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ID PMID Title PublicationDate abstract
20180124 Health-related quality of life in rheumatoid arthritis: comparison of RAQoL with other sca 2011 Jun Quality of life (QoL) is the gratification taken from life, happiness, and the way human beings perceive their situation within the system of culture and values. Rheumatoid arthritis (RA) is among the main conditions in which QoL is decreased. The aim of this study was to evaluate QoL and related variables in patients with RA. A total of 153 RA patients were included in the study. All patients were evaluated by the rheumatoid arthritis quality of life (RAQoL), Nottingham health profile (NHP), and the health assessment questionnaire (HAQ) scales. Disease activity score 28 (DAS28) was used for measuring disease activity, while the modified Sharp score developed by Van der Heijde was used for evaluating the radiological damage, and visual analog scale-pain (VAS-pain) was used to determine the level of pain. RAQoL had linear relations at high levels with VAS-pain, HAQ, DAS28, and the modified Sharp score (r values 0.86, 0.82, 0.82, and 0.38, respectively) and at a moderate level with disease duration (r 0.18). VAS-pain showed the highest correlation with the pain subgroup of NHP (r 0.91) and the second highest correlation was with RAQoL (r 0.86). As a result, it is concluded that in RA patients RAQoL is an important scale reflecting QoL related with pain, disease activity, functional status, and radiological progression. In our study pain ranked first among the variables that influenced QoL, and this was followed by disease activity and functional status.
20629510 Current concepts in the genetic diagnostics of rheumatoid arthritis. 2010 Jul Rheumatoid arthritis (RA) is a systemic, chronic and inflammatory disease of unknown etiology. HLA-DRB1 and PTPN22 1858T gene variants are risk factors of RA, clinical manifestations and rate of progression of joint destruction in this autoimmune disease. Currently, several immunopathogenetic models of other genes (CTLA4, MIF, PADI4 and SLC22A4) are under debate. The clinical influence of some of the gene polymorphisms associated with RA and the principles of pharmacogenetics applied to different therapies, such as classical disease-modifying anti-rheumatic drugs and new biological agents. Pharmacogenetics is a rapidly advancing area of research that holds the promise that therapies will soon be tailored to an individual patient's genetic profile.
19822050 Early inflammatory clinics. Experience with early arthritis/back pain clinics. 2009 Jul There is a clear need to assess patients presenting with a new onset of inflammatory peripheral arthritis and/or back pain early. Indeed, the clinical presentation of rheumatoid arthritis (RA) is not always characteristic but its early diagnosis is crucial to prevent irreversible structural damage. Likewise low back pain is common in the general population but may be related to ankylosing spondylitis (AS) and other axial spondyloarthritis (SpA) in up to 5% of cases. Mounting evidence suggests that early intervention leads to improve outcome both in RA and SpA which has important socioeconomic implications. Early inflammatory clinics (EIC) should therefore be considered in every rheumatology department to facilitate the early assessment and diagnosis of these patients allowing for prompt and targeted therapeutic intervention. In addition the EICs allow for a better focused follow-up of these patients in appropriate secondary clinics. Since the sustained remission of inflammatory and autoimmune diseases such as RA is highly dependent on how early treatment is instigated and its efficacy regularly assessed, there is legitimacy for the EICs. Furthermore, there is a clear research interest in building early inception cohorts that allow for the characterization of the different disease phenotypes.
19464743 Hypothetical bias, cheap talk, and stated willingness to pay for health care. 2009 Jul Subjects with rheumatoid arthritis (RA) enrolled in an online panel were asked to evaluate pairs of treatment alternatives with different attributes. Half of the sample saw a cheap-talk text. Preference parameters were estimated using random-parameters logit models to account for unobserved taste heterogeneity. The models also were estimated in willingness-to-pay (WTP) space instead of conventional utility space. Cheap talk not only affected the coefficient on the cost attribute, but also preferences for other attributes. WTP estimates were generally lower in cheap talk sample, except for the most important attribute and a 2-level attribute. Subjects who were presented with cheap talk discriminated between the adjoning attribute levels better than the subjects in the control sample.
