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ID PMID Title PublicationDate abstract
20851679 A clinico-pathological conference on constrictive pericarditis secondary to rheumatoid art 2011 Jan Constrictive pericarditis is the commonest cardiac complication of rheumatoid arthritis (RA). Two percent of patients with RA develop significant clinical symptoms of pericarditis, which may not correlate with joint disease duration or severity. Symptoms are often vague and non-specific, which frequently delays the diagnosis and subsequent management. Surgical excision of the pericardium is the only definitive treatment option. We present the case of a 60 year-old lady with RA who presented with symptoms due to pericardial constriction and underwent radical pericardectomy.
19760425 [Histomorphology of interstitial lung disease and pulmonary vasculitis]. 2009 Oct Rheumatic diseases or collagen vascular diseases represent a heterogeneous group of immunologically mediated inflammatory disorders. The respiratory system is often affected,the causes being manifold: infection, medication toxicity and specific manifestations of immunological processes due to the underlying disease. The lung can be involved in all its components. Due to their extremely broad differential diagnosis, pulmonary vasculitic syndromes still constitute a major challenge for the pathologist. Pulmonary involvement is frequent in primary systemic vasculitis (PSV) associated with anti-neutrophil-cytoplasmic antibodies (ANCA); other PSV only rarely affect the lungs. Histomorphologically, small vessel vasculitis with neutrophil alveolitis and diffuse alveolar hemorrhage, as well as extravascular intraparenchymal or peribronchial granulomas, can point to PSV. A single biopsy is often insufficient to identify all diagnostic criteria. Therefore, the selection of suitable biopsy material and correlation with clinical, serological and radiological parameters is indispensable. Almost all forms of interstitial lung disease may be present in collagen vascular disease; however, several parallel morphological types, rather than one in isolation, are frequently found.
20229259 Excellent therapeutic effect of tocilizumab on intestinal amyloid a deposition secondary t 2010 Oct A 64-year-old woman suffering from progressive amyloid A (AA) amyloidosis of the gastrointestinal (GI) tract, associated with active rheumatoid arthritis, was transferred to our hospital due to hypovolemic shock. Although intensive care, including treatment with prednisolone and methotrexate, improved the hypovolemic shock, paralytic ileus became dominant instead of the marked diarrhea, suggesting the terminal stage of AA amyloidosis of the GI tract. Thus, we administered tocilizumab, a humanized anti-interleukin 6 receptor antibody (8 mg/kg, repeated every 4 weeks). Two weeks after the first injection of tocilizumab, serum AA rapidly returned to their normal ranges in accordance with the amelioration of paralytic ileus and systemic joint pain. Surprisingly, after three courses of tocilizumab treatment, colon biopsy revealed no amyloid deposition. Tocilizumab is a promising agent to treat secondary AA amyloidosis by strongly suppressing serum AA levels.
19309435 Rheumatoid leptomeningitis: magnetic resonance imaging and pathologic findings--a case rep 2010 Apr BACKGROUND AND PURPOSE: Rheumatoid arthritis (RA) is a chronic inflammatory multisystem disease with articular and extra-articular manifestations. Intracranial manifestations of RA are rare. Purpose of this article is to report on a rarely described leptomeningeal involvement in RA, and on its neuroimaging features, including diffusion-weighted imaging (DWI). METHODS: The authors describe the case of a 74-year-old woman with a 5-year history of RA presenting with progressive left-side weakness and hypoesthesia. The patient underwent laboratory investigation and brain contrast-enhanced MRI, also with DWI, before undergoing brain biopsy. RESULTS: Neuroimaging revealed abnormal high T2-signal in right frontal and parietal lobes, restricted diffusion in the subarachnoid space, and diffuse thick linear leptomeningeal contrast-enhancement. These findings were interpreted as rheumatoid leptomeningitis, and brain biopsy confirmed this diagnosis. CONCLUSIONS: In summary, rheumatoid meningitis is a rare neurological complication of RA, but it should be considered in the proper clinical setting when patient presentation and laboratory results fail to support the other differential diagnostic possibilities proposed by the MR imaging findings.
