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ID PMID Title PublicationDate abstract
20460034 Survey of the therapeutic management of rheumatoid arthritis in France: the OPALE study. 2010 May OBJECTIVES: To describe the therapeutic practice used in 2006 by French rheumatologists and hospital staff in RA patients, and to estimate the proportion of patients currently treated with DMARDs including biologics, and to estimate the ratio of patients treated according to the SFR national recommendations. METHODS: This multicentre cross-sectional study was performed in a random sample of rheumatologists selected from a comprehensive national database and stratified by setting and region. Each rheumatologist established a registry of subsequent RA patients (first step), and filled in a detailed questionnaire for the 10 first patients from the registry (second step). At the day of inclusion, RA characteristics and DMARD treatments over the past 12 months were recorded. RESULTS: The majority of the RA patients were women (mean age: 58 yrs). The mean DAS 28 score was 3.6, and RA was considered as clinically and radiologically severe in almost 27.0% of the cases. In the registry part, 89.9% of RA patients were currently treated with DMARDs, and 29.3% of them received a biologic DMARD alone or in combination. In 1610 patients with detailed questionnaire record, the efficacy of the current DMARD treatment was good in almost 60% of the patients. Finally, the physician's decision was to continue the ongoing treatment in 4/5 cases. CONCLUSIONS: In this study, RA characteristics were similar to the typical RA observed in previous studies. Biologics were major drugs in DMARD treatments with 30.1% RA patients currently treated. Modification of treatments was essentially linked to a lack of therapeutic response.
19686542 Anti-CD20 antibody rituximab in the treatment of rheumatoid arthritis. 2010 Jan Rheumatoid arthritis (RA) is a chronic, autoimmune reaction-driven systemic inflammatory disease that affects joints and several other organs. Although anti-TNF therapy and combination therapy with traditional anti-rheumatic drugs have improved the treatment of RA, still quite a significant proportion of patients do not reach adequate anti-rheumatic response. The understanding of the pathogenesis of RA has developed markedly during the last two decades, and this has brought up new targets for anti-rheumatic therapy. B cells have been found to have a pivotal role in the development of arthritis both in experimental models and in humans. Rituximab, an anti-CD20 antibody that depletes B cells, has been introduced in the treatment of RA, and it has proven to be safe and efficacious in RA. This review gives an overview on the mechanism of action of rituximab in RA and summarizes the published clinical data of rituximab in the treatment of RA.
20125170 Rheumatoid arthritis: can we achieve true drug-free remission in patients with RA? 2010 Feb Since the introduction of new biologic agents and intensive treatment strategies that aim to tightly control disease activity, clinical remission has become a realistic target in patients with rheumatoid arthritis. Once patients are in continuous remission, however, is it realistic to consider withdrawing DMARD therapy?
19415332 Detection of disease-associated deletions in case-control studies using SNP genotypes with 2009 Aug Genomic deletions have long been known to play a causative role in microdeletion syndromes. Recent whole-genome genetic studies have shown that deletions can increase the risk for several psychiatric disorders, suggesting that genomic deletions play an important role in the genetic basis of complex traits. However, the association between genomic deletions and common, complex diseases has not yet been systematically investigated in gene mapping studies. Likelihood-based statistical methods for identifying disease-associated deletions have recently been developed for familial studies of parent-offspring trios. The purpose of this study is to develop statistical approaches for detecting genomic deletions associated with complex disease in case-control studies. Our methods are designed to be used with dense single nucleotide polymorphism (SNP) genotypes to detect deletions in large-scale or whole-genome genetic studies. As more and more SNP genotype data for genome-wide association studies become available, development of sophisticated statistical approaches will be needed that use these data. Our proposed statistical methods are designed to be used in SNP-by-SNP analyses and in cluster analyses based on combined evidence from multiple SNPs. We found that these methods are useful for detecting disease-associated deletions and are robust in the presence of linkage disequilibrium using simulated SNP data sets. Furthermore, we applied the proposed statistical methods to SNP genotype data of chromosome 6p for 868 rheumatoid arthritis patients and 1,197 controls from the North American Rheumatoid Arthritis Consortium. We detected disease-associated deletions within the region of human leukocyte antigen in which genomic deletions were previously discovered in rheumatoid arthritis patients.
