Browse

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

ID PMID Title PublicationDate abstract
19918045 Systematic review and metaanalysis of patient self-report versus trained assessor joint co 2009 Dec OBJECTIVE: Patient self-report outcomes and physician-performed joint counts are important measures of disease activity and treatment response. This metaanalysis examines the degree of concordance in joint counts between trained assessors and patients with rheumatoid arthritis (RA). METHODS: Studies eligible for inclusion met the following criteria: English language; compared patient with trained assessor joint counts; peer-reviewed; and RA diagnosis determined by board-certified or board-eligible specialist or met 1987 American College of Rheumatology criteria. We searched PubMed and Embase to identify articles between 1966 and January 1, 2008. We compared measures of correlation between patients and assessors for either tender/painful or swollen joint counts. We used metaanalysis methods to calculate summary correlation estimates. RESULTS: We retrieved 462 articles and 18 were included. Self-report joint counts were obtained by a text and/or mannequin (picture) format. The summary estimates for the Pearson correlation coefficients for tender joint counts were 0.61 (0.47 lower, 0.75 upper) and for swollen joint counts 0.44 (0.15, 0.73). Summary results for the Spearman correlation coefficients were 0.60 (0.30, 0.90) for tender joint counts and 0.54 (0.35, 0.73) for swollen joint counts. CONCLUSION: A self-report tender joint count has moderate to marked correlation with those performed by a trained assessor. In contrast, swollen joint counts demonstrate lower levels of correlation. Future research should explore whether integrating self-report tender joint counts into routine care can improve efficiency and quality of care, while directly involving patients in assessment of RA disease activity.
19716239 Does rheumatoid arthritis represent an adaptive, thrifty condition? 2010 Jan The present article presents epidemiological, and comparative evidence supporting the hypothesis that rheumatoid arthritis (RA) may represent a thrifty adaptation selected to compel animals to minimize voluntary energy expenditure. The autoimmune, pathophysiological manifestations underlying RA are framed here as constituting an evolved, protective mechanism that would have influenced animals to avoid exertion and maintain a sedentary lifestyle in order to minimize metabolic output and ultimately escape starvation. Arthritic pain is characterized here as a defensive, innate signal much like fatigue, fever, nausea and reflexive pain, and like these, is seen on a continuum varying between imperceptible encumbrance and debilitating disability. The epigenetic relationship between acute psychological stress and flare-up of arthritic symptoms is examined and taken to suggest that arthritis may be a predictive, adaptive response to severe stress allowing reductions in metabolism to follow adverse conditions or nutritional scarcity. The close associations between rheumatoid arthritis and the metabolic syndrome are also explored along with potential ties to the "thrifty genotype" and "thrifty phenotype" phenomena. This hypothesis is examined in the contexts of evolutionary medicine, phenotypic plasticity, the stress response and the bioenergetics of thrift. A brief and exploratory review of pertinent evidence suggests that RA, its subclinical manifestations, and even other forms of arthropathy may possibly represent adaptations that promoted metabolic thrift during our evolutionary past.
19608975 Atherosclerosis in rheumatoid arthritis versus diabetes: a comparative study. 2009 Oct OBJECTIVE: The extent to which atherosclerosis is accelerated in chronic inflammatory diseases is not established. We compared preclinical atherosclerosis in rheumatoid arthritis with diabetes mellitus, a known coronary heart disease equivalent. METHODS AND RESULTS: Endothelial function, arterial stiffness, carotid intima-media thickness, and analysis of atheromatous plaques were examined in 84 rheumatoid arthritis patients without cardiovascular disease versus healthy controls matched for age, sex, and traditional cardiovascular disease risk factors, as well as in 48 diabetes patients matched for age, sex, and disease duration with 48 rheumatoid arthritis patients. Rheumatoid arthritis duration associated with arterial stiffening, whereas disease activity associated with carotid plaque vulnerability. All markers of preclinical atherosclerosis were significantly worse in rheumatoid arthritis compared to controls, whereas they did not differ in comparison to diabetes despite a worse cardiovascular risk factor profile in diabetics. Both diseases were associated independently with increased intima-media thickness; rheumatoid arthritis, but not diabetes, was independently associated with endothelial dysfunction. CONCLUSIONS: Preclinical atherosclerosis appears to be of equal frequency and severity in rheumatoid arthritis and diabetes of similar duration with differential impact of traditional risk factors and systemic inflammation. Cardiovascular disease risk factors in rheumatoid arthritis may need to be targeted as aggressively as in diabetes.
