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ID PMID Title PublicationDate abstract
19479708 Single-center series and systematic review of randomized controlled trials of malignancies 2009 Jun 15 OBJECTIVE: To systematically review the occurrence of malignancies among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) treated with anti-tumor necrosis factor alpha (anti-TNFalpha) therapy in randomized controlled trials (RCTs), and to report a retrospective personal case series evaluating the frequency of malignancies in patients with RA, PsA, and AS requiring anti-TNF therapy selected with more comprehensive cancer screening procedures compared with patients screened according to previously published procedures. METHODS: The primary outcome was the report of frequency of malignancies in RCTs and the latency between the therapy introduction and the occurrence of the neoplasm. A total of 363 consecutive RA, PsA, and AS patients requiring anti-TNF therapy from 2002 to 2006 observed at the Rheumatology Unit in Prato, Italy, underwent extensive cancer screening procedures. An historical controlled group of 73 patients treated between January 1999 and December 2001 underwent the screening procedures accepted for the RCT procedures. RESULTS: Thirty-six RCTs were included for analysis. Malignancies occurred in 60 (0.75%) of 8,015 patients randomized to the active treatment arm and in 21 (0.52%) of 3,991 patients in the placebo arms (P = 0.15). In the personal retrospective case series, 1 study patient (0.27%) and 3 controls (4.1%) developed cancer over the followup period (P = 0.017). Mean +/- SD followup duration was 40.9 +/- 16.7 months in study patients and 50.6 +/- 18.1 months in controls. CONCLUSION: The results of RCTs and our data showing 26% of malignancies occurring within 12 weeks from enrollment suggest the need for a revision of current cancer screening procedures in RCTs and in clinical practice.
20827447 Cytokines of the Th1 and Th2 type in sera of rheumatoid arthritis patients; correlations w 2010 Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease which affects approximately 1% of the population worldwide. Recent research on the role of heat shock proteins (Hsps) in RA development indicates that they may have pro- or anti-inflammatory effect, most probably via modulating cytokine secretion. We investigated type Th1 (INFγ, TNFα, IL-2) and type Th2 (IL-10, IL-6, IL-4) cytokine levels in sera of RA patients and healthy controls, using flow cytometric bead array assay, and searched for correlations between the cytokine levels and serum antibodies against bacterial (DnaJ) and human (Hdj1, Hdj2 and Hdj3) Hsp40 proteins, as well as clinical and laboratory parameters. The levels of all cytokines studied were significantly increased in RA patients; the highest increase relative to healthy controls (7-fold) was observed for IL-6 and its levels correlated positively with the antibodies directed to DnaJ and to the C-terminal domain of Hdj2, and with diagnostic parameters (DAS 28, Steinbrocker RTG criteria, ARA/7, ESR, TEN, SW and GH). INFγ levels correlated negatively with DAS 28, ESR, TEN and SW. No correlations were found for TNFα, IL-2 or IL-4. Our results support the hypothesis of Hsp40 involvement in RA as well as indicate that IL-6 serum level is a good marker of the RA activity.
