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ID PMID Title PublicationDate abstract
20954304 [The clinical picture of rheumatoid arthritis--the complex of three independent mechanisms 2009 The assumption of inflamation as the only cause of the complex clinical picture of rheumatoid atrhritis does not correspond to facts. We have found and proven the existence of three seemingly unconnected mechanisms, and only their combination can account for the general clinical picture of rheumatoid arthritis. They are: 1. immunologic synovitis, responsible for pain, swelling and stiffnes; 2. oncological process ("tumorlike proliferation"), responsible for the destruction of joints; 3. Primary necrotizing process, responsible for the (sometimes lethal) destructions in the heart and blood vessels.
19730266 Dietary fish and fish oil and the risk of rheumatoid arthritis. 2009 Nov BACKGROUND: Intake of fish oil and oily fish has been reported to improve clinical symptoms in people who have rheumatoid arthritis. Whether the intake of oily fish and fish oil might also protect against the development of rheumatoid arthritis is not known. OBJECTIVE: We investigated the association between intake of oily fish and fish oil supplements and the risk of rheumatoid arthritis in a population-based case-control study. METHODS: The study comprised 1889 incident cases of rheumatoid arthritis and 2145 randomly selected controls recruited from a geographically defined area of Sweden during 1996-2005. Data on the consumption of oily fish and fish oil supplements 5 years preceding enrollment had been obtained through a questionnaire. We calculated odds ratios (ORs) for the development of rheumatoid arthritis, using logistic regression to adjust for age, residential area, body mass index, smoking, and alcohol consumption. RESULTS: Compared with subjects who never or seldom consumed oily fish, the OR for developing rheumatoid arthritis was 0.8 (95% confidence interval = 0.6-1.0) for subjects who consumed oily fish 1-7 times a week. The results did not change notably when stratifying the cases for rheumatoid factor or for antibodies to citrullinated peptide antigens. Similar results were seen for subjects consuming oily fish 1-3 times a month. Cases and controls did not differ in their consumption of fish oil supplements. CONCLUSION: Intake of oily fish was associated with a modestly decreased risk of developing rheumatoid arthritis.
18697184 Rheumatoid arthritis patients' knowledge of the disease and its treatments: a descriptive 2009 Mar OBJECTIVE: The purpose of rheumatoid arthritis (RA) patient education is to increase patients' knowledge levels. However, there are only a limited number of studies available concerning these patients' knowledge of their disease and its various treatments. The purpose of this study was to describe RA patients' understanding of their disease and its treatments. METHODS: A total of 252 RA patients participated in this survey in August 2004 (response rate 53.2%). The knowledge levels of the patients and their physical functioning were measured using self-reported questionnaires. The data were analysed using descriptive and non-parametric statistical methods. RESULTS: RA patients' knowledge of the disease and its treatments was, on average, good. However, the total scores of the Patient Knowledge Questionnaire ranged from 2 to 29 (maximum score 30). The patients knew well the aetiology and symptoms of RA, the blood tests and the physical exercise; they knew moderately well the facts relating to joint protection, energy conservation and how to use anti-rheumatic drugs and non-steroidal anti-inflammatory drugs. Young patients, women and patients with a long disease duration knew the most. There was a weak correlation between patient knowledge and physical functioning: the weaker the patient's functioning, the higher the knowledge level. CONCLUSIONS: RA patients' knowledge of their disease and its treatments varied from poor to good in this group. These results can be used for advancing RA patient education. However, more research is needed to evaluate RA patients' knowledge levels.
19293540 Circulating hepcidin in the crossroads of anemia and inflammation associated with rheumato 2009 OBJECTIVE: To investigate the role of circulating hepcidin, which is a homeostatic regulator of iron metabolism and a mediator of inflammation, in anemia associated with rheumatoid arthritis. METHODS: Forty patients with rheumatoid arthritis (19 with anemia and 21 without anemia), 12 patients with iron deficiency anemia and 14 healthy adults were studied. Serum hepcidin levels were analyzed with hepcidin prohormone solid phase enzyme-linked immunosorbent assay. RESULTS: The mean serum hepcidin levels were significantly higher in patients with rheumatoid arthritis with anemia compared to healthy adults and those with iron deficiency anemia. The active rheumatoid arthritis group had significantly higher mean serum hepcidin levels than the inactive rheumatoid arthritis group. In the rheumatoid arthritis group, serum hepcidin levels were positively correlated with disease activity, but inversely correlated with hemoglobin levels. The serum hepcidin level was found to be a significant predictor for hemoglobin level. CONCLUSION: Serum hepcidin levels are closely associated with disease activity in rheumatoid arthritis patients and might play a role in the pathobiology of chronic disease anemia associated with rheumatoid arthritis.
