Browse

Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
20536605 A case of emphysematous pyelonephritis in a patient with rheumatoid arthritis taking corti 2010 May Rheumatoid arthritis (RA) is a systemic autoimmune disease that is characterized by chronic synovial inflammation. Patients with RA have increased risk of infection; this is related to RA itself or the adverse effects of medication. In this report, we describe a case of emphysematous pyelonephritis in a patient with RA associated with AA amyloidosis and steroid-induced diabetes mellitus who was taking corticosteroid and low-dose methotrexate.
19405002 Problems experienced by people with arthritis when using a computer. 2009 May 15 OBJECTIVE: To describe the prevalence of computer use problems experienced by a sample of people with arthritis, and to determine differences in the magnitude of these problems among people with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). METHODS: Subjects were recruited from the Arthritis Network Disease Registry and asked to complete a survey, the Computer Problems Survey, which was developed for this study. Descriptive statistics were calculated for the total sample and the 3 diagnostic subgroups. Ordinal regressions were used to determine differences between the diagnostic subgroups with respect to each equipment item while controlling for confounding demographic variables. RESULTS: A total of 359 respondents completed a survey. Of the 315 respondents who reported using a computer, 84% reported a problem with computer use attributed to their underlying disorder, and approximately 77% reported some discomfort related to computer use. Equipment items most likely to account for problems and discomfort were the chair, keyboard, mouse, and monitor. Of the 3 subgroups, significantly more respondents with FM reported more severe discomfort, more problems, and greater limitations related to computer use than those with RA or OA for all 4 equipment items. CONCLUSION: Computer use is significantly affected by arthritis. This could limit the ability of a person with arthritis to participate in work and home activities. Further study is warranted to delineate disease-related limitations and develop interventions to reduce them.
19153216 Different methods of balancing covariates leading to different effect estimates in the pre 2009 Apr 1 A number of covariate-balancing methods, based on the propensity score, are widely used to estimate treatment effects in observational studies. If the treatment effect varies with the propensity score, however, different methods can give very different answers. The authors illustrate this effect by using data from a United Kingdom-based registry of subjects treated with anti-tumor necrosis factor drugs for rheumatoid arthritis. Estimates of the effect of these drugs on mortality varied from a relative risk of 0.4 (95% confidence interval: 0.16, 0.91) to a relative risk of 1.3 (95% confidence interval: 0.8, 2.25), depending on the balancing method chosen. The authors show that these differences were due to a combination of an interaction between propensity score and treatment effect and to differences in weighting subjects with different propensity scores. Thus, the methods are being used to calculate average treatment effects in populations with very different distributions of effect-modifying variables, resulting in different overall estimates. This phenomenon highlights the importance of careful selection of the covariate-balancing method so that the overall estimate has a meaningful interpretation.
19276224 Chronically ill mothers experiencing pain: relational coping strategies used while parenti 2009 Mar OBJECTIVE: There has been little research on women who are parenting while they experience pain and none of this research has focused on mothers with young children. The purpose of this study was to consider relational coping strategies generated by mothers that they used when parenting young children and experiencing pain. METHODS: Two-hundred sixty-two mothers participated in this survey research; 171 who have either multiple sclerosis (MS) or rheumatoid arthritis (RA), and a comparison group of 91well mothers. Mothers completed questionnaires inquiring about (a) their coping strategies, (b) levels of pain, fatigue and physical functioning, and (c) if they were currently experiencing an exacerbation of their chronic illness. RESULTS: Well mothers reported using more self-care when parenting while experiencing pain. Mothers with RA were more likely to set boundaries around their behaviour. Women with MS who were experiencing an exacerbation changed their coping strategies to include more child activities and encourage more mature child behaviour when compared to women with RA who were experiencing an exacerbation. DISCUSSION: From the perspective of relational coping theory, mothers consider their own pain while simultaneously attending to their responsibilities as a parent. Previous research has suggested that women may withdraw or reduce their parenting activities when they are in pain and this study supported the previous research, especially for women with RA.