20889596 Arsenic trioxide induces apoptosis of fibroblast-like synoviocytes and represents antiarth 2011 Jan OBJECTIVE: recent studies have demonstrated that rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS) proliferate as fiercely as tumor cells. Induction of apoptosis in RA FLS therefore provides a new approach for the inhibition of joint destruction. Arsenic trioxide (As(2)O(3)) was reported to be an effective apoptosis inducer in a variety of cell types. We investigated the possible effect of As(2)O(3) on apoptosis induction of RA FLS and the mechanisms involved in this process. METHODS: apoptosis was determined by flow cytometric analysis, terminal deoxynucleotide transferase-mediated dUTP nick end-labeling, and transmission electron microscopy. The activity and messenger RNA (mRNA) expression of nuclear factor-κB (NF-κB) was then detected by ELISA and real-time polymerase chain reaction, respectively. Activities of caspase-3 and caspase-8 were evaluated using luminogenic substrates. The effect of As(2)O(3) on the morphology of rats with collagen-induced arthritis was evaluated under a light microscope after H&E staining. RESULTS: as(2)O(3) significantly enhanced the apoptosis of RA FLS. It suppressed the DNA-binding activity and mRNA expression level of NF-κB, probably by inhibiting tumor necrosis factor-α-induced activation of NF-κB. As(2)O(3) treatment significantly increased the activity of both caspase-3 and caspase-8. Morphological analysis revealed histological recovery in the synovial membrane. Synovial hyperplasia and inflammation in the joints were effectively inhibited. CONCLUSION: as(2)O(3) represents an apoptotic effect on RA FLS through NF-κB signaling pathway, and this process is mediated by the activation of caspase cascade. Treatment with As(2)O(3) significantly improved the pathologic changes of collagen-induced arthritis and may have potential for treatment of RA.
19429808 Anti-tumor necrosis factor-alpha therapy provokes latent leishmaniasis in a patient with r 2009 Spring It has been reported that anti-tumor necrosis factor-alpha therapy increases the risk of opportunistic infections including rare case reports of leishmaniasis. Here we report a case of latent cutaneous leishmaniasis, which was provoked by anti-tumor necrosis factor-alpha therapy in a patient with rheumatoid arthritis.
21141208 Oral mucosa involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic 2010 Oct OBJECTIVES: To estimate the frequency and character of oral mucosal lesions in patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Furthermore, the relation between oral mucosal involvement and hyposalivation was investigated. DESIGN: Case-control study. SETTING: Rheumatology Clinic, University Hospital "Mother Theresa" in Tirana, Albania. PARTICIPANTS: 124 consecutive hospitalised patients (88 with rheumatoid arthritis, 22 with systemic lupus erythematosus and 14 with systemic sclerosis) and 124 age- and gender- matched healthy controls. METHODS: Oral lesions were clinically examined and classified according to their morphologic aspects and localisation. Examination included also measurement of unstimulated whole salivary flow. MAIN OUTCOME MEASURES: Frequency of oral mucosal lesions and hyposalivation. RESULTS: Oral mucosal lesions were observed in 58.9% of patients, but in only 33.1% of control subjects. Clinical aspects of lesions varied, and palate, buccal and labial mucosa, and tongue were the most affected sites. No significant associations were found between presence of oral lesions and hyposalivation, except oral candidosis which was associated with hyposalivation in controls. CONCLUSIONS: Patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis have a higher burden of oral mucosa disease than a healthy population. Collaboration of rheumatology and oral medicine units should allow appropriate management of these patients.
19103637 The metabolic syndrome is amplified in hypothyroid rheumatoid arthritis patients: a cross- 2010 Jan OBJECTIVES: Rheumatoid arthritis (RA) patients are at increased risk of cardiovascular disease (CVD), which is even more pronounced in hypothyroid RA patients. An unfavourable cardiovascular risk profile conferred by a higher prevalence of the metabolic syndrome (MetS) and a higher Framingham risk score might explain this amplified cardiovascular morbidity. This study compared first, MetS (features) and second, the Framingham 10-year CVD risk in RA patients with hypothyroidism compared with euthyroid RA patients. METHODS: RA patients participating in the CARRE investigation were divided into two groups: hypothyroid and euthyroid RA patients. MetS according to the National Cholesterol Education Program Third Adult Treatment Panel criteria and the Framingham risk score was compared between hypothyroid and non-hypothyroid CVD event-free RA patients. RESULTS: In total, 257 RA patients were included: 236 with RA (91.8%) and 21 with hypothyroid RA (8.2%), respectively. The prevalence of the MetS was significantly higher in hypothyroid RA patients (43%) compared with RA patients (20%). Moreover, female hypothyroid RA patients had a higher Framingham risk score compared with euthyroid RA patients. With RA patients as the reference category, the age and gender-adjusted prevalence odds ratio for the MetS was 3.5 (95% CI 1.3 to 9.1) in hypothyroid RA. CONCLUSIONS: Hypothyroid RA patients, particularly female patients, have a more unfavourable cardiovascular risk profile, reflected by an increased prevalence of the MetS and higher Framingham score, than euthyroid RA patients, suggesting a greater need for cardiovascular risk management in these patients to prevent future CVD events.