19899555 [Scleromalacia perforans. Rheumatoid arthritis--case report]. 2009 The authors present the case of a 73-year-old patient who comes in our clinic because of the existence of a tumoral formation pigmented and elevated, situated in the temporal side of the right eye and because of decreasing of her visual acuity at both eyes, as well as foreign body eye sensation, tearing, light sensitivity redness of the eye. The ophthalmological examination establishes the diagnosis of the right eye: Scleromalacia perforans, scleral temporal nodule considering the chronic, systemic inflammatory invalidated disorder, rheumatoid arthritis fourth stage. The purpose of this case presentation is represented by the rarity of this type of ocular manifestation presented in late stages of rheumatoid arthritis.
19365267 Recent concepts in the inhibition of radiographic progression with biologics. 2009 May PURPOSE OF REVIEW: To provide an update on new concepts in the inhibition of radiographic progression with current and emerging biologic therapy. RECENT FINDINGS: The advent of biologic therapies for the treatment of rheumatoid arthritis has given rise to the concept of a disconnect between clinical and radiographic outcomes. Radiographic progression has been observed in patients in clinical remission, whereas inhibition of radiographic progression has been demonstrated in patients with clinically active disease. Moreover, imaging remission has been shown to be much easier to achieve than clinical remission. Biologics are superior to methotrexate (MTX) in inhibiting radiographic progression at every level of disease activity and response. The majority of patients receiving biologics and a significant proportion receiving MTX alone do not progress radiographically. The combination of a biologic and MTX inhibits radiographic progression more than either alone, reducing both the proportion of patients progressing and the degree of progression of those who do progress. Although biologics are similar in their ability to inhibit radiographic progression in most patients, they differ in inhibiting the progression in the rapid radiographic progressors. SUMMARY: The disconnect between clinical and radiographic outcomes demonstrated with biologics implies the need to monitor both outcomes in order to treat patients most effectively. The superiority of biologics over MTX in inhibiting radiographic progression suggests that the clinical target for a biologic may differ from that for MTX to prevent structural damage and preserve function. For most patients, radiographic inhibition should not affect the choice of a biologic.
19233042 What have we learnt about the development and progression of early RA from RCTs? 2009 Feb Most randomized controlled trials (RCTs) investigating the treatment of early rheumatoid arthritis (RA) use the core set of measures proposed by consensus meetings in the 1990s; these include tender and swollen joint counts, pain, global assessments, disability, and acute-phase responders such as the erythrocyte sedimentation rate (ESR). Trials in early RA generally assess three key outcomes based on this core data set: symptoms and signs of inflammatory arthritis, progression of disability, and erosive damage. Adverse events are also recorded. This chapter considers the lessons learned from the various trials in terms of benefits and adverse effects of different treatment regimens.
19066900 Deforming arthropathy in SLE: review in the literature apropos of one case. 2009 Aug Among the clinical manifestations of systemic lupus erythematosus is an arthropathy, which is usually non-erosive. In many cases, the joint involvement is mild. A subset of patients has deforming, non-erosive Jaccoud's arthropathy, and a minority have an arthropathy with clinical findings similar to rheumatoid arthritis that has been called "rhupus". We report a case of a 48-year-old female rhupus patient. The lack of clinical criteria for this rheumatic condition has created confusion in the characterization of this disorder. Thus, more effort is needed to establish a potential and clear definition for rhupus.
19566938 Co-existence of acute myeloid leukemia with multilineage dysplasia and Epstein-Barr virus- 2009 Jun 30 Rheumatoid arthritis (RA) is an autoimmune disease mediated by inflammatory processes mainly at the joints. Recently, awareness of Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disorder (T-LPD) has been heightened for its association with methotraxate usage in RA patients. In the contrary, acute myeloid leukemia with multilineage dysplasia (AML-MLD) has never been documented to be present concomitantly with the above two conditions. In this report we present a case of an autopsy-proven co-existence of AML-MLD and EBV-associated T-LPD in a patient with RA.
