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ID PMID Title PublicationDate abstract
20521413 Impact of age on clinical manifestations and outcome in Puerto Ricans with rheumatoid arth 2010 Winter INTRODUCTION: Disease expression and outcomes in rheumatoid arthritis (RA) vary among different ethnic groups. There are limited data on the impact of age on disease severity and outcomes among Hispanics. Thus, we determined the demographic characteristics, clinical manifestations, comorbidities, pharmacologic profile, and functional status among Puerto Ricans with RA of different age groups. METHODS: A cross-sectional study was conducted in 214 Puerto Rican patients with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative RA manifestations, treatment profiles, disease activity (Disease Activity Score 28), comorbid conditions, and functional status (Health Assessment Questionnaire) were determined at study visit. Three age groups were studied: <40, 40-59, and > or =60 years. Data were examined using univariable and multivariable (logistic regression) analyses. RESULTS: The mean (SD) age of the study population was 56.5 (13.6) years with a mean disease duration (SD) of 10.8 (9.7) years; 180 patients (84.1%) were women. In the multivariable analyses, patients aged > or =60 years were more likely to have joint deformities, extra-articular manifestations, and comorbidities such as dyslipidemia, arterial hypertension, diabetes mellitus, vascular events, osteoarthritis, low back pain, and osteoporosis. In addition, older patients used corticosteroids more frequently. No differences were found for the use of disease-modifying anti-rheumatic drugs or biologic agents. CONCLUSIONS: Puerto Rican RA patients aged > or =60 years present a severe type of disease having more joint damage, extra-articular manifestations, and comorbidities than younger patients. These disparities must be considered when establishing effective therapy for older RA patients.
19618097 Associated factors for falls and fear of falling in Japanese patients with rheumatoid arth 2009 Nov The objective of this is to determine factors associated with falls in Japanese patients with rheumatoid arthritis (RA). Among the patients who participated in a single-institute-based prospective observational cohort study of patients with RA, namely, Institute of Rheumatology Rheumatoid Arthritis, 4,996 (male 765, female 4231, median age 60 years) responded to questions related to falls during the previous 6 months in April or May 2008. Logistic regression was used to determine the association between variables and falls. Five hundred and five (10.1%), 110 (2.2%), and 958 patients (19.2%) reported at least one fall, multiple falls, and fear of falling, respectively. Those who fell tended to report incident fractures during the same 6 months compared to those who did not (14.7% versus 1.1%, P < 0.001). In multivariate models, Japanese health assessment questionnaire (HAQ) scores (odds ratios (OR) 1.52, 2.49, and 3.88), tender joint counts (OR 1.39, 1.72, and 1.36), patient-reported visual analog scale for general health (OR 1.08, 1.16, and 1.20), and body mass index (OR 1.05, 1.08, and 1.04) were associated (P < 0.05) with at least one fall, multiple falls, and fear of falling, respectively. Other clinical variables and medications were also associated with falls and fear of falling. HAQ disability score, tender joint counts, and impaired general health appear to be associated with falls in Japanese patients with RA, as previously reported for patients of other ethnicities.
20888443 PTPN22 1858C>T polymorphism is strongly associated with rheumatoid arthritis but not with 2010 Dec PTPN22 (protein tyrosine phosphatase non-receptor type 22) 1858C>T single-nucleotide polymorphism (SNP) is one of the genetic risk factors of rheumatoid arthritis (RA). However, its role in the response of RA patients to therapy is not known. We examined a possible association of this SNP with a response of RA patients to methotrexate (MTX) treatment. RA was diagnosed in 371 patients according to the American College of Rheumatology (ACR) criteria. All 371 patients were typed for PTPN22 1858C>T SNP. Clinical data for 308 patients treated with MTX were available. Clinical improvement was evaluated according to the ACR 20% response criteria. Five hundred and forty three unrelated healthy individuals served as a control group. DNA was isolated from venous blood and 1858C>T SNP was established by polymerase chain reaction followed by restriction fragment length polymorphism using XcmI digestion. One hundred and seventy four patients responded to MTX with remission of symptoms, whereas 134 individuals were not responding. Although 78.6% of patients with 1858TT genotype responded to MTX in contrast to 49.5% and 58.1% of CT and CC genotype bearers, respectively, this difference was nonsignificant due to very low numbers of TT homozygotes in both groups of patients. We confirmed strong association of 1858T allele with RA and with a disease limited to joints, but did not observe any association with a lack of rheumatoid factor, described earlier for a smaller population sample. However, the response of RA patients to MTX treatment does not seem to depend on this SNP.