18728049 Sensitivity and specificity of the American College of Rheumatology 1987 criteria for the 2009 Jul OBJECTIVE: To evaluate the ability of the widely used ACR set of criteria (both list and tree format) to diagnose RA compared with expert opinion according to disease duration. METHODS: A systematic literature review was conducted in PubMed and Embase databases. All articles reporting the prevalence of RA according to ACR criteria and expert opinion in cohorts of early (<1 year duration) or established (>1 year) arthritis were analysed to calculate the sensitivity and specificity of ACR 1987 criteria against the "gold standard" (expert opinion). A meta-analysis using a summary receiver operating characteristic (SROC) curve was performed and pooled sensitivity and specificity were calculated with confidence intervals. RESULTS: Of 138 publications initially identified, 19 were analysable (total 7438 patients, 3883 RA). In early arthritis, pooled sensitivity and specificity of the ACR set of criteria were 77% (68% to 84%) and 77% (68% to 84%) in the list format versus 80% (72% to 88%) and 33% (24% to 43%) in the tree format. In established arthritis, sensitivity and specificity were respectively 79% (71% to 85%) and 90% (84% to 94%) versus 80% (71% to 85%) and 93% (86% to 97%). The SROC meta-analysis confirmed the statistically significant differences, suggesting that diagnostic performances of ACR list criteria are better in established arthritis. CONCLUSION: The specificity of ACR 1987 criteria in early RA is low, and these criteria should not be used as diagnostic tools. Sensitivity and specificity in established RA are higher, which reflects their use as classification criteria gold standard.
19962621 RAPID3, an index to assess and monitor patients with rheumatoid arthritis, without formal 2009 Nov RAPID3 (routine assessment of patient index data 3) is a pooled index of the 3 patient-reported American College of Rheumatology rheumatoid arthritis (RA) Core Data Set measures: function, pain, and patient global estimate of status. Each of the 3 individual measures is scored 0 to 10, for a total of 30. Disease severity may be classified on the basis of RAPID3 scores: >12 = high; 6.1-12 = moderate; 3.1-6 = low; < or =3 = remission. RAPID3 scores are correlated with the disease activity score 28 (DAS28) and clinical disease activity index (CDAI) in clinical trials and clinical care, and are comparable to these indices in capacity to distinguish active from control treatments in clinical trials. RAPID3 on a multidimensional health assessment questionnaire (MDHAQ) is scored in 5 to 10 seconds, versus 90 to 94 seconds for a formal 28-joint count, 108 seconds for a CDAI, and 114 seconds for a DAS28. An MDHAQ can be completed by each patient at each visit in the waiting room in 5 to 10 minutes, as a component of the infrastructure of routine care, with minimal effort of the rheumatologist and staff, to provide RAPID3 scores as well as additional data including a self-report joint count, fatigue, review of systems, and recent medical history. In all rheumatic diseases RAPID3 is able to provide a baseline quantitative value, and to quantitatively monitor and document improvement or worsening over time.
21139361 [Case report of rheumatoid arthritis associated with type A gastritis and Hashimoto thyroi 2010 Dec A 59-year-old woman was initially thought to have either type A gastritis, or autoimmune gastritis by upper-gastrointestinal-tract endoscopy and a serological examination. Furthermore, the patient was also suspected to have Hashimoto disease based on a positive antithyroid-antibody test. Rheumatoid arthritis was diagnosed 1 year later. Pernicious anemia, gastric-carcinoid and stomach cancer are the primary complications of A type gastritis. However, we hypothesized that the development of other autoimmune diseases, such as autoimmune thyroid disease, was the primary complication experienced in this case. Therefore, we report the findings of this case while taking into consideration the findings of several other previously published studies.