20435499 Multicentric reticulohistiocytosis: an autoimmune systemic disease? Case report of an asso 2010 May Multicentric reticulohistiocytosis is a rare, systemic, reactive histiocytic disease of unknown aetiology. Autoimmune diseases have previously been reported in association with multicentric reticulohistiocytosis, but whether this is a true association or mere coincidence is not known. Here, we report the case of a 50-year-old woman who had been diagnosed as suffering from rheumatoid arthritis (RA), four years ago with positive rheumatoid serology was evaluated for multiple asymptotic papulonodules eruption. Histopathologic examination was suggestive of multicentric reticulohistiocytosis. She developed concomitantly Sjogren syndrome with systemic manifestations. Multicentric reticulohistiocytosis may be misdiagnosed as RA, but evaluation of the time course of specific symptoms can greatly help in the correct diagnosis. The possibility of commune etiopathogeny of these affections is discussed.
21105472 [Lesions in lungs in patients with rheumatoid arthritis]. 2010 The aim of this work was to study the prevalence and clinical features of affection of lungs and lower respiratory tract (LRT) in patients with rheumatoid arthritis (RA). A total of 104 non-smoking patients with RA and 100 ones without RA or chronic pulmonary diseases were examined. RA was associated with affection of all parts of the respiratory tract including proximal and distal bronchi, lung interstitium, and pleura. Bronchopulmonary disorders in RA patients had multilevel character suggesting continuous inflammation and sclerotization of anatomic respiratory structures. Lesions in lungs and LRT are shown to be of prognostic value (bronchiectasis, bronchiolitis, interstitial pneumonia), they frequently produce only weak clinical symptoms, and therefore need to be actively detected. Combination of functional tests and imaging techniques is of primary importance for diagnosis of respiratory problems in patients with RA.
20125169 Immunology: TL1A in the inflammatory network in autoimmune diseases. 2010 Feb Several lines of evidence both from experimental models and from clinical studies reveal that TNF-like ligand 1A (TL1A) and its interaction with death receptor 3 (DR3) is critically involved in the pathogenesis of rheumatoid arthritis and other autoimmune diseases.
20347241 [Renal leiomyosarcoma, rheumatoid arthritis and methotrexate]. 2010 Jun Leiomyosarcoma of the renal vein is a rare and malignant tumor difficult to diagnose. No standard treatment has been defined and prognosis is poor. We described the case of a 68-year-old woman with rheumatoid arthritis treated by methotrexate who developed a leiomyosarcoma of the left renal vein with a fatal outcome in less than 1 year. Association of a leiomyosarcoma and rheumatoid arthritis raises the question of a casual association or of a predisposing factor since studies have shown increased risk of cancer with this rheumatism.
19533433 [The evaluation of early pulmonary involvement with high resolution computerized tomograph 2009 To investigate pulmonary involvement by high resolution computerized tomography (HRCT) in patients with rheumatoid arthritis (RA) who are asymptomatic and lifelong non-smoker. Twenty-five patients with RA who are asymptomatic and lifelong non-smoker were included in the study. After clinical and laboratory investigations, plain chest X-rays, pulmonary function tests (PFT) and HRCT were performed. End expiratory HRCT slices were obtained for air trapping. Chest X-ray, PFT and HRCT findings showed 12%, 16%, 48% abnormalities, respectively. Interstitial involvement was the most common finding on HRCT (36%) and followed by air trapping (20%). Bronchiectasis, pulmonary nodule, and pleural disease were seen in 16%, 12%, and 12% of patients, respectively. None of patients had emphysema and honeycomb pattern. There was no statistically significant correlation between HRCT findings and disease activity criteria, RF positivity, PFT results and duration of the disease. Our study shows that pulmonary involvement is not always together with respiratory symptoms and impaired pulmonary function in patients with RA. New studies are needed which investigating the effects of radiologically detected lung involvement on prediction of survival and treatment choice in asymptomatic and nonsmoker RA patients.
19771490 Palindromic rheumatism: a descriptive report of seven cases from North Dakota and a short 2010 Jan The population of North Dakota is predominantly of Scandinavian (Norwegian) or German descent. We analyzed a cohort of all patients diagnosed with palindromic rheumatism (PR) and followed-up (by the investigator PK) at the St. Alexius Medical Center, Specialty Clinics, Bismarck, North Dakota, from August 16, 2006 to September 16, 2008. Standard statistical methodology was used to analyze the data. The proportion of patients with PR out of the total number of patients with rheumatoid arthritis (RA) seen during the timeframe of this study at our institution was 0.9%. The demographics, clinical features, and response to treatment of our patient-population with PR were quite similar to what has been described in the literature. However, we did not observe an evolution of PR into rheumatoid arthritis or any other "identifiable" inflammatory arthropathy although the follow-up was done very regularly (at least every 3 months), the average duration of follow-up being 12.1 months. Also, testing for the HLA B27 allele was positive in 3 (42.86%) patients, much higher than the "background" prevalence of this gene. This small, longitudinal study describes the epidemiology, clinical features, laboratory and radiographic findings, and course of PR in a small but closed community. This is the first descriptive report of PR to the best of our knowledge from the unique state of North Dakota.
