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ID PMID Title PublicationDate abstract
19701637 Clinical efficacy of tocilizumab in patients with active rheumatoid arthritis in real clin 2010 Jun The previous clinical studies have demonstrated tocilizumab monotherapy to be highly effective in rheumatoid arthritis (RA). The objectives of the present article are to report the efficacy and safety of tocilizumab in patients with active RA in real clinical practice. In total, 61 patients with RA were treated with tocilizumab. Any comorbidities they had, especially infections, were treated thoroughly before they were given the drug. We provided guidance on infection control and prevention. Mean age of the patients was 60.9 +/- 12.4 years, and their mean disease duration 10.9 +/- 9.2 years. The patients remained on steroids, methotrexate, and tacrolimus as before, but were taken off any other drugs they had been using prior to the treatment. Mean of the 28-joint disease activity score using erythrocyte sedimentation rate was 4.75 +/- 1.15 initially and fell to 2.21 +/- 0.97 after two doses (n = 50). After four doses, the remission rate was 83.8% (31/37). All patients responded well to the therapy and there was no decrease in the efficacy of tocilizumab during the treatment. Even in the real clinical setting, treatment with tocilizumab can rapidly induce remission in RA in a high proportion of patients and is generally safe and well tolerated. Tocilizumab would seem to be promising as a first-line choice for the treatment of RA.
21290347 Patient with rheumatoid arthritis and acute renal failure: a case report and review of lit 2010 Rheumatoid arthritis (RA) is an autoimmune disease also known as an example of connective tissue disease. There are no case-controlled studies to determine the frequency of renal disease in RA. Most of patients present slow progression of chronic kidney disease while acute renal failure is uncommon in rheumatoid arthritis. We report a case of a 40-year-old woman with established medical history of RA who presented with abrupt onset of severe hypertension with rapidly growing serum creatinine concentration and oliguria. Renal biopsy revealed oedematous intimal thickening of vessels and ischemic changes in glomeruli, and nonspecific lesions in tubules and interstitium. These pathological findings were consistent with the scleroderma nephropathy. Additionally, we provided a brief literature overview on coincidence of hypertension and different types of connective tissue diseases.
19165556 Is the Alifax Test-1TH useful to determine the Disease Activity Score (DAS28) in rheumatoi 2009 Apr Treatment of rheumatoid arthritis (RA) is monitored with the disease activity score (DAS28), for which the erythrocyte sedimentation rate (ESR) is needed. Apart from the original gold standard method, other methods like the Alifax Test-1TH apparatus are widely used in laboratory worldwide. We compared ESR values obtained by the Alifax Test-1Th apparatus and the gold standard method for 218 RA patients. We found a good correlation (r=0.87) between the Alifax Test-1TH results and the gold standard method. A good correlation (r=0.96) was also found for the DAS28 results obtained with both methods. The number of patients that were misclassified when the Alifax Test-1TH is used is reasonable for both the ESR (14.7%) and the DAS28 (10.6%). These results suggest that it may be useful to determine the ESR by the Alifax Test-1TH, with a DAS28 misclassification in less than 11% of the patients.
19888505 [Socio-demographic aspects and therapeutic pathways in patients with rheumatoid arthritis 2009 Jul The research carried out by Censis Foundation, in collaboration with SIR (Italian Society of Rheumatology) and ANMAR (National Association of Rheumatic patients), with the sponsorship of Roche S.p.A., involved more than 600 patients, diagnosed with arthritis by a rheumatologist according to ACR criteria. The patients were recruited through a representative sample of 300 general practitioners. A number of different research and survey tools were used to collect data, helping to identify several of the problems that affect Italian patients: a survey form to be filled by the GPs, in order to verify the diagnosis and the comorbidity level; a questionnaire for the self-assessment of the disease activity, Rheumatoid Arthritis Disease Activity Index (RADAI), and a sociological questionnaire set up for the analysis of the main aspects of the patients' path. Among the most serious criticalities found, the difficulties and the time needed for the patients to get a clear AR diagnosis, the problems in interacting with health structures, and the differences in accessing pharmaceutical therapies (only a slight majority of patients use DMARDs drugs, a small amount takes biological drugs, while a large number of patients is treated exclusively with symptomatic drugs) stand out. The differences in patients' condition appear then to be exaggerated, regarding the chances to get an early diagnosis, the access path to specialised centres, and in receiving the most appropriate treatments. Moreover, these differences appear to be strongly dependent on both the social characteristics of the patients and the supply arrangement in their area.
