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ID PMID Title PublicationDate abstract
18726549 Assistive devices: usage in patients with rheumatoid arthritis. 2009 Feb We describe the usage of various assistive devices and identify factors associated with usage in patients with rheumatoid arthritis (RA). A cross-sectional, multicentre study was performed in three outpatient rheumatology clinics in the Netherlands. Two hundred forty patients with RA participated in the study. The main measures were questionnaires and a semi-structured interview regarding the possession and usage of 21 common assistive devices in the ISO9999 categories orthopaedic footwear, personal care, mobility, household and adaptations for housing. Potential factors associated with usage included sociodemographic variables, health status, quality of life, coping strategies, self-efficacy, outcome expectations and satisfaction. Out of 240 patients, 213 (89%) had one or more assistive devices in possession (median number of devices 3.0, interquartile range 3.0). The proportions of patients never using a device in possession varied between 8% for orthopaedic insoles and 23% for grab bars. The main factors related to usage varied among categories, but common determinants were a specific impairment or disability, satisfaction with the device or related services, self-efficacy and the number of devices in possession. In conclusion, in patients with RA, possession rates are high, with 23% or less of the devices in possession being abandoned. Overall, satisfaction rates were high. Factors associated with usage varied among categories and comprised, apart from the number of devices in possession and variables related to health status, also aspects of satisfaction with the device or related services or self-efficacy. The latter findings underline the need for a systematic evaluation of the outcomes of assistive devices by prescribing health professionals or suppliers in every individual case.
19232437 Innate immunity, epigenetics and autoimmunity in rheumatoid arthritis. 2009 Nov Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by the progressive and irreversible destruction of joints. RA remains an incurable condition, although a new class of drugs, biologicals, have made a major breakthrough in targeting and/or eliminating the immune cells, including T cells, B cells and monocytes/macrophages from the joints. That we cannot (yet?) cure the disease is most likely due to the lack of therapeutic targeting the endogenously activated RA synovial fibroblasts (RASF). Most interestingly, RASF express Toll-like receptors (TLRs) 1-6 rendering them prone to activation by exogenous and endogenous TLR ligands and resulting in the production of numerous powerful chemokines and cytokines. These factors are responsible for the repopulation of immune cells in the joints after ceasing cell depleting therapies. To characterize the molecular mechanisms of synovial activation, a new approach studying the epigenetic characteristics of RASF has been recently undertaken. Thereby, the pattern of histone acetylation, DNA methylation and gene expression regulating microRNA are being explored. Since auto-antibodies have the most predictive and diagnostic value for RA, it is challenging to study more comprehensively the contribution of auto-antibodies to the disease. A new screening technique, serological analysis of recombinant human cDNA expression library (SEREX), adapted from cancer research allowed for the identification of novel auto-antibodies in RA, including anti-serpin E2 auto-antibodies. The serpin E2 auto-antibodies were found to inhibit the activity of serpin E2 and have potentially a functional role in the disease. The recent findings in the field of innate immunity, epigenetics and autoimmunity related to the pathogenesis of RA are in the scope of this review.
19454405 Repair of joint erosions in rheumatoid arthritis: prevalence and patient characteristics i 2010 Apr BACKGROUND: Joint destruction in rheumatoid arthritis (RA) was until recently seen as an irreversible state. Lately, it was found that repair of bone erosions occurs; however, little is known about its prevalence. OBJECTIVE: To investigate the frequency of repair and patients' characteristics associated with repair in an inception cohort. PATIENTS AND METHODS: 250 patients with RA, included in the Leiden Early Arthritis Clinic between 1993 and 2000 and treated with conventional disease-modifying antirheumatic drugs, were studied (mean follow-up 10.1 years). Radiographs obtained annually were scored using the Sharp-van der Heijde method, initially aware of the chronology. Patients with a negative change in erosion scores on subsequent radiographs were selected and their series of radiographs were re-scored with concealed time sequence by three readers. Repair was defined as agreement between two readers of a negative change in erosion scores that persisted for at least 2 years. RESULTS: Repair was identified in 32 joints in 18 patients (7.2%). Patients with repair had a greater prevalence of autoantibodies (rheumatoid arthritis, anti-citrullinated protein antibody) and a higher level of joint destruction. In the joints with repair, arthritis was absent in the 2 years preceding repair. CONCLUSIONS: Repair occurred in 7.2% of the patients with RA, particularly in clinically inactive joints in patients with severe destructive disease.
