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ID PMID Title PublicationDate abstract
19296061 Calciphylaxis associated with rheumatoid arthritis: communication of the second case. 2009 Jun Calciphylaxis is the tissue sensitivity to calcification, described mainly in patients with chronic renal insufficiency, renal transplant of parathyroid dysfunction. There is only one case described in a patient with rheumatoid arthritis, without renal dysfunction, nor hyperparathyroidism. We present the second case in a woman with inactive rheumatoid arthritis.
20956990 MRI for the assessment and monitoring of RA--what can it tell us? 2011 Mar The past 15 years has seen an exponential rise in the use of MRI for the assessment of rheumatoid arthritis (RA). In this Perspectives article, we review the current and potential future role of MRI in the diagnosis, prognosis and monitoring of RA. We also review the impact of MRI research on the understanding of disease mechanisms. In our view, the pivotal role of synovitis in RA and its predilection for sonographically accessible joints makes it likely that MRI will be used diagnostically in joints that are inaccessible to ultrasonography or where the differential diagnosis is unclear. Additionally, MRI will probably assume an even more prominent role in clinical trials where the aim of therapy is the complete ablation of synovitis. Given the ever-increasing sophistication of MRI, we anticipate that it will continue to be a key research tool in the coming years.
20732644 Pharmacotherapy: concepts of pathogenesis and emerging treatments. Challenges in clinical 2010 Aug The prognosis for patients with rheumatoid arthritis has improved dramatically, thanks in large part to many new therapies and therapeutic approaches. Paradoxically, this has created problems for rheumatologists since clinically useful information from appropriate clinical trials has not kept pace with all the new therapeutic options. Essentially, rheumatologists now have many more therapeutic options than they know what to do with. This article discusses why we are in this situation and suggests opportunities to move forward.
20177384 Patient-tailored therapy in rheumatoid arthritis: an editorial review. 2010 May PURPOSE OF REVIEW: The list of therapeutic targets for the treatment of rheumatic diseases constantly grows. As a consequence, a growing number of agents that are specifically directed against these targets become clinically available. However, the more diverse (and expensive) the armamentarium, the more its use should be guided by informed decisions for an optimal treatment. Such personalized, patient-tailored therapy is still not a reality in rheumatology practice. However, several important steps have recently been made towards achievement of this important goal. RECENT FINDINGS: On the basis of the multifactorial nature of the pathogenesis of rheumatic diseases, the quest for single biomarkers that predict treatment response has proven difficult. Instead, biomarker signatures derived from genetic and proteomic expression studies using various biomaterials are being identified and demonstrate predictive value. Research focus has so far been placed on treatment responses to methotrexate and tumor necrosis factor antagonists, but interesting findings are already available for other agents as well. SUMMARY: Although still in their infancy in rheumatology, personalized treatment approaches offer the potential for improved safety and efficacy for the patient and ultimately have promises to reduce societal costs.
19285819 Quantification of synovial and erosive changes in rheumatoid arthritis with ultrasound--re 2009 Aug Synovitis is a predictive factor of irreversible changes in the joints, tendons, and ligaments in patients with rheumatoid arthritis (RA). Therefore, the early demonstration of reversible, pre-erosive inflammatory features to diagnose RA, the monitoring of disease activity, and the response to therapy are of great importance. Technical developments in ultrasound now allow the quantification of synovitis and erosions, and enable the assessment and follow-up of disease activity. However, both the subjective and objective quantification techniques are associated with different problems. This review article highlights the advantages and disadvantages of sonographic quantification, and revisits the somewhat controversial positions apparent in the current literature. Familiarity with the imaging findings and the scoring systems used to characterize erosive changes are prerequisites for considerably improving the detection and monitoring of synovitis and erosions. The role of ultrasound in the diagnostic approach to RA, particularly in the quantification of synovial and erosive changes, will be explored and the current literature will be reviewed.