19708298 [The biopsychosocial model of adjustment of the rheumatoid arthritis as chronic illness]. 2009 Jun Through biopsychosocial model, empirical research about rheumatoid arthritis highlights the interdependence among psychological factors (cognitive, behavioural and emotional ones), psychopatological outcomes (measured as anxiety and depression), physical outcomes (showed by self-reported pain and disability) and physiological ones (measured by activation of immune and neuroendocrine system indexes) to originate psychological and physical adjustment to illness.
20732643 Pharmacotherapy: concepts of pathogenesis and emerging treatments. Optimising the strategy 2010 Aug In rheumatoid arthritis (RA), early use of disease-modifying anti-rheumatic drugs (DMARDs), intensive follow-up and 'treating to target' to achieve low disease activity produce significant improvements in measures of disease activity, functional impairment and retard erosive radiographic progression. Step-up, parallel and step-down regimens are all significantly more effective than sequential monotherapy; although the most effective regimen has not been established. Minimising the period of exposure to synovitis, by including a rapidly acting agent (e.g., corticosteroids or tumour necrosis factor alpha (TNFalpha) inhibitor), may slow radiographic progression further. Biologic therapies, especially TNFalpha inhibitors, are effective in early RA; however, their exact role is unclear. Current measures may overestimate the number of patients in clinical remission; therefore, musculoskeletal ultrasound and/or novel biomarkers may also have a role. Pre-clinical immunological markers could possibly be used to trigger pre-emptive treatment in asymptomatic, 'at risk' individuals. Potential treatment developments include combining biologic agents or targeting alternative immunological pathways.
21040005 Predictors of disability in Taiwanese patients with rheumatoid arthritis. 2010 Nov AIM: The purpose of this study was to explore predictors of disability in patients with rheumatoid arthritis in Taiwan. BACKGROUND: Rheumatoid arthritis is a chronic inflammatory disease affecting mainly the joints. However, little information is currently available on the disability of Asian patients with rheumatoid arthritis. DESIGN: Cross-sectional survey. METHOD: Patients (150) were recruited by convenience sampling from those regularly visiting rheumatologic outpatient clinics at three teaching hospitals and a medical centre in northern Taiwan. Data were collected on demographic and disease-related characteristics, depressive tendency, pain and disability using a basic patient-information form, the Center for Epidemiological Survey Depression Scale, Chinese version of the Brief Pain Inventory-short form and the Chinese version of the Health Assessment Questionnaire, respectively. RESULTS: Our sample had moderate pain severity (Mean = 4.32, SD 1.68) and pain disturbance (Mean = 3.49, SD 2.15). The mean disability score was 0.61 (SD 0.66), representing mild disability. Regression analysis revealed that patients' disability was significantly predicted by disease stage (stage IV, III, or II), depressive tendency, duration of disease and education level (primary school), explaining 79.2% of the total variance in disability. CONCLUSION: The results of this study not only provide clinicians with predictive information of disability from rheumatoid arthritis, but also help them take suitable action on patients' depressive status according to their disability condition. RELEVANCE TO CLINICAL PRACTICE: The controllable predictor of disability in this study was depressive tendency. Thus, the authors recommend that clinicians regularly screen patients with rheumatoid arthritis for depressive tendency and teach self-care methods to minimise depressive symptoms.
19243466 Fatigue in patients with rheumatoid arthritis: British and Dutch nurses' knowledge, attitu 2009 Apr AIM: This paper is a report of a study conducted to compare the knowledge, attitudes and current management of rheumatoid arthritis-related fatigue in British and Dutch rheumatology nurses. BACKGROUND: After pain, fatigue is the most important symptom for patients with rheumatoid arthritis, but little is known about the current management of this fatigue by healthcare professionals. METHODS: A questionnaire was mailed in 2007 to rheumatology nurses who were members of British Health Professionals in Rheumatology (N = 267) and the Dutch Society of Rheumatology Nurses (N = 227). Descriptive statistics, independent samples t-test and Pearson chi-square tests were used for statistical analysis. RESULTS: A total of 494 nurses returned questionnaires (response rate 48%). In general, their knowledge about rheumatoid arthritis fatigue was in accordance with the literature and all indicated a positive attitude towards assessing and managing rheumatoid arthritis-related fatigue. However, respondents reported contradictory views about managing fatigue. Although they believed that other team members could help patients, they seldom referred patients on to other professionals. Although nurses believed that other advice besides pacing and balance between activity and rest might help, they did not offer this to patients. Despite acknowledging that there is poor communication about fatigue between patients and nurses, respondents reported that it is patients rather than nurses who raise the issue of fatigue in consultations. CONCLUSION: British and Dutch rheumatology nurses are sympathetic but do not know how to manage rheumatoid arthritis-related fatigue. Strategies to support self-management for this fatigue, and to increase communication between healthcare professionals and patients, should be initiated to help improve patient outcomes for rheumatoid arthritis-related fatigue.
