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ID PMID Title PublicationDate abstract
19301788 Interpositional arthroplasty of the calcaneocuboid joint using a regenerative tissue matri 2009 Feb Nonunion after foot arthrodesis is a difficult clinical problem to solve. This article presents a case of a patient who underwent 3 unsuccessful attempts at calcaneocuboid joint arthrodesis. This problem was salvaged with interpositional arthroplasty of the joint with successful clinical outcome. A 49-year-old woman with longstanding rheumatoid arthritis underwent triple hindfoot arthrodesis. Although the talonavicular joint and the talocalcaneal joints achieved successful arthrodesis, the calcaneocuboid joint did not unite. Revision arthrodesis of the joint, as well as another attempt at percutaneous grafting had failed. Infection was ruled out by biopsy. In each instance, her postoperative course was complicated by difficulty complying with nonweight bearing restrictions, changes in her rheumatoid arthritis medications, and medical comorbidities. Considering all of her medical and rehabilitation issues, she underwent interpositional arthroplasty using a regenerative tissue matrix, rather than a fourth attempt at arthrodesis. Allograft dermal matrix was used as interpositional material at the calcaneocuboid joint. One year postoperatively, the patient reports only mild discomfort in the hindfoot, which does not interfere with her activities of daily living. In the difficult setting of multiple failed attempts at arthrodesis, interpositional arthroplasty can be considered in a nonweight-bearing joint such as the calcaneocuboid joint. Interpositional arthroplasty represents a technique capable of providing pain relief in clinical situations in which osseous union cannot be achieved.
19387266 Current world literature. 2009 May This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 January 2008 and 31 December 2008 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.
20189950 The influence of ethnicity on the extent of, and reasons underlying, delay in general prac 2010 May OBJECTIVE: Delay in assessment by rheumatologists of patients with new-onset RA is an important determinant of delay in treatment initiation. The influence of ethnicity on delay in assessment has not been addressed. We studied the extent of delay in patients of South Asian origin compared with other patients and the reasons underlying this delay. METHODS: Data were collected from 272 patients with RA at the time of assessment by a rheumatologist; 43 were of South Asian origin. Delays were recorded at the level of the patient seeking advice from the general practitioner (GP), the GP referring to secondary care and the rheumatologist seeing the patient after the referral had been made. In addition, using qualitative methods, we assessed the reasons underlying delay in help-seeking behaviour in 10 patients of South Asian origin. RESULTS: Patient delay was significantly longer in patients of South Asian origin than in other patients. Delays at the level of primary and secondary care were not different. Four interlinking themes influenced how rapidly early RA patients of South Asian origin consulted their GPs: symptom experience, symptom evaluation, existing ideas, and knowledge of RA and influence of friends and family. CONCLUSIONS: Patient-dependent factors leading to delays in GP consultation, are the principal reason for the considerable delay in RA patients of South Asian origin being seen by rheumatologists. An understanding of the reasons underlying this delay will inform the development of interventions to reduce it in this population.
20420213 [Normalizing effect of rehabilitative techniques on the psychoemotional status of patients 2010 120 subjects with a verified diagnosis of rheumatoid arthritis (RA) and 94 ones with osteoarthrosis (OA) were examined to evaluate the influence of structural electromagnetic resonance therapy (SEMRT) on psychological status of patients suffering from both inflammatory and dystrophic joint diseases. Spielberger test for situational and personal anxiety and Beck test for depression were used to detect and assess changes in the patients' psychological condition. Comparative studies demonstrated advantages of incorporation of SEMRT in combined RA and OA treatment. Wide spectrum of SEMRT therapeutic actions accounts for its beneficial action in patients presenting with anxiety and depressive disorders associated with inflammatory and dystrophic joint diseases highly refractory to routine treatment.