20229609 Self-efficacy in rheumatoid arthritis: translation and test of validity, reliability and s 2010 Sep OBJECTIVES: To describe the translation and test of the Danish version of the original British 'Rheumatoid Arthritis Self-Efficacy Questionnaire' (RASE). METHODS: The questionnaire was forward and back translated by individuals with Danish and English as their respective primary languages. The questionnaire was tested by five lay-people and in the field by 10 + five persons with rheumatoid arthritis (RA). A test-retest was performed on 62 outpatients with RA. The sensitivity of the adapted Danish version of RASE (RASE-DK) was finally tested on 106 outpatients with RA - before, immediately after and three months after they had participated in a short self-management course performed by a multidisciplinary team. RESULTS: RASE-DK showed good face validity, but 'relaxation' was interpreted in various ways. Internal consistency evaluated by Cronbach's alpha was 0.91. Reliability evaluated by the intra-class correlation coefficient (ICC) was 0.88. A Bland-Altman plot showed good agreement. RASE-DK, like the original English version of RASE, was not associated with disease activity (Disease Activity Score, DAS-28) or disability (Health Assessment Questionnaire, HAQ), and correlated significantly with the Arthritis Self-Efficacy Scale (ASES) subscales 'other' and 'pain', and total ASES. RASE-DK showed a highly significant change, from baseline to immediately after participation in the short course (p < 0.001). The effect faded during the following three months. CONCLUSION: RASE-DK met the appropriate standards for validity, reliability and sensitivity, and is appropriate for use in Denmark. However, the concept of self-efficacy may be too abstract for a few individuals, and relaxation is interpreted in various ways by the Danish patients.
20346090 Vasculogenesis in rheumatoid arthritis. 2010 Decreased number and impaired functions of endothelial progenitor cells (EPCs) leading to impaired vasculogenesis have been associated with rheumatoid arthritis (RA). Defective vasculogenesis has also been implicated in premature atherosclerosis in RA. Recently, early-outgrowth monocytic and late-outgrowth hemangioblastic EPC subsets have been characterized. Hemangioblastic EPCs may exert increased numbers in active RA and may play a role in vascular repair underlying RA.
19999613 [Total hip arthroplasty in rheumatoid arthritis: results of 12-years follow-up]. 2009 Jul The aims of retrospective cohort study were: analysis of general and local factors, evaluation of clinical and radiographic results and presentation of authors' experience in total hip arthroplasty in rheumatoid arthritis. Study group consists of 222 consecutive total hip arthroplasties (205 cemented and 17 cementless) made in 216 patients. Mean patients' age was 58.4 y.o (range: 34-77 y.o.). In study group were 192 women and 24 men. Mean preoperative function was poor: 28.4 points (range: 24-32 p.). Clinical evaluation was made with Harris hip score, and radiographic one with criteria of Joined Committee of Hip Society, AAOS and SICOT. Clinical results of the study group were as follow: excellent--53 (23.9%), good--128 (57.6%), fair--34 (15.3%) and poor--7 (3.2%). Mean postoperative function was good: 86.8 points (range: 28-94 p.). There were following radiographic results of study group: good--176 (79.3%), fair--28 (12.6%) and poor--18 (8.1%). Complications another than aseptic loosening were observed in 56 (25.2%) hips. CONCLUSIONS: 1) general and local factors make total hip arthroplasty in rheumatoid arthritis more difficult procedure than the same one in osteoarthritis, 2) log-term survival rate of hip replacement in rheumatoid arthritis mainly depends on proper bone stock reconstruction, 3) 80-85% of excellent and good clinical and radiographic results are achieved at 12-year follow-up, 4) incidence of local and systemic postoperative complications are similar to osteoarthritis population, 5) preoperative autologous blood donation does not decrease demand of postoperative blood transfusion.