20046018 [Investigation of the clinical usefullness of leukocytapheresis on rheumatoid arthritis re 2009 Dec PURPOSE: To examine therapeutic effect of leukocytapheresis (LCAP) for rheumatoid arthritis (RA) resistant to various treatments. METHOD: Thirteen patients with RA (mean age : 60.8+/-11.4, male : female=5 : 8), 1 who were resistant to disease-modifying anti-rheumatic drugs (DMARDs) and biologics, or 2 who failed with those medicines because of side effects or complications. We performed LCAP, which was carried out once a week for a total of five sessions, with a throughput of about 0.1 L/kg. Before and after LCAP, we evaluated the effect of LCAP therapy. RESULT: DAS28 (CRP) score was 5.70+/-1.12 before LCAP, 4.57+/-1.19 (P<0.05) just after the final LCAP and 4.83+/-1.35 (P<0.05) about 4 weeks after LCAP. DAS28 score decreased in all patients after LCAP. No serious adverse events were observed except temporary anemia. CONCLUSION: LCAP therapy may be useful and safe for patients with RA resistant to conventional medication. Patients who show good clinical response by LCAP needs to be clarified.
19366996 Association of the 6q23 region with the rate of joint destruction in rheumatoid arthritis. 2010 Mar BACKGROUND: Two novel genetic polymorphisms on chromosome 6q23 are associated with susceptibility to rheumatoid arthritis (RA). Both polymorphisms (rs6920220 and rs10499194) reside in a region close to the gene encoding tumour necrosis factor alpha-induced protein 3 (TNFAIP3). TNFAIP3 is a negative regulator of NF-kappaB and is involved in inhibiting TNF-receptor-mediated signalling effects. Interestingly, the initial associations were detected in patients with longstanding RA. However, no association was found for rs10499194 in a Swedish cohort with early arthritis. This might be caused by over-representation of patients with severe disease in cohorts with longstanding RA. OBJECTIVE: To analyse the effect of the 6q23 region on the rate of joint destruction. METHODS: Five single nucleotide polymorphisms in 6q23 were genotyped in 324 Dutch patients with early RA. Genotypes were correlated with progression of radiographic joint damage for a follow-up time of 5 years. RESULTS: Two polymorphisms (rs675520 and rs9376293) were associated with severity of radiographic joint damage in patients positive for anti-citrullinated protein/peptide antibodies (ACPA). Importantly, the effects were present after correction for confounding factors such as secular trends in treatment. CONCLUSIONS: These data associate the 6q23 region with the rate of joint destruction in ACPA+ RA.
19922026 Did Philippe Pinel frame the concept of the disease rheumatoid arthritis in the year 1800? 2009 Nov The dissertation from 1800 by Landré-Beauvais (LB) is quoted as an early description of rheumatoid arthritis (RA) with the implication that the disease was new at that time. However, physicians of the past may not have been able to perceive an already existing disease due to a lacking concept of it. The dissertation has been studied in the context of contemporary medical literature, modern historical and biographical texts. LB's dissertation seems to have been influenced by LB's mentor Philippe Pinel. The present study does not permit to conclude whether RA was a new disease.
20186043 Viruses and arthritis: new challenges in diagnosis, therapy, and immunization. 2010 Jun BACKGROUND: Although many viruses produce musculoskeletal symptoms during an acute infection, a long-term inflammatory arthritis remains an unusual consequence. When evaluating arthritis in a patient with a chronic or latent viral infection, serologic testing and therapeutic options are significantly altered. RESULTS: The example of hepatitis C reveals how chronic infection can complicate the diagnosis of rheumatoid arthritis. Determination of rheumatoid factor is of limited utility, whereas the anticyclic citrullinated peptide has become a new test with improved specificity. Therapeutic options are severely constrained because of potential hepatotoxicity of oral agents such as methotrexate and leflunomide. Antitumor necrosis factor alpha biologics have demonstrated initial safety in the setting of hepatitis C virus but may be associated with reactivation of hepatitis B virus. Biologics such as abatacept and rituximab have been inadequately studied in this population to date. Prevention of viral infections by influenza and herpes zoster vaccines in rheumatoid arthritis patients needs improved administration rates and careful planning to maximize efficacy. CONCLUSIONS: Chronic viral infections complicate the diagnosis and therapy of inflammatory arthritis. The antitumor necrosis factor alpha biologics have become important therapeutic options for patients with hepatitis C. Vaccination against influenza and herpes zoster are underused in health maintenance of arthritis patients.