20726456 Rheumatoid arthritis: assessing disease activity and outcome. 2010 Jun The range of treatments for rheumatoid arthritis (RA) has increased significantly in recent years, with a parallel improvement in patient outcome. The development and assessment of new therapies and therapeutic strategies relies on the availability of valid and reliable outcome measures to assess the diverse impact of RA on the patient's life. This paper reviews the outcome measures in current use which assess disease activity, joint damage, physical function and health-related quality of life. Some measures have been combined into composite indices which are useful for summarising the patient's current condition and as primary outcome measures for clinical trials. There is still a need for better and more relevant tools especially for imaging multiple joints and for assessing fatigue.
20872596 The 2010 American College of Rheumatology/European League Against Rheumatism classificatio 2010 Sep OBJECTIVE: The American College of Rheumatology and the European League Against Rheumatism have developed new classification criteria for rheumatoid arthritis (RA). The aim of Phase 2 of the development process was to achieve expert consensus on the clinical and laboratory variables that should contribute to the final criteria set. METHODS: Twenty-four expert RA clinicians (12 from Europe and 12 from North America) participated in Phase 2. A consensus-based decision analysis approach was used to identify factors (and their relative weights) that influence the probability of "developing RA," complemented by data from the Phase 1 study. Patient case scenarios were used to identify and reach consensus on factors important in determining the probability of RA development. Decision analytic software was used to derive the relative weights for each of the factors and their categories, using choice-based conjoint analysis. RESULTS: The expert panel agreed that the new classification criteria should be applied to individuals with undifferentiated inflammatory arthritis in whom at least 1 joint is deemed by an expert assessor to be swollen, indicating definite synovitis. In this clinical setting, they identified 4 additional criteria as being important: number of joints involved and site of involvement, serologic abnormality, acute-phase response, and duration of symptoms in the involved joints. These criteria were consistent with those identified in the Phase 1 data-driven approach. CONCLUSION: The consensus-based, decision analysis approach used in Phase 2 complemented the Phase 1 efforts. The 4 criteria and their relative weights form the basis of the final criteria set.
20966495 [Mechanisms involved in the regulation of immune response in animal model of rheumatoid ar 2010 Aug 4 Rheumatoid arthritis (RA) represents an example of the autoimmune disease. With a prevalence of 1% worldwide, the pathogenesis of RA is not clear yet. At present it is thought that the pathogenesis of RA results from an inflammatory response mediated by CD4+ Th1 cells that recognize unidentified antigens present in bone joints. Recently, there is a growing evidence for a role for Th17 lymphocytes in autoimmunity, including RA, suggesting that this population of helper cells may be more important in the pathogenesis of RA than Th1 cells. Thus far, treatment modalities for RA are limited, with the prevailing one acting nonspecifically on the immune system. However, such an approach results in a general immunosuppression and is accompanied by severe side-effects. There is a large demand for developing RA therapy that particularly targets pathogenic antigen-specific T cells. Research on pathogenesis of the autoimmune diseases, and development of new drugs is now possible thanks to experimental animal models that mimic human diseases. Collagen-induced arthritis (CIA) in genetically susceptible strains of mice, rats, rabbits or rhesus monkeys has been used as an experimental model of RA, as it shares many histological and immunological features. The knowledge gained using this model allows to better understand the pathogenesis of RA and, consequently, to manipulate particular components of the immune system to develop efficient therapies.
