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ID PMID Title PublicationDate abstract
20576223 The impact of rheumatoid arthritis and treatment on patients' lives. 2010 May Rheumatoid arthritis (RA) is a chronic, debilitating disease that significantly impacts patients' quality of life and socioeconomic productivity. On a personal level, RA has a significant socioeconomic impact on patients' lives, being ranked among the highest of all chronic diseases for its effect on health-related quality of life (HRQoL), and limitations in physical function as well as increased pain and fatigue affect patients' attendance at paid work, their work performance within and outside the home, and their participation in family, social, and leisure activities. Additional paid or unpaid support, as well as increased flexibility and job modifications from employers, are often required so that patients can meet their role obligations. Disease-related reductions in work and household productivity are not just due to the physical limitations posed by RA; mental/emotional limitations also play a key role in reducing patients' HRQoL and productivity. Newer, effective treatments, such as tumor necrosis factor (TNF) inhibitors, improve the signs and symptoms of disease, inhibit progression of joint damage, and improve physical function and HRQoL. A recently available TNF inhibitor for RA, certolizumab pegol, has been shown to increase productivity outside and within the home and participation in family, social, and leisure activities as well as rapidly improve physical function, fatigue, and pain. Due to the importance of these parameters to patients, new therapies are increasingly assessed based on their ability to improve HRQoL, productivity, and participation. These extend the more traditional measures of efficacy into outcomes that are more central to patients' daily lives.
19577394 Treatment strategies in surgery for rheumatoid arthritis. 2009 Aug Rheumatoid arthritis due to the chronic inflammation of the synovial joints leads to permanent articular cartilage and bone damage. Subsequent instability and mutilation of the joint might happen, and the resulting joint pain and stiffness cause impaired function. The degree of damage is traditionally assessed by radiograph and represents a clinical tool for the evaluation of both disease progression and the effectiveness of interventional therapy. The classification of destruction is therefore done with radiograph and the assessment of the clinical picture. Depending on the radiologic stage different therapy concepts, ranging from conservative to operative, are established. It is the goal of surgery to restore motion and function in a painless joint. Surgery can be done to prevent the joint from further destruction or to replace the joint after resection. Different concepts based on radiologic findings are presented in this review.
19798027 Treatment of rheumatoid arthritis: state of the art 2009. 2009 Oct Few, if any, areas of medical therapeutics have witnessed such dramatic changes as those that have occurred in the therapy of rheumatoid arthritis (RA) during the past two decades. Improvements in clinical trials methodologies, the introduction of no fewer than nine biologic agents with distinct mechanisms of action, and the development of better strategies for the use of such agents have all contributed to the new age in RA therapeutics. Here, we review these developments and attempt to describe the current landscape of RA therapy in terms of available treatments, agreed-upon principles of RA management, as well as some important controversies in this field. Despite the great pace at which developments are moving, a treatment-free remission for patients with RA remains an elusive goal and unmet medical needs remain. The quest for better therapies for this potentially devastating disease is still as important as ever; research in this exciting area is ongoing, and it is reasonable to hope that, during the next decade, developments will lead to improved, rationally designed, targeted therapies for RA.
19232060 Developments in the clinical understanding of rheumatoid arthritis. 2009 The changes occurring in the field of rheumatoid arthritis (RA) over the past decade or two have encompassed new therapies and, in particular, a new look at the clinical characteristics of the disease in the context of therapeutic improvements. It has been shown that composite disease activity indices have special merits in following patients, that disease activity governs the evolution of joint damage, and that disability can be dissected into several components--among them disease activity and joint damage. It has also been revealed that aiming at any disease activity state other than remission (or, at worst, low disease activity) is associated with significant progression of joint destruction, that early recognition and appropriate therapy of RA are important facets of the overall strategy of optimal clinical control of the disease, and that tight control employing composite scores supports the optimization of the therapeutic approaches. Finally, with the advent of novel therapies, remission has become a reality and the treatment algorithms encompassing all of the above-mentioned aspects will allow us to achieve the rigorous aspirations of today and tomorrow.
20510232 How should rheumatoid arthritis disease activity be measured today and in the future in cl 2010 May Quantitative clinical monitoring of musculoskeletal conditions and inflammatory joint diseases is challenging. Traditional measures to assess rheumatoid arthritis (RA), such as joint assessment, laboratory, imaging, and patient self-report measures, have limitations and provide only a reflection of the underlying inflammatory process. A gold standard to define disease activity in RA does not exist and various indices of disease activity must be used. Standard quantitative monitoring with a treatment goal has been shown to be beneficial to patient outcomes in randomized clinical trials. Quantitative monitoring has also contributed to improved long-term outcomes for RA in clinical care. Challenges of the measures need to be recognized and hurdles identified that prevent quantitative monitoring in every-day clinical care concerning disease activity and beyond. These aspects are discussed in this article.
