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

ID PMID Title PublicationDate abstract
17583775 Anakinra in patients with treatment-resistant adult-onset Still's disease: four case repor 2007 Dec OBJECTIVE: To determine the efficacy of the interleukin (IL)-1-receptor antagonist (IL-1RA) anakinra in patients with adult-onset Still's disease (AOSD) refractory to standard treatments such as glucocorticosteroids (GC), immunosuppressive drugs, and tumor necrosis factor (TNF)-antagonists; to verify disease remission objectively by serial cytokine measurements; and to review the current literature on anakinra for this indication. METHODS: Four patients with AOSD--2 with acute flares of the chronic form of the disease and 2 with intermittent disease--were treated with prednisolone and methotrexate. One was also treated with several other immunosuppressive drugs including etanercept and infliximab. One patient had life-threatening symptoms (toxic megacolon, pneumonitis, disseminated intravascular coagulation) despite high-dose prednisolone. Treatment with anakinra 100 mg/d subcutaneously was initiated. White blood cells (WBC), C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), liver enzymes, ferritin levels, and serum cytokines were analyzed. The current literature on the efficacy of anakinra for AOSD is reviewed. RESULTS: Patients with chronic AOSD quickly responded to anakinra treatment (1 day to 3 days). GC could be tapered. ESR, CRP, WBC, ferritin, and liver enzymes returned to normal. Serum cytokine measurements revealed moderately elevated IL-1beta levels and highly elevated IL-18 levels in active disease, which normalized with anakinra. TNF-alpha and IL-6 were moderately elevated only in the 2 patients with chronic AOSD. In the literature, 17 similar cases have been reported to date. CONCLUSIONS: Anakinra is effective in treatment-resistant and in life-threatening AOSD. IL-18 serum levels, in addition to CRP, ESR, liver enzymes, ferritin, and WBC, may be helpful in assessing disease activity and response to treatment.
18389777 [Adult onset Still's disease with normal level of serum ferritin]. 2007 Oct We present a case of an adult onset Still's disease: a 51 year old men presented with one month history of high spiking fever, asymmetric migratory polyarthritis and a previous history of pharyngitis. The diagnostic was based upon clinical criteria and laboratory findings, and necessitated the exclusion of infectious, neoplastic, and other "autoimmune" disease. The systemic involvement in our case induced us to comment therapy with corticosteroid. Patients with systemic disease have a favorable prognosis, with only rare serious complications from the disease (pericarditis, tamponade, diffuse intravascular coagulation, amyloidosis, hepatic disease, and respiratory failure) or the treatment (infections, gastrointestinal bleeding etc.).
17510873 An atypical case of Sjögren's syndrome causing unilateral severe lacrimal gland enlargeme 2007 Mar We report the first case of Sjögren's syndrome causing gross lacrimal gland swelling and secondary hypoglobus and uncharacteristically absent sicca syndrome. Histopathological diagnosis of the excision biopsy of the orbital lobe of the gland confirmed a mixed T and B cell infiltrate of the gland with no lymphomatous transformation. The condition remains quiescent following complete excision.
18751827 Perioperative management of medications used in the treatment of rheumatoid arthritis. 2006 Sep Patients with rheumatoid arthritis (RA), an inflammatory arthritis that can destroy joint structures, are often on multiple medications to control disease activity. These medications may have significant toxicities and side effects. Over the course of their lifetime, patients with this disease often require orthopedic procedures, including total joint arthroplasty, and the medications they are taking present management issues specific to the perioperative period. As many of these medications are immunosuppressive, the concern for postoperative infection and delayed wound healing are particularly worrisome. We conducted a review of the available literature pertaining to the perioperative use of the most commonly prescribed medications for RA. Although the existing data directly addressing perioperative complications in orthopedic surgery is sparse, information on relevant complications resulting from the general use of these drugs may be used as a basis for conservative recommendations.
17987293 Role of power Doppler sonography in evaluation of therapeutic response of the knee in juve 2008 Apr The objective is to study the role of power Doppler sonography (PDS) in assessment of therapeutic response in juvenile rheumatoid arthritis (JRA) of knee joint. Thirty patients (age range 3-11 years) of JRA with knee joint involvement were selected for this study. Clinical assessment and ultrasound was done on the same day and repeated at the end of second and sixth month of therapy. All patients received naproxen (15-20 mg/kg/day) for a period of 6 months. Total clinical score (TCS) was calculated as sum of scores of pain, articular swelling and functional impairment. PDS was performed and degree of vascularity was assessed and graded. Total USG score was obtained by adding sum of scores of synovial effusion, synovial thickening and PDS. Results were compared between the total clinical score and the total ultrasound score and between clinical groups at baseline, end of second month and end of sixth month. There were statistically significant differences between clinical and ultrasound indices and confirmed that PDS is more sensitive in detection and follow-up of clinically silent cases of JRA. PDS holds great promise for detection of active synovial inflammatory disease in sub-clinical cases of JRA and is useful in objective assessment of therapeutic response.
