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ID PMID Title PublicationDate abstract
21794783 [Citrullinated proteins in rheumatoid arthritis]. 2011 Jan Rheumatoid arthritis is an autoimmune disease of multifactorial etiology characterized by inflammation of the joints and presence of autoantibodies directed against multiple autoantigens. Recently the study of the anti-citrullinated protein antibodies (ACP) has acquired great interest due to its high specificity and sensitivity for diagnosis, in addition to which it has shown to be a predictor of severity in patients with rheumatoid arthritis, suggesting an important participation in the pathogenesis of the disease.
19710928 Transcriptome analysis describing new immunity and defense genes in peripheral blood monon 2009 Aug 27 BACKGROUND: Large-scale gene expression profiling of peripheral blood mononuclear cells from Rheumatoid Arthritis (RA) patients could provide a molecular description that reflects the contribution of diverse cellular responses associated with this disease. The aim of our study was to identify peripheral blood gene expression profiles for RA patients, using Illumina technology, to gain insights into RA molecular mechanisms. METHODOLOGY/PRINCIPAL FINDINGS: The Illumina Human-6v2 Expression BeadChips were used for a complete genome-wide transcript profiling of peripheral blood mononuclear cells (PBMCs) from 18 RA patients and 15 controls. Differential analysis per gene was performed with one-way analysis of variance (ANOVA) and P values were adjusted to control the False Discovery Rate (FDR<5%). Genes differentially expressed at significant level between patients and controls were analyzed using Gene Ontology (GO) in the PANTHER database to identify biological processes. A differentially expression of 339 Reference Sequence genes (238 down-regulated and 101 up-regulated) between the two groups was observed. We identified a remarkably elevated expression of a spectrum of genes involved in Immunity and Defense in PBMCs of RA patients compared to controls. This result is confirmed by GO analysis, suggesting that these genes could be activated systemically in RA. No significant down-regulated ontology groups were found. Microarray data were validated by real time PCR in a set of nine genes showing a high degree of correlation. CONCLUSIONS/SIGNIFICANCE: Our study highlighted several new genes that could contribute in the identification of innovative clinical biomarkers for diagnostic procedures and therapeutic interventions.
18787830 Effects of leflunomide and methotrexate in rheumatoid arthritis detected by digital X-ray 2009 Jan The aim of the present study was to evaluate the effect of long-term leflunomide and methotrexate (MTX) therapy during the course of rheumatoid arthritis (RA) estimated by digital X-ray radiogrammetry (DXR) and computer-aided joint space analysis (CAJSA) as diagnostic tools for the quantification of disease-related periarticular osteoporosis and joint space narrowing. Fourty matchable patients with verified RA were treated with leflunomide or MTX during an observation period of 2.5 years. All patients underwent complete computerized calculations of bone mineral density (BMD) and metacarpal index (MCI) by DXR as well as semi-automated measurements of joint space widths (JSW) at the metacarpophalangeal articulations (MCP, thumb to small finger) and proximal interphalangeal joints (PIP, index finger to small finger) using digitized hand radiographs. DXR-BMD revealed an increase of 0.4% (leflunomide-group) versus a reduction of -9.1% (MTX-group). Regarding DXR-MCI, a reduction of -1.1% (leflunomide-group) and -5.3% (MTX-group) was observed. The CAJSA parameters showed a decline of -2.7% (JSW-MCP) versus -2.1% (JSW-PIP) in patients treated with leflunomide. An accentuated joint space narrowing was revealed (JSW-MCP: -5.7%; JSW-PIP: -6.2%) in the MTX group. Digital X-ray radiogrammetry and CAJSA could discriminate the influence of different therapeutic regimes on periarticular osteoporosis and joint space narrowing showing a less accentuated radiographic progression in patients treated with leflunomide.