20212386 [US evaluation of the hands and feet in rheumatoid arthritis]. 2010 Jan Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive damage of synovial-lined joints and variable extra-articular manifestations. Synovitis is usually found in the wrist, metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints. For these reasons, we believe that ultrasound with power doppler can be used for the detection and monitoring of synovitis with a simplified "hands and feet" protocol. In this article, we will describe this protocol used daily in our institution for early diagnosis and therapeutic management of this disease.
19452494 Patients' conceptions of the cause of their rheumatoid arthritis: a qualitative study. 2009 Dec BACKGROUND: Patients' perspective of the causes and consequences of rheumatoid arthritis (RA) can conflict with that of healthcare professionals and lead to misunderstanding, difficulties in management and a poorer outcome. OBJECTIVES: The aim of this study was to describe the variation in how patients conceive the cause of their RA. METHODS: An open written question from the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study, aimed at patients recently diagnosed with RA, was answered by 38 strategically selected patients during 2003 and analysed using the phenomenographic approach. RESULTS: Two descriptive categories and six concepts emerged: the category 'consequences beyond personal control' comprised not having a clue, being exposed to climatic change, being genetically exposed and unexpected effects of events; the category 'overloaded circumstances' involved work and family-related strain. Consequences beyond personal control implied that the patients could not prevent the disease and expressed their lack of understanding as to why they contracted it. Overloaded circumstances were described as strained situations that were both work and family related and could be influenced by the patient. CONCLUSIONS: The patient's perspective of the cause of their RA includes aspects that complement the current pathogenetic models and should therefore be considered in the management of the disease. When dealing with rheumatic diseases, it is necessary to be aware of the patient's perspectives in order to new management strategies. In addition to epidemiological studies, further studies of patients' own experience are needed in order to achieve a more tailored care model.
20927572 Diagnosis of arthritis through fuzzy inference system. 2012 Jun Expert or knowledge-based systems are the most common type of AIM (artificial intelligence in medicine) system in routine clinical use. They contain medical knowledge, usually about a very specifically defined task, and are able to reason with data from individual patients to come up with reasoned conclusion. Although there are many variations, the knowledge within an expert system is typically represented in the form of a set of rules. Arthritis is a chronic disease and about three fourth of the patients are suffering from osteoarthritis and rheumatoid arthritis which are undiagnosed and the delay of detection may cause the severity of the disease at higher risk. Thus, earlier detection of arthritis and treatment of its type of arthritis and related locomotry abnormalities is of vital importance. Thus the work was aimed to design a system for the diagnosis of Arthitis using fuzzy logic controller (FLC) which is, a successful application of Zadeh's fuzzy set theory. It is a potential tool for dealing with uncertainty and imprecision. Thus, the knowledge of a doctor can be modelled using an FLC. The performance of an FLC depends on its knowledge base which consists of a data base and a rule base. It is observed that the performance of an FLC mainly depends on its rule base, and optimizing the membership function distributions stored in the data base is a fine tuning process.
20423676 New and future agents in the treatment of rheumatoid arthritis. 2010 Apr Rheumatoid arthritis (RA) is the most common inflammatory musculoskeletal disease and an important cause of diminished quality-of-life for the affected individuals and with a major impact on society because of decreased work-force participation. Treatment of RA has been advanced dramatically during the past two decades by the advent of biological therapies. A large number of such agents have been approved and several additional ones are in late-stage clinical developments. Because of the high price of biologics, pharmacoeconomical considerations have become an important part of the appraisal of such medications. Current therapeutic developments include the development of additional biologics with various specific targets, the development of small-molecule compounds with similar efficacies, and entirely new approaches to treat autoimmune inflammatory diseases such as RA.