20374348 Prevalence of anti cyclic citrullinated peptide antibodies in Malaysian rheumatoid arthrit 2009 Sep AIM: The objectives of this study are to provide data regarding the prevalence of anti-cyclic citrullinated peptide (CCP) antibodies in Malaysian rheumatoid arthritis (RA) patients and to correlate the levels of anti-CCP antibody with the Disease Activity Score (DAS). METHOD: We studied the prevalence of anti-CCP antibodies in 51 RA patients attending our clinic and 29 controls. We also looked for correlation between anti-CCP antibody levels with the DAS and parameters such as duration of disease, rheumatoid factor (RF) and disease-modifying anti rheumatic drug (DMARD) usage. RESULTS: None of the controls demonstrated anti-CCP antibodies. Forty-one out of 51 patients (80.4%) were positive for anti-CCP antibodies. Sensitivity and specificity were 80.4% and 100% respectively in this study. Anti-CCP levels correlated significantly with rheumatoid factor, but no correlation was observed with the other parameters. CONCLUSIONS: Anti-CCP antibody is prevalent in Malaysian RA patients at 80.4% and more sensitive than RF in our cohort of established RA patients. Even though the anti-CCP levels correlated with RF, it did not show correlation with DAS.
19898480 Specific interaction between genotype, smoking and autoimmunity to citrullinated alpha-eno 2009 Dec Gene-environment associations are important in rheumatoid arthritis (RA) susceptibility, with an association existing between smoking, HLA- DRB1 'shared epitope' alleles, PTPN22 and antibodies to cyclic citrullinated peptides (CCP). Here, we test the hypothesis that a subset of the anti-CCP response, with specific autoimmunity to citrullinated alpha-enolase, accounts for an important portion of these associations. In 1,497 individuals from three RA cohorts, antibodies to the immunodominant citrullinated alpha-enolase CEP-1 epitope were detected in 43-63% of the anti-CCP-positive individuals, and this subset was preferentially linked to HLA-DRB1*04. In a case-control analysis of 1,000 affected individuals and 872 controls, the combined effect of shared epitope, PTPN22 and smoking showed the strongest association with the anti-CEP-1-positive subset (odds ratio (OR) of 37, compared to an OR of 2 for the corresponding anti-CEP-1-negative, anti-CCP-positive subset). We conclude that citrullinated alpha-enolase is a specific citrullinated autoantigen that links smoking to genetic risk factors in the development of RA.
20645116 Paid work is associated with improved health-related quality of life in patients with rheu 2010 Nov Numerous patients with rheumatoid arthritis (RA) end their working career due to consequences of the disease. No publication has reported whether there is an independent association between patients' health-related quality of life (HRQOL) and employment status. The objective of the study was to investigate the association of paid work and HRQOL in patients with RA whilst controlling for demographics and disease severity. This was a cross-sectional study. Three hundred and ten patients were consecutively recruited from two Norwegians hospitals when commencing disease modifying anti-rheumatic drug treatment. Data on demographics, employment status, disease activity (DAS28-3), physical functioning, pain, tiredness, and HRQOL (SF-36) were collected. HRQOL were compared between 123 patients working full- or part-time and 187 patients not working due to disability pension, retirement, being students or "home workers". The regression analyses showed an independent positive association between paid work and the physical (p=001) and the mental component (p=012) of the SF-36 when controlling for demographics and disease severity. Paid work was statistically significantly associated with better HRQOL in patients with RA. The positive association of performing paid work and HRQOL imply that health care providers should thoroughly evaluate the possibilities for the patients to continue with paid work.