20738208 Ultrasound findings in rheumatoid wrist arthritis highly correlate with function. 2011 PURPOSE: The wrist is almost invariably affected in rheumatoid arthritis (RA) and inflammation of the wrist can lead to impaired function and eventually to severe destruction. Classical signs of inflammation, pain, swelling and heat may often be observed in clinical examination of wrist arthritis and in ultrasound (US) investigation. We described the relation between clinical and ultrasound parameters of wrist arthritis and secondly their relation to function. PATIENTS AND METHODS: In 33 RA patients with wrist arthritis, clinical and US parameters were measured. Function was evaluated with the SODA-S (Sequential Occupational Dexterity Assessment-Short) and the DASH-DLV (Disabilities of the Arm, Shoulder and Hand-Dutch Language Version). Correlation coefficients were calculated and factor analysis was performed to describe the relation between the aforementioned measures. RESULTS: Correlation coefficients between clinical and ultrasound parameters of RA wrist inflammation in this study were fair to moderate. We found a good correlation between ultrasound and observed function. CONCLUSION: The classical signs of inflammation (pain, swelling, redness, heat and impaired function) seem to reflect different aspects of arthritis. Ultrasound correlates well with function, thus can give paramount information on wrist function, and might therefore be a valuable complementary tool in measuring wrist arthritis in RA.
19530996 Damage-associated molecular patterns--emerging targets for biologic therapy of childhood a 2009 Jun Juvenile idiopathic arthritis (JIA) is a group of chronic childhood arthritides of unknown origin. Although the use of glucocorticoids and immunosuppressants brought a substantial improvement in treatment, the present therapeutic regime could not be considered satisfactory. As inflammation seems to be an essential part of pathogenesis of JIA, efforts have been made to develop pharmaceutical means to mitigate the innate immune system. Emerging targets for treatment are alarmins, a family of multifunctional intracellular proteins with strong pro-inflammatory activity. In the context of JIA, particularly interesting are high mobility group box 1 (HMGB-1) and three members of the S100 family: S100A8, S100A9, and S100A12. No definite conclusion can be made at the time, but both animal models and clinical studies support the concept of alarmins as possible key mediators of JIA. Therefore, pharmacological interference with alarmin pathways could turn out to be an excellent strategy for long-term management of JIA. Several options have been tested and they either inhibit the release of alarmins or sequester the already secreted ones. Although still very few in number, therapeutic experiments on mice are quite optimistic. Thus, it was the purpose of the present review to give an overview of the present knowledge on the topic and to bring this exciting new therapeutic possibility to the focus of rheumatologists.
19607680 Methotrexate therapy associates with reduced prevalence of the metabolic syndrome in rheum 2009 INTRODUCTION: The metabolic syndrome (MetS) may contribute to the excess cardiovascular burden observed in rheumatoid arthritis (RA). The prevalence and associations of the MetS in RA remain uncertain: systemic inflammation and anti-rheumatic therapy may contribute. Methotrexate (MTX) use has recently been linked to a reduced presence of MetS, via an assumed generic anti-inflammatory mechanism. We aimed to: assess the prevalence of the MetS in RA; identify factors that associate with its presence; and assess their interaction with the potential influence of MTX. METHODS: MetS prevalence was assessed cross-sectionally in 400 RA patients, using five MetS definitions (National Cholesterol Education Programme 2004 and 2001, International Diabetes Federation, World Health Organisation and European Group for Study of Insulin Resistance). Logistic regression was used to identify independent predictors of the MetS. Further analysis established the nature of the association between MTX and the MetS. RESULTS: MetS prevalence rates varied from 12.1% to 45.3% in RA according to the definition used. Older age and higher HAQ scores associated with the presence of the MetS. MTX use, but not other disease modifying anti-rheumatic drugs (DMARDs) or glucocorticoids, associated with significantly reduced chance of having the MetS in RA (OR = 0.517, CI 0.33-0.81, P = 0.004). CONCLUSIONS: The prevalence of the MetS in RA varies according to the definition used. MTX therapy, unlike other DMARDs or glucocorticoids, independently associates with a reduced propensity to MetS, suggesting a drug-specific mechanism, and makes MTX a good first-line DMARD in RA patients at high risk of developing the MetS, particularly those aged over 60 years.