20972600 Comparison of composite disease activity indices for rheumatoid arthritis. 2011 Apr To evaluate the composite disease activity indices for rheumatoid arthritis (RA), we compared disease activities and the changes therein calculated using the Disease Activity Score based on 28 joint counts using erythrocyte sedimentation rate (DAS28-ESR), DAS28-CRP (C-reactive protein), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) in a cohort of 1,412 patients with RA. The median (1st; 3rd quartile) scores were 4.20 (3.31; 5.14) for DAS28-ESR, 3.44 (2.59; 4.36) for DAS28-CRP, 13.6 (7.49; 21.1) for SDAI, and 12.0 (6.9; 18.9) for CDAI. Absolute scores and their changes were significantly correlated (p < 0.0001) in all combinations among these four disease activity indices; however, their correlations were lower in males than in females. Correlations between disease activity indices and the clinical and acute phase reactant variables were different according to disease activity index, sex and age. A comparison of the number of patients in each disease activity category according to the disease activity indices using kappa-statistics revealed an almost perfect agreement between SDAI and CDAI (κ = 0.871), a moderate agreement between DAS28-ESR and SDAI (κ = 0.415) or CDAI (κ = 0.427), but only fair agreement between DAS28-ESR and DAS28-CRP (κ = 0.329). For the selection of a disease activity index for an evaluation of RA patients, both the convenience and the characteristics of the respective disease activity index should be considered.
19822046 Entheseal involvement. 2009 Jul Enthesitis is a distinctive pathological feature of spondyloarthritis and may involve synovial joints, fibrocartilaginous joints, syndesmoses and extra-articular entheses. Extra-articular pain may often be present in rheumatoid arthritis patients. This review focuses on peripheral enthesitis which is a clinical hallmark of spondylarthritis, by comparing the same findings in rheumatoid arthritis.
19265537 The effects of infliximab therapy on the serum proteome of rheumatoid arthritis patients. 2009 INTRODUCTION: Although the clinical effects of infliximab therapy in rheumatoid arthritis have been documented extensively, the biological effects of this intervention continue to be defined. We sought to examine the impact of infliximab therapy on the serum proteome of rheumatoid arthritis patients by means of a mass spectrometry-based approach. METHODS: Sera from 10 patients with rheumatoid arthritis were obtained prior to and following 12 weeks of infliximab therapy using a standard clinical protocol. The sera were immunodepleted of the 12 highest abundance proteins, labeled by the iTRAQ (isobaric tagging for relative and absolute protein quantification) technique, and analyzed by mass spectrometry to identify proteomic changes associated with treatment. RESULTS: An average of 373 distinct proteins were identified per patient with greater than 95% confidence. In the 3 patients demonstrating the most robust clinical responses, changes of greater than 20% in the serum levels were observed in 39 proteins following treatment. The majority of these proteins were regulated directly or indirectly by tumour necrosis factor-alpha (TNF-alpha) and nuclear factor-kappa-B, with acute-phase proteins being uniformly down-regulated. A number of proteins, including members of the SERPIN family and S100A8, were down-regulated irrespective of clinical response. CONCLUSIONS: The present study demonstrates that a robust clinical response to infliximab is associated with the down-regulation of a spectrum of serum proteins regulated by TNF-alpha, and provides a possible basis for defining the broader biological effects of the treatment in vivo.