18987778 Total knee arthroplasty for massive joint destruction in a patient with rheumatoid arthrit 2009 We report the case of a patient requiring total knee arthroplasty (TKA) due to massive knee bone deformities caused by rheumatoid arthritis (RA) complicated with polyostotic fibrous dysplasia. Reconstruction of the knee with large osseous defect was achieved with conventional TKA by impaction bone grafting. Benign tumor-like conditions such as fibrous dysplasia may be treated with conventional TKA instead of endoprosthesis, custom-made knee prosthesis, or osteoarticular allografting.
20510236 Cell-cell interactions in rheumatoid arthritis synovium. 2010 May Understanding the pathogenesis of joint inflammation and destruction in rheumatoid arthritis involves dissection of the cellular and molecular interactions that occur in synovial tissue. Development of effective targeted therapies has been based on progress in achieving such insights. Safer and more specific approaches to treatment could flow from discovery of cell-cell interaction pathways that are specific to inflammation of the joint and less important in the defense against systemic infection. This article highlights selected cell-cell interactions in rheumatoid arthritis synovium that may be worthy of evaluation as future therapeutic targets.
21095481 Safety profile of abatacept in rheumatoid arthritis: a review. 2010 Oct BACKGROUND: Abatacept, a soluble human fusion protein that selectively modulates the costimulatory signal required for full T-cell activation, is approved for the treatment of rheumatoid arthritis (RA) in the United States, Canada, and the European Union. Because rare but serious adverse effects have been associated with biologic therapies, it is important to assess the safety profiles of these agents on an ongoing basis. OBJECTIVE: This article reviews current evidence on the safety profile of abatacept in patients with RA. METHODS: PubMed/MEDLINE was searched for clinical trials of abatacept using the terms abatacept OR CTLA4Ig, rheumatoid arthritis, and safety. Searches of abstracts presented at the 2007-2009 annual meetings of the American College of Rheumatology, European League Against Rheumatism, and Canadian Rheumatology Association were also conducted. Reports from clinical trials of at least 6 months' duration that evaluated abatacept in adults with RA were included in the review. RESULTS: Seven placebo-controlled trials and 1 open- label trial were included in the review, as were the long-term extensions of 5 of the studies and an integrated safety analysis. Abatacept added to methotrexate had an acceptable safety profile in patients with RA who had an inadequate response to methotrexate or other traditional disease-modifying antirheumatic drugs, or who failed to respond to treatment with anti-tumor necrosis factor agents. In the 5 core trials, discontinuations due to adverse events ranged from 1.9% to 8.7% of abatacept recipients and 0.9% to 4.3% of placebo recipients. In the integrated safety analysis, serious infections were reported in 3.0% of abatacept recipients and 1.9% of placebo recipients; the corresponding rates of malignancies were 3.7% and 2.9%. No additional safety concerns emerged during up to 7 years of exposure in the long-term extension studies. Antibodies to abatacept developed in ≤3% of patients, with no association found between immunogenicity and adverse events. CONCLUSION: Based on the evidence reviewed, abatacept had an acceptable safety profile and was well tolerated in patients with RA.