18646168 Custom-made foot orthoses for the treatment of foot pain. 2008 Jul 16 BACKGROUND: Custom foot orthoses are commonly recommended for the treatment of foot pain. OBJECTIVES: To evaluate the effectiveness of custom foot orthoses for different types of foot pain. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), CINAHL (from January 1982) and the Physiotherapy Evidence Database (PEDro) (to June 2007). We also contacted authors of included trials and known researchers in the field and checked the reference lists of included trials to identify trials. No language or publication restrictions were applied. SELECTION CRITERIA: Randomised controlled trials and controlled clinical trials evaluating custom-made foot orthoses for any type of foot pain. Outcomes included quantifiable levels of foot pain, function, disability, health-related quality of life, participant satisfaction, adverse effects and compliance. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, rated methodological quality and cross checked data extraction. Data were analysed separately for different diagnoses of foot pain and follow-up time points. MAIN RESULTS: Eleven trials involving 1332 participants were included: five trials evaluated custom-made foot orthoses for plantar fasciitis (691 participants); three for foot pain in rheumatoid arthritis (231 participants); and one each for foot pain in pes cavus (154 participants), hallux valgus (209 participants) and juvenile idiopathic arthritis (JIA) (47 participants). Comparisons to custom-made foot orthoses included sham orthoses; no intervention; standardised interventions given to all participants; non-custom (prefabricated) foot orthoses; combined manipulation, mobilisation or stretching; night splints; and surgery. Follow up ranged from one week to three years. Custom-made foot orthoses were effective for painful pes cavus (NNTB:5), rearfoot pain in rheumatoid arthritis (NNTB:4), foot pain in JIA (NNTB:3) and painful hallux valgus (NNTB:6); however, surgery was even more effective for hallux valgus and non-custom foot orthoses appeared just as effective for JIA but the analysis may have lacked sufficient power to detect a difference in effect. It is unclear if custom-made foot orthoses were effective for plantar fasciitis or metatarsophalangeal joint pain in rheumatoid arthritis. Custom-made foot orthoses were a safe intervention in all studies. AUTHORS' CONCLUSIONS: There is limited evidence on which to base clinical decisions regarding the prescription of custom-made foot orthoses for the treatment of foot pain. Currently, there is gold level evidence for painful pes cavus and silver level evidence for foot pain in JIA, rheumatoid arthritis, plantar fasciitis and hallux valgus.
18304610 Assessing the impact of psoriatic arthritis on patient function and quality of life: lesso 2009 Feb OBJECTIVES: To identify and describe measures that can be used to assess the impact of psoriatic arthritis (PsA) on patient functioning and health-related quality of life (HRQOL). METHODS: A literature search of the PubMed database to identify papers describing assessment tools for quality of life and function in rheumatic diseases. RESULTS: Many tools have been developed that can be used to assess the impact of rheumatic disease on patient functioning and HRQOL. Although several disease-specific tools have been developed for rheumatoid arthritis, ankylosing spondylitis, and psoriasis, few have been developed specifically for PsA, a condition that affects both skin and joints. However, several have been adopted from their use in other conditions and used in clinical trials, such as the Health Assessment Questionnaire and Short Form 36 and have shown good performance characteristics. The Psoriatic Arthritis Quality of Life questionnaire, a recently developed disease-specific instrument, has good internal consistency, validity, and reliability. Initiatives are underway by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis to evaluate Psoriatic Arthritis Quality of Life responsiveness to treatment in clinical trials, in addition to other projects intended to improve the assessment of quality of life and function in PsA. These efforts are influenced by "lessons learned" from assessment tools in rheumatoid arthritis, ankylosing spondylitis, and psoriasis. CONCLUSIONS: Assessing the impact of PsA and its treatment on patient function and quality of life is critical to improving patient outcomes, and therefore, valid and reliable tools that can be easily used in both clinical trials and clinical practice are being developed and refined.