20554241 Elderly-onset rheumatoid arthritis. 2010 Jul The treatment of elderly-onset rheumatoid arthritis pursues the same objectives as in younger patients: to control the clinical manifestations, to prevent structural damage, to preserve function, and to decrease excess mortality. In the elderly, the presence of co-morbidities and increased rate of drug-related adverse effects raise specific therapeutic challenges. Nonsteroidal anti-inflammatory drugs are associated with cardiovascular, gastrointestinal, and renal adverse events. The role for corticosteroid therapy remains controversial. Although glucocorticoids provide a short-term decrease in clinical activity and probably a medium-term decrease in structural damage, these benefits are offset by numerous adverse effects. Methotrexate was effective in clinical trials and observational studies and did not produce a higher adverse event rate compared to younger patients, provided renal function was normal. Data on the efficacy of TNFalpha antagonists in therapeutic trials are available only for etanercept. Disease activity decreased and function improved. The adverse event rate was higher in older patients, but this was also true of the conventional drugs used as comparators. Registry data confirm that TNFalpha antagonist therapy is effective in RA. An increased rate of infections was found only in some registries. To combat the 2-fold cardiovascular risk increase associated with RA, disease activity should be stringently controlled and all cardiovascular risk factors managed aggressively.
19412193 Epigenetic control in rheumatoid arthritis synovial fibroblasts. 2009 May Rheumatoid arthritis synovial fibroblasts (RASFs) are the effector cells of cartilage and bone destruction. These cells show an 'intrinsically' activated and aggressive phenotype that results in the increased production of matrix-degrading enzymes and adhesion molecules, and is conserved over long-term passage in vitro. The three main mechanisms of epigenetic control -- DNA methylation, histone modifications and microRNA activity -- interact in the development of the RASF phenotype. The extent of global DNA methylation is reduced in synoviocytes in situ and RASFs in vitro. In addition, histone hyperacetylation occurs and specific microRNAs are expressed in RASFs. Normal synovial fibroblasts cultured in a hypomethylating milieu acquire an activated phenotype similar to that of RASFs. These findings suggest that epigenetic control, in particular the control of DNA methylation, is deficient in RASFs. Genome-wide analyses of the epigenome will enable the detection of additional genes involved in the pathogenesis of rheumatoid arthritis, the identification of epigenetic biomarkers, and potentially the development of a therapeutic regimen that targets activated RASFs.
20685609 Estrogens in rheumatoid arthritis; the immune system and bone. 2011 Mar 15 Rheumatoid arthritis (RA) is an autoimmune disease that is more common in women than in men. The peak incidence in females coincides with menopause when the ovarian production of sex hormones drops markedly. RA is characterized by skeletal manifestations where production of pro-inflammatory mediators, connected to the inflammation in the joint, leads to bone loss. Animal studies have revealed distinct beneficial effects of estrogens on arthritis, and a positive effect of hormone replacement therapy has been reported in women with postmenopausal RA. This review will focus on the influence of female sex hormones in the pathogenesis and progression of RA.
20436381 Occipitocervical fusion has potential to improve sleep apnea in patients with rheumatoid a 2010 Sep 1 STUDY DESIGN: Case series. OBJECTIVE: To analyze factors that contribute to the development of sleep apnea in patients with rheumatoid arthritis (RA) and upper cervical lesions. SUMMARY OF BACKGROUND DATA: No large prospective study has analyzed the association between sleep apnea and upper cervical involvement resulting from RA. Furthermore, only 1 report in the literature describes a case of sleep apnea accompanying rheumatoid vertical subluxation of the odontoid process. METHODS: The authors analyzed 8 consecutive RA patients with upper cervical lesions who underwent occipitocervical (O-C) fusion. The patients were examined with all-night polysomnography before and after surgery. Patients with apnea-hypopnea index values>or=5 were diagnosed to have sleep apnea. O-C2 angles were calculated from cervical radiographs. RESULTS: All 8 patients were diagnosed as having sleep apnea, and most of their apneic episodes were obstructive in origin. Among the 4 patients with medullary compression, central apneic episodes comprised