19110660 Enhanced propensity of T lymphocytes in patients with systemic lupus erythematosus to apop 2009 Mar OBJECTIVE: To determine the effect of inflammation through exposure to tumour necrosis factor (TNF)alpha on T lymphocytes in patients with systemic lupus erythematosus (SLE). METHODS: We studied the effect of TNFalpha on T-lymphocyte apoptosis in patients with SLE, rheumatoid arthritis (RA), and in healthy controls. Apoptosis of CD4 and CD8 T lymphocytes and naive and memory subpopulations was determined by flow cytometry using 7-amino-actinomycin D (7AAD) and propidium iodide (PI). In SLE, apoptosis was studied in patients with active and inactive disease and in patients on different medications. RESULTS: TNFalpha enhanced apoptosis of anti-CD3-activated T lymphocytes. The percentage of apoptotic cells was significantly higher in T lymphocytes from patients with SLE than RA patients and healthy controls. After 3 days of culture, 38% of CD4+ and 37% of CD8+ cells from SLE patients underwent apoptosis in the presence of TNFalpha compared with 25% CD4+ and 26% CD8+ T cells from the controls (p<0.001). In healthy controls, more memory than naive T lymphocytes underwent apoptosis. By contrast, in patients with SLE, more naive T cells underwent apoptosis with TNFalpha (p<0.01). Enhanced apoptosis of T cells in SLE was independent of disease activity or medication. Finally, inhibition experiments showed that apoptosis in the presence of TNFalpha was only partly blocked with anti-Fas ligand (FasL) antibody. CONCLUSIONS: This study demonstrates that T lymphocytes in patients with SLE are more prone to apoptosis in the presence of TNFalpha than T lymphocytes from healthy controls. Defects in TNFalpha signalling pathways rather than distribution of TNF receptors (TNFRs) probably explain the enhanced apoptosis in SLE.
20131276 Golimumab, a new human anti-tumor necrosis factor alpha antibody, administered intravenous 2010 Apr OBJECTIVE: To assess the efficacy and safety of intravenous administration of golimumab in patients with rheumatoid arthritis (RA). METHODS: Adult patients with RA in whom disease activity was persistent despite treatment with methotrexate (MTX) at a dosage of 15-25 mg/week for > or = 4 weeks were randomized to receive intravenous infusions of placebo plus MTX or intravenous infusions of golimumab at a dose of 2 mg/kg or 4 mg/kg, with or without MTX, every 12 weeks through week 48. Patients with <20% improvement in the swollen and tender joint counts could enter early escape and receive additional active treatment (week 16) or could have their dose regimen adjusted (week 24). The primary end point was the proportion of patients achieving a 50% response according to the American College of Rheumatology improvement criteria (ACR50) at week 14. RESULTS: The primary study end point was not met (at week 14, an ACR50 response was observed in 21% of the patients treated with golimumab plus MTX compared with 13% of the patients treated with placebo plus MTX [P = 0.051]). By week 24, significantly more patients treated with golimumab plus MTX had achieved an ACR50 response. Differences in the proportion of patients achieving an ACR50 response between the group receiving golimumab monotherapy and the group receiving placebo plus MTX were not significant at either week 14 (16% versus 13%) or week 24 (10% versus 9%). At week 48, the proportions of patients achieving ACR20 and ACR50 responses were highest among those who had received golimumab 4 mg/kg plus MTX (70% and 48%, respectively). Concomitant treatment with MTX was associated with a lower incidence of antibodies to golimumab. The most commonly reported adverse events through week 48 were infections (48% of patients treated with golimumab with or without MTX and 41% of patients receiving placebo plus MTX). CONCLUSION: The primary end point was not met. However, intravenously administered golimumab plus MTX appears to have benefit in the longer-term reduction of RA signs/symptoms in MTX-resistant patients, with no unexpected safety concerns.
