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ID PMID Title PublicationDate abstract
20017459 Prognostic value of anti-cyclic citrullinated peptide antibodies and rheumatoid factor in 2009 OBJECTIVES: To determine the predictive value for radiological damage of anti-cyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor (RF) in patients with rheumatoid arthritis (RA). METHODS: Ninety patients with RA were enrolled in this study. All patients had symptom duration of at least one year. Anti-CCP and IgM-RF were evaluated with enzyme linked immunosorbent assay and nephelometry methods, respectively. Radiological damage was assessed by Larsen score. RESULTS: In forward stepwise logistic regression analysis, anti-CCP positivity and RF positivity were seen as significant independent predictors of the radiological outcomes (p = 0.01, p < 0.05, respectively). The combination of these antibodies had the highest risk for erosive joint damage (odds ratio = 25.71; 95% confidence interval, 4.7 to 140.13; p = 0.001). CONCLUSION: Our results suggest that the combined use of RF and anti-CCP has greater predictive value for erosive RA than anti-CCP or RF alone, and may facilitate to make a decision about the individual treatment in RA (Tab. 4, Ref. 37). Full Text (Free, PDF) www.bmj.sk.
20490599 Effect of total knee arthroplasty on disease activity in patients with established rheumat 2010 Oct Though excellent clinical results have been reported for total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients, the medium-term effect of TKA on RA disease activity remains unknown. This analysis aimed to assess changes in disease activity after TKA in patients with established RA. We analyzed the systemic effects of TKA on RA disease activity 3 years after intervention. Routine clinical and laboratory assessments were recorded at baseline, less than less than 0.5 years after TKA, and 3 years after TKA. Of the registered RA patients, 130 TKA patients were followed for 3 years after surgery. RA disease activity was measured using the Disease Activity Score 28 (DAS28). Patients were divided into three groups by preoperative baseline DAS28: low (DAS28 ≤ 3.2, n = 8), moderate (DAS28 > 3.2 but ≤5.1, n = 68), and high (DAS28 > 5.1, n = 54) disease activity. The postoperative DAS28 (<0.5 years [DAS1] and 3 years [DAS3] after surgery) scores of each patient were compared to their baseline (DAS0) scores using the paired t-test. The mean DAS28 decreased from 4.85 (DAS0) to 4.14 (DAS1; P = 1.07E-12), and this decrease was sustained at 3 years (DAS3 = 3.97; P = 4.73E-15). Subanalysis results revealed a systemic effect of TKA on disease activity in patients with moderate or high disease activity (DAS0 = 4.33; DAS1 = 3.72 [P = 5.94E-06]; DAS3 = 3.81 [P = 7.89E-06]; and DAS0 = 5.79; DAS1 = 4.86 [P = 1.14E-08]; DAS3 = 4.37 [P = 1.03E-11], respectively). While no significant changes in medication were noted, the average dose of prednisolone tended to decrease over time. We conclude that TKA, which is known to result in good clinical outcomes for damaged knees, has a secondary systemic effect on RA disease activity. Combination therapy consisting of medical treatment and surgical intervention is thought to effectively improve the condition of RA patients who have destructive arthritis in the knee joint, with the effect lasting for at least 3 years.
20506371 Validity of the disease activity score in undifferentiated arthritis. 2010 Oct OBJECTIVE: To study whether the Disease Activity Score (DAS) is a valid measure of disease activity in undifferentiated arthritis (UA). METHODS: Data from a randomized, double-blind, placebo-controlled trial of methotrexate (MTX) and placebo involving 110 patients with UA were used. Data included baseline and 3, 6, 9, and 12 months, as well as diagnosis at 18 months. Validity of the DAS was analyzed using factor analysis, correlations with disease activity variables, correlations with changes in disability and joint damage, differences in DAS between diagnoses, and detecting the difference between placebo and MTX. RESULTS: Three disease activity factors were retrieved from the disease activity variables: patient reported outcomes, tender and swollen joints, and acute phase reactants. The DAS had its highest correlations (r > 0.77) with tender joint counts, followed by swollen joint counts (r > 0.63) and patient reported outcomes (r > 0.30), but the DAS correlated less with C-reactive protein levels (r = 0.32). Over time, the DAS was related to the Health Assessment Questionnaire response with an odds ratio of 4.1 (95% confidence interval 2.1-8.0), but not with change in joint damage. At 18 months, the mean DAS was 2.6 for rheumatoid arthritis patients, 2.2 for UA patients, and 1.9 for patients in remission (P = 0.001). The DAS discriminated better than all single variables between MTX and placebo, with a Guyatt's effect size of 0.89. CONCLUSION: The DAS appears to be a reasonably valid measure of disease activity for use in UA clinical trials.