21122264 Elevated prolactin levels in patients with rheumatoid arthritis: association with disease 2010 Nov OBJECTIVES: Prolactin (PRL) is a hormone with cytokine-like activities that has been demonstrated to be involved in immune responses. However, there are inconsistent results related to the role of PRL in rheumatoid arthritis (RA). Therefore, the aim of this study was to evaluate the levels of PRL in serum and synovial fluid in patients with RA and osteoarthritis (OA) and examine whether PRL might be associated with laboratory and clinical disease activity of RA. METHODS: A total of 29 patients with RA and 26 patients with OA were included in the study. The concentration of PRL in the serum and synovial fluid was measured by immunoradiometric assays, and the levels of serum anti-citrullinated protein/peptide autoantibodies (ACPA) and IgM rheumatoid factor (IgM-RF) were analysed by ELISA. Disease activity score (DAS 28) and radiological (Larsen) score were assessed. RESULTS: The levels of PRL in serum (299.55±27.28 vs. 230.59±16.61 mIU/l, p=0.041) as well as in synovial fluid (338.85±33.49 vs. 245.97±21.88 mIU/l, p=0.024) were significantly higher in patients with RA than in patients with OA. A moderate correlation was found between disease activity of RA and levels of PRL in synovial fluid (r=0.485, p=0.010) and the serum PRL levels correlated significantly with the total Larsen score (r=0.484, p=0.014). CONCLUSIONS: The findings of increased prolactin levels in patients with RA lead to the assumption that prolactin may play a role in disease severity and the process of joint damage in RA.
20461785 What outcomes from pharmacologic treatments are important to people with rheumatoid arthri 2010 May OBJECTIVE: Function, patient global assessment, and pain are routinely measured in rheumatoid arthritis (RA) clinical trials. However, other patient-reported outcomes identified as important to patients in qualitative studies, such as fatigue and quality of life, are commonly not included, and modern treatment regimens may have changed patients' expectations of treatment outcomes. Our objective was to elicit patient priority treatment outcomes for pharmacologic interventions since the common use of anti-tumor necrosis factor (anti-TNF) therapy, which will form the basis of a core set of patient priorities to complement existing professional core sets. METHODS: In-depth interviews were conducted with 23 RA patients, purposively sampled for age, sex, medication (anti-TNF or other disease-modifying antirheumatic drugs), disease severity, and work status. Grounded theory guided iterative data collection and analysis. Coding of the data was peer reviewed. A patient research partner collaborated in the research design and analysis. RESULTS: Sixty-three different outcomes important to patients were generated from the interviews. Four major categories of patient outcomes from pharmacologic treatments were developed: "RA under control," "Doing things," "Emotional health," and "Coping with illness." The core category (or overall theme) was "Minimizing the personal impact of RA." CONCLUSION: Although the routine outcomes of pain, function, and overall well-being were raised by the patients, they also generated a further 60 important outcomes that they look for from treatment. This difference in perspective may potentially influence treatment decisions. The next step is therefore to use these data to develop a patient core set.
20959355 Obesity in rheumatoid arthritis. 2011 Mar Obesity is a major threat for public health and its study has attracted significant attention in the general population, predominantly due to its association with significant metabolic and cardiovascular complications. In RA research, BMI is frequently reported as a demographical variable, but obesity, as such, has received little interest. This is surprising, in view of the clear associations of obesity with other arthritides, particularly OA, but also in view of the now-clear association of RA with increased cardiovascular morbidity and mortality. In this review, we summarize the studies that have looked into obesity in the RA population, evaluate their findings, identify knowledge gaps and propose directions for future research. We also pose a question of high clinical and research significance: is the use of BMI still a valid way of assessing obesity in RA?
