Browse

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

ID PMID Title PublicationDate abstract
21077801 Treatment with low-dose prednisolone is associated with altered body composition but no di 2011 May OBJECTIVES: To determine whether low-dose prednisolone affects body composition and bone mineral density (BMD) in patients with rheumatoid arthritis (RA), also considering inflammation and physical disability. METHODS: This cross-sectional study included 100 patients (50 women) with RA with a median (IQR) disease duration of 8 (4-15) years. Fifty patients had been treated with prednisolone (5-7.5 mg) for at least 2 years (the P-group) and 50 patients matched for gender and age had not (the NoP-group). Body composition and BMD were assessed by dual-energy X-ray absorptiometry (DXA). Disease activity (28-joint Disease Activity Score, DAS28) and physical disability (Health Assessment Questionnaire, HAQ) were assessed. RESULTS: The total patient group had increased fat mass (FM) and a high trunk:peripheral fat ratio, of which 38% had a fat free mass index (FFMI, kg/m²) below the 10th percentile of a reference population. The P-group had significantly higher FM but similar lean body mass (LBM) and BMD compared with the NoP-group. In multivariate analyses, treatment with prednisolone and a higher HAQ score were significantly and independently associated with higher FM but not with LBM. Higher C-reactive protein (CRP) was independently associated with lower LBM. Higher HAQ score and low weight were significantly and independently associated with lower BMD at femoral neck and lumbar spine. CONCLUSIONS: RA patients treated with low-dose prednisolone had significantly higher FM than patients without prednisolone, an effect that was independent of current inflammation. However, there was no association between prednisolone treatment and muscle mass or BMD. Thus, the net effect of prednisolone on body composition and bone is different in inflammatory diseases such as RA.
20191050 Multiple vertebral involvement of rheumatoid arthritis in thoracolumbar spine: a case repo 2010 Mar Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.
20699242 The 2010 American College of Rheumatology/European League Against Rheumatism classificatio 2010 Sep OBJECTIVE: To apply a data-driven approach to investigate, in patients newly presenting with undifferentiated inflammatory synovitis, key variables that discriminate the subset of patients at sufficiently high risk of persistent or erosive disease for the purpose of developing new criteria for rheumatoid arthritis (RA). METHODS: In this first phase of the collaborative effort of the American College of Rheumatology and European League Against Rheumatism to develop new criteria for RA, a pooled analysis of early arthritis cohorts made available by the respective investigators is presented. All the variables associated with the gold standard of treatment with methotrexate during the first year after enrolment were first identified. Principal component analysis was then used to identify among the significant variables those sets that represent similar domains. In a final step, from each domain one representative variable was extracted, all of which were then tested for their independent effects in a multivariate regression model. From the OR in that final model, the relative weight of each variable was estimated. RESULTS: The final domains and variables identified by this process (and their relative weights) were: swelling of a metacarpophalangeal joint (MCP; 1.5), swelling of a proximal interphalangeal joint (PIP; 1.5), swelling of the wrist (1.5), tenderness of the hand (ie, MCP, PIP or wrist (2)), acute phase reaction (ie, C reactive protein or erythrocyte sedimentation rate and weights for moderate or high elevations of either one (1 for moderate, 2 for high elevation)) and serological abnormalities (ie, rheumatoid factors or anti-citrullinated protein antibodies, again with separate weights for moderate or high elevations (2 and 4, respectively)). CONCLUSION: The results of this first phase were subsequently used in the second phase of the project, which is reported in a separate methodological paper, and for derivation of the final set of criteria.