20232479 Psychological well-being in rheumatoid arthritis: a review of the literature. 2010 Jun The psychological well-being of patients with rheumatoid arthritis (RA) is an important issue, and the advent of measurement tools has led to a better understanding of the mental aspects associated with this chronic illness. Patients with RA are more likely to suffer from anxiety, depression and low self-esteem, with high levels of associated mortality and suicide. The loss of the ability to carry out daily functions owing to RA is also associated with the onset of depressive symptoms. Furthermore, the psychological effects of RA can extend to the partners, families and carers of sufferers. Conventional treatment has focused on treating the symptoms of RA and containment of disease progression, but may not necessarily address the psychological issues associated with the condition. Furthermore, patient perception of RA and of the support offered to them can cause further unnecessary psychological distress. Access to psychological support for RA patients has been shown to be inconsistent and haphazard. It is now being recognized that what is needed is a multidisciplinary team approach to treat psychological distress in RA alongside conventional treatment, involving alternative therapies tailored to the psychological needs of the patient. The benefits of treatments such as cognitive behavioural therapy, meditation and exercise are clear and these treatments should be actively encouraged, thereby enabling patients with RA to better manage the psychological burden associated with this chronic condition.
19252241 [Joint destruction and its repair in rheumatoid arthritis]. 2009 Mar It is supposed that autoaggressive T cell activation, triggered by unknown microorganisms, initiates inflammation in rheumatoid arthritis. It leads to activation of macrophages and synovial fibroblasts in the synovial tissues, which form a granulomatous pannus tissue. It becomes a platform of joint destruction activating osteoclastogenesis and release of cartilage-degrading enzymes. Biological reagents recently brought into the clinics are potently anti-rheumatic, and, in some cases, stop progression of the joint destruction and even repair the joint. It is now a realistic goal for next-generation anti-rheumatic treatments to inhibit joint destruction completely.
20441606 Which patients with rheumatoid arthritis are still working? 2010 In the light of improved and costly treatment for rheumatoid arthritis (RA), the evaluation of work disability has gained increased attention. The assumption that better treatment of RA leads to increased work participation has not yet been supported by sufficient evidence. Differences in RA-related work disability have been observed between countries, also indicating an influence of non-disease-related macroeconomic factors. Work disability results from a complex interaction between a clinical disease, sociodemographic variables, macroeconomic conditions, and personal factors. Some of these factors are modifiable, while others are not.
19962617 Laboratory tests to assess patients with rheumatoid arthritis: advantages and limitations. 2009 Nov Laboratory tests provide the most definitive information for diagnosing and managing many diseases, and most patients look to laboratory tests as the most important information from a medical visit. Most patients who have rheumatoid arthritis (RA) have a positive test for rheumatoid factor and anticyclic citrullinated peptide (anti-CCP) antibodies, as well as an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). More than 30% 40% of patients with RA, however, have negative tests for rheumatoid factor or anti-CCP antibodies or a normal ESR or CRP. More than 30% of patients with RA, however, have negative tests for rheumatoid factor or anti-CCP antibodies, and 40% have a normal ESR or CRP. These observations indicate that, although they can be helpful to monitor certain patients, laboratory measures cannot serve as a gold standard for diagnosis and management in all individual patients with RA or any rheumatic disease. Physicians and patients would benefit from an improved understanding of the limitations of laboratory tests in diagnosis and management of patients with RA.
20651747 The changing face of rheumatoid arthritis: sustained remission for all? 2010 Aug Earlier diagnosis and treatment, plus biological therapies, have transformed the outlook for many patients with rheumatoid arthritis. In the future, new biomarkers for diagnosis, prognosis and therapeutic response will further improve outcomes. Additionally, preclinical diagnosis and tolerogenic therapies could provide sustained remission for some individuals, although ethical and societal challenges must also be addressed before rheumatoid arthritis becomes 'yesterday's disease'.
19509329 Practical aspects of therapeutic intervention in rheumatoid arthritis. 2009 Jun With the availability of more effective treatments for the management of rheumatoid arthritis (RA), patients look to their rheumatologist to guide their decision-making. The challenge for rheumatologists is to effectively communicate the risks and benefits related to the many options that are currently available for patients with RA. Physicians must be aware of patient preferences regarding the administration and dosing of their RA medications to help guide their treatment decisions.