19846407 Repair of erosions occurs almost exclusively in damaged joints without swelling. 2010 May BACKGROUND: Negative radiographic change scores obtained under blinded time-sequence conditions suggest that repair of joints may indeed occur. It is likely that, if repair truly exists, it would be preferentially seen in clinically inactive joints from patients treated with drugs with well-known structural efficacy. OBJECTIVE: To determine whether repair is associated with both the absence or improvement of swelling and with treatment. PATIENTS AND METHODS: Radiographs from patients of the TEMPO trial were scored twice by two readers according to the Sharp-van der Heijde score, blinded to both treatment and true time sequence. Single-joint change scores in erosions were coupled with single-joint swelling scores obtained from clinical examination. Consistency of observed improvement across readers and repeat reads was described, and factors expected to increase the likelihood of occurrence of both worsening and improvement of erosion were tested by generalised estimating equations (GEE) modelling. RESULTS: In all of the four independent reads, the mean change in erosion score was statistically significantly negative only in the subgroup of joints with absent or improved swelling, when erosions were present at baseline. Multivariate analysis showed that worsening of the erosion score in a joint was significantly increased if that joint was already damaged at study entry, clinical swelling persisted and methotrexate was used instead of etanercept. Repair was associated with improvement of swelling and use of etanercept (p
19206034 [Intersectoral patient care in rheumatology: concept and preliminary experiences with a mo 2009 Feb In October 2006 the Rheumaklinik Ostbayern was founded as a clinic for acute rheumatology patient care, carried by Landkreis Passau Krankenhaus GmbH. The clinic operates in close professional cooperation with the Orthopädiezentrum Bad Füssing, an adjacent rehabilitation clinic carried by Deutsche Rentenversicherung Bayern Süd. The close constructional and personnel network between the two institutions creates optimal conditions for an interdisciplinary and intersectoral approach. The authors report their first experiences since foundation of the clinic and completion of a cooperation contract.
20734483 [The prevalence of concomitant diseases among in-patients on the subject of rheumatic gout 2010 Mar The article contains the results of the study of rate, ratio and characteristics of concomitant diseases among in-patients with various clinical anatomic forms of rheumatic gout.
18996039 Diagnosis of synovitis by ultrasonography in RA: a one-year experience is enough for relia 2009 Jan OBJECTIVE: To evaluate the inter- and intra-observer agreement of ultrasonographic metacarpophalangeal joint static images in patients with rheumatoid arthritis by two investigators with different ultrasonographic experience. METHODS: Ultrasonography was performed by the senior on 386 metacarpophalangeal joints respectively in B-mode and 408 in power Doppler of 17 patients with active rheumatoid arthritis. A first interpretation was done and images were stored at examination time. Static images were then read twice by two independent investigators of different experiment (4-year and 1-year experience in musculoskeletal ultrasonography respectively for the senior and the junior). RESULTS: For the intra-investigator reproducibility kappa or weighted kappa coefficient ranged from 0.74 to 0.99 for the junior and the senior for B and power Doppler mode. For inter-investigator reproducibility kappa or weighted kappa coefficient ranged from 0.61 and 0.98 for qualitative B and power Doppler modes and semi-quantitative power Doppler. The inter-investigator weighted kappa was 0.49 for semi-quantitative B-mode. The agreement between the dynamic exam and the static exam; results were very good for both readers in power Doppler Mode (0.89). In B-Mode, they didn't reach statistical significance. The reliability for measuring synovial thickness was excellent--rho=0.7609 (p=0.00001). CONCLUSION: An experienced rheumatologist and a junior achieved high inter- and intra-observer agreement rates for the identification of synovitis and power Doppler activity for static images of ultrasonography. Trainees could use that method as a first step in US learning.
20577095 Factors associated with disability in patients with rheumatoid arthritis. 2010 Aug OBJECTIVE: Analyze disability determinants in a cohort of Argentine patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Consecutive patients with RA, according to ACR'87 criteria, were recruited from 6 rheumatology centers. Demographic and socioeconomic data, family history, comorbid diseases, extra-articular manifestations and information about received treatments were provided. Disease activity was assessed using Disease Activity Score 28 (DAS 28) and the Health Assessment Questionnaire (HAQ)-A was used for the functional capacity. Hand and feet radiographs were assessed using Sharp-van der Heijde score. RESULTS: A total of 640 patients with RA were included, of which 85.2% were females. Mean age was 53 years (interquartile range [IQR], 44-62) and mean disease duration was 8 years (IQR, 4-14). DAS 28 mean was 2.72 (IQR, 1.7-3.7) and HAQ-A mean was 0.62 (IQR, 0.13-1.25). Multiple linear regression showed that the main variables associated with disability were DAS 28, radiologic damage and age. Main predictors of functional disability in the multiple logistic regression using severe HAQ (>2) as dependent variable were DAS 28 (OR, 2; P < 0.0001); age (OR, 1; P = 0.008); and structural damage (OR, 1; P = 0.001). CONCLUSIONS: In this population, the disease activity was the variable that showed the highest impact on the physical function. Radiologic damage affected HAQ as the disease progressed.