19457481 Does the Comprehensive International Classification of Functioning, Disability and Health 2009 Oct BACKGROUND: The "Comprehensive ICF Core Set for Rheumatoid Arthritis (RA)" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with RA. OBJECTIVES: The objective of this study was to validate this ICF Core Set from the perspective of nurses. METHOD: Nurses experienced in RA treatment were asked about the patients' problems, patients' resources and aspects of environment that nurses take care of in a three-round survey using the Delphi technique. Responses were linked to the ICF. RESULTS: 57 nurses in 15 countries named 1170 concepts that covered all ICF components. 20 concepts were linked to the as yet undeveloped ICF component Personal Factors. 19 ICF categories are not represented in the Comprehensive ICF Core Set for RA. CONCLUSION: The validity of the Comprehensive ICF Core Set for RA was largely supported by the nurses. However, a number of body functions which address side effects of drug therapies were not included in the Comprehensive ICF Core Set for RA. Furthermore, several issues arose which were not precisely covered by the ICF like "dry mucous", "risk for decubitus ulcers" and "height" and need to be investigated further.
19858122 Cardiovascular morbidity and mortality remain similar in two cohorts of patients with long 2009 Dec OBJECTIVE: Patients with RA have an increased risk of cardiovascular disease. Management of RA has changed substantially over time. Our aim was to evaluate changes in cardiovascular morbidity and mortality over the period of 1978-2002. METHODS: Two cohorts of consecutive patients with RA seen at outpatient clinics in Malmö, Sweden, were started in 1978 (n = 148) and 1995 (n = 161) and compared with the corresponding background population. Patients were followed for 8 years, and fatal and non-fatal cardiovascular first events were identified using two national registers, hospital discharge and cause of death. Standardized morbidity ratio (SMoR) and standardized mortality ratio (SMR), adjusted for age and sex were calculated. RESULTS: Sex distribution, age at disease onset and disease duration were similar in both groups. The 1995 cohort was more extensively treated with DMARDs and had less disease activity and disability. Total cardiovascular morbidity was increased in the 1978 cohort (SMoR 158; 95% CI 111, 225) as well as in the 1995 cohort (SMoR 168; 95% CI 118, 232). This was mainly due to an increased risk of coronary artery disease. Overall mortality was elevated in the 1978 cohort but not in the 1995 cohort. There was no change in cardiovascular excess mortality (SMR 175; 95% CI 100, 284; and 172; 100, 276 for the two cohorts, respectively). CONCLUSIONS: There were similar elevations in the incidence of cardiovascular comorbidity in RA patients, identified two decades apart compared with the general population, in spite of more extensive treatment and reduced disease severity in the more recent cohort.
21218722 Radiological changes in rheumatoid arthritis patients at a teaching hospital in Saudi Arab 2010 Sep The frequency of radiological changes of the hands and the feet were investigated in a well-defined hospital population of patients with rheumatoid arthritis in Jeddah, Saudi Arabia. A total of 57 patients who fulfilled the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis were randomly chosen from the rheumatology outpatient clinic at King AbdulAziz University Hospital. Erosions were seen in 60% of the patients and periarticular osteopenia in 34%; deformity and soft tissue swelling were present in 26% and 14% of patients respectively. The proportion with erosions is lower than data reported from Western European and North American populations but higher than previous data from the Central region of Saudi Arabia.
19888506 Infliximab treatment in a case of rheumatoid scleromalacia perforans. 2009 Jul Ocular rheumatoid disease manifests as hyperemia of the conjunctiva and episclera, and in severe cases, episcleritis can result in nodular sclerotic and scleromalacia perforans. A clinical case of scleromalacia perforans in a 56-year-old woman with 20 years of seropositive rheumatoid arthritis of functional class IV is presented here. During that period, she received exclusively non-steroidal anti-inflammatory drugs (NSAIDs). She developed acute episcleritis of the left ocular globe, which rapidly progressed to scleromalacia perforans. Since the left eye became perforated, it was surgically enucleated, and the patient was maintained with steroidal therapy. Nevertheless, two months later she developed new-onset episcleritis of the right eye followed by scleromalacia. She was first evaluated by a rheumatologist and treated with 200 mg/dose of infliximab, which was administered monthly for the following four months. The biological treatment was accompanied by methotrexate and prednisone. With this therapy, the ocular lesion dramatically improved, and complete remission of rheumatoid arthritis and scleritis was archived four months later. In conclusion, tumour necrosis factor (TNF) blockers are effective therapeutic agents in ocular complications of rheumatoid arthritis.