20729120 Histone deacetylase inhibitors: new treatment options for inflammatory joint disease? 2010 Oct Histone deacetylase inhibitors (HDIs) are a new class of compounds that are being developed for the treatment of malignancies such as cutaneous T-cell lymphoma. HDIs inhibit the removal of acetyl groups from histones. The histone acetylation process is dependent on two enzymes, histone acetyl transferase (HAT) and histone deacetylase (HDAC), and regulates the expression of genes, including those encoding cell survival or apoptosis. In addition to regulating cell growth, HDIs exert anti-inflammatory effects by controlling the production of anti-inflammatory cytokines; modulating the function of cells such as T cells, monocytes-macrophages, chondrocytes, and osteoclasts; and modulating angiogenesis. In several animal models of arthritis, HDIs improve the clinical manifestations and prevent damage to the bone and cartilage. In humans, the only relevant data available so far come from studies of HAT and HDAC expression in the synovial membrane of patients with rheumatoid arthritis. HDIs may hold promise for the treatment of inflammatory joint disease.
20508962 Contribution of rheumatoid arthritis disease activity and disability to rheumatoid cachexi 2010 Oct This cross-sectional study was done to show how nutritional indices influence each other and the contributions made by inflammation to the development of rheumatoid cachexia. We studied 295 female patients with rheumatoid arthritis (RA). We chose five nutritional indices: body mass index (BMI), arm muscle area (AMA), triceps skinfold thickness (TSF), which were obtained via anthropometric measurements, and serum albumin and cholesterol. Clinical indicators of RA included disease duration, C-reactive protein (CRP) and Disease Activity Score 28 (DAS28). We performed a bivariate correlation test between the nutritional indices and multiple regression analysis for each nutritional index. Mean AMA was low, 87.3% of the normal value, whereas TSF was not different. Muscle protein expressed by AMA decreased according to RA duration, whereas visceral protein indicated by serum albumin decreased with an increase in RA activity. The continuation of inflammation appears to be essential for a decrease in muscle protein in rheumatoid cachexia. DAS28 showed a positive contribution to BMI in the regression model, and the increase in RA disease activity causes an increase in BMI via an accumulation of tissue fat.
20822707 A clinical prediction rule combining routine assessment and power Doppler ultrasonography 2010 Sep OBJECTIVES: The ability to predict the development of rheumatoid arthritis (RA) in patients with an early-onset undifferentiated arthritis (UA) is highly required if the remission or an adequate response to the treatment are the main goal. The aim of the study was to develop a predictive rule combining clinical variables, serological biomarkers and power Doppler ultrasonography (PDUS) for the progression from an early-onset UA to RA in daily rheumatological practice. METHODS: A prediction rule was developed after a 12 months study of 149 adult patients with a recent-onset UA. The combination of routine assessment variables and PDUS findings was investigated. Logistic regression analysis was performed to identify the independent factors for the development of RA and global predictive score was calculated. The score of the predictive rule ranged from 0 to 10. The area under the receiver operating characteristic curve was used to evaluate the diagnostic performance of the rule. The post-test probability (post-TP) was evaluated using the Bayes theorem. RESULTS: Sixty-two patients (41.6%) developed a RA. The rule demonstrated excellent discriminative ability, with an AUC of 0.919 (p=0.0001). With the optimal cut-off point of 5, sensitivity was 89.9%, specificity was 88.6% and positive likelihood ratio was 7.89. If a threshold of 6.5 was applied a higher value of specificity (97.7%) was obtained, but sensitivity (47.6%) decreased. The post-TP value of the two different cut-off points mentioned above were 62% and 80%, respectively. CONCLUSIONS: Our predictive rule, which includes PDUS assessment, revealed an excellent discriminative ability for assessing the likelihood of development of RA in patients with an early-onset UA. Further studies are required to confirm the results and to tailor a therapeutic approach in patients with an early-onset UA.