19962614 A biopsychosocial model to complement a biomedical model: patient questionnaire data and s 2009 Nov Modern medical care is based largely on a paradigm known as a "biomedical model," in which a single "gold standard" high-technology test guides clinical care. Patients with hypertension, diabetes, osteoporosis, and many other conditions often are unaware of their status in the absence of data from "objective" tests. By contrast, in rheumatoid arthritis (RA) and most rheumatic diseases, patients generally are aware of symptoms, and information from patients often is as or more important to taking direct clinical decisions than laboratory tests, imaging studies, or even physical examination data. Physical function on a patient self-report questionnaire generally is as significant as, or more significant than laboratory, imaging, or physical examination data in predicting severe outcomes of RA, such as work disability, costs, and mortality. Patient questionnaires may be viewed as contributing to a complementary "biopsychosocial model" that can overcome limitations of the traditional "biomedical model" in RA and other chronic diseases. Further relevance of a "biopsychosocial model" in RA and other rheumatic diseases is seen in evidence that socioeconomic status, most easily assessed as formal education level, identifies favorable or unfavorable clinical status and prognosis at high levels of significance. Socioeconomic status may be regarded as a surrogate for the importance of patient actions, in addition to actions of health professionals, in the course and outcomes of rheumatic and other chronic diseases.
18665324 The validity and reliability of the Turkish version of the Rheumatoid and Arthritis Outcom 2009 Jan The goal of our study was to develop a Turkish version of the Rheumatoid and Arthritis Outcome Score (RAOS) in patients with rheumatoid arthritis (RA) and to assess its reliability, validity, and sensitivity to change. The Turkish version of RAOS was developed according to cross-cultural guidelines by using the "translation-back translation" method. Fifty-eight patients with RA were assessed with it. To assess its validity, patients were also evaluated with Turkish versions of the Health Assessment Questionnaire, five subscales of Arthritis Impact Measurement Scales, and the Rheumatoid Arthritis Quality of Life questionnaire. Test-retest reliability of the RAOS questionnaire was calculated on 58 patients within 1 week. Construct validity was investigated with use of Spearman's rank correlation coefficient. Test-retest reliability was assessed with use of the intraclass correlation coefficient (ICC) and Cronbach's alpha score. Sensitivity to change after the 4-week home-based exercise program was evaluated with paired t test comparisons. The Turkish version of the RAOS met set criteria of reliability and validity. The random ICC for the five subscales ranged from 0.76 to 0.94. Interitem correlation measured by Cronbach's alpha ranged from 0.81 to 0.94. Correlations were found between RAOS subscales and all of the evaluation parameters (p < 0.01). RAOS subscales showed significant improvements after the 4-week home exercise program except for the symptom and quality of life subscales (p < 0.05). The effect sizes were ranged from 0.20 to 0.37 and were considered small. The results of this study showed that the Turkish version of RAOS was reliable, valid, and responsive in patients with rheumatoid arthritis.
21365949 [Psychologic stress and its predictors in rheumatoid arthritis]. 2010 This article presents the current conceptualization of stress with particular attention focused on psychologic stress in rheumatic diseases: its sources, pathophysiology, and techniques of coping. Predictors, i.e., factors heralding psychologic stress in a patient with rheumatoid arthritis (RA) are discussed in relation to the mechanism of the "vicious circle" as well as to the socio-economic and medico-psychologic context in which the patient functions. The author's results from a comparative Polish-German study on predictors of psychologic stress in RA patients are provided.
