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

ID PMID Title PublicationDate abstract
21190099 Three-dimensional analysis of image-free navigation system for total knee arthroplasty. 2011 Aug Malalignment causes abnormal forces that may lead to loosening after knee replacement. Whether a computer-assisted technique can improve the precision of implant positioning guaranteeing good long-term results in total knee arthroplasty, this is a matter of discussion. The authors evaluate the alignment accuracy of 20 primary total knee arthroplasties, performed using an image-free computer navigation systems, with standardized CT protocol and three-dimensional digital model reconstruction. The results of this study demonstrate that the image-free navigation system is able to improve accuracy in axial limb alignment and positioning of the components in the majority of cases; moreover, the difference between the mean mechanical axis value of the navigation system (179.7° ± 1.7°) and the median mean value obtained during the post-operative evaluation (180.3° ± 1.9°) is not statistically significant (P = 0.28).
20676828 Methotrexate-related Epstein-Barr Virus (EBV)-associated lymphoproliferative disorder--so- 2010 Dec Patients affected by autoimmune diseases (rheumatoid arthritis, psoriasis, dermatomyositis) who are treated with methotrexate (MTX) sometimes develop lymphoproliferative disorders (LPDs). In approximately 40% of reported cases, the affected sites have been extranodal, and have included the gastrointestinal tract, skin, lung, kidney, and soft tissues. However, MTX-associated LPD (MTX-LPD) is extremely rare in the oral cavity. Here we report a 69-year-old Japanese woman with rheumatoid arthritis (RA) who developed MTX-LPD resembling Hodgkin's disease--so-called "Hodgkin-like lesion"--in the left upper jaw. Histopathologically, large atypical lymphoid cells including Hodgkin or Reed-Sternberg-like cells were found to have infiltrated into granulation tissue in the ulcerative oral mucosa. Immunohistochemistry showed that the large atypical cells were positive for CD20, CD30 and Epstein-Barr virus (EBV)-latent infection membrane protein-1 (LMP-1) and negative for CD15. EBV was detected by in situ hybridization (ISH) with EBV-encoded small RNA (EBER), and polymerase chain reaction (PCR) for LMP-1 and EBNA-2 in material taken from the formalin-fixed, paraffin-embedded specimen. To our knowledge, this is the first reported case of MTX-related EBV-associated LPD (MTX-EBVLPD), "Hodgkin-like lesion", of the oral cavity in a patient with RA.
20632503 [Clinical research of posterior cruciate ligament-retained mobile-bearing total knee arthr 2010 Jun OBJECTIVE: To analyse the results of posterior cruciate ligament-retained mobile-bearing total knee arthroplasty (TKA) in treatment of rheumatoid arthritis (RA) and to solve the problems often encountered during surgery. METHODS: From February 1999 to August 2005, the clinical data from 73 patients with RA undergoing TKA were analysed retrospectively. In 73 patients, 38 patients were treated with posterior cruciate ligament-retained mobile-bearing prosthesis (group A), while 35 patients were treated with posterior stabilized fixed-bearing prosthesis (group B). Another 70 patients with osteoarthritis (OA) treated with an posterior cruciate ligament-retained mobile-bearing prosthesis served as controls (group C). In group A, there were 8 males and 30 females with an average age of 56.5 years and an average disease course of 16.8 years. In group B, there were 6 males and 29 females with an average age of 57.3 years and an average disease course of 17.1 years. In group C, there were 37 males and 33 females with an average age of 65.4 years and an average disease course of 10.8 years. There was no significant difference (P > 0.05) in general data between groups A and B, but there were significant differences (P < 0.05) when compared with group C. RESULTS: In groups A and B, 2 cases (5.3%) and 1 case (2.9%) had poor healing of incision, respectively; in group C, all cases had good healing of incision. There were significant differences in healing rate of incision between groups A, B and group C (P < 0.05). All patients were followed up 7.6 years on average (range, 3.5-10.5 years). Deep infection occurred in 1 case respectively in 3 groups, showing no significant difference (P > 0.05). Posterior instability occurred in 1 case (2.6%) 5 years after operation in group A and 2 cases (2.9%) 9 years after operation in group C, and no posterior instability occurred in group B; showing significant differences between groups A, C and group B (P < 0.05). There were significant differences (P < 0.05) in knee score, Feller patellar score, and anterior knee pain score between pre- and postoperative values among groups A, B, and C. There were significant differences (P < 0.05) in the function scores between pre- and post-operative values in 3 groups, between groups A, B and group C pre- and post-operatively. CONCLUSION: Posterior cruciate ligament-retained mobile-bearing TKA can yield satisfactory clinical results in treatment of RA at intermediate-term follow-up. This mobile-bearing prosthesis has a low prevalence of posterior instability and a good outcome for anterior knee function without patellar resurfacing.