19202223 [Serological markers of viral infections in patients with rheumatoid arthritis]. 2009 Jan The authors carried out serologic examination of 202 patients with rheumatoid arthritis (RA) and 200 healthy persons for detecting of specific markers of infections caused with herpes simplex virus (HSV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), hepatitis B and C viruses (HBV and HCV) and human T-cell lymphotropic retroviruses 1 and 2 (HTLV-1/2). It was demonstrated that detecting frequencies of HBsAg and total antibodies to HTLV-1/2, HSV and CMV among RA patients and healthy persons were practical equal--only anti-EBV were detected more often among RA patients than among healthy persons. But in the same time IgM-antibodies to HSV, CMV and EBV were detected more often among RA patients than among healthy persons. Authors concluded that most probable RA etiologically can be connected with chronic reproductive infections caused with HSV and EBV, which at least are able to participate in forming of predisposition to this disease by means of autoimmune reactions promotion.
19199037 Cell death in rheumatoid arthritis. 2009 Apr Apoptosis plays a pivotal role in tissue homoeostasis both under physiological and pathological conditions and several studies have shown that some characteristic changes in the composition and structure of the inflamed synovial membrane in rheumatoid arthritis (RA) are linked to an altered apoptotic response of synovial cells. As a result, a hyperplastic synovial tissue is generated that mediates the progressive destruction of articular cartilage and bone. In addition to inflammatory cells, these changes most prominently affect resident fibroblast-like cells that have been demonstrated to be of utmost importance for joint destruction. Once activated, these cells pass through prominent molecular changes resulting in an aggressive, invasive behaviour. Research of the past years has identified different mechanisms that prevent synovial cells in RA from apoptosis. They include changes in the mitochondrial pathway as well as altered expression of downstream modulators of death receptors and transcriptional regulators such as NFkappaB. This review summarises our recent progress in understanding aberrant apoptosis in the RA synovial membrane and points to possibilities of intervening specifically with this aspect of the pathogenesis of RA.
19378024 Toll-like receptors and rheumatoid arthritis. 2009 Rheumatoid arthritis (RA) is a chronic inflammatory disease that ultimately leads to the progressive destruction of cartilage and bone in numerous joints. There is mounting evidence for an important function of innate immunity in the pathogenesis of RA. Activation of cells by microbial components and also by endogenous molecules via Toll-like receptor (TLR) results in the production of a variety of proinflammatory cytokines, chemokines, and destructive enzymes, some of which can characteristically be found in RA.By immunohistochemistry we found elevated TLR2, 3, and 4 expressions in the rheumatoid synovium. In the synovial lining layer and at sites of invasion into cartilage, RA synovial fibroblasts (RASF) are the major cells expressing TLR2, 3, and 4. Stimulation of cultured RASF in vitro with the TLR2 ligand bacterial lipoprotein (bLP), the TLR3 ligand poly(I-C), and the TLR4 ligand LPS was shown to upregulate IL-6 as well as matrix metalloproteinases (MMPs) 1 and 3. These results suggest an important role for TLR2, 3, and 4 in the activation of synovial fibroblasts in RA leading to chronic inflammation and joint destruction.
19917173 Rheumatoid arthritis and thrombosis. 2009 Sep OBJECTIVE: To review prevalence, risk factors and mechanisms of thrombosis in rheumatoid arthritis (RA). METHODS: Available medical literature on PubMed was reviewed and relevant information summarized. RESULTS: Patients affected by RA present an increased risk of thromboembolism, an important cause of morbidity and mortality. Research is focused on the role of disease-associated risk factors and predisposing conditions such as endothelial dysfunction, hypercoagulability, pro-thrombotic conditions, inflammatory markers, immobility and complications following major knee or hip replacement. CONCLUSION: Thrombosis is a possible manifestation in RA patients. A number of factors are suspected to play a role in the increased thromboembolic risk. The mechanisms responsible for thrombosis in these patients remain unclear, however, the identification of the thrombophilic risk factors is clinically useful to determine in which patients occurrence is more likely.