19899068 Self-reported outcomes during treatment with tumour necrosis factor alpha inhibitors in pa 2010 Mar OBJECTIVE: To study how patients with rheumatoid arthritis (RA) self-report their experience of disease-related symptoms (fatigue, morning stiffness, pain) and their ability to cope with everyday life (capacity) using a nurse-led structured follow-up during the first year after starting treatment with tumour necrosis factor alpha (TNF-alpha) inhibitors. METHODS: Thirty-nine patients, who were being treated for their RA in our outpatient rheumatology clinic and were beginning treatment with TNF-alpha inhibitors, agreed to evaluate and self-report their experience of fatigue, morning stiffness, pain, and capacity using the visual analogue scale (VAS) every third month during their first year of treatment. A quantitative method was used to study the changes in these four variables. In addition, at the same time, we studied the relationship between self-reported capacity and each of the three symptoms. RESULTS: After 12 months' treatment with TNF-alpha inhibitors, the change (median interquartile range [IQR]) measured with VAS was -14 (-38, -7) mm for fatigue, -22 (-47, -4) mm for morning stiffness, -28 (-50, 0) mm for pain and -27 (-48, -6) mm for capacity. All changes were statistically significant (p < 0.001). Baseline and 12 months' capacity correlated significantly with fatigue, morning stiffness and pain (all p < 0.01). In addition, the median change in self-reported capacity correlated significantly with the median change in each of the three symptoms (p < 0.01). CONCLUSION: During the first year of treatment with TNF-alpha inhibitors, patients reported decreased fatigue, morning stiffness and pain, while their capacity increased. The increased capacity rate closely followed the decrease in symptom rate.
20373036 Health-related quality of life and disability in patients with rheumatoid, early rheumatoi 2010 Aug PURPOSE: To assess health-related quality of life (HR-QoL) in patients with Rheumatoid arthritis (RA), early RA and early psoriatic arthritis (PsA), and to evaluate the efficacy of etanercept in reducing disability. METHODS: Twenty healthy volunteers, 40 RA, 20 early RA and 20 early PsA patients were recruited. All patients received etanercept plus methotrexate. Assessments at baseline and after 2 years' therapy included Disease Activity Scores on 44 joints [DAS(44)], Health Assessment Questionnaire (HAQ) scores and Short Form-36 (SF-36) scores. RESULTS: HAQ and SF-36 scores were significantly worse in patients with RA, early RA or early PsA than in healthy volunteers. The HAQ score at baseline was significantly higher in RA patients than in patients with early RA or early PsA, whereas the scores were similar in patients with early RA and early PsA. Patients with early RA had greater impairment than patients with early PsA in several areas of disability. After 2 years' treatment, HAQ scores and SF-36 summary and subscale scores improved significantly in the three patient groups. CONCLUSIONS: This study suggests that early PsA is a less disabling disease than RA or early RA. It confirms the efficacy of etanercept in reducing disease severity and improving HR-QoL and suggests that early therapeutic intervention may lead to greater improvement in the mental and emotional components of these diseases.
20734214 Patterns of background factors related to early RA patients' conceptions of the cause of t 2011 Mar The aim of the present study was to identify patterns of background factors related to the early RA patients' conceptions of the cause of the disease. Conceptions from a qualitative study formed the basis for the stratification of 785 patients from the Swedish EIRA study answering a question about their own thoughts about the cause to RA. Logistic regression analyses were used to explore the associations between patients' conceptions and relevant background factors: sex, age, civil status, educational level, anti-cyclic citrullinated peptide antibody (anti-CCP) and smoking habits. The results were presented as odds ratios (OR) with 95% confidence intervals (CI). A conception of family-related strain was strongly associated with being young (OR 0.50; 95% CI 0.33-0.78 for age 58-70 vs. 17-46), female (OR 0.38; 95% CI 0.25-0.60 for male vs. female) and having a high level of education (OR 2.15; 95% CI 1.54-3.01 for university degree vs. no degree). A conception of being exposed to climate changes was associated with being male (OR 1.99; 95% CI 1.24-3.22 for male vs. female), having a low level of education (OR 0.33; 95% CI 0.18-0.58 for university degree vs. no degree) and positive Anti-CCP (OR 1.72; 95% CI 1.03-2.87 for positive vs. negative Anti-CCP). Linking patients' conceptions of the cause of their RA to background factors potentially could create new opportunities for understanding the complexity of the aetiology in RA. Furthermore, this information is important and relevant in the care of patients with early RA.