20521221 Cationic liposome formulations for RNAi-based validation of therapeutic targets in rheumat 2010 Jun Several molecules have been identified as critical mediators of chronic inflammation in immune system-mediated disorders such as rheumatoid arthritis (RA), and biological therapies targeting these molecules have been developed during the past two decades. Compared with conventional therapies, anti-TNF biotherapies have greatly improved the treatment of patients with RA, and several biological agents with distinct mechanisms of action are under development. Despite significant advances in this field, unmet medical needs remain. RA is the prototype disease for the evaluation of targeted therapies, and various novel genes have been described as being critically involved in disease pathogenesis. Thus, a novel area of research has recently emerged in the field of RA therapy, involving the genetic screening and validation of novel candidates in vivo using RNAi. Among the vehicles for the efficient targeting of macrophages, which play a critical role in disease chronicity, cationic liposomes represent the most promising option for the safe and specific use of RNAi in vivo. This review discusses the role of cationic liposomes as a mechanism for the systemic administration of siRNAs in the validation of RA therapeutic targets.
20236448 Is IgG galactosylation the relevant factor for pregnancy-induced remission of rheumatoid a 2010 During pregnancy, most patients with rheumatoid arthritis (RA) experience spontaneous improvement of their disease activity. Among the soluble candidates that have been investigated in search for the most relevant disease-remitting factor are the galactosylation levels of immunoglobulin G (IgG). In RA, a higher percentage of IgG lacking the terminal galactose residues, thought to play a pro-inflammatory role, is found. During pregnancy, however, IgG galactosylation levels increase and correlate with improved disease activity. The question remains whether the increase in IgG galactosylation during pregnancy is a mere epiphenomenon or a true remission-inducing factor.
20192927 Extra-articular manifestations of seronegative and seropositive rheumatoid arthritis. 2010 Feb Although considered a "joint disease," rheumatoid arthritis is associated with the involvement of extra-articular manifestations. The aim of the study is the investigation and comparison of frequency and type of extra-articular manifestations in a well defined community based cohort of patients with seropositive and seronegative rheumatoid arthritis. Using the ACR (1987) criteria for rheumatoid arthritis, patients have been classified into the 2nd and 3rd functional class (ARA). The studied group consisted of 125 seronegative patients with titters lower than 1:64 as defined by Rose-Waaler test, whereas the control group consisted of 125 seropositive patients with titters of 1:64 or higher. All patients were between 25-60 years of age (Xb=49,96), with disease duration between 1-27 years (Xb=6,41). In order to present the findings of the study, the structure, prevalence, arithmetic mean (Xb), standard deviation (SB), variation quotient (QV%) and variation interval (Rmax-Rmin) have been used. Probability level has been expressed by p<0,01 and p<0,05. Correlation between the number of extra-articular manifestations and duration of the disease has been calculated by means of Pearson linear correlation. Higher presence of diffuse lung fibrosis, central and peripheral nervous system damages have been confirmed in the seropositive group, and osteoporosis in the seronegative; however, no statistical difference has been found. In extra-articular manifestations, "rheumatoid core" in the seropositive subset (chi2=4,80, p<0,05) presented significant statistical difference. Rheumatoid nodules were more frequent in seropositive subset (12%:16%), in both sexes; however, they were not of significant statistical difference. Neuropathy and lung diseases were also frequently present in seropositive group, but no statistical difference has been found regarding the statistical difference. Longer duration of the disease resulted in an increase of the number of extra-articular manifestations. Calculated linear correlation by Pearson, resulted as positive and high correlation in total (r=0,36, p<0,01), and for groups [(r=0,52, p<0,01) seronegative, (r=0,25, p<0,01) seropositive], nevertheless no significant statistical difference was found regarding the sero-status. In conclusion, extra-articular manifestations are more frequent in the seropositive patients. The longer the duration of the disease the larger the number of extra-articular manifestations. Differences with regard to sero-status and sex, with some exceptions, are not observed.