20798264 The complexity of the treatment: the decision-making process among women with rheumatoid a 2011 Feb There are effective medications available for the treatment of rheumatoid arthritis (RA); yet, medication adherence remains a problem. In this study, grounded theory methodology was used to investigate the decision-making process used by 30 women with RA when deciding to participate in an evidence-based treatment regimen for this disease. From the study findings, a four-phase process was identified. Pain, life functioning, and exhaustion of health care resources are the components of the initial phase, decision initiation. During knowledge acquisition, the second phase, patients attain information about RA and medications used for its treatment from varying sources. The third phase, trusting the health care provider, is defined by a trusting relationship between patients and health care providers. Patients decide to take or not take medications for RA during the final phase, decision is made. The participating women with RA used a complex decision-making process when deciding to take medications for this disease.
19411397 Differences in longitudinal disease and treatment characteristics of patients with rheumat 2009 Jun OBJECTIVE: Studies on patients not answering postal questionnaires are scarce. We assessed the demographics and longitudinal disease and treatment characteristics of patients with rheumatoid arthritis (RA) in a Swedish biologics register who replied and who did not reply to a postal questionnaire. METHODS: In the South Swedish Arthritis Treatment Group register, we have detailed disease severity characteristics at baseline and at followup for rheumatology patients taking biologic drugs. In 2005 a questionnaire on smoking, comorbidities, education, and ethnicity was sent to 1234 RA patients who had started their first biologic drug. RESULTS: In total, 989 subjects (80%) answered the questionnaire. The 245 (20%) who did not answer generally had more severe RA [higher Disease Activity Score, worse Health Assessment Questionnaire score, higher visual analog scale scores for general health and pain at baseline and at followup, and stopped the drug treatment more frequently (72% vs 53%; p=0.0001)]. There were no statistically significant differences in gender and disease duration between those who replied and those who did not reply, but in general the patients who did not reply were younger. CONCLUSION: Patients with RA in a Swedish biologics register not replying to a postal questionnaire had more severe RA and stopped biological drug treatment more frequently. Thus a detailed analysis of prospectively collected data can clarify selection bias introduced by subjects who do not answer a postal questionnaire, which may influence the validity and interpretation of results from postal survey studies.
20535798 Exploring the public health impact of an intensive exercise program for patients with rheu 2010 Jun OBJECTIVE: To evaluate the implementation of an intensive group exercise program in patients with rheumatoid arthritis (RA). METHODS: In 4 regions in The Netherlands, the Rheumatoid Arthritis Patients In Training exercise program was implemented on a limited scale. Evaluation using the RE-AIM model included: Reach, the proportion of the target population participating; Efficacy, effects on muscle strength, aerobic capacity, functional ability, and psychological functioning; Adoption, program adoption by stakeholders; Implementation, intervention quality (quality audits); and Maintenance, stakeholders' willingness to continue the program in the future. RESULTS: Twenty-five physical therapists from 14 practices were trained to provide the program. In total, 150 RA patients were recruited (by estimation, 2% of the target population). Of the 81 patients who had finished the 12-month intervention and were available for followup directly after the intervention, 62 patients provided clinical data. Muscle strength improved significantly, whereas aerobic capacity, functional ability, psychological functioning, and disease activity did not change. All 9 informed local patient organizations facilitated patient recruitment, and 35 of 51 rheumatologists involved referred one or more patients. All 10 approached health insurance companies funded the program for 12 months. The quality audits showed sufficient quality in 9 of 12 practices. All of the providers of the program were willing to provide the program in the future, whereas future reimbursement by health insurance companies remained unclear. CONCLUSION: The implementation of an intensive exercise program for RA patients on a limited scale can be considered successful regarding its reach, adoption, and implementation. The limited effectiveness and the limited data regarding maintenance warrant additional research.