19057883 [Is the treatment response in elderly patients with rheumatoid arthritis diminished? Resul 2009 Feb BACKGROUND: With increasing age DMARD and TNF-alpha-Inhibitors are less frequently used. The goal of this work was to investigate whether the therapeutic response in elderly patients with rheumatoid arthritis (RA) is diminished. METHODS: In total, 192 patients admitted to hospital because of active RA were prospectively studied. The improvements in disease activity (RADAI), pain and function (FFbH) three months after release were measured and compared between two age groups. RESULTS: Patients <65 and > or =65 years of age (n=104 and 88, mean age of 52+/-10 and 72+/-5.6 years, respectively) showed comparable improvements of disease activity and pain in the complete group as well as in those who received newly administered DMARD or TNF-alpha-inhibitors (71.2% and 62.6%, respectively, for the two groups). A significant difference was demonstrated for the change in function: While patients <65 years of age in the mean had a moderate improvement of the FFbH, this could not be shown for the older patients (p=0.04). A close correlation of the improvements of RADAI and FFbH could be shown for the younger patients only. CONCLUSIONS: DMARD or TNF-alpha-inhibitors improve disease activity and pain in elderly patients with RA no less than in younger patients. However, in contrast to the younger patients, the older patients profit less in terms of functional impairment.
20229200 The role of interleukin-6 in rheumatoid arthritis-associated osteoporosis. 2010 Aug INTRODUCTION: Osteoporosis is highly prevalent in patients with rheumatoid arthritis (RA) and is a frequent cause of fractures, disability, reduced quality of life and increased use of healthcare resources. DISCUSSION: Factors associated with the development of osteoporosis and fractures in patients with RA include disease activity, inflammation, gender, age, low body mass and glucocorticoid exposure. Several processes contribute towards the pathology of RA-associated osteoporosis, and increased osteoclast activation and subsequent bone resorption mediated by pro-inflammatory cytokines are thought to play major roles. Given the key effects of interleukin-6 (IL-6) in both RA and osteoporosis, and its ability to modulate other inflammatory mediators, IL-6 may be an important factor specifically associated with osteoporosis in patients with RA. CONCLUSION: The development of agents that modulate the actions of IL-6 and those of other pro-inflammatory mediators of bone loss may provide alternative osteoporosis management strategies for patients with RA than existing general osteoporosis therapies.
20108756 Rheumatoid arthritis: travelling biological era a Romanian X-ray population. 2009 Oct BACKGROUND: Rheumatoid arthritis (RA) is associated with loss of overall functionality of the locomotion system and it is connected with substantial economic losses. OBJECTIVE: To describe the clinical characteristics and healthcare resource utilization characteristics and to analyze the correlations in a cross-sectional sample of 206 patients in Romania. METHOD: RA cases have been enrolled from southern and western part of the country, covering a surface of 23 counties. RESULTS: Particularly in the literature data, Romanian RA patients become work disabled at 5.65 +/- 5.99 years old after the diagnosis. At cohort level, retirement in the first year after RA diagnosis is of 22.9%. From those, 13% were treated with biologic DMARDs; those on non-biologic DMARDs were 28.6%. In oral therapy group the most prescribed drug is lefunomide (61.2%). RA has an important impact on pain, function and utility, influenced by social factors. Patients' follow up is often based on hospitalization. CONCLUSION: Currently, when the clinician may choose for one certain therapy or another, the social influence is still overwhelming at all the evaluation levels in RA patients, as well as at economic impact.