18720128 Understanding how to determine the intensity of physical activity--an interview study amon 2009 PURPOSE: The study sought to describe variation in understandings of how to determine the intensity of physical activity among individuals with rheumatoid arthritis (RA). METHOD: Nineteen individuals aged 21-82 years with RA participated in semi-structured interviews, which were recorded, transcribed verbatim and analysed using a phenomenographic approach. RESULTS: Four qualitatively different ways of understanding how to determine the intensity of physical activity were identified: a) focus on alterations of bodily features; b) focus on will-power and awareness; c) focus on type and performance of activity; and d) focus on consequences of the disease. CONCLUSIONS: The results suggest that there might be a discrepancy between health professionals and patients with RA regarding the understanding of physical activity intensity. This highlights the importance for health professionals to recognise what individuals focus most attention on when communicating 'intensity'. If necessary, health professionals should endeavour to reach a common understanding of evidence-based ways of determining physical activity intensity with each patient in order to prescribe accurately, and assess, physical activity.
20008916 Muscle quality, architecture, and activation in cachectic patients with rheumatoid arthrit 2010 Feb OBJECTIVE: To explore muscle-specific force (force per physiological cross-sectional area, or PCSA) and muscle activation in cachectic patients with rheumatoid arthritis (RA). METHODS: In 14 muscle-wasted patients with RA and age and sex matched healthy controls, vastus lateralis (VL) force and voluntary activation capacity were assessed during maximal isometric contractions with electromyography and superimposed electrical stimulations. VL PCSA was determined from ultrasound measures of fiber fascicle length (Lf), pennation angle, and volume, together with assessments of body composition by dual energy x-ray absorptiometry and objective physical function. RESULTS: Although patients with RA had reduced physical function, lower muscle mass, and VL volume relative to controls, there were no differences in muscle-specific force and activation. PCSA, force, and pennation angle tended to be lower in RA, with no differences in Lf. CONCLUSION: Muscle-specific force and activation are not compromised and thus are unlikely to contribute to reduced function in cachectic patients with RA.
20075588 A patient with rheumatoid arthritis who had a normal delivery under etanercept treatment. 2010 In recent years, biologics have been widely administered for treating rheumatoid arthritis (RA): however, the safety of these drugs has not been adequately established in embryos and fetuses. We report the case of a pregnant RA patient treated with etanercept, an anti-tumor necrosis factor (TNF) agent. She continued to receive etanercept treatment after becoming pregnant without any complications, finally giving successful birth to a baby girl at 39 weeks. This suggests that etanercept may be selected to treat RA patients with active arthritis who desire pregnancy with lower risks.
19884898 Osteoimmunology and the effects of the immune system on bone. 2009 Dec In the pathogenesis of bone destruction associated with rheumatoid arthritis, the synovium is a site of active interplay between immune and bone cells. The interaction between T cells and osteoclasts is a critical issue in the field of osteoimmunology. Accumulating evidence lends support to the theory that interleukin-17-producing T-helper cells induce the expression of receptor activator of nuclear factor kappaB ligand in synovial cells, which, together with inflammatory cytokines, stimulates the differentiation and activation of bone-resorbing osteoclasts. In addition to cellular interactions via cytokines, the immune and skeletal systems share various other molecules, including transcription factors, signaling molecules and membrane receptors. Studies of intracellular signaling mechanisms in osteoclasts have revealed that numerous immunomodulatory molecules are involved in the regulation of bone metabolism. The regulation of immune cells by bone cells is a new feature of the investigative area of osteoimmunology that implies the novel concept of the bone marrow being a crucial part of the immune system. The emerging field of osteoimmunology is important for increasing our understanding of how antirheumatic drugs (including anti-cytokine biologics) work, as well as contributing to the development of new therapeutic strategies for rheumatic diseases.