20603693 Development and psychometric testing of the patient-reported measure of activity performan 2010 Jul OBJECTIVE: To develop and assess the reliability and validity of a patient-reported measure of hand activity performance for persons with rheumatoid arthritis (MAP-Hand). METHODS: The development of the measure included a literature review, semi-structured interviews with 60 patients with rheumatoid arthritis, and testing of face and content validity by video-observation and classification of the initial items according to standardized methods. Further testing followed 2 surveys of 176 and 134 patients with rheumatoid arthritis and included Rasch analysis and comparing MAP-Hand scores with other measures of symptoms and functional ability. Test-retest reliability was assessed in 35 stable patients with rheumatoid arthritis. RESULTS: Most of the initial 31 items had good face and content validity. Following Rasch analysis the measure was reduced to 18 items, which had good evidence for unidimensionality, a broad range of item difficulty, good person separation and ordered thresholds in a 4-point scale. The test-retest intraclass correlation coefficient was 0.94 (95% confidence interval 0.89, 0.97), indicating high reliability. The results of validity testing generally followed the a priori hypotheses, with MAP-Hand scores having moderate to high correlations with scores for the other measures. CONCLUSION: The MAP-Hand is an 18-item patient-reported measure of hand activity performance, which showed good evidence for reliability and validity in patients with rheumatoid arthritis.
20066425 Lag time between onset of symptoms and diagnosis in Venezuelan patients with rheumatoid ar 2011 May A retrospective study in a hospital-based sample of Venezuelan patients with rheumatoid arthritis was made to estimate the lag time between onset of symptoms, diagnosis, and initiation of DMARD treatment. Medical records and in-person interview of patients to fill in a questionnaire collecting information on demographics and initiation of symptoms, first consultation with any physician, time of diagnosis, and initiation of first disease-modifying anti-rheumatic drug were reviewed. We performed descriptive statistics and multivariable linear regression analysis. Mean lag time between symptom onset and diagnosis of rheumatoid arthritis was 40.5 months (range 1-424). Mean lag time between onset of symptoms and first consultation with a physician and between first consultation and diagnosis was 16.3 and 23.9 months, respectively. Mean lag time between onset of symptoms and initiation of DMARD treatment was 56.9 months. A definitive diagnosis of rheumatoid arthritis was done by a rheumatologist in 251 patients (92.3%). First consultation with an orthopedist or a primary care physician, first consultation in a public versus a private health center, and diagnosis before 2000 were associated with longer lag time between onset of symptoms and diagnosis. Venezuelan patients with rheumatoid arthritis had a marked delay from disease onset to diagnosis and initiation of first DMARD. First consultation with an orthopedist and consultation in a public versus a private health center were the variables with the strongest effect on lag time to diagnosis and to initiation of first DMARD.
19833742 Changes over time in the diagnosis of rheumatoid arthritis in a 10-year cohort. 2009 Nov OBJECTIVE: We assessed levels of agreement between a diagnosis of rheumatoid arthritis (RA) at inclusion in a recent-onset arthritis cohort, then 2 and 10 years later. Performance of American College of Rheumatology (ACR) criteria alone or combined with rheumatologist diagnosis, and of recent new criteria adding antibodies to cyclic citrullinated peptides ("anti-CCP-revised criteria") to existing ACR criteria, was evaluated. METHODS: In total, 270 patients with recent-onset arthritis of less than 1 year duration were included between 1995 and 1997 and followed for 2 years. A diagnosis was recorded by an office-based rheumatologist (OBR) at inclusion, then 2 years later. In 2007, a questionnaire was sent to each rheumatologist to collect the final diagnosis, which was considered the reference. RESULTS: Final diagnosis was available for 164 patients: 57 had RA. Agreement was low (kappa = 0.27) between the baseline and final diagnoses, and substantial (kappa = 0.69) between the 2-year and final diagnoses. Anti-CCP-revised criteria had sensitivity of 65% to 81% and specificity of 55% to 75%. Sensitivity and specificity of ACR criteria were 57.9% (44.1%-70.9%) and 74.8% (65.5%-82.7%) at inclusion, 80.7% (70.5%-90.0%) and 63.6% (54.5%-72.7%) at 2 years. The combination OBR diagnosis/ACR criteria after 2 years showed considerably increased specificity (87% vs 64%) and slightly decreased sensitivity (77% vs 81%). CONCLUSION: ACR criteria for RA showed poor performance even at 2 years. The absence of exclusion criteria may explain the lack of specificity, which improved when combined with the OBR diagnosis. Adding anti-CCP criteria to the existing criteria could help in diagnosing RA.