19820941 A case with rheumatoid arthritis and systemic reactive AA amyloidosis showing rapid regres 2011 Feb Systemic reactive amyloid A (AA) amyloidosis is one of the critical complications associated with rheumatoid arthritis (RA). Recently, there are several useful reports of anti-tumor necrosis factor therapy for RA-related systemic reactive AA amyloidosis patients. However, the time-kinetic transition between effective anti-inflammatory therapies and regression of AA amyloid deposits remains uncertain. Here, we report a RA patient with systemic reactive AA amyloidosis who was successfully treated with prednisolone and etanercept, showing marked regression of gastroduodenal mucosal amyloid deposits within only 4 months. This is the first case report of RA-related systemic reactive AA amyloidosis histopathologically demonstrating rapid regression of amyloid deposits on gastroduodenal mucosa after adequate suppression of the underlying inflammatory condition.
19804846 Interleukin-6 subfamily cytokines and rheumatoid arthritis: role of antagonists. 2010 Jan Many cytokines have been implicated in the inflammatory pathways that characterize rheumatoid arthritis (RA) and related inflammatory diseases of the joints. These include members of the interleukin-6 (IL-6) family of cytokines, several of which have been detected in excess in the synovial fluid from RA patients. What makes the IL-6 group of cytokines a family is their common use of the glycoprotein 130 (gp130) receptor subunit, to which they bind with different affinities. Several strategies have been developed to block the pro-inflammatory activities of IL-6 subfamily cytokines. These include the application of monoclonal antibodies, the creation of mutant form(s) of the cytokine with enhanced binding affinity to gp130 receptor and the generation of antagonists by selective mutagenesis of the specific cytokine/gp130 receptor-binding site(s). The rationale for the use of anti-cytokine therapy in inflammatory joint diseases is based on evidence from studies in vitro and in vivo, which implicate major cytokines such as interleukin-1 (IL-1), tumour necrosis factor (TNF)-alpha and IL-6 in RA pathogenesis. In particular, IL-6 subfamily antagonists have a wide range of potential therapeutic and research applications. This review focuses on the role of some of the IL-6 subfamily cytokines in the pathogenesis of the inflammatory diseases of the joints (IJDs), such as RA. In addition, an overview of the recently developed antagonists will be discussed.
21495300 [Aggressive nature of rheumatic arthritis with citrullinated cyclic peptide antibodies]. 2009 Jan Numerous studies demonstrate the high specificity (90-98%) of the anticyclic citrullinated antibodies (antiCCP) in rheumatoid arthritis (RA) and their correlation with the erosive arthritis, these antibodies being a disease activity marker and a prognostic factor. MATERIAL AND METHODS: A total of 53 RA patients (48 women, 5 men), mean age 47.3 years old, diagnosed according to the ACR criteria were evaluated. The clinical evaluation was centered upon: tender joint count, swollen joint count, patient pain (VAS), morning stiffness and disease activity score (DAS28). The laboratory tests had in view: the inflammatory syndrome, blood count, immunological syndrome (antinuclear antibodies, rheumatoid factor, antiCCP antibodies), radiographs of the hands and feet. RESULTS: The high levels of the anti-CCP antibodies founded in 28 patients with RA were correlated with severity of the inflammatory syndrome, the immunological abnormalities and with the precocity appearance of the joint erosions. CONCLUSIONS: The presence of the anti-CCP antibodies at patients with RA are correlated with severe joint destruction and it represents a marker of the disease activity and progression.
20665026 Lack of association between poly(ADP-ribose) polymerase (PARP) polymorphisms and rheumatoi 2012 Jan Several studies have investigated the roles of genetic polymorphisms in rheumatoid arthritis (RA). Some of these studies reported that polymorphisms of poly(ADP-ribose) polymerase 1 gene (PARP-1) are linked to rheumatoid arthritis. Poly(ADP-ribose) polymerase is an enzyme involved in DNA repair, genomic stability, apoptosis, gene transcription, proliferation, and autoimmunity. To determine whether genetic polymorphisms of PARP-1 are related to rheumatoid arthritis in a Korean population, six single nucleotide polymorphisms (SNPs), which were selected based on LDs and minor allele frequency (MAF > 0.05) in our previous study, were genotyped in 1,202 patients with rheumatoid arthritis and 979 unrelated healthy controls. As a result, no significant association between the susceptibility to rheumatoid arthritis and PAPR-1 polymorphisms was found. However, in further analysis depending on the radiological severity of rheumatoid arthritis, one PARP-1 polymorphism, rs1805413 (OR = 0.11; 95% CI = 0.02-0.55; P = 0.007; P (corr) = 0.04), and one haplotype (ht6, OR = 0.11; 95% CI = 0.02-0.55; P = 0.007; P (corr) = 0.04) were significantly associated with the radiological severity risk of RA in a recessive model. In addition, a recessive model revealed a correlation between one RA haplotype (ht4) and anti-CCP antibody negativity (OR 0.24, 95% CI 0.10-0.63, P = 0.003; P (corr) = 0.02). Despite a possible association between PARP-1 and the radiological severity of RA, this study found no statistical association between PARP-1 polymorphisms and the susceptibility to rheumatoid arthritis in a Korean population.