19901917 Using ultrasonography to facilitate best practice in diagnosis and management of RA. 2009 Dec The key to successful management of rheumatoid arthritis (RA) is early objective quantification of inflammation and ongoing precise, tailored therapy to ensure long term suppression of inflammatory disease activity. Musculoskeletal ultrasonography (MSKUS) has emerged as a tool with the potential to enhance disease assessment and management in this area. This includes applications in patients with undifferentiated arthropathy attending an early inflammatory arthritis clinic, in which the diagnosis of inflammatory disease may be confirmed or refuted at an early stage, and those with treated RA where accurate measurement of outcomes, such as response to therapy, structural damage and disease remission, are extremely important. This imaging modality is safe and portable, making it ideal for outpatient and inpatient settings, and can be used to assess many joints in multiple planes and to demonstrate changes in disease activity and structural damage over time. MSKUS is gaining popularity among rheumatologists, as increasing evidence supports the added value of a physician-performed ultrasonography assessment above traditional clinical, laboratory and radiographic measures, enabling greater confidence in diagnostic and management decisions. Although additional longitudinal data are required and further applications are likely to arise, MSKUS may well possess the necessary attributes to facilitate best practice in inflammatory arthritis management.
19154212 Anti-tumor necrosis factor-alpha therapy is associated with less frequent mood and anxiety 2009 Feb AIMS: The purpose of the present study was to examine the current prevalence of mood and anxiety disorders, and factors related to mood and anxiety disorders in patients with rheumatoid arthritis (RA). METHOD: The study sample included 83 consecutive patients with RA who were admitted to a rheumatology outpatient clinic. Diagnoses of psychiatric disorders were determined using the Structured Clinical Interview for DSM-IV (SCID-I). To assess physical disability and disease activity, the Health Assessment Questionnaire and the Disease Activity Score, respectively, were used. RESULTS: The prevalence of any mood or any anxiety disorder was 43.4%. The two most common psychiatric diagnoses were major depression (21.7%) and generalized anxiety disorder (16.9%). Mood and anxiety disorders were unrelated to sociodemographic features, disease-related factors, and medications for RA except anti-tumor necrosis factor-alpha (TNF-alpha). These disorders, however, were identified less frequently in patients with RA receiving anti-TNF-alpha drugs compared to patients who did not receive such medications. CONCLUSION: Patients with RA frequently have mood and anxiety disorders, and anti-TNF-alpha drugs may be useful for the mental status of these patients.
19158113 Influence of gender on assessments of disease activity and function in early rheumatoid ar 2010 Jan OBJECTIVE: To evaluate gender differences in score on 28-joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and Signals Of Functional Impairment (SOFI) and to relate these scores to radiographic joint destruction. METHODS: In all, 549 patients with early RA (62% women) from the BARFOT (for "Better Anti-Rheumatic FarmacOTherapy") study were included. At baseline, 1, 2 and 5 years DAS28, HAQ and SOFI scoring, and radiographs of hands and feet were performed. The radiographs were scored using the van der Heijde-Sharp score. RESULTS: In women the DAS28 was significantly higher than in men due to higher scores for general health and tender joints. Likewise, HAQ and VAS pain were rated significantly higher in women. The SOFI score was worse in men during the first 2 years, depending on higher upper limb scores. Total Sharp score (TotSharp), erosion score and joint space narrowing score did not differ between the sexes at any time point. The DAS28 area under the curve (AUC) correlated significantly with TotSharp at 5 years in both genders (r = 0.316, r = 0.313) mainly owing to swollen joints and erythrocyte sedimentation rate (ESR). The SOFI AUC correlated significantly with TotSharp in women (r = 0.135 to 0.220) but not in men. CONCLUSIONS: Despite a similar degree of radiographic joint destruction women had, compared with men, worse scores for DAS28 and HAQ, possibly due to higher pain perception and less muscular strength and perhaps because men overestimate their functional capacity.
19689386 The role of melatonin in rheumatic diseases. 2009 Aug Melatonin is a neurohormone that has attracted a great deal of attention, being frequently investigated in recent years. Due to its wide-spectrum of properties, melatonin has been suggested to be effective with respect to the etiology and treatment of several diseases. Its action on the immune system and antioxidant features has brought interest to this hormone's role in chronic inflammatory diseases. Furthermore, the detection of a correlation between the circadian release of melatonin and the rhythmic symptoms and signs of rheumatoid patients has led scientists to address its involvement in rheumatic diseases. Studies with suitable methodologies and broad perspectives are required in order to determine the functions of this neurohormone, whose effects are dependent on its physiological and pharmacological doses.