18751844 Combination therapy for rheumatoid arthritis in the era of biologicals. 2006 Feb Early, aggressive disease management is critical for halting disease progression and joint destruction in patients with rheumatoid arthritis. Combination therapy with at least two disease-modifying antirheumatic drugs, such as methotrexate (MTX), sulfasalazine, or hydroxychloroquine, is often more effective than monotherapy in reducing disease activity. Biologic therapies represent more effective and tolerable treatment options that, when combined with MTX, have been shown to dramatically reduce inflammation, inhibit radiographic progression, and induce remission. Although several types of treatment strategies are used in clinical practice, the most aggressive approaches that target early disease have shown the most promise in reversing disease progression and reducing disease-related costs.
21063334 Neurophysiologic evaluation of the temporomandibular joint and related masticatory muscles 2008 Jul OBJECTIVES: To study the effect of rheumatoid arthritis (RA) on the temporomandibular joints (TMJ) and related muscles using CT scan and neurophysiologic tests. METHODS: Forty-two RA patients referred from the Maxillofacial Clinic at the Special Surgeries Hospital, Medical City, Baghdad, Iraq from February 2006 to September 2006 were included in this study. Thirty-seven of them underwent CT scan of the TMJ and 25 of these patients were neurophysiologically examined. The data were compared to 30 age-matched control subjects. RESULTS: Fifteen patients showed normal TMJ, whereas, abnormal TMJ on CT scan was present in 22 patients. Of these 22 patients, 6 showed decrease in the intra-articular space, 6 exhibited erosion of the condylar head, and 3 had flattening of the condylar head. The remaining 7 patients had all the abnormalities present. Electromyography (EMG) examination showed reduced interference pattern, poor recruitment of motor unit potentials, shift of the power spectra to the lower frequencies, low mean power frequency, and root mean square values, and prolonged blink reflex component latencies. CONCLUSION: Rheumatoid arthritis patients with positive CT scan findings have poorer neurophysiologic data than those without CT scan detectable lesions. Trigeminal motor neuropathy is suggested to be the cause of the masticatory muscle weakness. Root mean square voltage as a parameter of the EMG power spectra is of great value in diagnosing such weakness.
18466453 A Bayesian latent class analysis for whole-genome association analyses: an illustration us 2007 Although rheumatoid arthritis, a chronic and inflammatory disease affecting numerous adults, has a complex genetic component involving the human leukocyte antigen region, additional genomic regions most likely affects susceptibility. Whole-genome scans may assist in identifying these additional candidate regions, but a large number of false-positives are likely to occur using traditional statistical methods. Therefore, novel statistical approaches are needed. Here, we used a single replicate from the Genetic Analysis Workshop 15 simulated data to assess for marker-disease associations in 1500 rheumatoid arthritis cases and 2000 controls on chromosome 6. The statistical methods included a maximum-likelihood estimation approach and a novel Bayesian latent class analysis. The Bayesian analysis "borrows strength" from multiple loci to estimate association parameters and can incorporate differences across loci in the prior probability of association. Because of this, we hypothesized that the Bayesian analysis might be better able to detect true associations while minimizing false positives. The Bayesian posterior means for the log alleleic odds ratios were less variable than the maximum likelihood estimates, but the posterior probabilities were not as good as the simple p-values in distinguishing a signal from a non-signal. Overall, Bayesian latent class analyses provided no obvious improvement over maximum-likelihood estimation. However, our results may not be able to be generalized due to the large effect simulated in the human leukocyte antigen-DR locus.
17067442 Are carriers for MEFV mutations "healthy"? 2006 Sep OBJECTIVE: We aimed to compare whether carriers for the MEFV mutations display an increase or decrease in certain features. We compared the frequency of a number of inflammatory symptoms and diseases in carriers and a control population. METHODS: A questionnaire was designed to be applied to parents of children with FMF and a control group of parents. Clinical features and some diseases including the frequency of febrile episodes, abdominal pain, arthralgia, prophylaxis with penicillin, acute rheumatic fever, rheumatoid arthritis, vasculitis, spondyloarthropathy, urinary tract infection, asthma, allergy, irritable bowel disease, appendectomy and tonsillectomy were inquired. 676 parents of 440 children with FMF were surveyed in this study. Controls (n: 774) were selected as parents of healthy children. RESULTS: The presence of febrile episodes more than four per year, arthralgia, past diagnosis for acute rheumatic fever, rheumatoid arthritis and prophylaxis of penicillin, acute rheumatic fever, and rheumatoid arthritis were significantly higher in asymptomatic parents for the MEFV mutations compared to controls. The frequency of allergy was found to be significantly lower in the asymptomatic parents as compared to controls. There was no significant difference at the frequency of urinary tract infection and tonsillectomy between the parents of the patents and controls. CONCLUSIONS: We suggest that one MEFV mutation may indeed be conferring a heightened inflammation as suggested by the increased frequency in inflammatory symptoms. The carrier status for MEFV mutations seem to be unique, in that they cause an alteration in the state of "health".