19833415 [Current treatment of rheumatoid arthritis]. 2009 Dec Over the past 10 years, the management of rheumatoid arthritis has been revolutionized. Early diagnosis is essential and should allow an early initiation of disease modifying anti-rheumatic drugs (DMARD), if possible within the first 3 three months after disease onset, aiming at disease remission and the best long-term prognosis. Recommendations for the prescription of synthetic and biologic DMARD (mainly anti-TNFalpha agents) are available since September 2007 [6] by HAS in France. The great efficacy of these drugs has been established from many clinical trials including tens of thousands of patients. However, severe adverse side effects may occur (allergy, tuberculosis, opportunistic infections, demyelination) and rheumatologists should remain vigilant. Global care of the patient includes prescription of pharmacologic and non-pharmacologic treatments (education, physical treatment, ergotherapy, psychotherapy, surgery). A good coordination between all specialists is required. Screening and treatment of extra-articular manifestations, prevention of infections, osteoporosis and cardiovascular complications are essential to allow a better long-term prognosis, and reduce disability and mortality of rheumatoid arthritis.
19760426 [Interstitial lung disease]. 2009 Oct Vasculitis and connective tissue disease are often associated with interstitial lung disease. Involvement of lung parenchyma is found in small vessel vasculitis and mostly in ANCA-associated forms such as Wegener's granulomatosis. In addition to vasculitis and connective tissue disease, rheumatoid arthritis can lead to interstitial lung disease and lung fibrosis. Diagnostic tools include measurement of auto-antibodies, lung function test, chest X-rays and computed tomography of the thorax, as well as bronchoscopy with biopsy and bronchoalveolar lavage. The following article provides an overview of the clinical, histological and radiologic patterns of interstitial lung disease in vasculitis, rheumatoid arthritis and connective tissue disease. Treatment options will also be discussed.
19903325 Immunocytokines: the long awaited therapeutic magic bullet in rheumatoid arthritis? 2009 Modulatory cytokines such as IL-4 and IL-10 looked promising biologicals, but suffered from poor exposure at the inflamed joints when administered via the patient-friendly subcutaneous route. Immunocytokines have now been engineered with tissue targeting potential and are a possible solution to this problem, although challenges still exist. Local inflammatory processes cause destruction of extracellular matrix (ECM) components, leading to neo-eptitopes, and/or elicit the synthesis of new ECM components. This makes ECM elements interesting targets for antibody-mediated recognition and retention, to achieve higher levels of immunocytokines at the site of therapeutic interference. The study presented by Schwager and colleagues shows that targeted delivery of IL-10 is more efficacious in experimental arthritis. Clinical studies are warranted to show whether this strategy works for all rheumatoid arthritis patients or is better for subgroups with a defined ECM phenotype. In principle, the scFv-targeting system is plastic enough to allow for personalized strategies.
20503061 Pulmonary involvement in early rheumatoid arthritis patients. 2011 Feb Pulmonary involvement in rheumatoid arthritis (RA) is common and can be due to the disease itself as well as to the therapies used to treat it. The purpose of this study was to disclose the pulmonary involvement in early RA patients not more than 2 years disease duration using the computed tomography (CT) as well as the pulmonary function tests as ways of pulmonary involvement assessment. Forty patients aged 37.6 ± 10.3 with early rheumatoid arthritis not more than 2 years of disease duration were recruited for the study. All patients were assessed clinically for their RA with DAS28, which was utilized for disease activity determination. Ten percent of our patients were found to be clinically involved by interstitial lung disease (ILD), where 27% have abnormal HRCT finding and 32.5% with abnormal PFT. Predilection for clinically manifest ILD was evident in active RA patients with high DAS28 score, seropositive RA patients, and in patients receiving steroids and anti-TNFα therapy. ILD occurs early in the course of RA, with more predilection for clinically active RA disease.