19826820 Relative importance of the functional abilities comprising Health Assessment Questionnaire 2010 Sep The aim was to evaluate the relative importance of the 20 functions assessed by patients to produce the Health Assessment Questionnaire's Disability Index (HAQ-DI). A systematic sample of 242 rheumatoid arthritis patients was drawn. Altogether 179 subjects returned acceptably filled questionnaire including perceived rheumatoid arthritis status in the 20 functions comprising the HAQ-DI. A separate complementary questionnaire was sent to 80 randomly chosen subjects. They were asked to estimate how important each of the same 20 items were in their everyday life using the VAS method. Completely answered complementary questionnaires were returned by 66 (88%) of the subsample. The relative importance of the functions assessed varied considerably. Men assessed the highest importance to the ability to walk outdoors on flat ground and women to dressing themselves, getting in and out of bed and washing and drying their body. For both genders the least important function was the ability to take a tub bath. The importance of all other functions except taking a tub bath was positively highly significantly correlated with the importance of each of the other functions. Factor analyses with one factor model showed high loadings on most functions, with the exception of 'Take a tub bath'. The two-factor model formed one factor with loadings concentrating slightly more on 'lower extremity' and another on 'upper extremity'. Assessment of RA patients' functional status would benefit from further development of measures by giving relative weights from patients' perspective to those functional abilities which are used for index computations.
19994686 [Observation on therapeutic effect of muscular needling combined with scarring moxibustion 2009 Nov OBJECTIVE: To observe the therapeutic effect of muscular needling combined with scarring moxibustion on active stage of rheumatoid arthritis (RA). METHODS: Sixty cases of RA were randomly divided into a muscular needling group and a medication group, 30 cases in each group. The muscular needling group was treated by muscular needling on Quchi (LI 11), Sanyinjiao (SP 6), etc. combined with scarring moxibustion on Dazhui (GV 14), Zusanli (ST 36) etc., while the medication group was treated by oral administration of Diclofenac sodium and intramuscular injection of Methotrexate. The therapeutic effects, main symptoms and signs, erythrocyte sedimentation rate (ESR) and rheumatoid factor were observed in two groups before and after treatment. RESULTS: The total effective rate of muscular needling group was 76.7%, and that of medication group was 73.3%, there was no significant difference between two groups (P > 0.05). The clinical symptoms, signs, and E8R of two groups were improved obviously compared with those before treatment (P < 0.01, P < 0.05), however there were no significant differences between the two groups after treatment (all P > 0.05). The adverse reactions of medication group were more eminent compared to the muscular needling group. CONCLUSION: Muscular needling can obviously relieve the symptoms and signs of active stage rheumatoid arthritis and the effect is equivalent to oral administration of western medicine, the incidence of adverse reactions in the muscular needling group is obviously lower than that of western medication. Muscular needling is a safe and effective method for treatment of RA.
18849599 Proinflammatory cytokine profiles of patients with elderly-onset rheumatoid arthritis: a c 2009 BACKGROUND: Little is known about the differences in the immunopathogenesis between elderly-onset rheumatoid arthritis (EORA) and younger-onset RA (YORA) and the factors responsible for their clinical characteristics. OBJECTIVE: It was the aim of this study to investigate proinflammatory cytokines of EORA patients and compare them with those of YORA patients. METHODS: Serum levels of interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma were determined by cytometric bead array in 86 patients with active EORA, in 76 patients with active YORA and in 30 healthy controls. Disease activity of RA was assessed using the 28-joint disease activity score. Erosion scores were recorded using a modified version of the Sharp method. Levels of anti-cyclic citrullinated peptide antibodies were determined by ELISA, and levels of rheumatoid factor-IgM and C-reactive protein were measured by nephelometry. RESULTS: A higher proportion of men and a higher frequency of acute onset with constitutional symptoms and comorbidities were observed in EORA compared with YORA patients. Increased levels of serum IL-1beta, IL-6, TNF-alpha, IFN-gamma and IL-8 were positively correlated with the 28-joint disease activity score, and elevated levels of IL-1beta and TNF-alpha were positively correlated with erosion scores for both groups of RA patients. Significantly higher IL-6 levels and lower TNF-alpha levels were found in EORA compared with YORA patients. Higher levels of serum IL-6 were found in EORA patients with polymyalgia rheumatica-like symptoms than in those without and were also noted in male patients with EORA compared with female patients. Multivariate analysis showed that high levels of TNF-alpha were associated with the occurrence of constitutional symptoms, and high levels of IL-1beta were associated with the presence of anti-cyclic citrullinated peptide antibodies in EORA patients. CONCLUSION: EORA patients appear to have differences in clinical characteristics and the patterns of proinflammatory cytokines when compared with YORA patients.
