nov Triptolide has been clinically used to treat patients with rheumatoid arthritis, in which chemokine receptors play an important role in immune and inflammatory responses. To investigate the effect of triptolide on CCR5, we used complete Freund's adjuvant to produce adjuvant-induced arthritis (AIA) in rats. Our data show that both CCR5 mRNA and protein levels in synovial tissue of rats with AIA are significantly higher than those in normal rats. Triptolide can significantly inhibit rat AIA-induced overexpression of CCR5 at both mRNA and protein levels. These results may contribute to better understanding of the therapeutic effects of triptolide in rheumatoid arthritis.
18431093 Atypical arthritis due to combined hereditary hemochromatosis and active hepatitis C. 2008 Feb A 51-year-old Caucasian female presented with asymmetric arthritis and a positive rheumatoid factor. She was initially treated for rheumatoid arthritis. However, she had features such as abnormal liver function tests and osteoarthritis in an unusual location, the metacarpophalangeal joint. Further workup revealed that the patient had active hepatitis C and hereditary hemochromatosis. Phlebotomy treatment initiation seemed to be associated with improvement in joint symptoms but, more importantly, may have prevented future risk of cirrhosis and hepatocellular cancer. Treatment for the hepatitis C may also be needed. Clinicians should look for underlying systemic illnesses leading to atypical inflammatory arthritis.
18412300 Arthritis in Aboriginal Manitobans: evidence for a high burden of disease. 2008 Jun OBJECTIVE: To evaluate the relative burden of arthritis and patterns of care in Aboriginal Manitobans, using multiple data sets to ensure a representative picture. METHODS: Arthritis burden and healthcare utilization was ascertained using 3 separate data sources. Physician claims for 3 common ICD-9 musculoskeletal diagnoses were abstracted from the Population Health Research Data Repository for First Nations (FN) Manitobans and compared to all other Manitobans. Self-reported arthritis rates were obtained from the Manitoba First Nations Regional Longitudinal Health Survey (MFN Survey), which surveyed FN persons living on-reserve. Data on ethnicity and diagnoses were abstracted from the Arthritis Centre research database, which contains records of all patients seen at the Arthritis Centre. RESULTS: Twice as many FN Manitobans had physician claims for rheumatoid arthritis, degenerative arthritis, and unspecified arthropathy compared to all other Manitobans. MFN Survey data identified a self-reported arthritis rate of 21.0% and a rheumatoid arthritis (RA) rate of 3.0%. Data for 687 Aboriginal patients and 4135 Caucasian patients were abstracted from the Arthritis Centre database. Aboriginal patients seen in the Arthritis Centre were 2 to 4 times more likely to have a diagnosis of inflammatory disease, and less than half as likely to have noninflammatory disease. CONCLUSION: The data highlight the increased burden of arthritis in Aboriginal Manitobans, and draw attention to large gaps in our knowledge of how, why, and when Aboriginals access medical care.
17200199 Adrenomedullin protects from experimental arthritis by down-regulating inflammation and Th 2007 Jan Rheumatoid arthritis is a chronic autoimmune disease of unknown etiology characterized by chronic inflammation in the joints and subsequent destruction of the cartilage and bone. The present study proposes a new strategy for the treatment of arthritis: the administration of the immunomodulatory neuropeptide adrenomedullin. Treatment with adrenomedullin significantly reduced incidence and severity of collagen-induced arthritis, an experimental model of rheumatoid arthritis, completely abrogating joint swelling and destruction of cartilage and bone. The therapeutic effect of adrenomedullin was associated with a striking reduction of the two deleterious components of the disease, ie, the Th1-driven autoimmune and inflammatory responses. Adrenomedullin also induced the generation and/or activation of efficient CD4+ CD25+ regulatory T cells in arthritis with capacity to suppress autoreactive response and restore immune tolerance, which could play a pivotal role in the therapeutic effect of adrenomedullin on experimental arthritis contributing to the restoration of immune tolerance.
20569595 Minimally invasive atlanto-odontoid joint injection for involvement in rheumatoid arthriti 2006 Dec 15 This report shows that CT fluoroscopy guided anterior approach injections can be effectively utilized for inflammatory conditions affecting the atlanto-odontoid joint, and that steroid injections thus injected can provide pain relief lasting six months in properly selected patients. Patients with underlying rheumatoid arthritis demonstrating significant aggravation of neck pain with side to side (rotational) neck movements and refractory to medical therapy may be good candidates for the procedure.
21607230 A severe rash. 2008 A fifty-one-year-old man with history of treated hypertension and seronegative rheumatoid arthritis presented to hospital with a three day history of a rash affecting the whole body and general malaise. He had been commenced on sulfasalazine 2 weeks ago to control his rheumatoid arthritis, which the patient had discontinued taking three days prior to admission. On examination, he was comfortable with a temperature of 39°C and a widespread erythematous maculopapular rash. Investigations revealed a normal FBC, UEs, LFTs but high inflammatory markers with a CRP 125.9 and ESR 52. One day later the patient developed odynophagia and blisters on his lips and mouth shown in the picture below (Figure 1 and 2).