19207032 The effect of exon (19C>A) dihydroorotate dehydrogenase gene polymorphism on rheumatoid ar 2009 Feb OBJECTIVE: Leflunomide is an isoxazole derivative structurally and functionally unrelated to other known immunomodulatory drugs. The main molecular target of leflunomide is dihydroorotate dehydrogenase (DHODH), a key enzyme of de novo pyrimidine synthesis. The human DHODH gene sequence is highly conserved and contains only one common missense polymorphism in the coding regions. This SNP (refSNP ID: rs3213422) is localized in the first exon of the DHODH gene (19C>A) and leads to Gln7Lys amino acid substitution in the cationic N-terminal region of the DHODH polypeptide, and it has not yet been investigated in relation to enzyme activity or DHODH inhibitor efficacy. The aim of the study was to examine the effect of this polymorphism on leflunomide treatment outcome in rheumatoid arthritis (RA) patients. MATERIALS & METHODS: The study was carried out on 147 patients (123 women, 24 men, mean age: 52.8 +/- 11.03 years) diagnosed with RA and treated with leflunomide 20 mg daily. Clinical improvement was evaluated according to the American College of Rheumatology 20% and 50% response criteria. RESULTS: The frequency of remission was increased in C allele carriers compared with patients with the A allele. CONCLUSION: The results of this study suggest that DHODH polymorphism may be associated with leflunomide treatment outcome in RA patients.
20680379 Use of infliximab in a patient with pyoderma gangrenosum and rheumatoid arthritis. 2010 Dec Pyoderma gangrenosum (PG) is characterized by ulcerative skin lesions. Infliximab (IFX) may promote PG healing in patients with inflammatory bowel disease, but whether IFX is effective for treating PG in patients with rheumatoid arthritis (RA) has not reported. We report the case of a 53-year-old woman with PG complicated by RA who was treated using IFX therapy. This case suggests that IFX therapy might offer effective treatment for such patients.
20810510 Elevated serum glucose-6-phosphate isomerase correlates with histological disease activity 2010 Dec OBJECTIVE: To determine serum glucose-6-phosphate isomerase (GPI) concentrations in patients with rheumatoid arthritis (RA), and to test whether they correlate with objective measures of disease activity. METHODS: Sera from 116 patients with RA, 69 patients with non-RA rheumatic diseases, and 101 healthy controls were analyzed. Levels of soluble serum GPI were measured by ELISA. Histological disease activity was determined with the synovitis score in synovial needle biopsies from 58 of the 116 patients with RA. Thirty-one of the 58 synovium samples were stained for CD68, CD3, CD20, CD38, CD79a, and CD34 by immunohistochemistry. Demographic data were collected, as well as serological and clinical variables that indicate RA disease activity, for Spearman correlation analysis. RESULTS: Serum GPI level correlated positively with the synovitis score (r = 0.278, p = 0.034). Significantly higher soluble GPI levels were detected in the RA sera compared with sera from healthy controls and the non-RA disease controls (2.25 ± 2.82 vs 0.03 ± 0.05 and 0.19 ± 0.57 μg/ml, respectively; p < 0.0001). The rate of serum GPI positivity was significantly higher in the RA patients than in the non-RA disease controls (64.7% vs 10.1%; p < 0.0001). Spearman analysis showed no significant correlation between serum GPI level and Disease Activity Score in 28 joints at baseline. After initiation of antirheumatic treatments, GPI levels decreased significantly (2.81 ± 3.12 vs 1.44 ± 2.09 μg/ml; p = 0.016), paralleling improvement of the disease activity indices. CONCLUSION: Elevated serum GPI may be involved in the synovitis of RA and may prove useful as a serum marker for disease activity of RA.