19252242 [Recent topics in histopathology associated with joint destruction in rheumatoid arthritis 2009 Mar Histopahological features of rheumatoid arthritis, beginning from synovitis through deteriorating cartilage and bone to joint destruction has basically unchanged since the old days. On the other hand many inflammatory factors initiating, sustaining and/or activating inflammation such as cytokines and proteolytic enzymes, were successively detected, and followed by genetic analysis using animal models such as transgenic and knockout methods. Newly developed therapies by biological products remarkably have influenced the inflammatory these factors and genes, and seemed to modify the histopathological features. This article refers the histopathlogical features of RA in topics such as places involved in early stage, and the cellular origin, especially about the fibroblast like cells (FLS) which have been paid attention recently as key cells presenting immunological, histiocytic and fibroblastic properties, furthermore, participating the bone destruction in part as well as osteoclast in RA. We also introduce the several animal models of RA applied by many researchers for therapeutic and genetic analyses in RA.
20843808 BRAF drives synovial fibroblast transformation in rheumatoid arthritis. 2010 Nov 5 Synovial fibroblasts destroy articular cartilage and bone in rheumatoid arthritis, but the mechanism of fibroblast transformation remains elusive. Because gain-of-function mutations of BRAF can transform fibroblasts, we examined BRAF in rheumatoid synovial fibroblasts. The strong gain-of-function mutation, V600R, of BRAF found in melanomas and other cancers was identified in first passage synovial fibroblasts from two of nine rheumatoid arthritis patients and confirmed by restriction site mapping. BRAF-specific siRNA inhibited proliferation of synovial fibroblasts with V600R mutations. A BRAF aberrant splice variant with an intact kinase domain and partial loss of the N-terminal autoinhibitory domain was identified in fibroblasts from an additional patient, and fibroblast proliferation was inhibited by BRAF-specific siRNA. Our finding is the first to establish mechanisms for fibroblast transformation responsible for destruction of articular cartilage and bone in rheumatoid arthritis and establishes a new target for therapeutic intervention.
21145775 Ghrelin gene polymorphisms in rheumatoid arthritis. 2011 Jul OBJECTIVES: Ghrelin, an endogenous orexigenic peptide, has anti-inflammatory effects, down-regulates pro-inflammatory cytokines, and its altered levels are reported in various inflammatory diseases. The human preproghrelin (ghrelin/obestatin) gene shows several single nucleotide polymorphisms (SNPs) including Arg51Gln, Leu72Met, Gln90Leu, and A-501C. The aim of this study was to investigate the frequency, and clinical significance, of these four SNPs in a small cohort of Turkish patients with rheumatoid arthritis (RA). METHODS: The study included 103 patients with RA and 103 healthy controls. In the RA group, disease activity and disease-related damage were assessed using the Disease Activity Score-28 (DAS-28), and the modified Larsen scoring (MLS) methods. In all the participants, genomic DNA was isolated and genotyped by polymerase chain reaction and restriction fragment length polymorphism analysis. RESULTS: The frequencies of ghrelin gene SNPs were 82.5 and 79.6% in the RA and control groups, respectively, and there were no significant differences in terms of genotype distributions and allele frequencies for these four SNPs between the groups. However, the A-501C SNP was found to be associated with early disease onset, and Gln90Leu SNP with less frequent rheumatoid factor positivity, in the RA group. CONCLUSION: A-501C SNP is associated with earlier onset of RA suggesting that genetic variations in the ghrelin gene may have an impact on RA.
20470960 The complications encountered with the rheumatoid surgical foot and ankle. 2010 Apr Rheumatoid arthritis (RA) is a chronic, degenerative, systemic disease that leads to the destruction of articular cartilage of the joints. Complications, including infection, delays in wound healing, malunion, nonunion, implant failure, and degeneration of adjacent joints soon after primary fusion, have been described in the literature and are generally accepted as commonplace in reconstructive surgeries of the foot and ankle. The combined efforts of the surgeon and supporting physicians to maintain optimal health for the patient, along with the principles discussed in this article, can lead to superior outcomes with fewer complications in the postoperative course.
19527206 Anti-citrullinated peptide antibody: death of the rheumatoid factor? 2009 Jun 15 Early diagnosis and treatment of rheumatoid arthritis (RA) is necessary to prevent joint damage and long-term disability. High rates of false-negative and false-positive results of the rheumatoid factor (RF) test make it generally unhelpful in the early diagnosis of RA. A new clinical test for RA--the anti-citrullinated peptide antibody (ACPA) test--is now widely available in Australia. Owing to its high specificity (95%), a positive ACPA test result usually confirms a diagnosis of RA in a patient with undifferentiated inflammatory arthritis. The superior specificity of the ACPA test provides an argument for it to replace the RF test in the primary care setting. Performing both tests adds little to the use of the ACPA test alone. An early diagnostic opinion from a rheumatologist is still recommended, as the ACPA and RF tests frequently return negative results in early RA.