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ID PMID Title PublicationDate abstract
21097117 Diagnostic performance of the Forced Oscillation Technique in the detection of early respi 2010 The objective of this study was to evaluate the clinical potential of the Forced Oscillation Technique (FOT) in the detection of the early alterations in respiratory mechanics of Rheumatoid Arthritis (RA) patients. A total of 36 individuals were analyzed, 18 healthy and 18 with RA. The clinical usefulness of the parameters was evaluated investigating sensibility (Se), specificity (Sp) and the area under the receiver operating characteristic curve (AUC). In the RA group, all the 3 studied parameters obtained high accuracy for clinical use (AUC>0.9), while in spirometric parameters, no parameter obtained appropriate accuracy for clinical use (AUC < 0.7). In conclusion, the parameters obtained by FOT presented adequate Se and Sp, indicating that this technique can be helpful in the evaluation of the early respiratory mechanical alterations in patients with RA.
20359987 [First documented cases of rheumatoid arthritis in Niger]. 2010 Jan The authors report the first eight documented cases of rheumatoid arthritis in Niger, all diagnosed during one year at the National Lamordé Hospital of Niamey. Systemic manifestations were rare.
20714764 Correlations between coping styles and symptom expectation for rheumatoid arthritis. 2010 Dec BACKGROUND: In pain conditions, active coping has been found to be associated with less severe depression, increased activity level and less functional impairment. Studies indicate that there is a high expectation for chronic disability following a diagnosis of rheumatoid arthritis. The objective of this study was to compare both the expectations and the coping style for rheumatoid arthritis in disease-naïve subjects. METHODS: The Vanderbilt Pain Management Inventory was administered to university students. Subjects who had not yet experienced rheumatoid arthritis (RA) and did not know a person with RA were given a vignette concerning a new onset diagnosis of RA and were asked to indicate how likely they were to have thoughts or behaviours indicated in the coping style questionnaire. Subjects also completed expectations regarding daily functioning according to the Stanford Health Assessment Questionnaire (HAQ) for RA. RESULTS: The mean active coping style score for RA was 27.3 ± 4.6 (40 is the maximum score for active coping). The mean passive coping style score was 26.2 ± 7.0 (50 is the maximum score for passive coping). Those with high passive coping styles had a higher mean expectation score (higher HAQ score) of disability from rheumatoid arthritis. The correlation between passive coping style score and expectation score was 0.48, while the correlation between active coping style score and expectation was -0.34. CONCLUSIONS: Both expectations and coping styles may interact or be co-modifiers in the outcomes of RA patients. Further studies of coping styles and expectations in RA are required.
19083077 Improvement of the HAQ score by infliximab treatment in patients with RA: its association 2009 We conducted a two-year prospective study to clarify the efficacy of infliximab at improving the health assessment questionnaire (HAQ) score and associated factors in 67 patients with advanced rheumatoid arthritis (RA). All patients were scheduled to receive infliximab at a dose of 3 mg/kg at weeks 0, 2, 6 and every eight weeks thereafter through to week 102, and were fully examined at the time of each infusion. Parameters of disease activity such as the serum level of C-reactive protein (CRP), the serum level of matrix metalloproteinase-3 (MMP-3) and the 28-joint disease activity score (DAS28) were obtained, and the functional capabilities of the patients were assessed using the HAQ score. The serum CRP, the MMP-3, the DAS28(CRP) level, and the mean HAQ score decreased rapidly at two weeks after the start of infliximab treatment (CRP from 3.7 to 0.9 mg/dl, MMP-3 from 362.3 to 192.8 ng/ml, DAS28(CRP) from 5.6 to 3.7, and HAQ score from 1.5 to 0.9). Compared with the baseline values, the mean progression of the modified van der Heijde (vdH)-Sharp score after one year was 4.4 +/- 5.8 (median: 3.0), and that after two years was 3.1 +/- 6.9 (median: 1.0). A 93% reduction in the rate of joint destruction, as measured using the vdH-Sharp score, was estimated after infliximab therapy. Patients with less joint damage (shorter disease duration or lower vdH-Sharp score) regained more of their daily activities. The present study demonstrated the importance of activity control before the progression of irreversible factors, such as joint destruction, for maintaining the functional capacities of RA patients.