20130483 Atypical insufficiency fracture of the tibia associated with long-term bisphosphonate ther 2010 Mar Osteoporosis is a major public health threat affecting millions of individuals in the United States. Bisphosphonate therapy is currently recognized as a first-line treatment of osteoporosis through the inhibition of osteoclast activity. Concerns have been raised about potential oversuppression of bone turnover and the development of atypical skeletal fragility associated with long-term use of bisphosphonates. A number of case reports in the literature have documented atypical insufficiency fractures in patients on long-term bisphosphonate therapy. This case outlines what we believe is the second documented atypical tibial insufficiency fracture in a patient on long-term bisphosphonate therapy, and highlights the need for increased awareness of atypical insufficiency fractures as well as the need for more data concerning the long-term effects of bisphosphonate therapy.
19336805 The incidence of the patellar clunk syndrome in a recently designed mobile-bearing posteri 2009 Apr The patellar clunk syndrome describes painful catching, grinding or jumping of the patella when the knee moves from a flexed to an extended position after total knee replacement (TKR). The posterior stabilised TKR had been noted to have a higher incidence of this problem. Mobile-bearing posteriorly stabilised TKRs have been introduced to improve patellar tracking and related problems by a mechanism of self-alignment. We evaluated the patellar clunk syndrome in 113 knees in 93 patients with such a TKR at a mean follow-up of 2.3 years (2.0 to 3.2). The syndrome was identified in 15 knees (13.3%). Logistic regression analysis showed that the absolute value of the post-operative angle of patellar tilt was significantly associated with the occurrence of patellar clunk (p = 0.025). Patellar tracking should be carefully checked during surgery.
20332595 Leg ulceration in rheumatoid arthritis--an underreported multicausal complication with con 2010 BACKGROUND: Rheumatoid arthritis (RA) is a systemic inflammatory disease which may present with extra-articular symptoms, including cutaneous manifestations. Ulcerated rheumatoid nodules, necrotic vasculitic lesions and pyoderma gangrenosum are fairly characteristic and well-recognized causes of skin ulcers in RA. However, most RA patients develop leg ulcers due to other pathophysiological factors posing a diagnostic and therapeutic challenge and leading to considerable morbidity. METHODS: A retrospective chart analysis of all patients with RA and leg ulcers hospitalized at our Dermatology Department between January 1998 and March 2008 was performed to evaluate risk factors and identify underlying conditions that predispose RA patients to the development of leg ulcers. RESULTS: A total of 36 patients with RA and leg ulcers were identified. Three patients presented with necrotizing vasculitis and 2 with pyoderma gangrenosum. Chronic venous insufficiency was diagnosed as the underlying cause of leg ulcers in 8 patients, peripheral arterial disease in 4 patients, and combined arterial and venous malfunction in 3 patients. Five patients suffered from pressure ulcers. Interestingly, in 11 patients (31%) other underlying causes besides constricted mobility followed by secondary lymphedema could not be identified, and these ulcers were classified as 'inactivity leg ulcers'. CONCLUSIONS: The majority of leg ulcers in patients with RA are due to underlying venous/arterial malfunction while vasculitic or traumatic ulcers are less common. Additionally, we identified a relevant subgroup of patients with 'inactivity ulcers' due to impaired mobility and consecutive lymphedema. Morphology and localization of ulcerations as well as duplex sonography provide the most important clues for accurate diagnosis, ensuring adequate treatment.