19604437 Increased lipid levels but unchanged atherogenic index in rheumatoid arthritis patients tr 2009 May BACKGROUND: Cardiovascular disease (CVD) is a major cause of increased mortality in rheumatoid arthritis (RA) patients, and it is recommended to treat risk factors for CVD in RA patients aggressively, including increased lipid levels. However, the effect of biological disease modifying antirheumatic drugs (DMARD) on the lipid profile of RA patients remains under-researched, and what data exist are often contradictory. OBJECTIVES: To review available data published to date on lipid profile changes in RA patients treated with biologic DMARDs. METHODS: We searched the PubMed database without time limits until January 31, 2008 for original clinical trials regarding the effect of biological DMARDs on the lipid profiles of RA patients, tabulating total cholesterol, LDL, HDL and atherogenic index (ratio of total cholesterol to HDL) data for RA patients treated with biologic DMARDs. Percent change values from baseline to end of study were calculated. RESULTS: Eighteen studies fulfilled our inclusion criteria. The total cholesterol levels of patients treated with biological DMARDs was reported to increase in eleven studies (mean change 14.8%). One study reported a decrease (change 4.07%), and six reported no significant change. In HDL levels, nine studies reported increases (mean change 13.1%), two reported decreases (mean change 8.69%) and six reported no significant changes. Five studies reported an increase in LDL levels (mean change 11.2%), no studies reported a decrease, and six studies reported no significant change. The atherogenic index was reported to increase in two studies (mean change 4.27%), decrease in two studies (mean change 7.26%), and not significantly change in nine studies. Only a third of the reviewed articles reported on the LDL/HDL ratio, but of those that did, two reported an increase (mean change 4.55%), one reported a decrease (change 8.03%), and three reported no significant changes. DISCUSSION: Our data suggest increases in lipid levels between baseline and end of study in clinical trials of RA patients treated with biologic DMARDs. However, the clinical implications of this finding with regard to cardiovascular outcomes are not clear in part due to the fact that in most of the studies the atherogenic index was not significantly changed from baseline to end of study. Those studies that do provide data on effects on cholesterol rarely provide information on the complete lipid profile.
19327222 Ultrasound imaging for the rheumatologist XIX. Imaging modalities in rheumatoid arthritis. 2009 Jan The field of inflammatory arthritis owes much to the advances in imaging technology which have enlightened not only clinical specialists but also researchers worldwide. The most exciting developments in recent decades have centred upon rheumatoid arthritis (RA) and more specifically the ultrasound (US) and magnetic resonance imaging (MRI) findings at various stages of the natural history of this condition. Investigation of RA using the standard techniques of plain radiography (x-ray) and more sophisticated computerised tomography (CT) have now been superseded by the exponential growth of use of US and MRI and this has been born out by the profusion of scientific papers published on these subjects.This paper aims to review the array of imaging modalities available as investigative tools to the rheumatologist when presented with various clinical scenarios by patients with RA.
19671812 Testing of the OMERACT 8 draft validation criteria for a soluble biomarker reflecting stru 2009 Aug OBJECTIVE: To test the OMERACT 8 draft validation criteria for soluble biomarkers by assessing the strength of literature evidence in support of 5 candidate biomarkers. METHODS: A systematic literature search was conducted on the 5 soluble biomarkers RANKL, osteoprotegerin (OPG), matrix metalloprotease (MMP-3), urine C-telopeptide of types I and II collagen (U-CTX-I and U CTX-II), focusing on the 14 OMERACT 8 criteria. Two electronic voting exercises were conducted to address: (1) strength of evidence for each biomarker as reflecting structural damage according to each individual criterion and the importance of each individual criterion; (2) overall strength of evidence in support of each of the 5 candidate biomarkers as reflecting structural damage endpoints in rheumatoid arthritis (RA) and identification of omissions to the criteria set. RESULTS: The search identified 111 articles. The strength of evidence in support of these biomarkers reflecting structural damage was low for all biomarkers and was rated highest for U-CTX-II [score of 6.5 (numerical rating scale 0-10)]. The lowest scores for retention of specific criteria in the draft set went to criteria that refer to the importance of animal studies, correlations with other biomarkers reflecting damage, and an understanding of the metabolism of the biomarker. CONCLUSION: Evidence in support of any of the 5 tested biomarkers (MMP-3, CTX-I, CTX-II, OPG, RANKL) was inadequate to allow their substitution for radiographic endpoints in RA. Three of the criteria in the draft criteria set might not be required, but few omissions were identified.
19535279 Targeting lymphocyte activation to treat rheumatoid arthritis. 2009 Jul The introduction of targeted treatments has radically changed the management of patients with rheumatoid arthritis (RA). Abatacept is among these new treatments emerging from recent insights into joint immunopathology. Abatacept blocks the interaction between antigen-presenting cells and T-cells, thereby diminishing T-cell activation and possibly improving overall cell regulation. In RA patients, abatacept is effective in decreasing the arthritis, pain, disability, fatigue, and radiological joint damage. Abatacept provides lasting remissions or low levels of disease activity and therefore constitutes a valuable addition to the current therapeutic armamentarium for RA, which is hoped to make a full remission an attainable goal in the overall population of RA patients.