20440105 A case of normal-pressure hydrocephalus associated with rheumatoid arthritis. 2010 Apr Rheumatoid arthritis may cause central nervous system complications by means of various mechanisms. We describe the case of a patient with a new diagnosis of rheumatoid arthritis (RA) complicated by normal-pressure hydrocephalus. After treatment with prednisone, the patient improved remarkably as regards mental status, urinary control and gait. We suggest that normal-pressure hydrocephalus may occur as an extra-articular manifestation of RA, caused by a pathogenic inflammatory mechanism. We analyse previous case reports describing a relationship between RA and normal-pressure hydrocephalus, and discuss potential mechanisms underlying this association.
20463190 Changing trends in serious extra-articular manifestations of rheumatoid arthritis among Un 2010 Sep OBJECTIVES: The purpose of this study was to examine prevalence trends of serious extra-articular manifestations (EAMs) in a data set representing both hospitalized and ambulatory patients with RA. METHODS: This retrospective cohort study used serial cross-sectional data to examine the prevalence of serious EAMs in patients with RA from 1985 to 2006 across the United States (US) Veteran's Health Administration system. Serious EAMs included rheumatoid carditis, RA lung disease, FS and pooled EAM rates included previously reported vasculitis prevalence as queried by ICD-9 searches. Statistical analysis employed auto-regression and time series analysis using the Chow and Durbin-Watson tests to detect breakpoints and linear time-trends. RESULTS: Among 3 million veterans, including >35,000 RA patients annually, we noted declining RA hospitalizations emphasizing the importance of examining both the inpatient and outpatient settings to assess EAM prevalence. Individual EAM trends varied, demonstrating linear declines in FS, increases in RA lung disease and significant breakpoint declines in carditis and pooled serious EAMs. Pooled EAM prevalence dropped around 2000, from an early linear trend peak of 10% among inpatients, to <7% among both inpatients and outpatients by 2006. CONCLUSIONS: Overall, serious EAMs of RA have declined among US veterans in both the inpatient and outpatient settings, with the exception of RA lung disease likely reflecting improved detection. Breakpoints in pooled EAM prevalence appear to demonstrate consistent, true declines in severe RA extra-articular disease around 2000. Future work should explore the relationship between temporal EAM trends and specific RA therapies including adoption of biological agents.
21120535 Osteoblast physiology in normal and pathological conditions. 2011 Feb Osteoblasts are mononucleated cells that are derived from mesenchymal stem cells and that are responsible for the synthesis and mineralization of bone during initial bone formation and later bone remodelling. Osteoblasts also have a role in the regulation of osteoclast activity through the receptor activator of nuclear factor κ-B ligand and osteoprotegerin. Abnormalities in osteoblast differentiation and activity occur in some common human diseases such as osteoporosis and osteoarthritis. Recent studies also suggest that osteoblast functions are compromised at sites of focal bone erosion in rheumatoid arthritis.