20191820 Adalimumab therapy in patients with active rheumatoid arthritis. 2009 Jul AIM: To evaluate efficacy and safety of adalimumab (ADA), a monoclonal anti-TNFalpha antibody, in rheumatoid arthritis (RA). MATERIAL AND METHOD: 5 years retrospective observational study on 70 active RA (ARA 1987 modified criteria; 48 women; mean age 52.6 +/- 11.7 years; mean disease duration 6.7 +/- 3.2 years, mean DAS28 6.5 +/- 1.3) treated with ADA (classic regimen). All patients have been assessed according to a standard protocol: (i) clinical (tender and swollen joints; pain; global disease evaluation), (ii) inflammatory and (iii) immune parameters (total antinuclear and anti-double stranded DNA antibodies), (iv) activity and functional scores, (v) response to therapy (EULAR), (vi) adverse events. Evaluation was performed at baseline and every 3 months. Statistical analysis was done in SPSS-13, p < 0.05. RESULTS: Statistical significant improve in RA activity (mean final DAS28 3.6 +/- 0.8, p < 0.05), functional scores (mean HAQ 1.3 +/- 0.3, p < 0.05) and decreased X-ray progression (Sharp score) have been reported; 60% RA were responders (mean EULAR 2.7 +/- 1.2), 35.7% in remission, while switching to another biological agent (14.28% ADA failure) was done in 20% cases, clinical, biological and radiological efficacy and favorable safety profile of ADA have been demonstrated in real life long-term administration in active RA.
20810513 Evaluation of selected rheumatoid arthritis activity scores for office-based assessment. 2010 Dec OBJECTIVE: Patient-reported measures can quickly provide assessments of rheumatoid arthritis (RA) disease activity in the office setting and do not require a laboratory test or physician examination. The goal of our study was to establish the validity of patient-reported indices compared to the C-reactive protein-based Disease Activity Score (DAS28-CRP4). METHODS: Baseline and 1-year followup DAS28-CRP4 data were obtained from 740 RA subjects and were compared to indices (MDHAQ, CDAI, RAPID, RADAI, GAS) according to cyclic citrullinated peptide (CCP) status and change at 1 year. Pairwise correlations were calculated for each index. RESULTS: Among 740 subjects, mean age 57 years, disease duration 14 years, the CDAI (r = 0.84, Δ r = 0.80) and RAPID (r = 0.71, Δ r = 0.70) had the highest correlation with the DAS28-CRP4 scores at baseline and 1 year. These correlations were not influenced by CCP status, disease-modifying antirheumatic drug use, biologic use, or by disease duration. CONCLUSION: In RA, the CDAI and RAPID correlated well with the DAS28-CRP4. They may both be practical and informative in the care of patients in the office setting.
19233043 Predicting the development of RA in patients with early undifferentiated arthritis. 2009 Feb The rapidity with which bone and cartilage damage occurs in patients with rheumatoid arthritis (RA), and the increasing body of evidence for the effectiveness of early intervention in RA, mean that there is a great need for approaches to accurately predict the development of RA in patients with early undifferentiated arthritis. We will review developments in the prediction of outcome on the basis of clinical and laboratory features, including measures of anti-citrullinated protein/peptide antibody status. Although accurate predictions are possible in the majority of patients using recently developed predictive algorithms which utilize clinical and serological variables, there remains a group of patients for whom it is very difficult to predict the development of RA. The utility of new strategies for prediction will be discussed, including recently discovered genetic associations of RA, an assessment of material from the primary site of pathology (the joint), and assessment using the highly sensitive imaging modalities of ultrasound and magnetic resonance imaging.