20223500 Indirect comparison of tocilizumab and other biologic agents in patients with rheumatoid a 2010 Jun OBJECTIVES: To compare the patterns of American College of Rheumatology (ACR) response between tocilizumab and other biologic agents in patients with rheumatoid arthritis who have inadequate response to disease-modifying antirheumatic drugs (DMARD-IR). METHODS: Systematic literature review identified similarly designed double-blind, randomized, placebo-controlled trials over an 18-year period that investigated the effectiveness of abatacept (2), rituximab (2), and TNF-alpha inhibitors etanercept, infliximab, and adalimumab (11) in DMARD-IR patients; data from 3 placebo-controlled, phase 3 trials for tocilizumab, a newly developed IL-6 inhibitor, were included. The endpoint of interest was ACR20/50/70 response criteria at 24 to 30 weeks. Results were analyzed simultaneously using Bayesian mixed-treatment comparison techniques. Nonoverlapping ACR response rates (ACR70) for each agent were compared among treatments to identify differences in ACR response pattern. Separate analyses of overlapping ACR20/50/70 responses were conducted to identify the source of any differences. Results were expressed as relative risk of ACR20/50/70 response and associated 95% credible interval (CrI). RESULTS: Patterns across nonoverlapping ACR response levels varied significantly across treatments. In subsequent analyses, the effectiveness of tocilizumab appeared to be comparable to that of other biologic agents for ACR20 and ACR50 responses but greater for ACR70. Specifically, tocilizumab had greater ACR70 responses than both TNF-alpha inhibitors (relative risk = 1.8; CrI = 1.2, 2.6) and abatacept (relative risk = 2.0; CrI = 1.3, 3.1). CONCLUSIONS: Among DMARD-IR patients, tocilizumab shows a pattern of response that differs from that of other biologic agents. Post-hoc analyses suggest that the difference lies in a higher likelihood of ACR70 response with tocilizumab.
19644897 Effectiveness of two finger splints for swan neck deformity in patients with rheumatoid ar 2009 Aug 15 OBJECTIVE: To compare the effectiveness and acceptability of silver ring splints (SRS) and commercial prefabricated thermoplastic splints (PTS) in treating swan neck deformities in patients with rheumatoid arthritis (RA). METHODS: Consecutive patients with RA and a mobile swan neck deformity were included in a randomized, crossover trial. In 2 different sequences, patients used both splints for 4 weeks, with a washout period of 2 weeks. Afterward, patients used the preferred splint for another 12 weeks. The primary outcome measure was dexterity measured with the Sequential Occupational Dexterity Assessment (SODA). Secondary outcome measures included other measures of hand function, satisfaction with the splints, and splint preference. RESULTS: Fifty patients were included, and 47 (94%) of those completed the study. Eighteen patients (36%) had 1 swan neck deformity, whereas the other patients had 2 or more. The improvement of the total SODA score with the SRS (11.2; 95% confidence interval [95% CI] 8.1, 14.3) and PTS (10.8; 95% CI 7.5, 14.1) was similar (difference -0.5; 95% CI -2.2, 1.2). In addition, there were no significant differences in change scores regarding the other clinical outcome measures, or satisfaction. Twenty-four patients preferred the SRS, 21 preferred the PTS, and 2 patients chose neither. A comparison in the 12-week followup period yielded similar clinical outcomes, with the exception of a significantly higher score in 3 items of satisfaction in the SRS group. CONCLUSION: For patients with RA and a mobile swan neck deformity, SRS and PTS are equally effective and acceptable.