20164773 Cardiovascular disease in rheumatoid arthritis: a step forward. 2010 May PURPOSE OF REVIEW: The present review highlights the recent findings on cardiovascular disease in rheumatoid arthritis (RA), and outlines the current concepts and prospects of cardiovascular disease detection and management in RA. RECENT FINDINGS: Over the past year the knowledge of cardiovascular disease in RA has been augmented by a number of studies further explicating the interplay between RA and cardiovascular risk factors and highlighting the impact of inflammatory measures, immune mediators and other markers as early determinants of cardiovascular disease in RA. Other studies reported potential beneficial effects on cardiovascular outcomes for some antirheumatic medications. SUMMARY: Knowledge of the increased burden of cardiovascular disease in RA is substantial and is continuously growing. Early detection, control and management of cardiovascular disease in RA appear to be a rapidly advancing field of research. However, much more work is needed to develop effective interventions to reduce cardiovascular morbidity and mortality in RA patients. More studies are needed to identify specific biomarkers for cardiovascular disease in RA and to develop cardiovascular risk scoring tools and evidence-based algorithms to promote more effective cardiovascular prevention and management of cardiovascular disease in RA.
21050958 Emerging trends in diagnosis and treatment of rheumatoid arthritis. 2010 Dec Rheumatoid arthritis is an inflammatory disease of the joints causing pain and stiffness, pathologically characterized by chronic synovitis. Without proper treatment, it progresses to cause joint deformity that results in significant loss of function. Extra-articular disease can also occur, which exacerbates morbidity and mortality associated with the disease. Patients from all age groups can acquire the disease, hence the additional categories of juvenile onset and elderly onset rheumatoid arthritis. Disease-modifying antirheumatic drugs are the mainstay of therapy, and should be initiated as early as possible in the course of the disease in consultation with a rheumatologist.
21199462 Citrullinated peptide and its relevance to rheumatoid arthritis: an update. 2010 Oct Citrullinated peptides in autoimmune diseases have been extensively studied in the last two decades. It is suggested that citrullination and the anti-citrullinated peptide antibodies (ACPA) plays a critical role in initiating inflammatory responses in autoimmune diseases, such as rheumatoid arthritis (RA). The most commonly accepted molecular mechanism for citrullinated peptides/proteins in RA is that the modified antigen resulting from cell damage or uncontrolled apoptosis could evoke an immune response leading to autoantibodies against these peptide or the whole protein. Citrullination of arginine is catalyzed by the enzyme peptidylarginine-deiminase (PAD) in the presence of calcium, changing the positively charged arginine to a polar but neutral citrulline. These citrullinated peptides/proteins and the relevant antibodies (ACPA) are important, not only in initiation of RA, but also in the diagnosis of the disease. In this evidence-based clinical review, we summarize recently published data on peptide citrullination and ACPA gauging the ability of anti-cyclic citrullinated peptide (anti-CCP) antibodies for diagnosis of RA. We also recapitulate results of studies elucidating the mechanism underlying the disease.
19636334 Prognostic factors in rheumatoid arthritis in the era of biologic agents. 2009 Sep The management of patients with rheumatoid arthritis (RA) has changed dramatically in recent years, largely because of the unrivaled efficacy of biologic agents in ameliorating clinical disease activity and in preventing joint damage; however, the use of biologic agents is associated with medical risks and socioeconomic costs. Guidance is, therefore, needed to identify those patients who might benefit most from this intensive treatment approach--and to identify those individuals who can be spared the potential adverse effects of such treatment without risking disease progression. As reviewed here, a variety of serological, clinical, immunological, radiological, and genetic markers have been proposed to predict clinical outcome in RA. These markers can all be determined without difficulty; however, with the notable exception of the genetic markers and erosions, these parameters are for the most part indicative of inflammatory disease activity and, therefore, subject to variation. As tight control of disease activity dissociates the prognostic markers from the clinical course, these predictive parameters should be assessed at baseline for every patient and used to guide individualized treatment strategies.