20859229 Antisynthetase syndrome presenting as rheumatoid-like polyarthritis. 2010 Oct BACKGROUND: The antisynthetase syndrome is a systemic inflammatory disease associated with anti-tRNA synthetase antibodies and consisting of the clinical features of inflammatory myopathy arthritis, interstitial lung disease (ILD), fever, Raynaud syndrome, and rash. It rarely presents with symmetric arthritis as the initial manifestation of the disease. OBJECTIVE: The aim of the study was to describe the clinical, laboratory, and radiographic characteristics of patients with antisynthetase syndrome who presented with symptoms of inflammatory arthritis, mimicking rheumatoid arthritis (RA) at the time of initial evaluation. METHODS: Six cases derived from a single university-based rheumatology clinic in Wisconsin are presented. The major clinical, laboratory, radiographic, and histopathologic data are described. RESULTS: All 6 patients demonstrated symmetric synovitis involving the hands. Five patients met the American College of Rheumatology classification criteria for RA. Three patients had nail-fold capillary abnormalities, and 4 patients were observed to have Raynaud phenomenon. Three patients demonstrated a cytoplasmic pattern when testing for antinuclear antibodies by immunofluorescent assay, and all had t-RNA synthetase antibodies. Two patients had positive rheumatoid factors, but none had strongly positive cyclic citrullinated peptide antibodies. None of the patients demonstrated radiographic erosions. All patients had evidence of ILD by imaging or pulmonary function testing. Prognosis was generally favorable, although disease severity and treatment varied considerably. CONCLUSION: In patients who present with features mimicking but atypical for RA, such as early ILD, nail-fold capillary abnormalities, Raynaud phenomenon, cytoplasmic antinuclear antibody pattern, negative cyclic citrullinated peptide antibody status, and nonerosive arthritis, the antisynthetase syndrome should be considered.
20432529 Rheumatoid arthritis: a new challenge in coming era. 2010 Feb Rheumatoid arthritis (RA) is mainly an auto-immune disease characterized by inflammation in joints. 1 in 50 people develop RA at some stage and at any age. This review summarizes the etiology, pathophysiology, risk factor, and treatment related to RA. The emphasis has been laid in particular on the new potential biological targets and the possible treatment as well as the current ongoing research status on RA.
20496429 Collaboration with patients in the design of patient-reported outcome measures: capturing 2010 Nov OBJECTIVE: Patient-reported outcome measures (PROMs) need to include concepts and language relevant to patients and be easily understood. These studies aimed to develop draft PROMs to measure rheumatoid arthritis (RA) fatigue and its impact by collaborating with patients to identify language and experiences, create draft PROM items, and test them for comprehension, with decisions supported throughout by a patient research partner. METHODS: In study 1, interview transcripts of RA patients describing their fatigue (n = 15) were subjected to content and inductive thematic analysis to identify fatigue language and experiences. In study 2, 3 focus groups of RA patients (n = 17) explored these and developed the wording for visual analog scales (VAS) and identical numerical rating scales (NRS), then a draft multi-item questionnaire was developed with the patient research partner. Study 3 comprised 15 RA patients who completed the PROMs during cognitive interviewing to explore understanding. RESULTS: Studies 1 and 2 identified key patient terminology (fatigue, exhaustion) and 12 potential fatigue concepts (Cognition, Coping, Duration, Emotion, Energy, Frequency, Impact, Planning, Quality of Life, Relationships, Sleep, and Social Life). Patients' proposals were clarified into draft screening VAS/NRS for fatigue severity, effect, and coping, plus a draft 45-item questionnaire. Study 3 showed that 14 questions required clarification or revision of response options. CONCLUSION: Collaboration with patients enabled development of draft RA fatigue PROMs grounded in the patient data, strengthening face and content validity and ensuring comprehension. The draft conceptual framework that emerged has resulted in draft PROMS ready for item reduction, and testing of construct and criterion validity and reliability.
18942777 Using short-term evidence to predict six-month outcomes in clinical trials of signs and sy 2009 Apr A model is presented to generate a distribution for the probability of an ACR response at six months for a new treatment for rheumatoid arthritis given evidence from a one- or three-month clinical trial. The model is based on published evidence from 11 randomized controlled trials on existing treatments. A hierarchical logistic regression model is used to find the relationship between the proportion of patients achieving ACR20 and ACR50 at one and three months and the proportion at six months. The model is assessed by Bayesian predictive P-values that demonstrate that the model fits the data well. The model can be used to predict the number of patients with an ACR response for proposed six-month clinical trials given data from clinical trials of one or three months duration.