20632179 [Bacterial infections of the rheumatoid foot]. 2010 Aug BACKGROUND: A high incidence of infections has been reported in rheumatoid arthritis (RA) patients, either due to intrinsic factors or as a side effect of immunosuppressive agents used for treatment. The present article provides an overview of incidence and distribution patterns of septic complications in RA. MATERIALS AND METHODS: We prospectively assessed all data from RA patients who underwent in-patient treatment for septic complications in the 3-year period from 01.01.2006 to 31.12.2009. All disease- and infection-specific data were gathered and analysed. RESULTS: Of the 36 cases in total, infection was localized in the rheumatoid foot in 23 patients (64%) and at the lower extremities in 32 (89%). The bacterial spectrum was heterogenous, with Staphylococcus aureus representing the most frequent causative agent. In total, 34 of 36 cases were cured. CONCLUSIONS: Since approximately 2/3 of all infections occur in the rheumatoid foot, regular foot examinations to identify predisposing deformities and/or ensure early diagnosis of existing infections are recommended.
19718981 [Surgery of the wrist and hand in rheumatoid arthritis]. 2009 Jan Wrist and hand surgery in rheumatoid arthritis has continued to evolve since first being tried fifty years ago. Improvements have flowed from a better understanding of pathophysiological mechanisms, from technical progress and from more effective medical treatment. The use of methotrexate and the subsequent development of biological therapies have transformed the course of the disease, increasing the chances of positive and durable surgical results. Priority must be given to re-alignment of the wrist in order to protect the fingers. It is equally important to perform synovectomies of the extrinsic tendons and to re-align extensor tendons with the metacarpophalangeal joints. At a later stage, metacarpophalangeal arthroplasty can re-establish a useful range of mobility in these joints. Early correction of swan-neck deformity is essential. Arthrodesis of the metacarpophalangeal joint of the thumb is also beneficial as it improves finger-thumb pinch grip. These procedures are usually performed under regional block anaesthesia. They take less than two hours and the techniques employed are compatible with early mobilisation. Effective surgical management of rheumatoid arthritis requires close collaboration between surgeons, rheumatologists, physiotherapists, orthotists and occupational therapists. There are thought to be some 500,000 patients in France who might benefit from such treatment but, as yet, there are too few multidisciplinary teams equipped to manage them effectively.
20803632 Perceived benefits and barriers to joint protection among people with rheumatoid arthritis 2010 Sep BACKGROUND: Deciding whether or not to perform a health behaviour is an active decision-making process which has an impact on current and future behaviour and can be influenced by the beliefs both of patients and their healthcare professionals. The aim of this study was to explore rheumatoid arthritis (RA) patients' and occupational therapists' (OTs) perceptions of the benefits of and barriers to performing joint protection (JP). METHODS: A mixed methods design was used. Questionnaires applied a theoretical framework of key themes to assess the relevance of JP benefits and barriers both to people with RA and OTs. Focused interviews with people with RA then enabled data triangulation. Investigator triangulation was used to check the validity of data interpretation. FINDINGS: Ten people with RA and nine OTs participated. From the questionnaires, both groups agreed that highly relevant key themes for JP benefits were physical well-being, potential benefit and personal control. By contrast, the three key themes for JP barriers - negative attitude of others, negative impact on others and taking time from other things - were relevant for the majority of the OTs but not patients. The interviews enabled an understanding of the meaning behind RA patients' ratings, particularly their differences from OTs. People with RA explained JP benefits, and disease acceptance had altered some initial barriers into perceived benefits over time. CONCLUSIONS: Emphasizing benefits and identifying individually relevant barriers could be an important communication strategy for OTs in understanding patients' rationale for whether or not to adopt JP methods.
19233045 The preclinical stages of RA: lessons from human studies and animal models. 2009 Feb Rheumatoid arthritis (RA) is a systemic autoimmune disorder based in the synovium of peripheral joints. Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs) are autoantibodies detectable in the majority of patients, with the latter being highly specific for RA. Retrospective studies utilizing preclinical serum samples have demonstrated that RF and ACPAs are detectable in the serum of RA patients months to years before disease onset. Moreover, a close association between ACPAs, smoking, and disease-predisposing HLA-DRB1 alleles has been identified, suggesting that these risk factors may converge to precipitate autoantibody-positive RA. Animal models of RA have added considerable information regarding the immune events that precede joint inflammation. These models have demonstrated that autoantibodies to ubiquitous antigens can directly precipitate chronic organ-specific inflammation centred in the joint. Furthermore, it has recently been possible to demonstrate a role for ACPAs in the animal models of RA. The major challenge currently is to develop a robust predictive model for RA onset, identifying the factors that serve to initiate, amplify, and mature the immune responses towards citrullinated autoantigens. Recent data from a high-risk population of RA family members indicate that the nature and specificity of the ACPA response in healthy individuals differs considerably from that in RA patients, and support the concept that this autoimmune response evolves over time and leads to the onset of clinically detectable synovitis. Ultimately, the availability of data from prospective studies of RA onset will allow for novel strategies that can potentially prevent disease in high-risk individuals.