18823005 A comparison of multiplex suspension array large-panel kits for profiling cytokines and ch 2009 May BACKGROUND: Multiplex analysis allows measurements of a large number of analytes simultaneously in each sample. On the basis of the Luminex multiplex technology (xMAP), kits for measuring multiple cytokines and chemokines (immunomodulators) are commercially available and are useful in investigations on inflammatory diseases. This study evaluated four multiplex kits (Bio-Plex, LINCOplex, Fluorokine, and Beadlyte) that contained 27, 29, 20, and 22 analytes each, respectively, for the analysis of immunomodulators in plasma of patients with rheumatoid arthritis (RA) who underwent treatment with antibody against CD20 (rituximab), a B-cell reductive therapy. METHODS: Multiplex kits were tested on serial plasma samples obtained from six RA patients at baseline and multiple time points (3, 6, and 9 months) post-treatment with rituximab. The RA patients included in this study had previously failed therapy with disease modifying anti-arthritis drugs (DMARD) and treatment with anti-TNFalpha antibody (infliximab). RESULTS: Computer modeling and hierarchical cluster analysis of the multiplex data allowed a comparison of the performance of multiplex assay kits and revealed profiles of immunomodulators in the RA patients. CONCLUSIONS: In plasma of RA patients who appeared to have benefited from the rituximab treatment, the profile of significantly elevated immunomodulators by at least two of the three kits (BioPlex, LINCOplex, Beadlyte) is as follows: IL-12p70, Eotaxin, IL-4, TNFalpha, Il-9, IL-1beta, IFNgamma, IL-10, IL-6, and IL-13. Immunomodulator profiling by multiplex analysis may provide useful plasma biomarkers for monitoring response to B-cell reductive therapy in RA patients.
20181673 TNF-alpha-induced aquaporin 9 in synoviocytes from patients with OA and RA. 2010 May OBJECTIVES: To determine whether aquaporins (AQPs) are expressed in the synovial tissues of patients with OA and RA, and to examine the patterns of expression in patients with and without hydrarthrosis. METHODS: AQPs were detected in synovial tissue samples from patients with OA and RA using RT-PCR and immunohistochemistry. Fibroblast-like synoviocytes (FLSs) from patients with OA and RA were cultured and stimulated with TNF-alpha. The expression of AQPs in FLSs was examined using RT-PCR and western blot analyses and the function of aquaglyceroporins was examined by a glycerol uptake assay. RESULTS: AQP1, -3 and -9 mRNAs were expressed in synovial tissues from patients with OA and RA. AQP1, -3 and -9 proteins were also detected by immunohistochemistry. AQP9 mRNA was expressed more strongly in the synovial tissues of OA patients with hydrarthrosis than those without. AQP9 mRNA and protein expression were strongly induced with TNF-alpha treatment in FLSs, whereas the expression of AQP1 and -3 mRNAs was not induced with TNF-alpha treatment. AQP9 as an aquaglyceroporin was induced by TNF-alpha. CONCLUSIONS: AQP9 mRNA was detected in synovial tissues from OA and RA patients with hydrarthrosis. AQP9 expression was strongly induced in FLSs with TNF-alpha. Although the functions of AQP1, -3 and -9 in synovial tissues remain to be elucidated, it suggested that AQP9 might be related to the pathogenesis of hydrarthrosis and inflammatory synovitis.
19756664 [Health-economic assessment of combination therapy for rheumatoid arthritis with methotrex 2009 Dec BACKGROUND: The TEMPO study has shown that the combination of etanercept and methotrexat (MTX) in the treatment of rheumatoid arthritis (RA) is superior to monotherapy. It further suggested that remission of RA is a realistic treatment objective. A health-economic assessment of the combination needs to demonstrate the suitability of the combination for daily clinical practice taking economic aspects into consideration. PATIENTS AND METHODS: For the 686 patients in the TEMPO study, a re-analysis was carried out in the form of a Monte-Carlo-Markov-Chain simulation. Study types were cost-effectiveness analysis and cost-utility analysis. Comparators were combined etanercept and MTX vs. MTX alone; the perspective was that of society as a whole. RESULTS: The incremental cost-effectiveness ratio of the combination is 21,300 per life year in remission as compared with MTX alone. The incremental cost-utility ratio of the combination is 38,700 per quality-adjusted life year. CONCLUSION: Both health-economic parameters suggest to adopt the combination therapy into daily clinical practice of RA patients.