19648801 Reliability of in-shoe plantar pressure measurements in rheumatoid arthritis patients. 2009 Mar Plantar pressures measurement is a frequently used method in rehabilitation and related research. Metric characteristics of the F-Scan system have been assessed from different standpoints and in different patients, but not its reliability in rheumatoid arthritis patients. Therefore, our objective was to assess reliability of the F-Scan plantar pressure measurement system in rheumatoid arthritis patients. Twelve rheumatoid arthritis patients were included in this study. Plantar pressures measurement was carried out in six consecutive walks and average peak pressure on seven spots analyzed for each walk. Intraclass correlation was estimated for each spot and for within-patient coefficient of variation between spots. For each spot, average within-patient coefficient of variation between walks was also calculated. Repeated measures of analysis of variance and Hotelling's T test, both with Holm correction, were used to test equality of mean measurement across patients between walks. The intraclass correlations, which were all statistically significant at P<0.0001, ranged from 0.897 to 0.999, with a mean of 0.97 for single measure and 0.99 for average measure estimates. Overall median of within-patient coefficient of variation between walks was 7%. None of the tests of equality of means showed significant differences between walks. On both feet, the highest variability of measurements was observed at midfoot, whereas all the other spots demonstrated excellent reliability. The measurement setup was found to be highly reliable and therefore suitable for clinical practice, as well as for research. If possible, taking an average of several measurements is recommended.
20519953 Migratory potential of rheumatoid arthritis synovial fibroblasts: additional perspectives. 2010 Jun 15 Cell migration is a central part of physiological and pathophysiological processes including wound healing, immune defense, matrix remodeling and organ homeostasis. Different cell types have migratory potential including cells of the immune system and cells required in wound healing and tissue repair. These cells migrate locally through the tissue to the site of damage. The fibroblast is a central cell type of wound healing. In rheumatoid arthritis (RA), activated synovial fibroblasts (SFs) have the ability to invade joint cartilage, actively contributing to joint destruction in RA. Recently, RASFs have been shown to be able to migrate to non-affected areas and joints through the blood stream and to invade distant cartilage. RASFs most likely use similar mechanisms comparable to lymphocytes and tumor cells for long-distance and vascular trans-migration. Future experiments will address the goal to keep the transformed-appearing fibroblasts in the affected joints using therapeutical strategies that inhibit the pathophysiological changes of transformed-appearing RASFs but do not interfere with the physiological processes of 'normal' fibroblasts.
21115252 Herbal medicinal products target defined biochemical and molecular mediators of inflammato 2011 Jan 1 Rheumatoid arthritis (RA) is a chronic debilitating disease characterized by synovial inflammation, damage to cartilage and bone, and deformities of the joints. Several drugs possessing anti-inflammatory and immunomodulatory properties are being used in the conventional (allopathic) system of medicine to treat RA. However, the long-term use of these drugs is associated with harmful side effects. Therefore, newer drugs with low or no toxicity for the treatment of RA are actively being sought. Interestingly, several herbs demonstrate anti-inflammatory and anti-arthritic activity. In this review, we describe the role of the major biochemical and molecular mediators in the pathogenesis of RA, and highlight the sites of action of herbal medicinal products that have anti-arthritic activity. With the rapidly increasing use of CAM products by patients with RA and other inflammation-related disorders, our review presents timely information validating the scientific rationale for the use of natural therapeutic products.
20853196 Prognostic evaluation of early rheumatoid arthritis. 2010 The progression of rheumatoid arthritis (RA) is quite variable, ranging from very mild or subclinical forms (approx. 10%) to rapidly progressing and debilitating forms (10-15%). The majority of patients present with an intermediate stage with episodes of exacerbation separated by periods of relative inactivity, which evolves to progressive functional losses. To optimise the therapeutic management of early RA it is necessary to perform periodic evaluations of the clinical and laboratory test responses to the treatment instituted, as well as the parameters indicating disease prognosis. Composite measures are frequently used to evaluate the disease activity score (DAS), including the response criteria of the American College of Rheumatology (ACR), the response criteria and the DAS according to the European League Against Rheumatism (EULAR) and the composite indices of disease activity (CIDsA): DAS, the index of disease activity based on 28 joints (DAS 28), the simplified disease activity index (SDAI) and the clinical disease activity index (CDAI). The evaluation of prognosis includes investigation of the absence or occurrence of disease and joint damage remission. Due to the multifaceted nature of RA, no single clinical or laboratory parameter is able to describe satisfactorily the level of inflammatory activity or the disease prognosis at any given time.