19046446 Aseptic meningitis in a patient taking etanercept for rheumatoid arthritis: a case report. 2008 Dec 1 BACKGROUND: We report a case of a 53 year old lady recently commenced on etanercept, an anti-TNF (tumour necrosis factor) therapy for rheumatoid arthritis presenting with confusion, pyrexia and an erythematous rash. CASE PRESENTATION: A lumbar puncture was highly suggestive of bacterial meningitis, but CSF cultures produced no growth, and polymerase chain reactions (PCR) for all previously reported bacterial, fungal and viral causes of meningitis were negative. CONCLUSION: This case report describes aseptic meningitis as a previously unreported complication of etanercept therapy, and serves as a reminder of the rare but potentially life-threatening risk of serious infections in patients taking anti-TNF therapy for a variety of conditions.
18466600 Novel approach for genome scan meta-analysis of rheumatoid arthritis: a kernel-based estim 2007 Genome scan meta-analysis (GSMA) can prove very useful in detecting genetic effects too small to be detected in an individual linkage study and can also lead to more consistent results. In this paper, we propose a new kernel-based estimation procedure for GSMA. Instead of estimating identity by descent between markers, as performed in interval mapping approaches, we estimated directly the nonparametric linkage score between markers using a kernel procedure. The GSMA is then extended to take into account the kernel estimate of the nonparametric linkage score and its variance at a given chromosomal position. The method is applied to the rheumatoid arthritis genome scan data (Genetic Analysis Workshop 15 Problem 2).
18466450 Multilocus analysis of GAW15 NARAC chromosome 18 case-control data. 2007 The Genetic Analysis Workshop 15 rheumatoid arthritis data included a set of 460 cases and 460 controls genotyped at 2300 closely spaced markers on a 10 megabase region of chromosome 18q. We conducted a multilocus analysis of these data using a localized haplotype clustering method that adapts to linkage disequilibrium structure and can be applied to large, densely genotyped data sets such as this one. We found a protective haplotype carried by 33 individuals that was significantly associated with rheumatoid arthritis in these data after adjusting for multiple testing. This haplotype was located less than 500 base pairs upstream of the CCBE1 gene. The association was not detected using single-marker tests, but could be found using a variety of multilocus tests.
18827415 An autopsy case of Sjögren's syndrome with acute encephalomyelopathy. 2008 OBJECTIVE: This study was to clarify the neuropathological findings of acute encephalomyelopathy with Sjögren's syndrome. METHODS: We examined an autopsied case of acute encephalomyelopathy with Sjögren's syndrome. CASE REPORT: A 40-year-old woman developed acute myelopathy and brainstem dysfunction. Magnetic resonance imaging (MRI) revealed high-intensity lesions on T2-weighted axial images (T2WI) in the medulla oblongata and cervical spinal cord. We established a diagnosis of Sjögren's syndrome (SjS) according to the European Community criteria. The patient was treated with intravenous methylprednisolone (500 mg/day) for three days, followed by oral prednisolone. Although her neurological symptoms improved, her general condition deteriorated after the onset of acute colonic pseudo-obstruction and she died of multiple organ failure associated with hemophagocytosis. RESULTS: Autopsy showed atrophy of the secretory glands and an accumulation of lymphocytes around the ducts, confirming the diagnosis of Sjögren's syndrome. Neuropathological examination revealed multifocal lesions in the cervical spinal cord and medulla, along with scattered perivascular lymphocytic infiltration. In addition, there was demyelination, spongy change and axonal swelling in the white matter, but no remarkable vasculitic changes were seen in the central nervous system. CONCLUSION: Although the steroid therapy may have had a significant influence, the main pathological finding in this case was not vasculitis, but rather axonal degeneration with spongy change and axonal swelling.
18197929 Primary Sjogren's syndrome complicated by bilateral pleural effusion. 2008 Jan Sjogren's syndrome can cause many organic changes, but is rarely accompanied by pleuritis. We report a 65-year-old patient with primary Sjogren's syndrome who developed bilateral pleuritis with moderately large effusions. He was diagnosed as having Sjogren's syndrome, based on xerophthalmia, xerostomia, positive results for anti-Sjogren's syndrome (anti-SS-A/SS-B) antibodies, the Schirmer test and biopsy findings in the minor salivary glands. The pleural fluid was lymphocyte rich and contained high levels of anti-SS-A/SS-B antibodies. There was no evidence of infection, malignancy or other collagen diseases which cause pleuritis. We conclude that this case adds to the eight previously published reports of primary Sjogren's syndrome complicated by pleural effusion.