18618520 Effectiveness of an integrated outpatient care programme compared with present-day standar 2009 Mar OBJECTIVES: To investigate the effectiveness of an integrated care programme in daily practice compared with present-day standard care for ambulatory early rheumatoid arthritis patients. METHODS: In this cross-sectional study, group A received programmed multidisciplinary outpatient care and group B standard rheumatologist-centred care. Demographics, disease duration, initial and actual treatment, disease activity (Disease Activity-28 Score), general health (Short Form-36 [SF-36]), functionality (Health Assessment Questionnaire [HAQ]), coping style (Utrecht's Coping List), illness perception (Dutch-Revised Illness Perception Questionnaire) and satisfaction about care were recorded. RESULTS: Eight-nine patients were included in group A and 102 in group B. Demographics, rheumatoid factor, antibodies against cyclic citrullinated peptides and disease duration were comparable. More patients in group A received initial combination therapy (35% versus 3%). Actual treatment regimens were comparable. More patients were in remission (69% versus 39%) or had low disease activity (80% versus 60%), mean HAQ-scores were lower (0.52 versus 0.80), more patients had no functional impairment (38% versus 15%) and SF-36 scores were higher in group A. Coping style and illness perception were similar, except for illness coherence. Satisfaction differed only for aspects typically favouring a care programme. Participation in a care programme independently predicted remission and absence of disability in a regression model, including gender and initial treatment as other predictors. CONCLUSION: Disease activity was better controlled and functionality and general health better preserved in patients following an outpatient care programme. This was partly due to the easier implementation of an intensive initial treatment strategy but apparently also to other aspects of organized pharmacological and non-pharmacological care, to be defined in randomized, controlled studies.
19432035 Pulmonary functions testing in patients with rheumatoid arthritis. 2009 Feb BACKGROUND: A high incidence of abnormal pulmonary function tests has been reported in cross-sectional studies among patients with rheumatoid arthritis. Few patients have been enrolled in longitudinal studies. OBJECTIVES: To perform PFT in rheumatoid arthritic patients without pulmonary involvement and to identify variables related to changes in PFT over 5 years of follow-up. METHODS: Consecutive RA patients underwent PFT according to recommendations of the American Thoracic Society. All surviving patients were advised to repeat the examination 5 years later. RESULTS: PFT was performed in 82 patients (21 men, 61 women). Their mean age was 55.7 (15.9) years and the mean RA duration was 11.1 (10) years. Five years later 15 patients (18.3%) had died. Among the 67 surviving patients, 38 (56.7%) agreed to participate in a follow-up study. The initial PFT revealed normal PFT in only 30 patients (36.6%); an obstructive ventilatory defect in 2 (2.4%), a small airway defect in 12 (17%), a restrictive ventilatory defect in 21 (25.6%), and reduced DLco in 17 (20.7%). Among the 38 patients participating in the 5 year follow-up study, 8 developed respiratory symptoms, one patient had a new obstructive ventilatory defect, one patient developed a restrictive ventilatory defect, and 5 patients had a newly developed small airway defect. The DLco had improved in 7 of the 8 patients who initially had reduced DLco, reaching normal values in 5 patients. Over the study period a new reduction in DLco was observed in 7 patients. Linear regression analyses failed to identify any patient or disease-specific characteristics that could predict a worsening in PFT. The absolute yearly decline in forced expiratory volume in 1 sec among our RA patients was 47 ml/year, a decline similar to that seen among current smokers. CONCLUSIONS: Serial PFT among patients with RA is indicated and allows for earlier identification of various ventilatory defects. Small airways disturbance was a common finding in our RA patients.
21092849 Hypothalamic-pituitary-adrenal axis in rheumatoid arthritis. 2010 Nov The controlled data accumulated so far support only subtle alterations in HPA axis function in RA, mainly at the adrenal level, and particularly in a subset of premenopausal-onset women. Such interpretation is supported by consistent findings of lower levels of adrenal androgens, particularly DHEAS, in premenopausal-onset RA patients. Consequences of the subtle HPA alterations in RA for the disease development remain unclear. From a broader perspective, the unresponsiveness of the HPA axis to chronic inflammation in RA simply can be seen as an ongoing adaptation to the disease state with higher priority to proper regulation of core body functions over the immune homeostasis.
19822068 Rehabilitation in rheumatoid arthritis and ankylosing spondylitis: differences and similar 2009 Jul The aim of the paper is to summarize and compare the best available evidence concerning the effectiveness of rehabilitative interventions and provide an overview of recommendations or international guidelines on non-pharmacological treatments in rheumatoid arthritis (RA) and ankylosing spondylitis (AS).It was found that, compared to RA, there are relatively fewer non-pharmacological intervention studies in AS. Overall, the literature on the effectiveness of non-pharmacological treatment modalities in RA and AS supports the use of exercise and educational interventions with a cognitive behavioural component. The evidence on electro-physical modalities, balneotherapy, and dietary interventions and alternative or complementary interventions for managing RA and AS is generally weak or inconclusive.International practice guidelines on RA and AS management recommend non-pharmacological interventions as adjunctive interventions to medications.Areas for future research include non-pharmacological interventions in AS, studies on the effectiveness and costs of various health care delivery models, and the usage of alternative or complementary treatments.