20476640 Diagnostic performances of anti-cyclic citrullinated peptide antibodies type IgM, IgA and 2010 BACKGROUND: To determine the diagnostic performances of anti-cyclic citrullinated peptide antibodies (anti-CCP) type IgM, IgA and IgG and rheumatoid factor (RF) in Syrian patients with rheumatoid arthritis. METHODS: 64 patients with rheumatoid arthritis were included in our study. Anti-CCP IgM, IgA and IgG and rheumatoid factor (RF) were detected using ELISA. Blood samples were collected from patients with definite rheumatoid arthritis according to (ACR) criteria in Al Mwasaa University Hospital and Al Assad University Hospital, Damascus, Syria, from December 2007 to December 2008. RESULTS: The sensitivity of anti-CCP IgG was 71.9% and specificity was 100%, Whereas the sensitivity of anti-CCP IgM was 70.3% and specificity was 64%, the sensitivity of anti-CCP IgA was 43.75% and specificity was 100%, RF IgM showed a sensitivity of 70.3% and a specificity of 96%, and anti-CCP IgG prevalence in patients with negative RF was 31.6%. All tests showed no correlation with gender in RA patients. CONCLUSIONS: This study demonstrates that anti-CCP IgG is a highly specific marker for RA and has diagnostic value especially in RF negative patients.
20483138 Technical tips: Modified resection arthroplasty for correction of rheumatoid forefoot defo 2010 Jun Forefoot deformity occurs in nearly 90% of patients with rheumatoid arthritis. Resection arthroplasty of the lesser metatarsophalangeal joints is one of the commonest procedures performed in case of patients failed to respond to conservative treatment. Kirschner wires are used to stabilize the resection arthroplasty sites. We present a modified technique to improve the sagittal plane alignment by bending of the wires dorsally at the site of resection arthroplasty.
19662331 Association of 22 cytokine gene polymorphisms with rheumatoid arthritis in population of e 2009 Nov To examine the possible role of 22 cytokine gene polymorphisms in host susceptibility to or protection against RA in Macedonians. In this study, 301 healthy unrelated individuals and 85 patients with RA were studied. Cytokine genotyping was performed by PCR with sequence-specific priming (PCR-SSP) (Heidelberg kit). Results showed susceptible association for four cytokine alleles, six cytokine genotypes, one haplotype, and four combinations of haplotypes, while protective associations were found for four cytokine alleles, three cytokine genotypes, three haplotypes, and only one combination of haplotypes. These results suggest that IL-4 -1098, IL-4 -590, IL-10 -1082, IL-10 -819, IL-2 -330, IL-6 -174, and TNF-alpha -238 cytokine gene polymorphisms might be significantly associated and affect host susceptibility and/or resistance to RA in Macedonians.
20632990 Progress toward the development of a new definition of remission in rheumatoid arthritis. 2010 The first definition of remission in rheumatoid arthritis was proposed by Pinals and colleagues in 1981. Although its development process was of high quality, the definition proved unfeasible and was not often applied. Subsequently many other definitions appeared, either as variations or as cutpoints of disease activity indices. The American College of Rheumatology, together with the European League Against Rheumatism and the Initiative for Outcome Measures in Rheumatology (OMERACT) decided to develop a new definition that would meet the OMERACT Filter of Truth, discrimination and Feasibility. This article summarizes the development process to date. The new definition is expected to be launched in 2010.
19650566 [An estimate of functional state in patients with rheumatoid arthritis]. 2009 May INTRODUCTION: Rheumatoid arthritis is an inflammatory chronic disease that affects 0.5-1% of the population, many of whom develop disease as working-age adults. MATERIAL AND METHODS: The aim of examination was to estimate functional disability in patients with rheumatoid arthritis and relationship between radiological damage, disease duration, disease activity, functional disability. The examination involved 60 patients with rheumatoid arthritis, aged (53.92 +/- 7.06) of both genders (48 female, 12 male). The following variables were assessed at one time point: swollen and tender joint count, visual analogue scale for pain, erythrocite sedimentation rate, health assessment questionnaire (HAQ) score, anatomical stage and functional class according to Stenbrocker's criteria. Disease activity was expressed as 28 joint disease activity score (DAS28). Correlations were calculated by Spearman's coefficient of correlation. RESULTS: In our study 82% of the patients had II and III anatomical stage and 80% of the patients had II and III functional class according to Steinbrocker's criteria. The median HAQ score was 1.25 +/- 0.70, and the median DAS28 was 5.74 +/- 0.98. Poor functional status was observed in 37 (61.66%) of the patients with an HAQ score of = 2. Functional disability in patients with rheumatoid arthritis was most strongly related to the presence of pain (rs=0.338, p<0.01) and to a lesser extent to anatomical and functional stage, disease duration, disease activity. DISCUSSION AND CONCLUSION: The results of the study show that functional disability significantly correlated with subjective pain score (rs=0.338, p<0.01). We observed strong correlation between functional disability presented by HAQ score and pain but no significant correlation with other common clinical variables used for rheumatoid arthritis patients evaluation such as disease duration, disease activity, radiological damage.