20601833 Therapeutic strategy and significance of serum rheumatoid factor in patients with rheumato 2010 To predict the response of patients with rheumatoid arthritis (RA) to infliximab, patient profile and laboratory findings were compared to determine whether there was any association with the clinical course of the disease, and the clinical significance of serum rheumatoid factor (RF) in the response to this treatment was considered. Sixty-two RA patients were treated with infliximab, 87.9% of whom were positive for RF. At baseline and 12 months after the start of treatment, RF titers were significantly lower in the low-CRP group (CRP at 12 months<0.3 mg/dl) compared with that in the high-CRP group (CRP at 12 months >1.5 mg/dl). Furthermore, at baseline and 12 months, RF titers were significantly lower in the good-CRP-response group (DeltaCRP>or=1.5 mg/d) compared with the poor-CRP-response group (DeltaCRP
20191574 Prediction of nonspecific side effects in rheumatoid arthritis patients by beliefs about m 2010 Jun OBJECTIVE: This study examines the determinants of patients' side effects from arthritis medication. Proposed predictors were patients' beliefs about medications, objective disease activity, treatment regimen, and psychiatric and rheumatoid arthritis symptoms. METHODS: In a longitudinal design, 100 rheumatoid arthritis outpatients were investigated at baseline and again at 6 months after receiving both pharmacologic and psychosocial treatment. RESULTS: Multivariate analyses showed no influence of disease status, type of treatment, or psychiatric or arthritis symptoms on side effects. Heightened concerns about arthritis medication at baseline predicted side effects at baseline (partial correlation r = 0.37, P < 0.001) and at 6 months (partial correlation r = 0.25, P < 0.001) after controlling for relevant disease- and treatment-related variables. In a cross-lagged panel analysis, prior experience with side effects from arthritis medication was ruled out as a cause of heightened concerns, indicating that negative beliefs genuinely contribute to side effects. A comparison of patients who did and did not start new medications showed no difference in side effects in patients with positive beliefs about medications, but led to significantly more side effects in patients with negative beliefs. CONCLUSION: Patients' beliefs about arthritis medications were stable and consistently associated with side effects. Patients with greater concerns about their arthritis medications are at higher risk for developing side effects, especially when starting new drugs. Identifying those patients is important to avoid premature drug discontinuation. Research into cause and preventability of negative attitudes to prescribed medicines is needed.
18807253 Rheumatoid cranial pachymeningitis successfully treated with long-term corticosteroid. 2009 Mar We report a 68-year-old man without clinical history of rheumatoid arthritis who presented with acute bilateral palsy of the IX and X cranial nerves secondary to pachymeningitis confirmed on cranial MRI. Rheumatoid factor in both serum and cerebrospinal fluid and anti-agalactosyl IgG antibody in serum were positive. The radiographs of hands and feet revealed signs of early rheumatism. The dural biopsy specimen showed chronic inflammation with infiltration of lymphocytes and histiocytes. A diagnosis of rheumatoid cranial pachymeningitis was made. Treatment with long-term corticosteroid was excellently effective.
19585227 Osteoimmunology: crosstalk between the immune and bone systems. 2009 Sep INTRODUCTION: The interaction between the immune and skeletal systems has long been acknowledged, but investigation into rheumatoid arthritis (RA) as well as the various bone phenotypes found in immunocompromised gene-deficient mice has highlighted the importance of the dynamic interplay between the two systems. This has led to the recent emergence and subsequent rapid evolution of the field of osteoimmunology. BONE DESTRUCTION WITH ARTHRITIS AS A RANKL DISEASE: In the bone destruction associated with RA, IL-17-producing helper T cells (T(H)17) play a major role by inducing receptor activator of nuclear factor-kappaB ligand (RANKL). RANKL stimulates osteoclastogenesis through nuclear factor of activated T cells cytoplasmic 1 (NFATc1), which is well known as a crucial regulator of immunity. NEW PLAYERS IN OSTEOIMMUNOLOGY: In addition to cellular interactions via cytokines, the immune and skeletal systems share various molecules, including transcription factors, signaling molecules, and membrane receptors. CONCLUSION: The scope of osteoimmunology has grown to encompass a wide range of molecular and cellular interactions, the elucidation of which will provide a scientific basis for future therapeutic approaches to diseases of both the immune and skeletal systems.