19832979 The prognostic value of baseline erosions in undifferentiated arthritis. 2009 INTRODUCTION: Undifferentiated arthritis (UA) has a variable disease course; 40 to 50% of UA patients remit spontaneously, while 30% develop rheumatoid arthritis (RA). Identifying the UA patients who will develop RA is essential to initiate early disease-modifying anti-rheumatic drug (DMARD) therapy. Although the presence of bone erosions at baseline is predictive for a severe destructive disease course in RA, the prognostic importance of erosive joints for disease outcome in UA is unknown. This study evaluates the predictive value of erosive joints for the disease outcome in UA as measured by RA development and disease persistency. METHODS: Baseline hands and feet radiographs of 518 UA patients were evaluated for erosions using a clinical definition as well as the Sharp/van der Heijde method. After 1 year follow-up, patients were re-assessed for the fulfillment of the 1987 ACR classification criteria for RA. Disease persistency was defined as the absence of sustained remission during all available follow-up (mean 8 +/- 3 years). RESULTS: At baseline, 28.6% of UA patients had erosive joints. Presence of > or = 2 erosive joints showed a positive predictive value for RA development of 53% and for persistent disease of 68%. Patients with erosions that did not develop RA were less often anticyclic citrullinated peptide antibody (ACPA)+ve, rheumatoid factor (RF)+ve and had lower C-reactive protein (CRP), erythrocytic sedimentation rate (ESR) and number of swollen joints compared to those who developed RA. Feet erosions are equally predictive compared to erosions at hands. CONCLUSIONS: Presence of > or = 2 erosive joints at baseline in UA patients gives a risk for RA development of 53% and for persistent disease of 68%, indicating that erosions in UA are not always predictive for unfavorable disease outcomes.
19655156 [Infectious pulmonary complications of rheumatic diseases]. 2009 Oct Infectious complications are a central problem in the treatment of patients with rheumatic diseases. The increased infection rate is mainly caused by immunosuppressive medication, particularly glucocorticoids. A more aggressive diagnostic approach, often including bronchoscopic procedures, is often necessary to obtain samples for microbiological examinations. In immuno-compromised patients the failure of a calculated empiric antibiotic therapy is associated with a higher risk of fatal outcome. Among possible opportunistic infections Pneumocystis jirovecii pneumonia (PCP), invasive aspergillosis and CMV reactivations are most relevant. Furthermore, particularly with the use of TNF-blocking agents, reactivation of latent tuberculosis (TB) might be observed. There are only a few situations in which anti-infective chemo-prophylaxis is established: In the case of latent TB INH-prophylaxis should be given when anti-TNF-therapy is considered. There is evidence in favour of PCP prophylaxis with trimethoprim/cotrimoxazole in patients receiving intense immunosuppression with high dose glucocorticoids and cyclophosphamide.
19851770 Anaplastic large cell lymphoma in a patient with rheumatoid arthritis. 2011 Apr It is known that patients with rheumatoid arthritis (RA) have an increased risk for non-Hodgkin's lymphomas in comparison with the general population. Although increased risk of lymphoma is attributed to the disease activity, the drugs used in the therapy of RA may also cause increased risk of malignancy. Herein, we report on an RA patient who developed non-Hodgkin's lymphoma after methotrexate therapy and review the literature about it. A 74-year-old man with RA had been treated with low-dose methotrexate and subsequently developed anaplastic large cell lymphoma of the T-cell phenotype. Anaplastic large cell lymphoma has been reported rarely in rheumatoid arthritis.