19411392 Immunogenetic risks of anti-cyclical citrullinated peptide antibodies in a North American 2009 Jun OBJECTIVE: To determine the prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies in unaffected relatives of North American Native probands with rheumatoid arthritis (RA); and the associations of the shared epitope (SE) and HLA-DRB1*0901 with RA and anti-CCP antibodies. METHODS: The subjects were RA probands, affected relatives, unaffected first-degree (FDR) and more distant relatives, and unaffected controls from the same population. HLA-DRB1 typing was determined by DNA sequencing and anti-CCP antibodies were determined by ELISA. RESULTS: DRB1*0901, SE, and SE/DRB1*0901 genotypes were all associated with RA. SE/DRB1*0901, but not other SE genotypes, was associated with disease onset at age<16 years. The frequency of anti-CCP antibodies was 82% in RA probands, 17% in FDR, 11% in more distant relatives, and 3% in controls. Among unaffected relatives, a significant increased risk of anti-CCP was associated with SE/DRB1*0901 genotype, but not with SE. CONCLUSION: An independent association of the non-SE allele DRB1*0901 with RA was confirmed in this population, and this allele in combination with a SE allele was associated with younger age at disease onset. FDR of RA probands have a higher prevalence of anti-CCP antibodies than more distant relatives and unrelated controls, suggesting a gradient of risk for disease development. Immunogenetic risks may act early in disease pathogenesis at the level of initiation of RA autoantibody formation; however, it is not clear what additional genetic and environmental risks are involved in progression to clinical disease.
20884981 The Kudo 5 total elbow replacement in the treatment of the rheumatoid elbow: results at a 2010 Oct Between September 1993 and September 1996, we performed 34 Kudo 5 total elbow replacements in 31 rheumatoid patients. All 22 surviving patients were reviewed at a mean of 11.9 years (10 to 14). Their mean age was 56 years (37 to 78) at the time of operation. All had Larsen grade IV or V rheumatoid changes on X-ray. Nine (three bilateral replacements and six unilateral) had died from unrelated causes. One who had died before ten years underwent revision for dislocation. Of the 22 total elbow replacements reviewed six had required revision, four for aseptic loosening (one humeral and three ulnar) and two for infection. Post-operatively, one patient had neuropraxia of the ulnar nerve and one of the radial nerve. Two patients had valgus tilting of the ulnar component. With revision as the endpoint, the mean survival time for the prosthesis was 11.3 years (95% confidence interval (10 to 13) and the estimated survival of the prosthesis at 12 years according to Kaplan-Meier survival analysis was 74% (95% confidence interval 0.53 to 0.91). Of the 16 surviving implants, ten were free from pain, four had mild pain and two moderate. The mean arc of flexion/extension of the elbow was 106° (65° to 130°) with pronation/supination of 90° (30° to 150°) with the joint at 90° of flexion. The mean Mayo elbow performance score was 82 (60 to 100) with five excellent, ten good and one fair result. Good long-term results can be expected using the Kudo 5 total elbow replacement in patients with rheumatoid disease, with a low incidence of loosening of the components.
19638598 Mind and body management strategies for chronic pain and rheumatoid arthritis. 2009 Aug Chronic pain (CP) and rheumatoid arthritis (RA) pose particular challenges for the individual. Although biomedicine inevitably plays a role in the reduction or control of some symptoms for people living with chronic pain, directed self-management is also increasingly recognized as an important tool. Self-management can address pain-associated symptoms of CP and RA, and often has broader aims, such as promoting positive well-being. Forty-six interviews with people experiencing CP and 46 interviews with those living with RA-associated pain were analyzed. Our analysis uncovered three broad strategies adopted by participants: body management, mind-management and mind-body management. The analysis demonstrated that for those living with pain, a sense of well-being is achieved not through pain control alone, but also through various mind/body techniques for managing pain, accepting new limits, and adjusting the way people relate to themselves. These self-management strategies are an important adjunct to biomedical care for those experiencing chronic pain.