19877084 Inflammatory mediators and premature coronary atherosclerosis in rheumatoid arthritis. 2009 Nov 15 OBJECTIVE: Rheumatoid arthritis (RA) is an inflammatory disease associated with premature atherosclerosis. We hypothesized that mediators of inflammation associated with atherosclerosis in other populations (interleukin-6 [IL-6], tumor necrosis factor alpha [TNFalpha], serum amyloid A [SAA], vascular endothelial growth factor, neutrophil count, IL-1alpha, E-selectin, intercellular adhesion molecule 1 [ICAM-1], myeloperoxidase [MPO], matrix metalloproteinase 9, and vascular cell adhesion molecule 1) would be increased and associated with the severity of coronary atherosclerosis in patients with RA. METHODS: Clinical variables, concentrations of inflammatory mediators, and coronary artery calcification were measured in 169 patients with RA and 92 control subjects. Differences in concentrations of inflammatory mediators were compared using median quantile regression. The relationship of inflammatory mediators with the severity of coronary calcification in RA and control subjects was examined using proportional odds logistic regression, allowing for interaction with disease status. Models were adjusted for traditional cardiovascular risk factors. RESULTS: Median serum concentrations of IL-6, SAA, ICAM-1, E-selectin, TNFalpha, and MPO and peripheral blood neutrophil count were higher in patients with RA than controls (all P < 0.05), independent of Framingham risk score and diabetes mellitus (DM). IL-6 (main effect odds ratio [OR] 1.72; 95% confidence interval [95% CI] 1.12, 2.66) and TNFalpha (main effect OR 1.49; 95% CI 1.16, 1.90) concentrations were significantly associated with higher amounts of coronary calcium, independent of Framingham risk score and DM, and such main effects significantly differed from controls (P = 0.001 and 0.03 for interaction, respectively). CONCLUSION: TNFalpha and IL-6 are significantly associated with the severity of subclinical atherosclerosis, independent of Framingham risk score, in RA.
20937001 Explaining functioning outcomes across musculoskeletal conditions: a multilevel modelling 2010 PURPOSE: To determine whether changes in health outcomes result from changes in domains of functioning and relevant environmental factors in musculoskeletal conditions. METHOD: Longitudinal observational study on a convenience sample of 291 patients with low back pain, osteoarthritis, osteoporosis, rheumatoid arthritis and chronic widespread pain. The study was part of the MHADIE project. Data collection was performed at baseline, after 4 and 8 weeks using the ICF Core Sets for the corresponding musculoskeletal conditions. Multilevel models for change were used to determine which ICF categories explain the variability and change over time of the general, physical and mental health according to the SF-36. RESULTS: There are only small fluctuations in the health outcomes. These are related to functions of the locomotor apparatus, such as muscle power, and to activities and participation domains related to them, such as lifting and carrying objects. A large amount of baseline variance is explained with a relatively small number of ICF categories of functioning. CONCLUSIONS: This study presents a list of functioning problems and environmental factors relevant to map out both the patterns and the variations in the experience of living with a chronic and painful condition. These are intervention targets common across MSC conditions.