19945896 Non-drug treatment (excluding surgery) in rheumatoid arthritis: clinical practice guidelin 2009 Dec OBJECTIVES: Because drugs do not halt joint destruction in rheumatoid arthritis (RA), non-drug treatments are an important adjunct to drug treatment. Establishing rules governing their use is difficult because treatment is multidisciplinary, complex, and difficult to assess. The aims of these guidelines were to (a) establish the indications for physical therapies and for educational, psychological, and other non-drug interventions, (b) address social welfare, occupational, and organizational issues. METHODS: A systematic literature search (MEDLINE, EMBASE, CINAHL, Pascal, Cochrane Library, HTA database) (1985-2006) was completed with information obtained from specialty societies and the grey literature. A review of the studies meeting inclusion criteria, with evidence levels, was used by a multidisciplinary working group (18 experts) to draft guidelines. Consensus was reached when evidence was lacking on key topics. The draft guidelines were scored by 60 peer reviewers, amended when necessary, and then validated by the HAS Board. RESULTS: Of the 1819 articles retrieved, 817 were analysed and 382 cited in the report. Low-power randomized clinical trials constituted the highest level of evidence. Grade B guidelines (intermediate evidence level) concerned aerobic activities, dynamic muscular strengthening, and therapeutic patient education. Grade C (low evidence level) concerned use of rest orthoses or assistive devices, balneotherapy and spa therapy, self-exercise programmes, and conventional physiotherapy. Professional agreement (no scientific evidence) was reached for orthotic insoles and footwear, chiropody care, thermotherapy, acupuncture, psychological support, occupational adjustments, and referral to social workers. CONCLUSION: Aerobic activities, dynamic muscular reinforcement, and therapeutic patient education are valuable in non-drug management of RA.
19412196 Assessing infection risk with biologic agents in RA: methodological challenges. 2009 May Patients with rheumatoid arthritis (RA) are at increased risk of infection compared with the general population. As new DMARDs, in particular biologic agents, become more widely prescribed for the treatment of RA, adverse events that were not previously identified in randomized, controlled trials might develop, including opportunistic and serious infections. Understanding the strengths and weaknesses of data derived from randomized clinical trials, registries and meta-analyses is necessary to interpret the results of these studies. Whereas the risk of infection might be increased for the majority of biologic agents that have been approved for use in RA, differences between these agents might affect patients' susceptibility to specific types of infection, immunocompetence and relative risk of infection.
20483788 Membrane-type I matrix metalloproteinase-dependent regulation of rheumatoid arthritis syno 2010 Jun 1 In rheumatoid arthritis, the coordinated expansion of the synoviocyte mass is coupled with a pathologic angiogenic response that leads to the destructive remodeling of articular as well as surrounding connective tissues. Although rheumatoid synoviocytes express a multiplicity of proteolytic enzymes, the primary effectors of cartilage, ligament, and tendon damage remain undefined. Herein, we demonstrate that human rheumatoid synoviocytes mobilize the membrane-anchored matrix metalloproteinase (MMP), membrane-type I MMP (MT1-MMP), to dissolve and invade type I and type II collagen-rich tissues. Though rheumatoid synoviocytes also express a series of secreted collagenases, these proteinases are ineffective in mediating collagenolytic activity in the presence of physiologic concentrations of plasma- or synovial fluid-derived antiproteinases. Furthermore, MT1-MMP not only directs the tissue-destructive properties of rheumatoid synoviocytes but also controls synoviocyte-initiated angiogenic responses in vivo. Together, these findings identify MT1-MMP as a master regulator of the pathologic extracellular matrix remodeling that characterizes rheumatoid arthritis as well as the coupled angiogenic response that maintains the aggressive phenotype of the advancing pannus.
20204371 Traditional Chinese medicine in the treatment of rheumatoid arthritis: a general review. 2010 Apr Rheumatoid arthritis (RA) is difficult to cure. Many methods have been used for its treatment, among which traditional Chinese medicine (TCM) has been considered as an important strategy. All of the three parts of TCM: Chinese herbs, acupuncture, and massage have been reported with varying degrees of therapeutic effects on RA. Also the mechanism exploration is under process. Many effective ingredients of anti-rheumatic Chinese herbs have been found to inhibit RA development and some of the effective ingredients have been verified. Furthermore, greatly enhanced life quality of RA patients was obtained using acupuncture and massage to relieve pain, expand joint motion and modulate emotion which mainly correlated with the possible modulation of immune system, nerve system, endocrine system, etc. Thus, a systemic review on the therapeutic effect of TCM on RA is necessary. In our paper, the current status of TCM application in the clinic for the therapy of RA was summarized accompanied with the related mechanism exploration using modern test facilities.