20689230 Interleukin 6 in autoimmune and inflammatory diseases: a personal memoir. 2010 In this review, the author discusses the research that led to the identification and characterization of interleukin 6 (IL-6), including his own experience isolating IL-6, and the roles this cytokine has on autoimmune and inflammatory diseases. The cDNAs encoding B-cell stimulatory factor 2 (BSF-2), interferon (IFN)-beta2 and a 26-kDa protein were independently cloned in 1986, which in turn led to the identification of each. To resolve the confusing nomenclature, these identical molecules were named IL-6. Characterization of IL-6 revealed a multifunctional cytokine that is involved in not only immune responses but also hematopoiesis, inflammation, and bone metabolism. Moreover, IL-6 makes significant contributions to such autoimmune and inflammatory diseases as rheumatoid arthritis (RA).IL-6 activates both the STAT3 and SHP2/Gab/MAPK signaling pathways via the gp130 signal transducer. F759 mice, which contain a single amino-acid substitution in gp130 (Y759F) and show enhanced STAT3 activation, spontaneously develop a RA-like arthritis as they age. F759 arthritis is dependent on CD4(+) T cells, IL-6, and IL-17A, and is enhanced by the pX gene product from human T cell leukemia virus 1 (HTLV-1). Arthritis development in these mice requires that the F759 mutation is present in nonhematopoietic cells, but not in immune cells, highlighting the important role of the interaction between nonimmune tissues and the immune system in this disease. Furthermore, this interaction is mediated by the IL-6 amplifier through STAT3 and NF-kappaB. Ultimately, this model may represent a general etiologic process underlying other autoimmune and inflammatory diseases. More importantly, the understanding of IL-6 has paved the way for new therapeutic approaches for RA and other autoimmune and inflammatory diseases.
20121289 Response to rituximab and timeframe to relapse in rheumatoid arthritis patients: associati 2010 Feb 1 OBJECTIVE: Rituximab is used to deplete B cells and control disease activity, mainly in patients with rheumatoid arthritis (RA) who have not responded to anti-tumor necrosis factor (TNF) therapy. Response rates and time to relapse vary significantly among treated individuals. The objective of this study was to monitor the response of seropositive and seronegative RA patients to rituximab and correlate relapse with B-cell markers in the two groups. METHODS: Seventeen RA patients (eight seropositive for rheumatoid factor [RF+] and nine seronegative [RF-]) were treated with two cycles of rituximab. After treatment, all patients were re-evaluated at the outpatient clinic, and rituximab was readministered when disease relapse was confirmed by clinical-laboratory measures (Disease Activity Score [DAS]-28). CD20+ cells and CD20 receptor expression levels were estimated at initiation, relapse, and re-evaluation timepoints, and were compared between the two groups. RESULTS: Seropositive patients responded favorably to treatment compared with the seronegative group. The mean time to relapse was 337.5 +/- 127.0 days for the RF+ patients versus 233.3 +/- 59.6 days for the RF- patients (p = 0.043), despite more aggressive concomitant treatment in the seronegative group. The DAS28 decrease 3 months after treatment was 1.695 +/- 1.076 in seropositive patients versus 0.94 +/- 1.62 in seronegative patients. At relapse, CD20 receptor expression (molecules/cell) was higher in RF+ patients than in their RF- counterparts, despite a significantly lower percentage of CD20+ cells. CONCLUSION: Rituximab treatment is efficient in both seropositive and seronegative RA. However, seropositive RA patients tend to respond favorably compared with seronegative patients. The differential CD20 receptor expression in the two groups at relapse potentially suggests a different pathogenetic mechanism of relapse and merits further investigation.
19490600 Antibody engineering to develop new antirheumatic therapies. 2009 There has been a therapeutic revolution in rheumatology over the past 15 years, characterised by a move away from oral immuno-suppressive drugs toward parenteral targeted biological therapies. The potency and relative safety of the newer agents has facilitated a more aggressive approach to treatment, with many more patients achieving disease remission. There is even a prevailing sense that disease 'cure' may be a realistic goal in the future. These developments were underpinned by an earlier revolution in molecular biology and protein engineering as well as key advances in our understanding of rheumatoid arthritis pathogenesis. This review will focus on antibody engineering as the key driver behind our current and developing range of antirheumatic treatments.