16915358 Cutaneous findings in patients with primary Sjogren's syndrome. 2007 Aug Sjogren's syndrome (SS) is an autoimmune disease that is characterized by exocrine gland involvement. It is reported that the skin is affected in nearly half of SS patients. Cutaneous manifestations consist of xerosis, angular cheilitis, eyelid dermatitis, pruritus, cutaneous vasculitis (frequently manifesting as palpable purpura), and erythema annulare. Most of them are nonspecific and less severe than the oral, ocular, or musculoskeletal symptoms. We present two patients with primary SS who have many cutaneous manifestations including erythema annulare and pernio-like lesions and review the literature about this topic.
18973662 Induction of apoptosis of human primary osteoclasts treated with extracts from the medicin 2008 Oct 30 BACKGROUND: Osteoclasts (OCs) are involved in rheumatoid arthritis and in several pathologies associated with bone loss. Recent results support the concept that some medicinal plants and derived natural products are of great interest for developing therapeutic strategies against bone disorders, including rheumatoid arthritis and osteoporosis. In this study we determined whether extracts of Emblica officinalis fruits display activity of possible interest for the treatment of rheumatoid arthritis and osteoporosis by activating programmed cell death of human primary osteoclasts. METHODS: The effects of extracts from Emblica officinalis on differentiation and survival of human primary OCs cultures obtained from peripheral blood were determined by tartrate-acid resistant acid phosphatase (TRAP)-positivity and colorimetric MTT assay. The effects of Emblica officinalis extracts on induction of OCs apoptosis were studied using TUNEL and immunocytochemical analysis of FAS receptor expression. Finally, in vitro effects of Emblica officinalis extracts on NF-kB transcription factor activity were determined by gel shift experiments. RESULTS: Extracts of Emblica officinalis were able to induce programmed cell death of mature OCs, without altering, at the concentrations employed in our study, the process of osteoclastogenesis. Emblica officinalis increased the expression levels of Fas, a critical member of the apoptotic pathway. Gel shift experiments demonstrated that Emblica officinalis extracts act by interfering with NF-kB activity, a transcription factor involved in osteoclast biology. The data obtained demonstrate that Emblica officinalis extracts selectively compete with the binding of transcription factor NF-kB to its specific target DNA sequences. This effect might explain the observed effects of Emblica officinalis on the expression levels of interleukin-6, a NF-kB specific target gene. CONCLUSION: Induction of apoptosis of osteoclasts could be an important strategy both in interfering with rheumatoid arthritis complications of the bone skeleton leading to joint destruction, and preventing and reducing osteoporosis. Accordingly, we suggest the application of Emblica officinalis extracts as an alternative tool for therapy applied to bone diseases.
17343255 Comparison of the different classification criteria sets for primary Sjögren's syndrome. 2006 Nov OBJECTIVE: To assess the comparability of different classification criteria sets for primary Sjögren's syndrome (pSS). METHODS: In a prospective study we examined all patients with suspected pSS who were admitted to our Department of Rheumatology or referred to our outpatient clinic between 1 January 2001 and 31 December 2002. The Copenhagen, Californian, 1996 European, and American-European consensus group (US-EU) criteria sets were used to assess each patient. RESULTS: Ninety out of 222 patients (41%) were diagnosed with pSS by fulfilling at least one classification criteria set. The highest number of patients who were diagnosed with pSS fulfilled the European criteria set (36%), followed by the Copenhagen (28%), the US-EU (26%), and the Californian (9%) criteria sets. On average, the group of patients fulfilling the Californian criteria set were 5.6 years older than the patients in the other three groups (p < 0.05). In addition, the disease duration before diagnosis was 2.6 years longer than in the other three groups. The groups of patients fulfilling either the Californian or the US-EU criteria sets had a higher prevalence of leucopaenia (p < 0.05). Those fulfilling the US-EU criteria set also had a higher prevalence of arthritis (p < 0.05). No significant differences were found in the prevalence of the other clinical and laboratory parameters studied. CONCLUSIONS: Different patients are diagnosed with pSS if different classification criteria sets are used. Therefore, studies based on different classification criteria sets for diagnosing pSS are not directly comparable.
16431344 A short review of the pathogenesis of Sjögren's syndrome. 2006 Feb Sjögren's syndrome can present in a heterogeneous manner with symptoms varying from systemic features such as unexplained fever, weight loss and neurological manifestations to the more typical symptoms of dry mucus membranes. There is discussion of the wide differential diagnosis, followed by a brief overview of the diagnosis, extraglandular manifestations and pathogenesis of primary Sjögren's syndrome.