20371432 Relationship between serum acute-phase proteins and high disease activity in patients with 2010 PURPOSE: The aim of this study was to assess the relationship between serum acute-phase proteins and high disease activity evaluated by activity score (DAS28) in patients with rheumatoid arthritis. MATERIAL/METHODS: Studies were carried out on 27 females with RA and 32 control women. Acute-phase proteins were divided into 4 fractions as follows: alpha1-globulins represented by alpha1-acid glycoprotein (AGP) and alpha1-antitrypsin (AAT); alpha2-globulins - haptoglobin (Hp); beta-globulins - complement C3 (C3) and total transferrin (Tf); gamma-globulins - C reactive protein (CRP), rheumatoid factor (RF) and immunoglobulin G (IgG), and determined by immunoturbidimetric methods. RESULTS: The serum levels of acute-phase proteins changed in RA patients. On account of the alterations of concentration, acute-phase proteins are placed in the downgrade scale as follows: CRP, Hp, AGP, C3, AAT and Tf. None of the acute-phase proteins correlated with the RF and the majority of them were closely related to ESR. Almost all of the acute-phase proteins (without C3) were closely related to RA activity (based on DAS28) and their places in the downgrade scale were as follows: CRP, Tf, AGP, Hp and AAT. The degree of disability evaluated by Health Assessment Questionnaire has affected on the concentrations of AGP, Tf and CRP. Serum AGP, AAT and RF levels significantly correlated with the patient's age. No correlations were observed between IgG, TP levels, and clinical data. CONCLUSIONS: Among the entire panel, the CRP and AGP appeared to be the most useful biochemical markers for evaluation of the disease activity of patients with RA.
21045791 Emerging MRI methods in rheumatoid arthritis. 2011 Feb New MRI techniques have been developed to assess not only the static anatomy of synovial hyperplasia, bone changes and cartilage degradation in patients with rheumatoid arthritis (RA), but also the activity of the physiological events that cause these changes. This enables an estimation of the rate of change in the synovium, bone and cartilage as a result of disease activity or in response to therapy. Typical MRI signs of RA in the pre-erosive phase include synovitis, bone marrow edema and subchondral cyst formation. Synovitis can be assessed by T2-weighted imaging, dynamic contrast-enhanced MRI or diffusion tensor imaging. Bone marrow edema can be detected on fluid-sensitive sequences such as short-tau inversion recovery or T2-weighted fast-spin echo sequences. Detection of small bone erosions in the early erosive phase using T1-weighted MRI has sensitivity comparable to CT. Numerous MRI techniques have been developed for quantitative assessment of potentially pathologic changes in cartilage composition that occur before frank morphologic changes. In this Review, we summarize the advances and new directions in the field of MRI, with an emphasis on their current state of development and application in RA.
19317926 Patellar reconstruction using posterior femoral condyle: a 5-year follow-up. 2009 Mar A patient with rheumatoid arthritis presented to clinic with an increasingly painful knee. The patient had undergone patellectomy for patellofemoral arthritis 10 years previously. After knee arthroscopy showing extensive arthritic changes, it was decided to offer primary arthroplasty of the knee with patellar reconstruction using posterior lateral femoral condyle graft taken at the time of arthroplasty. The positive outcome from this case is encouraging and constitutes a further option in patients with prior patellectomy undergoing knee arthroplasty.
19009296 Serum and synovial fluid leptin levels and markers of inflammation in rheumatoid arthritis 2009 May This study was designed to investigate the serum and synovial fluid leptin levels, and inflammatory markers in rheumatoid arthritis (RA) patients. Serum and synovial fluid leptin levels were significantly higher (P > 0.05) in RA patients than control group; RA patients with moderate disease activity (DAS < 2.7) having significantly higher leptin levels (P > 0.05) than those with low disease activity (DAS < 2.7). Leukocytes and erythrocyte sedimentation rate (ESR) were found to be significantly higher in moderate disease activity RA group compared to low activity group (P > 0.05, P < 0.001, respectively). Serum leptin level is found to be independent of age and inflammatory markers. ESR is positively correlated with DAS activity and CRP values. Our finding of no correlation between leptin and BMI shows that regulation of leptinemia is complex, and leptin levels cannot be used to assess RA activity.