19623830 Functional and physiological effects of yoga in women with rheumatoid arthritis: a pilot s 2009 Jul CONTEXT: Stress, both psychological and physiological, has been implicated as having a role in the onset and exacerbations of rheumatoid arthritis (RA). OBJECTIVE: This study investigated whether neuroendocrine and physical function in women with RA can be altered through a yoga intervention. DESIGN: Exercise intervention. SETTING: University research conducted at a medical clinic. PARTICIPANTS: Sixteen independently living, postmenopausal women with an RA classification of I, II, or III according to the American College of Rheumatology functional classification system served as either participants or controls. INTERVENTION: The study group participated in three 75-minute yoga classes a week over a 10-week period. MAIN OUTCOME MEASURES: At baseline and on completion of the 10-week intervention, diurnal cortisol patterns and resting heart rate were measured. Balance was measured using the Berg Balance Test. Participants completed the Health Assessment Questionnaire (HIQ), a visual analog pain scale, and the Beck Depression Inventory. RESULTS: Yoga resulted in a significantly decreased HAQ disability index, decreased perception of pain and depression, and improved balance. Yoga did not result in a significant change in awakening or diurnal cortisol patterns (P = .12).
20981466 Achilles paratendonitis as the initial manifestation of rheumatoid arthritis. 2011 Apr We report a case of rheumatoid arthritis in which the earliest symptom was bilateral paratendonitis of the Achilles tendons, followed by paratendonitis of a finger extensor. A series of musculoskeletal ultrasonograms revealed a progression from paratendonitis of the extensor tendon to erosive synovitis of the adjacent metacarpophalangeal joint. High-resolution ultrasonography combined with power Doppler imaging seems to be a useful and convenient tool both for diagnosing paratendonitis early and for closely monitoring the progressing inflammation.
21036875 Comorbidity affects all domains of physical function and quality of life in patients with 2011 Feb OBJECTIVE: Comorbidities have been reported to influence physical function, but it is not clear which activities are predominantly impaired, or which other domains of health status are affected in addition to physical function. In this study, we investigated the impact of comorbidities on individual activities of daily living, and other aspects of quality of live in patients with RA. METHODS: In 380 patients with established RA, we quantified comorbidity levels according to the age-adjusted Charlson Comorbidity Index (CCI(A)) and functional disability by serial measures of the HAQ over 1 year. In a subset of 185 patients, we assessed quality of life using Short Form-36 (SF-36). To analyse the relationship between comorbidities, different activities of daily living and health status, we divided patients into four subgroups of CCI(A) and performed analysis of variance (ANOVA) and multivariable general linear regression models adjusted for gender, disease duration and disease activity. RESULTS: ANOVA showed significant (P < 0.03) increase of disability within each domain of HAQ with increasing level of comorbidity. Similar results were observed using the physical component score (P = 0.003) of the SF-36 and its domains, whereas mental component score (P = 0.31) and its domains were unaffected by comorbidities. In a sub-analysis stratifying patients into different levels of disease activity, we found increase in almost all domains of HAQ within respective groups of CCI(A). CONCLUSIONS: Activities of daily living represented by HAQ are equally affected by comorbidities. More generally, health status was only affected with respect to its physical but not its mental domains.
19995754 The value of productivity: human-capital versus friction-cost method. 2010 Jan Many cost-of-illness studies have investigated the impact of rheumatoid arthritis on productivity, invariably concluding that productivity costs are high. Different methods exist to value productivity. The human-capital method takes the patient's perspective and counts any hour not worked as an hour lost. By contrast, the friction-cost method takes the employer's perspective, and only counts as lost those hours not worked until another employee takes over the patient's work. Both methods can produce widely different results. Productivity costs have the potential to compensate for the costs of expensive biological agents, but only in early-onset disease when patients still have jobs and if productivity is given full weight by using the human-capital method. If productivity is given less weight by excluding productivity costs or by using the friction-cost method, then currently, biological agents are probably too expensive.