19798030 G-CSF and GM-CSF as therapeutic targets in rheumatoid arthritis. 2009 Oct Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are well-recognized regulators of hematopoiesis and have an established role as growth factors in clinical practice. G-CSF and GM-CSF regulate myeloid cell production, differentiation and activation, and might also be important for driving inflammatory responses. Inappropriate engagement of this pathway could be a critical amplification mechanism when maladaptive immune responses predispose to autoimmunity and sterile tissue inflammation. We postulate that antagonism of G-CSF or GM-CSF could represent a novel therapeutic approach for a variety of autoimmune-mediated inflammatory diseases, including rheumatoid arthritis.
19597731 Gynecomastia associated with low-dose methotrexate therapy for rheumatoid arthritis amelio 2010 Aug A 62-year-old male with a 10-year history of seropositive rheumatoid arthritis (RA) developed gynecomastia 8 months after beginning oral low-dose methotrexate (MTX) therapy. Two months after folate supplementation, the gynecomastia symptoms improved. Gynecomastia associated with low-dose MTX is a rare occurrence, with only nine cases previously reported in the literature. This is the first report showing folate supplementation to be effective against gynecomastia following low-dose MTX. Although it occurs infrequently, gynecomastia associated with low-dose MTX therapy should be considered in male patients with RA.
19327227 Sleep problems in fibromyalgia and rheumatoid arthritis compared with the general populati 2009 Jan OBJECTIVE: Our aim was to evaluate how frequently problems of quality and quantity of sleep and depression occur in patients with fibromyalgia (FM), and compare these findings with those occurring in patients with rheumatoid arthritis (RA) and in the general population. MATERIALS AND METHODS: The patients were recruited from rehabilitation courses in the Rheumatism Foundation Hospital, Finland. There were 37 patients with FM and 31 patients with RA participating in the study. For comparison, we used the results from a general population study of 1284 adult subjects. The data had been collected earlier in a longitudinal cohort study for the Finnish Social Insurance Institution. RESULTS: The patients with FM and RA slept fewer hours a day than the population sample. The FM patients reported more insomnia, less contentment with sleep and more lack of deep and restful sleep in comparison to the RA patients and the participants of the population study. The FM patients also reported significantly more depression and pain than the RA patients (p0.01). It was still shown in a logistic regression analysis that insomnia was almost five times more frequent in FM patients than in RA patients, even when depression and pain were adjusted. CONCLUSION: The FM patients reported more insomnia-related symptoms than either RA patients or the population sample. The higher prevalence of insomnia-related symptoms among FM patients was not explained by depression or pain. Both patient groups reported somewhat shorter nocturnal sleep than the general population.
19252252 [Effect of the inhibition of joint destruction in RA by TNF-blocking agents]. 2009 Mar Recently, the treatment of patients with rheumatoid arthritis has changed dramatically. The goal of therapy is not only the control of inflammation, but the prevention of joint destruction, the improvement and maintenance of good functional capacity, and moreover, complete remission or cure. Under the circumstance, tumor necrosis factor (TNF) -blocking agents, that have shown the excellent clinical effect and remarkable inhibition of joint destruction, are the medicine of important role.