21089427 [The results of the baseline therapy of the rheumatoid arthritis]. 2010 Aug Retrospective comparative analysis of therapy of the rheumatoid arthritis was undertaken. The following variants of antiphlogistic prescription: inactive tactics (long-lasting administration of one medicine), tactics of protracted treatment (separate courses of disease-modifying antirheumatic drugs with long breaks between them), tactics of first aid (at the beginning "passive treatments", after the appearance of complications begun active therapy with cytostatics); tactics of pyramid (the order of the prescription of medicines corresponds to classical strategy of baseline therapy with short breaks during the treatment), tactics of active therapy (the early beginning of baseline therapy with consistent change of medicine); effectiveness and safety of long-lasting administration of antiphlogistic in complex therapy of the rheumatoid arthritis.
20938818 Outcome measures in pediatric rheumatology. 2010 Oct Children with rheumatologic disorders need periodic systematic evaluation of their disease status so that all aspects of the child's life that are affected can be adequately assessed. The commonest rheumatologic disease that afflicts children is Juvenile Idiopathic Arthritis (JIA). The child with JIA should have several domains assessed at regular intervals. These outcome measures include the physical, functional and the quality of life assessment measures. No single measure can capture the full impact of the disease on the child's life. This article highlights the key outcome measures in a child with JIA and introduces the readers to several disease measurement tools that have been developed for assessment of outcome for the child with JIA.
19005635 Limiting cardiovascular risk in Irish rheumatoid arthritis patients. 2009 Mar BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease and premature death. OBJECTIVES: Our aims were: (1) to assess how thoroughly RA patients were being screened for cardiovascular risk factors in our outpatient population and (2) to evaluate the benefit of introducing a shared care cardiovascular booklet. METHODS: We assessed 80 patients who attend our service with RA. Our initial audit revealed that 80% of patients had not been thoroughly assessed for basic cardiovascular risk. Based on these findings, we created a shared care booklet. RESULTS: On re-auditing our service, we found a significant improvement in the assessment of cardiovascular risks. CONCLUSION: There is currently a low level of screening for cardiovascular risks in busy outpatient clinics. We felt the introduction of a shared care booklet allowed an increased level of screening in our clinics and also acted as a tool for doctor and patient education.
19822054 A systematic comparison of rheumatoid arthritis and ankylosing spondylitis: structural out 2009 Jul Rheumatoid arthritis and ankylosing spondylitis are both chronic diseases with inflammation as a hallmark. Both diseases are characterized by structural abnormalities of the peripheral joints (RA) or the spine (AS) that can be visualized on conventional radiographs. RA is associated with destruction (erosions, joint space narrowing) whilst AS is dominated by bone formation (syndesmophytes). The causative relationship between inflammation and structural damage in RA is well established, whilst this relation is largely unknown but certainly less strong in AS. Progression of structural damage in RA is inhibited by disease modifying anti-rheumatic drugs and especially by TNF-blockade, whilst progression of structural damage in AS seems insensitive to TNF-blockade but sensitive to non-steroidal inflammatory drugs.In this article, similarities and dissimilarities with respect to structural damage in RA and AS are discussed and set against a background.
20515276 Anti-CCP: challenges in quantifying auto-antibodies and creating international reference m 2010 Anti-CCP assays (antibody to cyclic citrullinated peptides) possess a high specificity for RA (rheumatoid arthritis). In lack of an international reference material the absolute values among different assays strongly diversify. The cut-off showed a variance from 5 U/mL Euroimmun anti-CCP to 25 U/mL Euro-Diagnostica Immunosan RA. The Autoantibody Standardization Committee is currently trying to establish a reference specimen of human polyclonal anti-CCP.