20555356 Pharmacogenomics of infliximab treatment using peripheral blood cells of patients with rhe 2010 Dec To provide insight into the pharmacological changes in the peripheral blood (PB) molecular profile induced by tumor necrosis factor (TNF)-blockade in patients with rheumatoid arthritis (RA), blood was obtained in PAXgene tubes from 33 RA patients before and 1 month after TNF-blocking therapy (infliximab). From 15 randomly chosen patients pre- and post-treatment gene expression profiles were determined. The remaining 18 RA patients served as validation cohort. A group-based paired analysis of the gene expression profiles from the post- vs pre-treatment samples revealed a signature of genes significantly regulated by TNF-blockade. Downregulated genes reflected several biological pathways such as inflammation, angiogenesis, B- and T-cell activation. Further analysis revealed that the pharmacological response signature was significantly regulated in all treated patients, irrespective of clinical response, which is indicative for the presence of an active TNF pathway in all RA patients. The data imply that all patients carried features of TNF bioactivity irrespective of clinical response. These results favor a model for the parallel presence of TNF-dependent and TNF-independent pathways in the individual RA patient. Clinical response status to TNF-blockade may be dependent on the relative contribution of TNF-independent effector pathways.
19772797 Increased incidence of stroke and impaired prognosis after stroke among patients with sero 2009 Jul OBJECTIVE: To examine the incidence of, and outcome after, a stroke in patients with rheumatoid arthritis (RA) compared with the general population. METHODS: The northern Sweden MONICA register was used to compare the incidence of stroke in a cohort of RA patients with the general population. Forty RA patients who had also suffered a stroke were identified. For each patient with RA, three controls with a history of stroke but without RA were randomly collected from the same register, and matched for age and sex. RESULTS: The standardised incidence ratio (SIR) for stroke was 2.7 in RA patients compared with the general population (p<0.05). During the follow-up, RA patients had a higher overall case fatality (CF) following stroke compared with controls (hazard ratio (HR) =1.70, p<0.05). CONCLUSIONS: Both the incidence of a stroke, and the subsequent CF, were higher among RA patients compared with the general population. The results emphasize the necessity of optimising the prevention of stroke and follow-up care after a stroke in RA.
19520595 A comparison of patient questionnaires and composite indexes in routine care of rheumatoid 2009 Dec OBJECTIVE: To evaluate the agreement between the Routine Assessment of Patient Index Data 3 (RAPID-3) and a modified version of the Rheumatoid Arthritis Disease Activity Index (RADAI-5), as well as the Disease Activity Score including a 28 joint count (DAS28-ESR) and the Clinical Disease Activity Index (CDAI) in daily routine. METHODS: One hundred and twenty-eight rheumatoid arthritis (RA) out-patients completed the RADAI-5 and the RAPID-3. Simultaneously, the DAS28-ESR and the CDAI were applied. Cronbach's Alpha as a measure for reliability was calculated and factorial analysis was performed. For agreement analysis, Kendall's Tau was calculated. RESULTS: Time to score the questionnaires was 25seconds. The median RADAI-5 was 2.8 (0-9.2), the median RAPID-3 3.3 (0-8.6), the median DAS28-ESR 2.95 (0.43-6.24), and the median CDAI 5.6 (0-37.5). Cronbach's Alpha for the RADAI-5 was 0.906 and 0.871 for the RAPID-3, however, only 0.165 for the DAS28-ESR and 0.210 for the CDAI, respectively. Factorial analysis revealed that both questionnaires and the DAS28-ESR, but not the CDAI, constitute mono-dimensional instruments. Tau for the agreement between the RADAI-5 and the RAPID-3 appeared to be 0.587 (p<0.001), and to be 0.582 (p<0.001) between the DAS28-ESR and the CDAI, while it was lower for the relationship between the questionnaires and the composite indexes. CONCLUSION: Reliability of the RAPID-3 and RADAI-5 was significantly higher than of the indexes. The questionnaires as well as the indexes proved to be in highly moderate agreement, while agreement between the questionnaires and the indexes appeared to be lower.