19962628 A Standard Protocol to Evaluate Rheumatoid Arthritis (SPERA) for efficient capture of esse 2009 Nov An efficient, uniform procedure to collect essential data for patients who have rheumatoid arthritis (RA) using a two- to four-page patient questionnaire and a three-page form for health professionals is known as a Standard Protocol to Assess Rheumatoid Arthritis (SPERA). The two- to four-page patient questionnaire may be a health assessment questionnaire (HAQ), multidimensional HAQ (MDHAQ), or variant, including a four-page format used in the Questionnaire in Standard Care of Patients with Rheumatoid Arthritis (QUEST-RA) program. On each page, the three-page form for health professionals addresses (1) clinical features of RA; (2) medications taken currently, and major disease-modifying antirheumatic drugs (DMARDs) taken previously; and (3) a 42-joint count, with joints assessed for four variables: swelling, tenderness, deformity/limited motion, and surgeries, and an entry for no abnormality. A radiographic scoring sheet may be included for a comprehensive baseline database. The 15 to 20 minutes needed to complete the SPERA generally produces efficiency over time in standard clinical care and does not preclude collection of additional information for clinical research or clinical care. The SPERA is presented as an example of a possible approach to develop a uniform common format for collecting core data in usual clinical care.
19233049 Drug management of early rheumatoid arthritis - 2008. 2009 Feb Modern therapy of rheumatoid arthritis (RA) is based on recognition of the severity of the natural history of disease, with early and aggressive treatment strategies. Methotrexate is the anchor drug, with addition of other disease-modifying anti-rheumatic drugs (DMARDs) in combinations, and biological targeted therapies. The approach emphasizes 'tight control', aiming for remission and low disease activity according to quantitative monitoring. In this chapter, we review selected randomized controlled studies for data concerning early versus delayed therapies. We present a historical perspective for the treatment of early RA using early RA cohorts from Finland as an example. Finally, we discuss principles of contemporary treatment of early RA in 2008.
18395771 Lipid profiles in patients with rheumatoid arthritis: mechanisms and the impact of treatme 2009 Apr OBJECTIVE: To describe the impact of rheumatoid arthritis (RA), and its treatment, on lipoprotein levels with potential implications for atherosclerosis. METHODS: A PubMed literature search was undertaken for studies published between 1990 and May 2007, using the search terms "rheumatoid arthritis" AND "lipid" OR "lipoprotein," and including all relevant drug treatment terms for glucocorticoids, disease-modifying antirheumatic drugs, and biologics. RESULTS: Patients with RA face an increased risk of developing premature cardiovascular disease and limited ability to modify risk factors, eg, through exercise. RA is associated with an abnormal lipoprotein pattern, principally low levels of high density lipoprotein (HDL) cholesterol. Most treatments for RA tend to improve the atherogenic index (total/HDL cholesterol ratio), with more evidence for biologics in this regard. The improvement in the lipoprotein profile in RA appears to be associated with suppression of inflammation. CONCLUSIONS: Lipid levels should be monitored and managed in patients with RA to minimize the long-term risk of cardiovascular disease. More research is needed to quantify the relationship between systemic inflammation and lipoprotein levels and to determine the impact of specific lipoprotein particles, eg, small dense low-density lipoprotein and subfractions of HDL on long-term risk. Control of inflammation may have an effect on modifying cardiovascular risk.
19583560 Monitoring response to therapy in rheumatoid arthritis - perspectives from the clinic. 2009 The major objectives in treating patients with rheumatoid arthritis are managing the symptoms of disease and preserving joint structure, with the ultimate goal of disease remission. Several independent studies have shown that treatment decisions driven by quantitative rather than subjective monitoring of disease activity result in significantly improved patient outcomes. Various assessment tools are available that measure both clinical and patient-reported outcomes. While some measurement tools may be more appropriate for use in clinical trials, several have been developed that are simple and practical to use, even in a busy clinic. As pivotal members of the multidisciplinary rheumatology healthcare provider team, the nurse and the rheumatologist play key roles in managing a patient's progress by closely monitoring their response to treatment. Here, we discuss optimal disease management founded on a multidisciplinary approach and provide an overview of some key measures for assessing patient response to treatment.
19233044 Current concepts in the pathogenesis of early rheumatoid arthritis. 2009 Feb Rheumatoid arthritis (RA) is a systemic inflammatory disease with a predilection for symmetrically distributed diarthroidal joints. It is clinically heterogeneous, with particular disease phenotypes defined according to a complex interplay of genes and the environment. In this chapter we first summarize current knowledge of RA genetic susceptibility, a field which has been transformed in recent years by powerful modern genotyping technologies. The importance of a recently described subclassification for the disease based upon the presence or absence of circulating autoantibodies to citrullinated peptides has further informed genetic studies, and we consider the implications for our understanding of RA pathogenesis. We then review the cellular and molecular processes that initiate and perpetuate joint destruction.