19476397 Guidelines for the use of conventional and newer disease-modifying antirheumatic drugs in 2009 Treatment strategies in the management of rheumatoid arthritis (RA) have significantly changed in the past decade. The early use of disease-modifying antirheumatic drugs (DMARDs) is the basis of this new treatment strategy. Because these agents alter the natural disease course of RA, early aggressive intervention results in better outcomes with respect to future structural damage and disability. The arrival of the 'biologic agents' era in rheumatology has further improved the therapeutic options in patients with RA. A significant portion of individuals with this ailment are elderly, with approximately one-third of patients experiencing their first symptoms after the age of 60 years. Yet, many elderly patients with RA do not receive optimal treatment. Although the reasons for this have not been completely defined, it seems clinicians are reluctant to use DMARDs in the elderly because of uncertainty regarding their efficacy and safety in this population. The aging process is associated with important changes in drug pharmacokinetics and pharmacodynamics. It appears that the former, mainly through decreased renal clearance, is responsible for an increased incidence of adverse effects with some DMARDs. The old are also more susceptible to infection than the young, making prevention of infectious disease through vaccination of particular importance; however, healthcare professionals should be aware that some DMARDs, including biologic agents, may interfere with responses to vaccination. The available data, although limited, suggest that DMARDs, including some biologic agents, are similarly effective in the old and the young, while maintaining very good adverse effect profiles. Therefore, the elderly with RA should not be excluded from receiving optimal treatment with these medications. At the same time, clinicians must be aware of the possible increased risk of drug toxicities, recognize the need to adjust therapy to match individual patient characteristics (i.e. renal function, co-morbidities, concomitant medication use or polypharmacy), and use the lowest possible effective dosage. This review describes the special considerations to be taken into account when administering conventional (synthetic) or biologic DMARDs to elderly patients with RA.
20597276 [Clinical and immunological aspects of early-stage rheumatoid arthritis]. 2010 Rheumatoid arthritis (RA) is a chronic autoimmune disease that is characterized by a systemic inflammatory and destructive joint lesion that is manifested by the involvement of various organs and systems into the pathological process. Whether the variants of the course and outcomes of RA may be predicted early is the most important inadequately studied problem. HLA-DRB1* genotypes affect disease severity; however, different alleles encoding the identical amino acid sequence have a varying association with the disease and their combinations can differently increase the risk of RA. Total epitope (SE) is associated not only with the risk of RA as a whole, but also with the development of the severe course of the disease to a greater extent. A number of studies have demonstrated that if a patient has concurrently antibodies to cyclic citrullinated peptide (CCP) and rheumatoid factor, as well as HLA-DRB1 alleles, the likelihood of rapid X-ray progression is 10 times greater than that in a patient without these markers. The paper considers the course of early RA depending on the combined determination of immunological and immunogenetic markers (SE and CCP antibodies). Each of them makes a substantial contribution to the development of a destructive process in early RA, which necessitates the assessment of a combination of the factors.