20190309 Combination joint-preserving surgery for forefoot deformity in patients with rheumatoid ar 2010 Mar Proximal osteotomies for forefoot deformity in patients with rheumatoid arthritis have hitherto not been described. We evaluated combination joint-preserving surgery involving three different proximal osteotomies for such deformities. A total of 30 patients (39 feet) with a mean age of 55.6 years (45 to 67) underwent combined first tarsometatarsal fusion and distal realignment, shortening oblique osteotomies of the bases of the second to fourth metatarsals and a fifth-ray osteotomy. The mean follow-up was 36 months (24 to 68). The mean foot function index scores for pain, disability and activity subscales were 18, 23, and 16 respectively. The mean Japanese Society for Surgery of the Foot score improved significantly from 52.2 (41 to 68) to 89.6 (78 to 97). Post-operatively, 14 patients had forefoot stiffness, but had no disability. Most patients reported highly satisfactory walking ability. Residual deformity and callosities were absent. The mean hallux valgus and intermetatarsal angles decreased from 47.0 degrees (20 degrees to 67 degrees) to 9.0 degrees (2 degrees to 23 degrees) and from 14.1 degrees (9 degrees to 20 degrees) to 4.6 degrees (1 degree to 10 degrees), respectively. Four patients had further surgery including removal of hardware in three and a fifth-ray osteotomy in one. With good peri-operative medical management of rheumatoid arthritis, surgical repositioning of the metatarsophalangeal joint by metatarsal shortening and consequent relaxing of surrounding soft tissues can be successful. In early to intermediate stages of the disease, it can be performed in preference to joint-sacrificing procedures.
20950461 Women's experiences of sexual health when living with rheumatoid arthritis--an explorative 2010 Oct 15 BACKGROUND: The ICF core sets for patients with Rheumatoid Arthritis (RA) acknowledge sexual function and intimate relationships as important since the patients' sexual health can be affected by the disease. About 36-70% of all RA-patients experience a reduced sexual health, and their perceived problems are directly or indirectly caused by their disease. Physiotherapy is often used as non-pharmacological treatment for RA. Mobility treatment, pain reduction, and physical activities are often included in physiotherapy for patients with RA. The aim of the study was to explore sexual health in relation to physiotherapy in women living with RA. METHOD: An explorative qualitative interview study with a phenomenological approach was performed. The study consisted of ten interviews with women with RA. The analysis was performed according to Giorgi. RESULTS: The main theme that emerged in the material was that the body and the total life situation affected sexual health. Three categories were included in the theme: 1) sexual health - physical and psychological dimensions, 2) Impacts of RA, and 3) Possibilities to increase sexual health - does physiotherapy make a difference? CONCLUSIONS: Sexual health was affected by RA in different ways for the informants. Possibilities to improve sexual health were improved partner communication and physiotherapy. Physiotherapy can play an active role in improving sexual health for patients with RA.
21306034 Disease remission the goal of therapy in rheumatoid arthritis. 2010 Dec In order to achieve remission, rapid diagnosis of rheumatoid arthritis (RA) is a key priority. The new RA classification system allows a diagnosis to be made much earlier than previously. The criteria focus on clinical, biochemical and immunological features associated with persistent and/or erosive disease. Following presentation to primary care, patients with symptoms and signs of an inflammatory arthritis should be referred to a rheumatologist. Any patient with suspected persistent synovitis of undetermined cause should be referred for specialist opinion and urgent referral if any of the following apply: the small joints of the hands or feet are affected; > 1 joint is affected; there has been a delay of > 3 months between onset of symptoms and seeking medical advice. Early treatment results in a greater chance of inducing remission. Ideally, this should be within 6 weeks of symptom onset. Patients who develop severe persistent inflammatory arthritis who have normal investigations at disease onset should be referred regardless. Similarly, referral should not be delayed pending investigations. A fundamental shift in the approach to treating RA has occurred with the archaic 'start low, go slow' management pyramid having been rejected. EULAR recommends initiating traditional DMARDs as soon as the diagnosis of RA is made, aiming to achieve the target of remission or low disease activity as rapidly as possible. Once prolonged and satisfactory levels of disease control have been achieved, drug doses may be cautiously reduced to levels that still maintain disease control. EULAR guidelines state that if the treatment target is not achieved following the first traditional DMARD strategy, in the presence of poor prognostic factors, or in patients responding insufficiently to DMARDs, then biologic therapy should be considered.