20120402 Prevalence and risk factors of the rheumatoid arthritis in Herzegovina region in 2003-2005 2009 Dec In this study we evidenced prevalence of the rheumatoid arthritis (RA) in Herzegovina region of the Bosnia and Herzegovina and studied selected RA risk factors. Sample of subjects comprised RA diagnosed subjects which were compared to randomly selected controls. In diagnosing the RA we used criteria for the classification of rheumatoid arthritis suggested by The American College of Rheumatology. Risk factors of RA included in this investigation were (1) educational status, (2) quality of nutrition, and (3) socioeconomic status. Average prevalence of the RA in our sample was 0.46/100, ranged from 0.36/100 to 0.64/100, which is comparable to other European samples. The RA occurrence is six times more often in females than in males. We have found indices that the Mediterranean diet has to be considered as protective factor against RA. Although RA occurrence is more frequent in the low socioeconomic samples of subjects, because of the methodological reasons we can not undoubtedly support the socioeconomic status as significant risk factor of the RA. Finally, it is interesting that we have found education level as risk factor significantly related to RA occurrence in our sample. All evidenced should be more precisely studied in some future study, while accurately controlling all relevant factors.
19822049 Classification criteria for rheumatoid arthritis and ankylosing spondylitis. 2009 Jul The history of classification and diagnostic criteria for rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is similar and different. Important criteria sets have been published for both disease in the mid eighties, for AS in 1984 and for RA in 1987. The leading clinical symptoms, inflammatory back pain (IBP) in AS and the predominant polyarticular symmetric involvement of the hands in RA were, of course, central, and so was morning stiffness as a major clinical sign of an inflammatory disease state. In RA, there was more focus on laboratory parameters (rheumatoid factor), while this could have been the case also in AS (HLA B27) but this was not recognized at this point in time. In contrast, imaging has played a more important role in AS - especially because the sacroiliac joints are involved in the vast majority of AS patients, while in RA radiographic changes of the joints of hands and feet may contribute to the diagnosis. However, in both diseases, early structural changes visualized by conventional radiography rather have prognostic impact since these patients are much more likely to progress in comparison to others who do not have cartilage and joint damage early in the course of the disease. Further developments of criteria for AS have broadened the spectrum of AS to spondyloarthritis (SpA) and axial SpA which covers most early forms. The leading clinical symptom is chronic back pain in young adults and IBP. New criteria for RA which include more patients with early disease and anti-CCP antibodies as new markers are being developed. This is important since early treatment strategies are increasingly and successfully used to treat inflammatory diseases more efficiently.
21125160 Demographic and clinical characteristics of a cohort of patients with early rheumatoid art 2010 May INTRODUCTION: Very few studies carried out with Latin American populations on the demographic and clinical characteristics of patients diagnosed with early rheumatoid arthritis (RA) can be found in the literature. OBJECTIVE: To characterize a population of patients with early RA, prospectively followed, concerning demographic and clinical aspects and compare them with other similar cohorts. PATIENTS AND METHODS: The data presented are part of an incident cohort prospective study, in which 65 patients with early RA were evaluated and followed regularly for 36 months at the Early Rheumatoid Arthritis Outpatient Clinic of the University Hospital of Brasília (HUB, from the Portuguese). The demographic and clinical data of the initial evaluation, including general characteristics, clinical history, and physical examination were recorded. Descriptive statistics of the variables was applied. RESULTS: Women (86%) with a mean age of 45.6 years, Caucasian or Black (47.6%), belonging to intermediate-low social classes (53.85%), with 8.3 years of schooling, predominated. The presenting symptoms of the majority of patients were acute (76.9%), with polyarticular onset (69.2%), persistent synovitis of the hands (90.7%), and prolonged morning stiffness (157 minutes on average). Patients had a high average score of painful (18.6) and swollen (13.9) joints and high prevalence of rheumatoid nodules (15.3%), which suggests disease with aggressive presentation in its initial phases. CONCLUSION: The demographic and clinical characteristics of patients enrolled in this Brazilian cohort differed, on several aspects, from previously published North American, European, and Latin American cohorts.