20650876 From bone biology to clinical outcome: state of the art and future perspectives. 2010 Aug In the last decade progress has been made in our understanding of bone biology. In particular, the relation between inflammation and bone has become much clearer, leading to bone-targeting therapies in inflammatory rheumatic diseases. The clinical sequelae of the influences of both inflammation and immobility (due to arthritis) on bone for different rheumatic diseases (such as rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritides) have also now captured the attention of clinicians. In the last decade the well-known negative influences of glucocorticoids on bone have become more treatable as a result of new drugs that stimulate osteoblasts and restore the negative bone balance.
20977720 Collagen-induced arthritis in common marmosets: a new nonhuman primate model for chronic a 2010 INTRODUCTION: There is an ever-increasing need for animal models to evaluate efficacy and safety of new therapeutics in the field of rheumatoid arthritis (RA). Particularly for the early preclinical evaluation of human-specific biologicals targeting the progressive phase of the disease, there is a need for relevant animal models. In response to this requirement we set out to develop a model of collagen-induced arthritis (CIA) in a small-sized nonhuman primate species (300 to 400 g at adult age); that is, the common marmoset (Callithrix jacchus). METHODS: Twenty-two animals divided into three experiments were immunized with collagen type II (CII) of either bovine or chicken origin with different immunization strategies. The animals were analyzed for clinical manifestation of arthritis, hematology and clinical chemistry, immunological responses against CII and histopathological features of the arthritis. RESULTS: Clinically manifest arthritis was observed in almost 100% (21 out of 22) of the animals. Fifty percent of the animals developed semi-acute CIA while the other 50% displayed a more chronic disease. Both cellular (CD3/CD4 and CD3/CD8) and humoral responses (IgM and IgG) against CII were involved in the development of the disease. Besides mild histopathological changes in bone and cartilage, severe inflammation in extraarticular tissues like periosteum and subcutaneous tissues was observed. CONCLUSIONS: This new model in marmosets more closely resembles chronic RA with respect to the chronic disease course and pathomorphological presentation than the more acute monophasic and destructive CIA model in macaques. This model can therefore fill a niche in preclinical testing of new human specific therapeutics.
20576222 The importance of the patients' experience of RA compared with clinical measures of diseas 2010 May Improvements in rheumatoid arthritis (RA) treatment have led to an increased focus on specialized and validated outcome measures, resulting in a decrease in the use of subjective assessments such as patient perceptions. However, to achieve optimal outcomes in the treatment of RA, there is a need to balance clinical goals with those that may be more important to patients. Although the treatment goals of physicians and patients are generally aligned, the framework in which these goals are expressed differs widely, and there are pronounced differences in how patients and physicians view their interactions regarding the decision-making process about treatment and information sharing. Detailed discussion between the physician and the patient regarding the patient's perspectives can lead to valuable insights into the patient's unmet needs from treatment as well as enhancement of the physician-patient relationship and an overall improvement in patients' quality of life.