19818765 GDF-5 is suppressed by IL-1beta and enhances TGF-beta3-mediated chondrogenic differentiati 2010 Feb OBJECTIVE: To investigate the expression of growth differentiation factor-5 (GDF-5) in chondrocytes (HC) and fibroblast-like synoviocytes (FLS) from humans with rheumatoid arthritis (RA) when stimulated with proinflammatory cytokines and to explore whether GDF-5 plays a role in regulating the differentiation of FLS-RA into chondrocytes. METHODS: Expression of GDF-5 in synovium and cartilage in RA and osteoarthritis (OA) was assessed by immunohistochemistry. GDF-5 production in FLS-RA and HC-RA was examined through real-time quantitative RT-PCR (Q-PCR) and western blotting. Expressions of GDF-associated receptors on FLS-RA were determined by semiquantitative-PCR, and MTT assay was used to study the effects on FLS-RA proliferation. Effect of GDF-5 and TGF-beta3 on in vitro chondrogenic ability of FLS-RA was investigated using pellet-culture system, Q-PCR and histological analysis. RESULTS: Immunohistochemical analysis demonstrated that GDF-5 expression in the synovium and cartilage from joints of RA patients was much lower than that of OA patients. Addition of IL-1beta or TNF-alpha appeared to downregulate the expression of GDF-5 in HC-RA and FLS-RA. Inhibition of GDF-5 expression by IL-1beta in RA-FLS was attenuated by pretreatment with MEK1/2 inhibitor. GDF-5-associated receptors were expressed in FLS-RA, but GDF-5 had no effect on FLS-RA proliferation. GDF-5 had a strong chondrogenic-promoting effect on TGF-beta3-induced chondrocyte differentiation in FLS-RA. CONCLUSIONS: GDF-5 is expressed in FLS-RA and HC-RA, and its expression is strongly downregulated by proinflammatory cytokines. MEK-ERK pathway is a negative regulator of GDF-5 expression in FLS-RA. In FLS-RA, synergy between GDF-5 and TGF-beta3 enhances chondrogenesis. Anti-inflammatory drugs combined with GDF-5 might be a new therapeutic treatment for RA.
20137780 ROADTRIPS: case-control association testing with partially or completely unknown populatio 2010 Feb 12 Genome-wide association studies are routinely conducted to identify genetic variants that influence complex disorders. It is well known that failure to properly account for population or pedigree structure can lead to spurious association as well as reduced power. We propose a method, ROADTRIPS, for case-control association testing in samples with partially or completely unknown population and pedigree structure. ROADTRIPS uses a covariance matrix estimated from genome-screen data to correct for unknown population and pedigree structure while maintaining high power by taking advantage of known pedigree information when it is available. ROADTRIPS can incorporate data on arbitrary combinations of related and unrelated individuals and is computationally feasible for the analysis of genetic studies with millions of markers. In simulations with related individuals and population structure, including admixture, we demonstrate that ROADTRIPS provides a substantial improvement over existing methods in terms of power and type 1 error. The ROADTRIPS method can be used across a variety of study designs, ranging from studies that have a combination of unrelated individuals and small pedigrees to studies of isolated founder populations with partially known or completely unknown pedigrees. We apply the method to analyze two data sets: a study of rheumatoid arthritis in small UK pedigrees, from Genetic Analysis Workshop 15, and data from the Collaborative Study of the Genetics of Alcoholism on alcohol dependence in a sample of moderate-size pedigrees of European descent, from Genetic Analysis Workshop 14. We detect genome-wide significant association, after Bonferroni correction, in both studies.