21517637 Preventing the progression from undifferentiated arthritis to rheumatoid arthritis: the cl 2010 Nov A significant percentage of patients presenting with undifferentiated arthritis (UA) will progress to rheumatoid arthritis (RA), while others will undergo spontaneous remission. Evidence supports the use of therapeutic intervention in patients with UA to delay or halt disease progression and its long-term consequences. However, there is first a need to screen patients with UA to identify those with a high probability of progressing to RA who would benefit from antirheumatic therapy. The 2010 American College of Rheumatology/European League Against Rheumatism RA classification criteria were designed for this purpose. These criteria can aid clinicians in deciding when it is appropriate to initiate therapy in patients at risk of progressing to RA. These criteria can also have important implications in reducing the inappropriate and unnecessary use of antirheumatic agents in patients less likely to develop RA, thus reducing healthcare costs and minimizing the risk of sequelae associated with these agents. Use of disease-modifying antirheumatic drugs and biologic agents in patients with UA has been associated with delays in disease progression. However, further clinical studies are needed to fully evaluate the long-term clinical and economic outcomes of these agents in patients with UA.
20959326 State-of-the-art: rheumatoid arthritis. 2010 Nov The understanding of the pathogenesis and optimal therapeutics for rheumatoid arthritis (RA) has advanced remarkably over the last decade. This review highlights these key advances, particularly the outcomes of genome-wide scans which have provided an increasingly robust appraisal of the complex genetics that underpin RA. Such observations are placed in pathogenetic context, particularly concerning the breach of tolerance that presages synovitis and the mechanisms that subserve chronicity. The key therapeutic strategies and treatment agents, both conventional and biological, now available to effectively manage the disease are described. Throughout the review, emphasis is placed on unanswered questions and challenges in this exciting field.
20851025 Blood vessels, a potential therapeutic target in rheumatoid arthritis? 2011 Mar New micro-vessels formation within synovium and macro-vessels endothelial damage with atheroma are two major features of rheumatoid arthritis, the former related to the articular involvement of the disease, the latter to its main systemic complication. The similarities between pannus development and solid tumors growth, and the efficacy of anti-angiogenic treatments in oncology, opened the perspective of directly targeting angiogenesis in arthritis. Nevertheless, despite the success of different anti-angiogenic therapeutic strategies in many arthritis experimental models, the application in human disease is still lacking. Recent data suggest that synovial neoangiogenesis and macro-vessels endothelial damage might be two linked phenomena. While synovial angiogenesis seems to be detrimental to endothelial damage repair, even anti-angiogenic treatments might paradoxically aggravate macro-vascular disease, especially in the context of uncontrolled inflammation. These elements induce to further explore the interconnections between inflammation and angiogenesis on one side and between micro- and macro-vascular diseases on the other, in order to establish the proper way to therapeutically target blood vessels in rheumatoid arthritis.
19274516 Use of the Stanford Health Assessment Questionnaire in estimation of long-term productivit 2009 Mar OBJECTIVE: To evaluate the utility of the Stanford Health Assessment Questionnaire (HAQ) in the estimation of loss of productivity due to early rheumatoid arthritis (RA) and to develop a simple model for analysis of the cost-benefit of therapies. METHODS: In the Finnish Rheumatoid Arthritis Combination Therapy (FIN-RACo) trial, 162 patients with recent-onset RA who were available for the workforce were randomized to receive either a combination of three disease-modifying anti-rheumatic drugs (DMARDs) or a single DMARD for 2 years and were followed up for 5 years. No biological drugs were used. Data on sick leave and RA-related disability pensions came from official register records. Loss of productivity was computed by both the human capital approach (HCA) and the friction cost approach (FCA). Functional capacity was assessed by the HAQ at baseline and at 6 months. RESULTS: Over 5 years, mean loss of productivity per year was EUR 8344 by the HCA and EUR 1928 by the FCA. The level of the HAQ index at 6 months, but not the change in HAQ from baseline, determined productivity costs. With the HCA, a monotonous association between annual loss of productivity and the 6-month HAQ was found: EUR 2087 [95% confidence interval (CI) 1340-2903] per one step (0.13) on the HAQ scale from 0 to 1.88. With the FCA, the increase in loss of productivity was cut at the HAQ level of 0.5 to 0.75 (EUR 17 740 in 5 years). CONCLUSION: The HAQ index at 6 months may serve as a determinant of long-term RA-related indirect costs in economic analyses in early RA.