19922335 Amyloid arthropathy mimicking seronegative rheumatoid arthritis in multiple myeloma: case 2009 Dec We report two patients who suffered from symmetrical polyarthritis simulating rheumatoid arthritis. Acute phase response was almost within normal limits, and autoantibodies including rheumatoid factor were negative. Both of them were diagnosed as having amyloid arthropathy (AmyA) secondary to kappa multiple myeloma based on deposition of kappa-light chain-immunoreactive amyloid in biopsied tissue and Bence Jones protein in urine. Systemic AL amyloidosis may be important in the differential diagnosis of chronic polyarthralgia.
19441735 Periodontitis and rheumatoid arthritis: epidemiologic, clinical, and immunologic associati 2009 May THE PURPOSE OF REVIEW: Rheumatoid arthritis (RA) is a prevalent autoimmune-mediated, chronic inflammatory disorder that has been found in multiple epidemiologic studies to be associated with periodontal disease (PD). Despite the extensive epidemiologic evidence, the biologic basis of this association remains unclear. This article focuses on new insights into the potential mechanisms underlying the association between PD and RA. RECENT FINDINGS: Chronic periodontal and synovial inflammation share many common pathologic, cellular, and molecular features. In particular, the mechanisms involved in the destruction of the adjacent connective tissues are quite similar. Recent studies have shown anti-citrullinated protein antibodies (ACPA) that are highly specific for RA are detectable years before disease development. Emerging evidence suggests the oral pathogen porphymonas gingivalis may serve to break immune tolerance or amplify autoimmune responses to citrullinated antigens and, in turn, ultimately initiate RA in genetically susceptible persons. SUMMARY: Recognition of the association between RA and PD on both a clinical and biologic level may provide new opportunities for intervention that will modify the course of both of these prevalent chronic inflammatory disorders. Furthermore, an enhanced understanding of the early events that initiate RA may result in strategies that prevent disease-onset.
20954306 [Renal involvement in patients with rheumatoid arthritis]. 2009 In rheumatoid arthritis (RA) kidney is commonly affected organ with clinical presentation characterised by proteinuria (often nephrotic range) and microhematuria followed by chronic renal failure. This condition is well recognized as a rheumatoid nephropathy (rheumatoid glomerulonephritis), which is mediated by an immunological inflammation and by nephrotoxic effects of numerous drugs usually used in rheumatoid arthiritis treatment, such as NSAID, DMARD. In the patohistological examination various kinds of associated renal lesions could be seen. The most often are amyloidosis, glomerulonephritis, interstitial nephritis. In this study, we presented 15 patients, 10 women and 5 men, mean age of 60.2 with average rheumatoid arthritis duration of 19.4 years and signs of rheumatoid nephropathy. In all patients renal biopsy was performed with frequency of histopathological findings as follows: amyloidosis in 5 patients, IgA nephropathy in 3 patients, FSGS in 3 patients, mesangial proliferative glomerulonephritis in 3 patients, minimal change disease, pauci-immune glomerulonephritis and thin membrane disease in 1 patient. In all patients (except patient with thin membrane nephropathy) we started immunossuppresive therapy with glucocorticoids in combination with cyclophosphamide or cyclosporin or azatioprine. In conclusion, in all patients with rheumatoid arthritis, parameters of renal function should be monitored and in the case of patologic results, renal biopsy should be be performed. In the treatment of RA patients with related renal disorder, suspected causal drug should be removed from the treatment and specific immunosuppressive therapy initiated.
20426296 Rheumatoid arthritis. 2: Exploring treatment options to achieve early control and remissio 2010 Mar 16 This second in a two part unit on rheumatoid arthritis discusses its impact on patients and treatment and management options. Part 1 examined the background of the condition, signs and symptoms and diagnostic tests.