19962620 The Simplified Disease Activity Index and Clinical Disease Activity Index to monitor patie 2009 Nov Rheumatoid arthritis (RA) disease activity plays a central role in causing disability directly and via indirect effects mediated through joint damage, a major sequel of persistent active disease. Evaluation of RA disease activity is therefore important to predict the outcome and effectiveness of therapeutic interventions during follow-up. However, disease activity assessment is among the greatest challenges in the care of patients with RA. The authors regard measurement of activity as an essential element in following the fate of joint diseases such as RA. This evaluation can be facilitated by the use of reduced joint counts and simple indices, such as the Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI). These scores are validated outcomes for RA and allow the assessment of actual disease activity, response to therapy, and achievement of particular states such as remission. The simplicity of these scores enables patients to understand the level of their disease activity, as assessed by the rheumatologist, and to correlate increments and decrements of disease activity directly with all aspects of the disease. Moreover, remission criteria of CDAI and SDAI are currently the most stringent.
20692379 Cardiac involvement in systemic rheumatic diseases: An update. 2010 Oct The high rates of cardiovascular (CV) mortality and morbidity observed in patients with systemic autoimmune diseases (SADs) cannot be fully explained by traditional atherosclerosis risk factors as standard therapy (i.e. corticosteroids and methotrexate), cytokines and disease activity may all contribute to accelerated atherosclerosis. There is considerable evidence showing that chronic inflammation and immune dysregulation play a pathogenetic role in the development of atherosclerosis in patients with SADs. Chronic inflammation, accelerated atherosclerosis and functional abnormalities of the endothelium suggest that subclinical CV involvement begins soon after the onset of the disease and progresses with disease duration. All cardiac structures may be affected during the course of SADs (valves, the conduction system, the myocardium, endocardium and pericardium, and coronary arteries), and the cardiac complications have a variety of clinical manifestations. As these are all associated with an unfavourable prognosis, it is essential to detect subclinical cardiac involvement in asymptomatic SAD patients, and begin adequate management and treatment early.
20597267 [Pneumonia in patients with rheumatoid arthritis: the frequency of development, the specif 2010 AIM: To study the frequency of development of pneumonia, the specific features of its course and risk factors (RF) in inpatients with rheumatoid arthritis (RA). MATERIALS AND METHODS: The archival records (a total of 9059 case histories) of patients with RA treated at the Institute of Rheumatology, Russian Academy of Medical Sciences, during 7 calendar years (1994-1996, 2003-2006) were retrospectively studied. Case histories containing evidence for pneumonia sustained during the patient's hospital stay were selected for analysis. During the analysis, the authors took into account the clinical characteristics of RA, laboratory and X-ray parameters, and comorbidity, including pneumonia. RESULTS: In the inpatients, the frequency of development of pneumonia was 0.8%. The risk factors of pneumonia were the high activity of RA, its systemic manifestations and no use of essential antirheumatic drugs. In 70% of RA patients developing pneumonia, the body temperature was normal or subfebrile; productive cough was absent in 50% of the patients; a third had no cough. Clear X-ray lung tissue infiltration was seen in 48% of cases. Clinical leukocytosis was absent in 50% of the patients; at the same time, there were statistically significant increases in the count of stab neutrophils and erythrocyte sedimentation rate. CONCLUSION: The inpatients with RA develop pneumonia in about 0.8% of cases, which is characterized by an obliterated course and usually develops with the high activity of RA, its systemic manifestations and no use of essential antirheumatic drugs.
19784543 Acute respiratory distress syndrome associated with rapid aggravation of rheumatoid arthri 2010 Feb A 76-year-old woman with seropositive rheumatoid arthritis (RA) developed acute respiratory distress syndrome (ARDS) following an appearance of severe inflammatory symptoms in multiple synovial joints. High-dose pulse therapy with methylprednisolone induced a marked improvement in pulmonary conditions. To the best of our knowledge, this is the first case in the literature to show a causal relationship between ARDS and RA. We should be alert to the possibility that ARDS can occur as an acute-type pulmonary complication of RA, particularly when patients show rapid aggravation of rheumatic activity.