19382425 Expression of CC chemokine ligand 5 in patients with rheumatoid arthritis and its correlat 2009 Mar OBJECTIVE: To determine the levels of CC chemokine ligand 5 (CCL5) in serum and synovial fluid (SF) from patients with rheumatoid arthritis (RA) and their relations with disease activity and medication. METHODS: CCL5 in serum and SF was quantified by enzyme-linked immunosorbent assay (ELISA) in 28 RA patients and 21 osteoarthritis (OA) patients. In RA patients, the correlations of CCL5 levels in serum and SF with disease activity were analyzed. Meanwhile, the serum CCL5 levels among RA patients treated with disease-modifying antirheumatic drugs (DMARDs), Tripterygium Glucosides, and other Chinese herbs without disease-modifying effects were also compared. RESULTS: CCL5 levels in both serum and SF of RA patients were significantly higher than those of OA patients (P < 0.05). Moreover, the level of CCL5 was higher in SF than that in serum of RA patients (P < 0.01). Serum CCL5 level was correlated significantly with the number of swollen joints (r = 0.3329, P < 0.05), erythrocyte sedimentation rate (r = 0.4001, P < 0.05), and C reactive protein (r = 0.3735, P < 0.01). In addition, the level of CCL5 had a trend of lower in patients treated with DMARDs or Tripterygium Glucosides than those treated with other Chinese herbs, although the difference was not significant among those patients due to the small number of patients in each group. CONCLUSIONS: In RA patients, the expression of CCL5 increases and correlates with some clinical and laboratory parameters of RA, which indicate that CCL5 plays an important role in RA and may serve as a useful marker of disease activity. DMARDs and Tripterygium Glucosides might exert their clinical effects through reducing CCL5 production in RA.
20396714 Clinical efficiency and tolerability of artrofoon in patients with rheumatoid arthritis as 2009 Sep Clinical, laboratory, densitometric, and prognostic parameters were evaluated in 50 patients with rheumatoid arthritis complicated with osteopenic syndrome, 30 of these received artofoon for 12 months in addition to basis therapy. Antiinflammatory and analgesic effects of artrofoon were demonstrated and the possibility of using this preparation in pharmacotherapy of rheumatoid arthritis associated with osteopenic syndrome was proven.
19821162 Medical care costs of patients with rheumatoid arthritis during the prebiologics period in 2010 Feb Our objective was to describe outpatient medical care costs of patients with rheumatoid arthritis (RA) in the prebiologics period in Japan. The outpatient costs of 6,771 RA patients (17,666 patient years) who were enrolled in an observational cohort study at the Institute of Rheumatology, Rheumatoid Arthritis (IORRA), in Tokyo, Japan, were calculated from the billing records dated from 2000 to 2004. Associations between outpatient costs and variables such as age, RA duration, RA disease activities, and disability levels were assessed. The average outpatient cost gradually increased (+7.7% in 4 years) from 271,498 JPY per year in 2000 to 292,417 JPY per year in 2004. Medications accounted for approximately 50% of total outpatient costs, which increased 29.6% during the 4 years. The outpatient costs increased in association with aging, longer RA duration, higher Disease Activity Score of 28 Joints (DAS28), and higher Japanese version of Health Assessment Questionnaire (J-HAQ) score. Generalized linear regression analysis revealed that both DAS28 and J-HAQ scores were the most significant factors associated with outpatient costs (p < 0.001). Outpatient costs for patients with RA increased year after year over the 4-year period under observation in Japan. Medical costs were higher with increasing RA disease activity and disability levels.