21125279 Eruptive molluscum contagiosums in a patient with rheumatoid arthritis and lung cancer. 2011 Aug A 67-year-old woman with rheumatoid arthritis (RA) treated with systemic prednisolone and methotrexate over 20 years developed eruptive molluscum contagiosums on the trunk and extremities. Investigation revealed lung cancer 2 years later. Newly development of molluscum contagiosums ceased after the surgical operation of lung cancer. Immunologic dysfunctions have been shown in RA, and especially patients under long-term methotrexate therapy are susceptible to miscellaneous skin conditions. Eruptive molluscum contagiosums are induced in association with hematologic malignancies such as lymphoma, leukemia, and HIV infection; however, it is important to investigate internal malignancies, not only hematologic malignancies but also solid cancers, when patients with RA under immunosuppressive therapies presented eruptive or disseminated molluscum contagiosums.
18948258 High affinity glycosaminoglycan and autoantigen interaction explains joint specificity in 2009 Jan 23 In the K/BxN mouse model of rheumatoid arthritis, autoantibodies specific for glucose-6-phosphate isomerase (GPI) can transfer joint-specific inflammation to most strains of normal mice. Binding of GPI and autoantibody to the joint surface is a prerequisite for joint-specific inflammation. However, how GPI localizes to the joint remains unclear. We show that glycosaminoglycans (GAGs) are the high affinity (83 nm) joint receptors for GPI. The binding affinity and structural differences between mouse paw/ankle GAGs and elbows/knee GAGs correlated with the distal to proximal disease severity in these joints. We found that cartilage surface GPI binding was greatly reduced by either chondroitinase ABC or beta-glucuronidase treatment. We also identified several inhibitors that inhibit both GPI/GAG interaction and GPI enzymatic activities, which suggests that the GPI GAG-binding domain overlaps with the active site of GPI enzyme. Our studies raise the possibility that GAGs are the receptors for other autoantigens involved in joint-specific inflammatory responses.
20391482 Excess mortality emerges after 10 years in an inception cohort of early rheumatoid arthrit 2010 Mar OBJECTIVE: To investigate mortality rates, causes of death, time trends in mortality, prognostic factors for mortality, and the relationship between disease activity and mortality over a 23-year period in an inception cohort of rheumatoid arthritis (RA) patients. METHODS: A prospective inception cohort of RA patients diagnosed between January 1985 and October 2007 was followed for up to 23 years after diagnosis. Excess mortality was analyzed by comparing the observed mortality in the RA cohort with the expected mortality based on the general population of The Netherlands, matched for age, sex, and calendar year. Period analysis was used to examine time trends in survival across calendar time. Prognostic factors for mortality and the influence of the time-varying Disease Activity Score in 28 joints (DAS28) on mortality were analyzed using multivariable Cox proportional hazards models. Causes of death were analyzed. RESULTS: Of the 1,049 patients in the cohort, 207 patients died. Differences in observed and expected mortality emerged after 10 years of followup. No improvement in survival was noted over calendar time. Significant baseline predictors of survival were sex, age, rheumatoid factor, disability, and comorbidity. Higher levels of DAS28 over time, adjusted for age, were associated with lower survival rates, more so in men (hazard ratio [HR] 1.58, 95% confidence interval [95% CI] 1.35-1.85) than in women (HR 1.21, 95% CI 1.04-1.42). CONCLUSION: Excess mortality in RA emerged after 10 years of disease duration. Absolute survival rates have not improved in the last 23 years and a trend toward a widening mortality gap between RA patients and the general population was visible. Higher disease activity levels contribute to premature death in RA patients.