20436069 Systematic monitoring of disease activity using an outcome measure improves outcomes in rh 2010 Jul OBJECTIVE: To systematically review the literature on the value of outcome measures to monitor treatment response in patients with rheumatoid arthritis (RA). METHODS: Canadian rheumatologists participating in the International 3e (evidence expertise exchange) Initiative formulated the question "Which parameters should be recommended for use in the management of RA patients to assess a clinically meaningful response in clinical practice?". Searches in 3 electronic databases, Medline, Embase, and Cochrane Central Register of Controlled Trials, yielded no relevant study addressing this question. Experts in the field proposed to extrapolate evidence from 3 randomized controlled trials of systematic monitoring or tight control strategy in the management of RA. RESULTS: Three studies were included in this review. The TICORA study showed that intensive management using systematic monitoring with the Disease Activity Score (DAS) aiming at least low disease activity, monthly followup, and more aggressive disease-modifying antirheumatic drug (DMARD) treatment improves outcomes with higher remission rates (65% vs 16%; p < 0.0001). Fransen, et al demonstrated that targeted therapy aimed at low disease activity (DAS28 < 3.2) led to more changes in DMARD treatment, resulting in a larger number of patients with low disease activity (31% vs 16%; p = 0.028). The CAMERA study showed that systematic monitoring using the objective computer decision program evaluation and monthly followup yielded a greater remission rate (50% vs 37%; p = 0.0001). CONCLUSION: Systematic monitoring of disease activity, aiming for at least low disease activity, and frequent followup improves outcome in RA.
19214653 Power Doppler ultrasonography of symptomatic rheumatoid arthritis ankles revealed a positi 2009 The aim of this study was to characterize the pathological conditions of symptomatic ankles in patients with rheumatoid arthritis (RA) using power Doppler sonography (PDS). We analyzed 17 consecutive ultrasonography (US) records of RA patients with symptomatic ankles who underwent B-mode ultrasonography (BUS) combined with PDS of their ankles in our department because of clinical need. Correlations between US findings and clinical and serological data were assessed. The diagnostic capabilities of BUS and PDS were also compared. Common US findings were talocrural synovitis (76%), subtalar synovitis (71%), and talonavicular synovitis (59%). Tenosynovitis around the ankle was detected in ten patients (59%), including several cases of tenosynovitis of tibialis posterior (41%) and tenosynovitis of peroneus longus and brevis (35%). Achilles tendon enthesitis was detected in six patients, and retrocalcaneal bursitis was detected in five. Compared with BUS, PDS offers demonstrably superior diagnostic capability for the detection of rheumatoid ankle diseases, especially subtalar joint synovitis and peroneal tenosynovitis. Rheumatoid factor (RF) levels were significantly higher in patients with tenosynovitis than in patients without tenosynovitis. PDS is an excellent modality for diagnosing both intra- and extracapsular synovitis in rheumatoid ankles. Using PDS, we found positive association between ankle tenosynovitis and RF levels in RA patients.
19217650 Is remitting seronegative symmetrical synovitis with pitting edema (RS3PE) a subset of rhe 2010 Aug OBJECTIVES: To contrast and compare the spectrum of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) with rheumatoid arthritis (RA) using an illustrative case. METHODS: The relevant English literature of RS3PE was searched using the keywords "RS3PE" alone and in combination with terms such as neoplasia and rheumatic disease. Original and review articles were reviewed and the clinical setting was exemplified with a case report. RESULTS: RS3PE initially was reported to represent a form of RA. However, RS3PE has clinical features that are different from both early- and late-onset RA, such as lack of bony erosions and rheumatoid factor. RS3PE is thought to involve vascular endothelial growth factor, suggesting an infectious etiology, generally has an excellent prognosis, and is associated with neoplasia not commonly seen in RA, and the RA associated human leukocyte antigen (HLA) DRB1 genotype is absent. CONCLUSIONS: Based on the clinical, laboratory, suspected infectious etiology, genetic differences, and types of associated malignancies, RS3PE appears to be a distinct entity rather than a subset of RA.