19255828 Sixty percent of patients with rheumatoid arthritis in Japan have used dietary supplements 2009 We conducted a survey on the use of dietary supplements and health foods (DS/HF) in definite rheumatoid arthritis (RA) patients treated by RA specialists. Among 296 patients (male 48, female 248), 179 patients (60.5%) had experience of DS/HF use. Prevalence of DS/HF use was significantly higher in female than in male patients (63.7% versus 43.8%). Overall, patients who have used DS/HF were significantly younger than those who have not used; it was particularly notable in female patients. The proportion of current users was significantly higher in those less than 5 years from diagnosis than those who had been diagnosed for 5 years or more. Products of herbs or algae (44.1%) and components of cartilage (40.8%) were the most popular DS/HF. Primary sources of product information were family members or friends (56.4%) and advertisements in the mass media (34.1%). Of the users, 73.7% did not disclose DS/HF use to their physicians. The users expected alleviation of the symptoms (35.2%) and improvement of health (34.6%). However, 59.2% of the users were unsure of the benefits. In conclusion, physicians should be aware of the high prevalence of DS/HF usage in patients with RA in Japan.
18410349 The effect of parental consanguinity on the clinical and laboratory findings of rheumatoid 2009 Jul AIMS: We aimed to evaluate the frequency of consanguinity among the parents of patients with rheumatoid arthritis (RA) and the influence of parental consanguinity on several clinical and laboratory parameters which reflect the severity of the disease. METHODS AND PATIENTS: The study population consisted of 265 patients with RA which were divided into two groups with respect to the presence or absence of consanguinity between their parents. The frequency of parental consanguinity was compared with the general population. The two groups were compared with respect to family history of RA, the age of onset, the age at which RA was diagnosed, duration of the disease, the presence of rheumatoid nodules, vasculitis, serositis and the need for orthopaedic surgery, amyloidosis, the presence and level of rheumatoid factor and anti-cyclic citrullinated peptide antibodies, erosive changes on radiographs, and the need for anti-tumour necrosis factor therapy. RESULTS: Twenty-one patients (8%) had parents who were consanguineous, which was not more frequent compared with the general population (14%). The mean age of disease onset and the mean age at which RA was diagnosed were lower in patients with parental consanguinity, although the difference was not statistically significant. The other clinical and laboratory parameters were also not different between the two groups. CONCLUSION: The present data suggests that parental consanguinity has no effect on disease severity, and the frequency of consanguinity is not increased among the parents of patients with RA. A possible exception is the earlier disease onset and age at diagnosis which needs to be confirmed by larger studies.
19156864 Immunoadsorption with tryptophan columns: a therapeutic option for the treatment of rheuma 2009 Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease affecting multiple organs and tissues. Although there is a wide range of therapeutic applications, the coexistence of severe side effects and contraindications outlines the necessity of new therapeutic options in the treatment of severe RA. We report on the case of a 71-year-old patient with successful treatment of a complicated RA with tryptophan immunoadsorption combined with low-dose steroids. Bacterial spondylitis developed in this patient during long-term treatment with infliximab and methotrexate. Weekly immunoadsorption sessions with tryptophan columns resulted in continuous suppression of RA activity over a period of more than 5 months, as indicated by laboratory findings, the disease activity score, and the visual analog scale. This is the first report of successful treatment of a refractory and complicated RA using tryptophan immunoadsorption columns. In conclusion, immunoadsorption is a safe and effective therapeutic alternative, which should be considered to bridge infectious complications in patients with severe RA.
19687080 Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands. 2010 May We evaluated the clinical outcome of tendon reconstruction using tendon graft or tendon transfer and the parameters related to clinical outcome in 51 wrists of 46 patients with rheumatoid arthritis with finger extensor tendon ruptures. At a mean follow-up of 5.6 years, the mean metacarpophalangeal (MP) joint extension lag was 8 degrees (range, 0-45) and the mean visual analogue satisfaction scale was 74 (range, 10-100). Clinical outcome did not differ significantly between tendon grafting and tendon transfer. The MP joint extension lag correlated with the patient's satisfaction score, but the pulp-to-palm distance did not correlate with patient satisfaction. We conclude that both tendon grafting and tendon transfer are reliable reconstruction methods for ruptured finger extensor tendons in rheumatoid hands.