19302705 Testing for the association of the KIAA1109/Tenr/IL2/IL21 gene region with rheumatoid arth 2009 INTRODUCTION: A candidate gene approach, in a large case-control association study in the Dutch population, has shown that a 480 kb block on chromosome 4q27 encompassing KIAA1109/Tenr/IL2/IL21 genes is associated with rheumatoid arthritis. Compared with case-control association studies, family-based studies have the added advantage of controlling potential differences in population structure. Therefore, our aim was to test this association in populations of European origin by using a family-based approach. METHODS: A total of 1,302 West European white individuals from 434 trio families were genotyped for the rs4505848, rs11732095, rs6822844, rs4492018 and rs1398553 polymorphisms using the TaqMan Allelic discrimination assay (Applied Biosystems). The genetic association analyses for each SNP and haplotype were performed using the Transmission Disequilibrium Test and the genotype relative risk. RESULTS: We observed evidence for association of the heterozygous rs4505848-AG genotype with rheumatoid arthritis (P = 0.04); however, no significance was found after Bonferroni correction. In concordance with previous findings in the Dutch population, we observed a trend of undertransmission for the rs6822844-T allele and rs6822844-GT genotype to rheumatoid arthritis patients. We further investigated the five SNP haplotypes of the KIAA1109/Tenr/IL2/IL21 gene region. We observed, as described in the Dutch population, a nonsignificant undertransmission of the AATGG haplotype to rheumatoid arthritis patients. CONCLUSIONS: Using a family-based study, we have provided a trend for the association of the KIAA1109/Tenr/IL2/IL21 gene region with rheumatoid arthritis in populations of European descent. Nevertheless, we failed to replicate a significant association of this region in our rheumatoid arthritis family sample. Further investigation of this region, including detection and testing of all variants, is required to confirm rheumatoid arthritis association.
19487519 Total elbow arthroplasty in patients forty years of age or less. 2009 Jun BACKGROUND: It is generally accepted that prosthetic elbow replacement should be avoided in young patients because of an anticipated high rate of early failure. The purpose of this paper was to define the success, prosthetic survival rate, and problems encountered in patients who were treated with a semiconstrained total elbow arthroplasty when they were forty years of age or less. METHODS: We retrospectively reviewed the records of 758 patients who had undergone primary arthroplasty with the Coonrad-Morrey total elbow prosthesis for any reason between 1982 and 2003. We identified fifty-five total elbow arthroplasties that had been performed in forty-nine patients (thirty-eight women and eleven men) who were forty years of age or less (mean, thirty-three years) at the time of the operation and that had been followed for a minimum of five years. Six patients had a bilateral procedure. The indication for the arthroplasty was inflammatory arthritis in thirty patients and posttraumatic arthritis in nineteen. Patients with hemophilia or a neoplasm were excluded. The medical record data were used to calculate the preoperative and postoperative Mayo Elbow Performance Score. RESULTS: The mean duration of follow-up was ninety-one months. During this period, twelve (22%) of the elbows had undergone a subsequent surgical procedure: four because of loosening, three because of triceps weakness, three because of wear, and two because of deep infection. On the basis of the Mayo Elbow Performance Score at the last review, thirty-six results (65%) were considered to be excellent; fifteen (27%), good; three (5%), fair; and one (2%), poor. CONCLUSIONS: Semiconstrained total elbow arthroplasty in young patients was associated with a 22% revision rate at a mean of ninety-one months, and the rate of revision was significantly higher for patients with posttraumatic arthritis. Despite this revision rate, fifty-one elbows (93%) had a good or excellent Mayo Elbow Performance Score.