20664466 Adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: 2010 Jul AIM: This paper synthesizes findings from available research about medication adherence to disease-modifying antirheumatic drugs (DMARDs) in the population with rheumatoid arthritis (RA). RESULTS: This review of literature included 35 articles. Medication adherence to DMARDs ranged from 30% to 107%. Adherence rates of more than 100% indicated that patients took more than the prescribed amount of medication. There were no consistent risk factors for nonadherence to DMARD prescriptions identified, but some evidence was provided for self-efficacy, patient-healthcare provider relationships, social support, patient beliefs about medications, and age as factors affecting medication adherence. Support for educational interventions focused on medication adherence was equivocal. CONCLUSION: Further research is necessary to develop a comprehensive, theoretically based understanding of medication adherence in RA patients.
20561316 Clustering Rasch results: a novel method for developing rheumatoid arthritis states for us 2010 Sep PURPOSE: Health states that describe an investigated condition are a crucial component of valuation studies. The health states need to be distinct and comprehensible to those who appraise them. The objective of this study was to describe a novel application of Rasch and cluster analyses in the development of three rheumatoid arthritis health states. METHODS: The Stanford Health Assessment Questionnaire (HAQ) was subjected to Rasch analysis to select the items that best represent disability. K-means cluster analysis produced health states with the levels of the selected items. The pain and discomfort dimension from the EuroQol-5D was also incorporated. RESULTS: The results demonstrate a methodology for reducing a dataset containing individual disease-specific scores to generate health states. The four selected HAQ items were bending down, climbing steps, lifting a cup to your mouth, and standing up from a chair. CONCLUSIONS: The combined use of Rasch and k-means cluster analysis has proved to be an effective technique for identifying the most important items and levels for the construction of health states.
20398973 [S100A8, S100A9 and S100A12 proteins in rheumatoid arthritis]. 2010 Jun Although S100 proteins represent 40% of the neutrophil cytoplasmic proteins, their physiological and pathological functions are still unclear. S100A8, S100A9 and S100A12 protein concentrations are dramatically enhanced in synovial fluid and synovium of patients suffering from rheumatoid arthritis. Their expression seems to correlate with disease activity and joint damage. These proteins are likely involved in rheumatoid arthritis pathogenesis by enhancing extracellular matrix proteolysis, autoimmunity and inducing the pseudotumoral phenotype of the synoviocytes in rheumatoid arthritis. S100A8, S100A9 and S100A12 assessment will probably constitute a relevant tool for rheumatoid arthritis diagnosis and will improve inflammatory arthritides management.
19252244 [Cartilage degradation in rheumatoid arthritis]. 2009 Mar Rheumatoid arthritis (RA) is a polyarticular joint disease. The inflammatory process is characterized by infiltration of inflammatory cells into the joints, leading to proliferation of synoviocytes and destruction of cartilage and bone. The Matrix metalloproteinases (MMPs) are a family of zinc-dependent proteinases. It had been well recognized that MMP play major roles in the cartilage breakdown in RA and OA. Moreover ADAM-TS-1, -4, -5 have aggrecanase activity, and also involve the cartilage degradation in RA and OA. Of course they contribute the cartilage homeostasis in healthy subjects. Failure to regulate the synthesis, activation and inhibition of the proteinases finally leads to cartilage destruction. Aggrecan and type II collagen are major components in cartilage matrix. Cleavage of aggrecan by aggrecanase and that of collagen by collagenase are critical steps for degradation of articular cartilage in RA. To prevent the cartilage damage, inflammatory synovitis should be suppressed in early stage.
19598318 Revision metacarpophalangeal joint replacement 30 years after primary swanson flexible sil 2009 We report a case of a patient with rheumatoid arthritis undergoing revision surgery 30 years after primary metacarpophalangeal joint arthroplasty using a Swanson implant. Removal and replacement of the implant were successfully performed, and the patient was satisfied with the revision surgery.