21077800 Gustatory and olfactory function in rheumatoid arthritis. 2011 May OBJECTIVES: To evaluate the gustatory and olfactory functions of patients with rheumatoid arthritis (RA) compared to sex- and age-matched healthy subjects and to investigate a potential relationship between disease activity [using the 28-joint Disease Activity Score (DAS28)] and chemosensory capacity. Furthermore, to dissect possible impacts of standard anti-inflammatory medications on the gustatory and olfactory functions. METHODS: Patients with established RA underwent standardized assessment of their gustatory and olfactory functions. The patients were also examined for their disease activity, had their specific blood-test results analysed, and were asked to answer a standardized questionnaire about their quality of life, the negative effects of their disease, and about comorbidities. RESULTS: A total of 101 RA patients (75 women, 26 men, mean age: 57.9 ± 13.8 and 64.2 ± 10.9 years, respectively) were analysed. In relation to age- and sex-related subjects, both female and male RA patients had a significantly decreased taste score (p < 0.001) and also a significantly decreased olfactory score (p < 0.05), indicating that a substantial number of patients suffer from hypogeusia or hyposmia. This abnormality did not correlate with disease activity, the duration of the disease, disease-modifying anti-rheumatic drug (DMARD) or tumour necrosis factor (TNF) inhibitor use, and the loss of the chemosensory functions, together indicating that hypogeusia and hyposmia are frequent clinical manifestations in RA patients independent of the inflammatory activity of their disease. CONCLUSION: The results indicate that there is a significant decrease in the olfactory and gustatory function in RA patients compared to those of healthy controls, which can seriously and substantially affect the quality of the patients' life.
19767228 Low and stable prevalence of rheumatoid arthritis in northern France. 2009 Oct OBJECTIVES: Few data are available on the prevalence of rheumatoid arthritis (RA) in France. Results of the Epidémiologie des rhumatismes inflammatoires (EPIRHUM-2) study suggest a lower prevalence in northern France (0.13%) than nationwide (0.31%) or in southern France (0.66%). Here, our objective was to confirm the lower prevalence of RA in northern France than in the rest of the country or in Europe. METHODS: We used the universal health insurance database to identify patients with RA in northern France (Nord-Pas de Calais region) in 2005. RESULTS: Seven thousand one hundred and twenty-eight patients of the 3,617,224 individuals receiving health insurance under the plan for salaried workers in the Nord-Pas de Calais region (89.3% of the population in the region) were listed as receiving free care for RA, yielding a prevalence of 197.1/100,000 population (female-to-male ratio, 2.99:1; mean age, 60.8 years). DISCUSSION: The prevalence of RA in northern France (0.197% in 2005) is lower than in southern France and northern Europe; thus, the prevalence gradient in France is in the opposite direction to the decreasing north-to-south gradient previously described in Europe. Although environmental and genetic factors involved in the pathogenesis of RA may be involved, the main explanation to the low prevalence in northern France may be the young age of the population.