20945623 Dermatoglyphics of digitopalmar complex in forty male patients affected by rheumatoid arth 2009 Quantitative analysis of digitopalmar ridge count was performed in forty male patients with rheumatoid arthritis to evaluation of genetic factors in that disease. Twenty five variables (ridge count on each of ten fingers, their sum on five and ten fingers, four traits on each palm, i. e. ridge count between a-b, b-c and c-d triradii, their sum on each and both palm and at angle on two palms and their bilateral sum) were determined. The data thus obtained were compared with digitopalmar prints of 200 healthy men who served as a control group. A significant difference from the control group was found in eight variables. Ridge count was increased on the first and fifth finger bilaterally, on the fourth right finger tip, and their sum on each, and both fists. Accordingly, a polygenic system identical in some loci to the polygenic system predisposing to rheumatoid arthritis susceptibility might be found responsible for the dermatoglyphic pattern development. That means that they could used, and that is the aim of this study, as a diagnostic tool in rheumatic diseases.
20848219 Targeting interleukin-21 in rheumatoid arthritis. 2011 Mar Interleukin-21 (IL-21) is a new member of the type I cytokine superfamily, which binds to a composite receptor that consists of a private receptor (IL-21R) and the common cytokine receptor γ chain. Recently, increasing evidence has shown that IL-21 contributes to the pathogenesis of chronic inflammatory and autoimmune diseases because of its pro-inflammatory and immune-mediated properties. IL-21 induced T-cell activation and pro-inflammatory cytokine secretion in rheumatoid arthritis (RA). IL-21R RNA transcripts were found in synovial tissue samples of patients with RA. In addition, blockade of the IL-21/IL-21R pathway ameliorated disease in animal models of RA and significantly inhibited inflammatory cytokine production in vitro. Moreover, IL-21R deficiency in the K/BxN mouse model of inflammatory arthritis was sufficient to block arthritis initiation completely. All theses findings suggest that IL-21 has important biological effects in autoimmunity that might be a promising therapeutic target for RA. In this review, we discuss the biological features of IL-21 and summarize recent advances in the role of IL-21 in the pathogenesis and treatment of RA.
21080449 Treatment and nontreatment predictors of health assessment questionnaire disability progre 2011 Mar OBJECTIVE: To examine predictors of progression of disability in rheumatoid arthritis (RA), as measured by the Health Assessment Questionnaire disability index (HAQ), and to determine rates of progression during biologic treatment. METHODS: We followed 18,485 RA patients for up to 11 years (mean 3.7 years) in a longitudinal study of RA outcomes. Patients were characterized as having moderate or severe RA versus less severe RA at study entry. Annualized progression rates were determined in multivariable analyses using generalized estimating equations. RESULTS: Although all of the demographic and severity characteristics were associated with baseline differences in HAQ score, progression was only associated with age, comorbidity, initial severity, and treatment. HAQ score increased fastest in patients ages >65 years (0.031; 95% confidence interval [95% CI] 0.028, 0.034). HAQ progression was independently associated with the presence of baseline cardiovascular disease, hypertension, diabetes mellitus, and the number of comorbid conditions. Annualized progression rates were greater in patients with mild to inactive RA (0.021; 95% CI 0.019, 0.023) than in moderate to severe RA (0.003; 95% CI 0.001, 0.006). The overall progression rate during biologic treatment was 0.008 (95% CI 0.005, 0.011); for patients with moderate to severe RA, the rate was 0.001 (95% CI -0.005, 0.003). CONCLUSION: Age and comorbidity are important predictors of the rate of loss of functional status, and have a stronger effect on HAQ progression than does biologic treatment. There is little difference in progression rates among biologics. Patients with more severe RA progress less than those with less severe RA, a possible function of regression to the mean.
19915307 Long-term results of ankle arthrodesis using an intramedullary nail with fins in patients 2009 Oct We report herein the results of a retrospective study of 30 ankle arthrodesis procedures performed in 27 patients with rheumatoid arthritis from 1994 through 2001 using a novel design of intramedullary nail with fins. The surgical treatment, post-operative management and clinical evaluation are described. The clinical evaluation, at an average follow-up period of more than 10 years, was based on foot disease scores from the Japanese Orthopaedic Association and scores obtained preoperatively, postoperatively, and during follow-ups 1 (November 2001) and 2 (November 2007) were compared. These variables showed significant improvement between before surgery and at follow-up evaluations. Non-union was not observed and no marked changes of the Chopart joint were seen between before surgery and at follow-up evaluations. Delayed wound healing was seen in 9 of 30 joints. However, infection neuropathy or other complications were not found. We conclude that arthrodesis using an intramedullary nail with fins is an effective treatment for severe hindfoot deformities in patients with rheumatoid arthritis because no cases of non-union were observed and because clinical results over the mean 10-year follow-up period were good or satisfactory.