19772796 Poor to modest agreement between rheumatoid arthritis response measures in clinical practi 2009 Jul OBJECTIVE: To evaluate the agreement among several rheumatoid arthritis (RA) response measures in a clinical setting. METHODS: 529 patients with RA were seen at 2 regular visits where the following response measures were determined: ACR-20, EULAR good or moderate (EULAR-GM), Simplified Disease Activity Index moderate (SDAI-M), Clinical DAI moderate (CDAI-M), and Patient Reported Outcomes Index-M 20 (PRO-IM-20). Each measure was modified to include a "worse" response, i.e. the inverse of the respective guidelines for a positive improvement response.Introduced for comparison was the Real-time Assessment of Disease Activity in Rheumatoid Arthritis (RADARA), a response measure that registers improvement if the patient's tender and swollen joint counts and HAQ score all improve and worsening if all three increase. Contingency tables comparing the three responses (worse, no change, and improvement) along with Cohen's kappa were calculated. RESULTS: The mean (SD) baseline characteristics of the patients included: age 66.5 (10.7) years, RA duration 12.9 (11.0) years, 91.3% male, 84.1% rheumatoid factor positive, and a Disease Activity Score-28 of 3.5 (1.3). The percentage of patients who improved/worsened were as follows: ACR-20 4.7/9.1, EULAR-GM 23.4/26.3, SDAI-M 16.1/20.6, CDAI-M 16.3/20.0, PRO-IM-20 22.5/34.4, and RADARA 7.0/11.5. Agreement (kappa) was poor to slight (
19699879 Pleuropulmonary complications of rheumatoid arthritis: a thoracic surgeon's challenge. 2009 Sep Approximately 1% of patients with rheumatoid arthritis have chronic lung disease develop, which can lead to complications, including pneumothorax and bronchopleural fistula. Given the inflammatory changes found, along with the immunosuppressant regimen used in management, these complications are often recalcitrant to initial surgical maneuvers. Our goal in reviewing these patients is to demonstrate the escalation of therapeutic interventions that may be needed to ensure successful resolution of this challenging disease process.
19723906 Adherence rates and associations with nonadherence in patients with rheumatoid arthritis u 2009 Oct OBJECTIVE: Nonadherence in patients with rheumatoid arthritis (RA) using disease modifying antirheumatic drugs (DMARD) may result in unnecessarily high levels of disease activity and function loss. The aim of this descriptive study was to assess adherence rates with self-report measures in a large random population, and to identify potential risk factors for nonadherence. METHODS: A randomly selected sample of 228 patients with RA using DMARD was invited for a standardised interview. For each medicine, the patients were asked about adherence, consumption and perceived (side) effects. After the interview, the patients received self-report questionnaires to assess adherence [Compliance Questionnaire on Rheumatology (CQR) and the Medication Adherence Scale (MARS)], coping, beliefs about medicines, satisfaction about medicine information, and physical functioning. Subsequently, associations between adherence and demographics, clinical characteristics, and patient attitudes were examined. RESULTS: Depending on the instrument used, 68% (CQR) and 60% (MARS) of the patients were adherent to DMARD. Nonadherence was not associated with demographic and clinical characteristics, satisfaction about information, medication concerns, and coping styles. The disease duration, the number of perceived side-effects, and beliefs about the necessity of the medicine were weakly associated with adherence. CONCLUSION: In this large study with a random RA population, 32%-40% of the patients did not adhere to their DMARD prescription. As none of the possible risk factors was strongly related to adherence, no general risk factor seems to be powerful enough as a possible screening tool or target for adherence-improving interventions. This implies that nonadherence barriers should be assessed on an individual basis.
19371393 Treatment-induced stable, moderate reduction in blood cell counts correlate to disease con 2009 May BACKGROUND: Treatment of rheumatoid arthritis (RA) has become more intensive, thereby raising concerns regarding toxicities, including leucopenia. The objective was to analyse cell counts obtained as routine surveillance for adverse effects to assess the effect of intensive treatment and treatment dosage and to examine correlations to disease activity scores. METHODS: Patients with early RA were treated with combinations of disease-modifying anti-inflammatory drugs according to pre-defined rules, with dose adjustments contingent on residual disease activity and tolerance. RESULTS: Mean leucocyte, neutrophil and platelet counts fell with levels that correlated to disease activity scores. The strongest correlation was between platelets and disease activity scores. There was a modest, inverse correlation between methotrexate dose and monocyte and lymphocyte counts. No serious toxicity associated with the therapy was seen. CONCLUSION: Moderate reductions in cell counts are well tolerated in RA and appear to contribute to disease control.