20483049 Anti-tumor necrosis factor alpha therapy normalizes fibrinolysis impairment in patients wi 2010 Mar OBJECTIVES: Rheumatoid arthritis (RA) is associated with increased cardiovascular risk and involvement of inflammation, coagulation and fibrinolysis. Treatment with infliximab, a tumour necrosis factor-alpha (TNF-alpha) blocking chimeric monoclonal antibody, induces a long-term reduction of inflammation and coagulation, but its effect on fibrinolysis is still unknown. We carried out an observational study investigating plasma biomarkers of inflammation and fibrinolysis in RA patients before and after 14 weeks of infliximab treatment given according to the therapeutic guidelines for RA. METHODS: We studied 20 selected patients with active RA and without any other atherosclerosis risk factor as well as 40 healthy controls. Patients, treated with a stable dose of methotrexate, received infliximab (3 mg/kg) at week 0, 2, 6 and 14. At week 0 and 14, we assessed clinical, inflammatory and fibrinolyitic parameters. RESULTS: At baseline, plasminogen activator inhibitor (PAI-1) antigen, PAI-1 activity and tissue-type plasminogen activator (t-PA) antigen were significantly higher in RA patients than in controls (p=0.01, p=0.001 and p=0.0001 respectively). After 14 weeks of infliximab treatment, the levels of PAI-1 antigen, PAI-1 activity and t-PA antigen significantly decreased till normalization (p=0.0001). Plasma levels of C reactive protein (CRP) and interleukin-6 (IL-6) were directly correlated with levels of PAI-1 antigen (p=0.011 and p=0.0001), PAI-1 activity (p=0.013 and p=0.027) and t-PA antigen (p=0.017 and p=0.040). CONCLUSIONS: This study provides evidence that TNF-alpha blockade by infliximab not only decreases inflammation, but also reduces the inhibition of fibrinolysis. Such a combined effect may be pivotal in reducing the whole thrombotic risk in these patients.
21181221 Observational studies: a valuable source for data on the true value of RA therapies. 2011 Mar The validity of observational studies is sometimes questioned because of the limitations of non-randomly assigned controls, various biases such as channeling bias, confounding by indication, and other pitfalls. Yet, (post-marketing) observational data can provide important information regarding not only drug safety but also the effectiveness and appropriate use of agents in the real world, outside of clinical trials. Observational studies also provide data regarding the wider value of these agents in terms of, for example, reducing the need for surgical procedures, reducing absenteeism and increasing productivity. Importantly, data from some observational registry studies have subsequently been confirmed by clinical trials, supporting the overall validity of the registry-based approach. Observational studies also allow measures such as health assessment questionnaire scores, disease activity scores, and glucocorticoid use over time to be monitored for longer periods. Furthermore, observational data in real, less strictly selected patients without the constraints of formal study populations may produce findings not observed in clinical trials but that warrant further investigation in a controlled trial environment. For example, recent data from the Stockholm tumor necrosis factor follow-up registry in Sweden showed increases in the time people worked after initiation of biologics that, surprisingly, continued into the fourth and fifth years of treatment--a finding not observed with standardized outcomes. Observational studies are truly an underappreciated and valuable source of data on the real value of anti-rheumatic therapies, and these data are essential for making sound decisions regarding coverage and reimbursement.
20032904 Evidences of memory dysfunction and maladaptive coping in chronic low back pain and rheuma 2009 Dec AIM: This study investigates whether chronic low back pain (LBP) and rheumatoid arthritis (RA) patients have deficits in memory functioning and whether there is correlation between memory scores and coping skills, as a disability evaluation measure. METHODS: We studied 2 samples of patients of both genders between 20 and 70 years-old, in a cross-sectional design: 21 low back pain and 23 rheumatoid arthritis. Patients were compared to historical controls. Assessment of primary outcome included memory evaluation (Wechsler Memory Scale III) and measures of coping strategies (FABQ, CPCI, CSQ). Other data included depression (HAD), pain (VAS), work status, use of medications, and perceived memory complaints. Analysis were made of between-group differences. RESULTS: Both groups were comparable regarding demographic status, had high scores of memory complaint, and low performance in memory assessment when compared to normative data. Only LBP patient's measures of catastrophizing and coping were significantly correlated to late memory indices. No correlations were found between memory and Visual Analogue Scale (VAS) or pain chronicity in both groups. One may suggest that both chronic localized and widespread pain can imply in cognitive changes and be correlated to coping dysfunction. However, bias of existence of depression/ anxiety and psychotropic medication cannot be excluded. CONCLUSIONS: Both groups of chronic pain patients are likely to have impaired memory. Maladaptive coping correlates to LBP, but not to RA. A further controlled protocol must include greater sample of patients. By analyzing memory deficits of chronic pain patients, clinicians could establish targeted rehabilitation programs and outcomes. Some techniques are discussed.