18823647 Augmentation index and large-artery remodeling in patients with longstanding rheumatoid ar 2009 Dec OBJECTIVE: There is growing evidence of premature atherosclerosis in patients with rheumatoid arthritis (RA), leading to a higher rate of cardiovascular events than in the general population. The augmentation index (AIx), a marker of arterial stiffness, is an indicator of vascular function. The aim of the study was as follows: (1) to investigate whether AIx is increased in RA patients without traditional cardiovascular risk factors and (2) to evaluate whether there is an interrelationship with large artery remodeling as ascertained by carotid ultrasound. METHODS: Thirty-six RA patients (age, 46.4 +/- 7.7 years; 31 female) were recruited. Patients were eligible for analysis if they had no traditional cardiovascular risk factors. AIx was assessed noninvasively during pulse wave analyses. For large artery remodeling the intima-media thickness (IMT) was measured in both common carotid arteries with ultrasound. Results were compared with 36 age- and sex-matched controls. RESULTS: AIx was statistically significantly higher in RA patients as compared with controls (27.4 +/- 9.4% versus 18.4 +/- 9.0%; P < 0.001). In addition, IMT was significantly higher in RA patients (0.73 +/- 0.16 mm versus 0.65 +/- 0.12 mm; P = 0.01). In RA patients there was a positive correlation between IMT and AIx (r[IMT; AIx] = 0.45; P = 0.008). CONCLUSION: AIx, a marker of arterial stiffness, as well as IMT, a marker of large-artery remodeling, are increased in RA patients without traditional cardiovascular risk factors. Measuring AIx might assist in better assessing the increased cardiovascular risk in RA patients.
21063825 The risk of malignancies in RA patients treated with biologics. 2010 Nov Ever since biologics were introduced in the treatment of RA around 10 years ago, concerns about their safety profiles, including cancer, have been raised. In the case of cancer, these concerns are based on our incomplete understanding of the full effects of these drugs, or the pathways that they inhibit, and their relation to cancer. Thus, it has been difficult to formulate specific hypotheses regarding what to expect (Which cancer types? In which patients? When?), and it will take time until we feel confident that all relevant risks are well characterized. Through RCT meta-analyses and observational studies including the biologics registers, some data have emerged. So far, but with exceptions both in terms of risks observed and absence of data, the emerging picture is reassuring rather than alarming.
19593569 Perceived functional disabilities among rheumatoid arthritis patients. 2010 Mar The aim of this study was to determine from patient perspective the most relevant physical functions when estimating the functional disabilities, and to estimate the perceived relative influence of them. Structured telephone interviews were conducted among 143 RA patients. The subjects were asked to name functions and activities in their everyday life, which were affected by RA. After this, they were asked to score each of the named item with a scale from 0 to 100. These were combined with earlier collected data on sociodemographic background and clinical status. Listed activities were grouped to functional disabilities and further categorized according to joints, limbs and body areas. One or more functional disabilities affecting everyday life because of RA was mentioned by 87.4%, altogether 354 mentions. The most commonly mentioned disabilities were walking and opening jars. However, the most commonly mentioned disabilities were not those with highest perceived disabilities. Of the 59 different types of disabilities mentioned, 25 were connected with movements of the shoulder, 30 with elbow, 40 with wrist, and 37 with fingers. Movements of the back were involved in 20 mentioned disabilities, hip and knee both in 8, and ankles in 6. Disabilities related to lower extremity functions were considered most disabling. In conclusion, to describe RA patients' functional disability, the measured functions should be those which the patients themselves consider relevant and causing disability. Furthermore, the studied functional measures ought to be weighted according to the relative influence of each function to the patients.
19812023 [Two faces of an illness: rheumatoid arthritis followed by ankylosing spondylitis]. 2009 Oct 25 Author presents the clinical history of a 35 years old female patient, who suffered from seronegative rheumatoid arthritis at the age of 29. Remission of the illness was followed by successful gravidity. Almost two years later spondylarthritis was diagnosed, showing only axial symptoms. The major histocompatibility complex analyzed by normal serological methods revealed the HLA B27 haplotype, typical for ankylosing spondylitis, and the HLA DR1 haplotype, typical for rheumatoid arthritis. During the examination of HLA DRB polymorphism, presence of DR B1 0101 allele was found, that plays role in the pathophysiology of rheumatoid arthritis. This case proves that a combination of HLA alleles typical for ankylosing spondylitis and rheumatoid arthritis can be found in the same patient.