20451345 Effectiveness of individual resource-oriented joint protection education in people with rh 2011 Jan OBJECTIVE: the modern joint protection (JP) concept for people with rheumatoid arthritis (RA) is an active coping strategy to improve daily tasks and role performance by changing working methods and using assistive devices. Effective group JP education includes psycho-educational interventions. The Pictorial Representation of Illness and Self Measure (PRISM) is an interactive hands-on-tool, assessing (a) the individual's perceived burden of illness and (b) relevant individual resources. Both issues are important for intrinsic motivation to take action and change behaviour. This study compared individual conventional JP education (C-JP) with PRISM-based JP education (PRISM-JP). METHODS: an assessor-blinded multicentre randomized controlled trial, including four JP education sessions over 3 weeks, with assessments at baseline and 3 months. RESULTS: in total 53 RA patients participated. At 3 months, the PRISM-JP (n=26) participants did significantly better compared to the C-JP participants (n=27) in JP behaviour (p=0.02 and p=0.008 when corrected for baseline values), Arthritis Self-efficacy (ASES, p=0.015) and JP self-efficacy (JP-SES, p=0.047). Within-group analysis also showed less hand pain (p<0.001) in PRISM-JP group. CONCLUSION: PRISM-JP more effectively supported learning of JP methods, with meaningful occupations, resource activation and self-efficacy acting as important mediators. PRACTICE IMPLICATIONS: PRISM improved patient-clinician communication and is feasible for occupational therapy.
19252247 [Efficacy of new biologics on bone destruction in rheumatoid arthritis]. 2009 Mar Rheumatoid arthritis (RA) is a representative bone disease. TNF-alpha plays a pivotal role in the pathological processes of RA, leading to cartilage and bone destruction. Although biologics targeting TNF have brought about a marked reduction of progression of bone destruction, the rate of remission induction is about 30% and the rest of the patients require alternative biologics such as B cell targeting (chimeric anti-CD20 antibody : rituximab) or T cell targeting (CTLA [cytotoxic T-lymphocyte antigen]-4-Igfusion protein : abatacept) therapies. To date, the efficacy of these new biologics on the disease activity and bone destruction was confirmed by randomized control trials. Then abatacept and rituximab were recommended for the treatment of the patients who do not respond adequately to TNF inhibitors.
19917171 Membranous nephropathy in rheumatoid arthritis: a case report. 2009 Sep Rheumatoid arthritis is a chronic disease characterized by inflammation, abnormal cellular and humoral immune responses, synovial hyperplasia and rarely by renal involvement, characterized principally by secondary amyloidosis and nephrotoxic effects related to drugs, while renal lesions directly due to the disease itself are infrequent. In this report we describe a patient with rheumatoid arthritis who developed membranous nephropathy associated with nephrotic syndrome while receiving adalimumab, an anti-tumour necrosis factor-alpha drug.
20597275 [New approaches to pharmacotherapy for rheumatoid arthritis: perspective for use of tocili 2010 The author considers a role of interleukin-6 (IL-6) as a cytokine, elevated concentrations of which in serum and synovial fluid correlate with the activity of articular inflammation and the development of systemic manifestations in rheumatoid arthritis (RA). There is strong evidence suggesting that effective treatment with gene-engineering biologicals causes a reduction in IL-6 concentrations. Detailed information is given on the novel drug tocilizumab that is humanized monoclonal antibodies (IgG) and the first and only agent that is able to suppress IL-6-dependent inflammatory reactions and is permitted for use in RA.
19252240 [Imaging methods in rheumatoid arthritis]. 2009 Mar Biological agents revolutionized a therapeutic aspect of rheumatoid arthritis (RA) . It is important to establish early diagnosis and the evaluation method for RA. In addition to conventional X-ray, joint magnetic resonance imaging (MRI) and ultrasonography became to be focused on. Conventional X-ray is not useful for early diagnosis for RA, but important for assessing bone destruction. Joint MRI is able to detect specific joint change such as synovitis and bone oedema, these are early change and strong predictor of bone destruction, hence useful for early diagnosis and prognostic decision for RA. Joint ultrasonography is reported as useful method for both evaluation of disease activity and imaging remission of synovitis. It is important to understand feature of these imaging tools to use in actual practice.