19015210 Influence of age on the outcome of antitumour necrosis factor alpha therapy in rheumatoid 2009 Sep OBJECTIVE: To investigate the influence of age on the effectiveness and tolerance of antitumour necrosis factor alpha (TNFalpha) therapy in rheumatoid arthritis (RA). METHODS: 730 patients of the Dutch Rheumatoid Arthritis Monitoring (DREAM) register were categorised into three groups according to their age at initiation of anti-TNFalpha therapy (<45, 45-65 and >65 years). Effectiveness of anti-TNFalpha therapy was primarily assessed by longitudinal analysis of the DAS28 during the first 12 months of treatment. RESULTS: Improvement in disease activity and physical functioning was significantly less in elderly patients, correcting for relevant confounders. Elderly patients reached the EULAR categories of good responders and remission less often than younger patients. Drug survival, co-medication use and tolerance were comparable between the three age groups. CONCLUSION: Anti-TNFalpha therapy significantly reduced disease activity in all age groups of patients; however, it appeared less effective in elderly compared with younger RA patients.
20870441 A polymorphism in the 3'-UTR of interleukin-1 receptor-associated kinase (IRAK1), a target 2010 Oct OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disorder with many genetic factors predisposing to disease susceptibility. MicroRNAs are a new discovered class of molecules that participate in post-transcriptional regulation of genes' expression. MicroRNA-146a was found to be increased in synovial fibroblasts, synovial tissue and PBMC from patients with RA. The aim of the present study was to reveal if there is any association of miRNA-146a variant rs2910164 and the two interleukin (IL) 1 receptor associated kinase (IRAK1, a target gene of mir-146a) polymorphisms rs3027898 and rs1059703 with RA predisposition. METHODS: One hundred and thirty-six RA patients and 147 controls were enrolled in the study. RESULTS: Strong statistically significant difference was observed in IRAK1 rs3027898 A > C polymorphism distribution between RA patients and controls (p = 0.044), which was higher comparing the distribution of allele A vs. allele C between the studied groups (p = 0.017). CONCLUSION: This is the first study that addresses association of a variant in a target of miR-146a, IRAK1 gene, with RA susceptibility. Further studies in other ethnic groups of patients could help to understand the extent of the proposed association.
20237123 Evidence for treating rheumatoid arthritis to target: results of a systematic literature s 2010 Apr OBJECTIVES: To summarise existing evidence on a target oriented approach for rheumatoid arthritis (RA) treatment. METHODS: We conducted a systematic literature search including all clinical trials testing clinical, functional, or structural values of a targeted treatment approach. Our search covered Medline, Embase and Cochrane databases until December 2008 and also conference abstracts (2007, 2008). RESULTS: The primary search yielded 5881 citations; after the selection process, 76 papers underwent detailed review. Of these, only seven strategic clinical trials were extracted: four studies randomised patients to routine or targeted treatment, two compared two different randomised targets and one compared targeted treatment to a historical control group. Five trials dealt with early RA patients. All identified studies showed significantly better clinical outcomes of targeted approaches than routine approaches. Disability was reported in two studies with no difference between groups. Four studies compared radiographic outcomes, two showing significant benefit of the targeted approach. CONCLUSION: Only few studies employed randomised controlled settings to test the value of treatment to a specific target. However, they provided unanimous evidence for benefits of targeted approaches. Nevertheless, more data on radiographic and functional outcomes and on patients with established RA are needed.