17121486 Psoriatic arthritis update. 2006 Psoriatic arthritis is an inflammatory arthritis occurring in up to 30% of patients with psoriasis. Its clear distinction from rheumatoid arthritis has been described clinically, genetically, and immunohistologically. Updated classification criteria have been recently derived from a large international study. Key pathophysiologic cellular processes are being elucidated, increasing our understanding of potential targets of therapy. Therapies that target cells, such as activated T cells, and proinflammatory cytokines, such as tumor necrosis factor alpha (TNFalpha), are rational to pursue. Outcome measures have been "borrowed" from rheumatoid arthritis and psoriasis studies. A variety of domains are assessed including joints, skin, enthesium, dactylitis, spine, function, quality of life, and imaging assessment of disease activity and damage. The performance qualities of outcome measures in these various domains is being evaluated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), and improved measures are being developed and validated specifically for psoriatic arthritis. Traditional therapies for psoriatic arthritis have included nonsteroidal anti-inflammatory agents, oral immunomodulatory drugs, topical creams, and light therapy. These therapies have been helpful in controlling both musculoskeletal and dermatologic aspects of the disease, but they may not be fully effective in all disease domains, may eventually show diminished benefit, and may produce treatment-limiting toxicities. In the past several years, use of biologic agents has generally yielded greater benefit across more domains, yielding significant and enduring benefits for clinical manifestations, function, and quality of life, and especially with the anti-TNF agents, inhibition of structural damage. Adverse effects with these agents can be significant but are usually manageable. Cost is also significant, but cost-effectiveness analysis is demonstrating reasonable trade-off between cost and benefit.
16787214 A review of current knowledge of the complement system and the therapeutic opportunities i 2006 The complement activation system, a key component of the innate immune system, protects the host from microorganisms such as bacteria, and other foreign threats including abnormal cells. However, it is also double-edged in that it can have negative effects in the host; excessive complement activation damages the host and can even kill in anaphylactic shock and septic shock. Regulation of the complement system is a useful strategy to control inflammatory diseases, including inflammatory arthritis. Rheumatoid arthritis is a common inflammatory disease worldwide. Many medicines are developed to control inflammation, including recently developed biological response modifiers such as anti-TNF and IL-6 agents. Nevertheless, in some patients disease remains difficult to control because of complications, side effects and tolerance of medicines. In inflammatory arthritis, including rheumatoid arthritis, there is abundant evidence implicating complement activation in humans and animal models. Therefore, anti-complement agents might be beneficial as part of clinical treatment. However, at present, there are still no applicable agents for therapeutic regulation of excessive complement activation in chronic disease. Novel agents in development might be useful as a strategy to control complement activation. Here I describe recent knowledge of the complement system in inflammatory arthritis, the recent developments in anti-complement agents and their considerable potential for the future.
20476947 Rituximab in the treatment of rheumatoid arthritis. 2007 Jan Rheumatoid arthritis is a chronic, disabling condition and the most common form of inflammatory arthritis affecting approximately 1% of the population. The outlook has improved considerably over the last decade with the recognition that better outcomes accompany early and optimal suppression of synovitis. In some patients, this can be achieved with conventional, oral disease-modifying anti-rheumatic drugs. For those with more severe disease, the introduction of biologic therapies targeting the pro-inflammatory cytokine tumor necrosis factor (TNF)-alpha has led to further, significant improvements in outcome. However, in general, these drugs are being used for long-term maintenance therapy and are associated with a very high expense that limits their availability in most healthcare economies. Furthermore, approximately a third of patients fail to achieve clinically significant responses. There is therefore a need for new, effective approaches to therapy, in particular for those patients refractory to TNF blockade. Rituximab, a B cell-depleting antibody, is the first biologic targeting B cells to be approved in the USA and Europe for the treatment of active rheumatoid arthritis in anti-TNF non-responders. This article reviews the background to this therapeutic approach and the encouraging clinical trial data to date indicating that enduring responses can be achieved in a majority of patients after a single treatment cycle comprising two rituximab infusions given 2 weeks apart.
18676065 [Cutaneous lupus induced by etanercept in rheumatoid arthritis]. 2008 Sep Therapy with anti-TNFalpha in rheumatoid arthritis may induce autoimmune disorders. Induction of autoantibodies is frequently observed, but lupus-like syndrome is rare and few cases only have been reported. We report a 41-year-old female, treated with etanercept for a rheumatoid arthritis, who developed a cutaneous lupus induced without any other organ involvement, associated with high ANA and DNA antibody titres. The skin biopsy and the histological analysis with immunofluorescence confirmed the diagnosis. The anti-TNFalpha treatment was stopped. Corticosteroids were increased and hydroxychloroquine administered because skin lesions persist after three months.
16780097 [A case of severe adult-onset Still' s disease presenting with pleuropericarditis]. 2006 May Adult-onset Still' s disease (AOSD) is an uncommon rheumatic disease characterized by high spiking fever, arthritis, an evanescent skin rash and variety of systemic symptoms, though initial onset of pleuropulmonary manifestation is relatively rare and could be responsible for a delay in diagnosis. We report a case of AOSD presenting with pleuritis with concomitant pericardial effusion. A 42-year-old Japanese man was admitted with a spiking fever of 40 degrees C, hyperleucocytosis (21.6 x 10(9)/l), and a high titer of C-reactive protein (16.84mg/dl). Chest X-ray film and computed tomography showed bilateral pleural effusion and massive pericardial effusion which both required tube drainage. Analyses of fluids revealed that both were exudative and sterile, and pleural biopsy showed nonspecific inflammation with mild fibrosis. Neither antibiotics nor antituberculosis drugs were effective. Rash, hepatosplenomegaly, polyarthritis, pharyngitis and right hypochondralgia were accompanied by serum hyperferritinemia. After exclusion of the possibility of infection, other connective tissue disease and malignancy, a diagnosis of AOSD was made. Improvement was not observed with nonsteroidal anti-inflammatory drug and corticosteroid therapy. Double filtration plasmapheresis (DFPP) following steroid pulse therapy alleviated the symptoms and the laboratory data immediately and corticosteroids could be tapered. DFPP is a safe therapeutic procedure and can be an alternative for refractory AOSD.