20622490 [Successful treatment with cyclosporine for myelodysplastic syndrome with erythroid hypopl 2010 Jun A 65-year-old female was admitted to our hospital for evaluation of transfusion-dependent progressive anemia. She had a history of rheumatoid arthritis for twenty-four years. Two years earlier, MDS (refractory anemia) was diagnosed based on laboratory findings and bone marrow examination. After diagnosis, the patient received anabolic steroid, Vitamin D3 and Vitamin K2. Although her hemoglobin level was maintained at 8.0 g/dl approximately 9.0 g/dl until January 2009, anemia gradually progressed thereafter. In April, we recognized marked anemia (Hb 6.0 g/dl) and reticulocytopenia (2.0 per thousand), but this was not accompanied by any other significant changes in laboratory findings. Bone marrow examination demonstrated a low percentage of erythroid precursors without an increase of blast cells. Rheumatoid arthritis remained stable by low dose steroid and NSAID administration. We did not recognize evidence suggesting any other cause of acquired PRCA, such as thymoma, human parvovirus B19 infection or drugs. A diagnosis of MDS with erythroid hypoplasia was made. The patient was successfully treated by an immunosuppressive regimen using cyclosporine. MDS with erythroid hypoplasia, coexisting with rheumatoid arthritis, is rare. To our knowledge, this is the third reported case.
20532790 [Treatment of patients with destructive arthritis with certolizumab pegol]. 2010 Sep Certolizumab pegol is a new anti-TNF-alpha inhibitor which has been approved for the treatment of rheumatoid arthritis since October 2009. Due to the modification of the antibody fragment by the adherence of polyethylene glycol (PEG) a sufficient distribution in inflammatory tissue was found in animal experiments. In two individual case reports a remission of therapy refractive arthritis was achieved by administration of certolizumab pegol.
20859227 The prevalence of rheumatoid arthritis in Argentina: a capture-recapture study in a city o 2010 Oct OBJECTIVE: The objective of this study was to assess the prevalence of rheumatoid arthritis (RA) in the population of a city of 70,000 inhabitants located in Buenos Aires, Argentina. METHODS: Based on the hypothesis that RA is an underdiagnosed disease in Argentina, a capture-recapture method was applied. A local registry of RA patients of Luján City was taken as the primary source; a telephone survey was specifically carried out as a secondary source of information. Patients suspected of having RA were referred to a local hospital to be examined by a team of 12 rheumatologists. Anamnesis and physical examination were followed by hand and foot radiography and erythrocyte sedimentation rate and rheumatoid factor measurements. RESULTS: According to the American College of Rheumatology criteria, a prevalence rate of 0.94% (95% confidence interval [CI], 0.86%-1.02%) was found in the surveyed population; in agreement with other studies, this prevalence was higher in women when compared with men (for female, 1.54% [95% CI, 1.40%-1.69%]; for male, 0.40% [95% CI, 0.32%-0.49%]). CONCLUSION: The prevalence of RA in a representative sample of the population of a city from the central region of Argentina seems to be close to 1%.
19890634 Effects of home-based exercise program on the functional status and the quality of life in 2011 Feb We previously reported the efficacy of a 4-week home-based exercise therapy for patients with rheumatoid arthritis (RA). In this study, we aimed to investigate whether short-term improvements in the functional status and quality of life were maintained at 1 year. Patients who completed 4-week home-based exercise program were advised to maintain the same exercises for 1 year duration. Changes of functional status and quality of life in patients with RA were evaluated by the Health Assessment Questionnaire (HAQ) and the Rheumatoid Arthritis Quality of Life Scale (RAQoL). The change of the variables at the different time points (baseline, 4 weeks, and 1 year) was assessed by the repeated measure of ANOVA test with Geisser-Greenhouse correction. Pairwise ANOVA comparisons adjusted using the Bonferroni correction were conducted. Twenty-eight (63.6%) of 44 patients were available for follow-up at 1 year. The results of repeated measure ANOVA showed that there was a statistically significant difference between three assessments in the HAQ (P = 0.015) and RAQoL (P = 0.037) scores at the end of the follow-up. Improvements in the functional status and health-related quality of life at 4 weeks were maintained at 1-year follow-up. In conclusion, we observed significant improvements in the functional status and health-related quality of life by 4-week home-based exercise program. Furthermore, these improvements were maintained at 1-year follow-up. Further studies are needed to confirm the usefulness of the home-based exercise therapy.