20952462 Tocilizumab for rheumatoid arthritis: a Cochrane systematic review. 2011 Jan OBJECTIVE: to compare the benefit and safety of tocilizumab to placebo in patients with rheumatoid arthritis (RA). METHODS: we searched multiple databases for published randomized or controlled clinical trials comparing benefit and safety of tocilizumab to placebo, disease-modifying antirheumatic drugs (DMARD), or other biologics. For dichotomous outcomes, we calculated the relative risk, and for continuous outcomes, the mean difference. RESULTS: eight randomized controlled trials were included in this systematic review, with 3334 participants, 2233 treated with tocilizumab and 1101 controls. The US and Canadian approved dose of tocilizumab, 8 mg/kg every 4 weeks, was given to 1561 participants. In patients taking concomitant methotrexate, compared to placebo, patients treated with approved dose of tocilizumab were substantially and statistically significantly more likely than placebo to achieve the American College of Rheumatology 50 (absolute percentage, 38.8% vs 9.6%, respectively; RR 3.2, 95% CI 2.7, 3.7); Disease Activity Score remission (30.5% vs 2.7%; RR 8.7, 95% CI 6.3, 11.8); and a clinically meaningful decrease in Health Assessment Questionnaire (HAQ)/Modified HAQ scores (60.5% vs 34%; RR 1.8, 95% CI 1.6, 1.9). There were no substantive statistically significant differences in serious adverse effects (0.8% vs 0.7%; RR 1.2, 95% CI 0.8, 1.6) or withdrawals due to adverse events (4.9% vs 3.7%; RR 1.4, 95% CI 0.9, 2.1); however, tocilizumab-treated patients were significantly more likely to have any adverse event (74% vs 65%; RR 1.05, 95% CI 1.03, 1.07); elevation in the ratio of low-density lipoprotein to high-density lipoprotein cholesterol (HDL; 20% vs 12%; RR 1.7, 95% CI 1.2, 2.2); and increase in the ratio of total to HDL cholesterol (12% vs 7%; RR 1.7, 95% CI 1.2, 2.6); and they were less likely to withdraw from treatment for any reason (8.1% vs 14.9%; RR 0.6, 95% CI 0.5, 0.8). CONCLUSION: at the approved dose of 8 mg/kg every 4 weeks, tocilizumab in combination with methotrexate/DMARD is beneficial in decreasing RA disease activity and improving function. Tocilizumab treatment was associated with a significant increase in cholesterol levels and occurrence of any adverse event, but not serious adverse events. Larger safety studies are needed to address these safety concerns.
18797940 Risk factors for opportunistic infections in infliximab-treated patients: the importance o 2009 Apr We sought to determine factors associated with opportunistic infections (OI) in infliximab-treated patients. A retrospective study cohort (1999-2004) was examined. Nine OI were diagnosed in 94 infliximab-treated patients: tuberculosis (four), visceral leishmaniasis (one), pyogenic muscular abscess (one Salmonella spp. and one Streptococcus pneumoniae), and two viral infections (hepatitis B virus [HBV] and zoster ophthalmicus). The risk for OI was significantly higher in the first year of treatment (odds ratio [OR] 8; 95% confidence interval [CI] 2-50). Previous treatment with more than two immunosuppressive drugs was the only factor related to OI (OR 8.686; 95% CI 1.889-39.943). We identified the subset of patients treated with infliximab who had a higher risk for OI. The screening of latent infections is key to diminishing the incidence of these infections.
20065633 Tocilizumab. 2009 Sep Roche is co-developing tocilizumab (Actemra, RoActemra), a humanized anti-interleukin-6 receptor (IL-6R) monoclonal antibody, with Chugai Pharmaceutical. Tocilizumab is marketed in Japan for Castleman disease and several types of arthritis. The product is approved in the European Union for treatment of moderate-to-severe rheumatoid arthritis, and is currently undergoing review by the US Food and Drug Administration for this condition. Tocilizumab has also been studied for potential use in the treatment of other IL-6 related disorders including Crohn disease.
21078711 Disease phenotypes and gender association of FCRL3 single-nucleotide polymorphism -169T/C 2011 Feb OBJECTIVE: To investigate the association of the functional FCRL3 single-nucleotide polymorphism (SNP) -169T/C with disease phenotypes and susceptibility to systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in Taiwanese. METHODS: FCRL3 SNP -169T/C was genotyped in 573 patients with SLE, 670 patients with RA, and 758 controls. Genotype distributions and allele frequencies were compared among the 3 groups as aggregates or as stratified by clinical characteristics, autoantibody profile, and sex within patient groups. RESULTS: Overall, FCRL3 SNP -169T/C was not associated with susceptibility to either SLE or RA. However, -169CC genotype was significantly reduced in leukopenia-positive SLE patients as compared to the leukopenia-negative SLE patients (CC vs CT+TT, p = 6 × 10(-4), OR 0.444, 95% CI 0.279-0.708) and controls (p = 6.1 × 10(-3), OR 0.583, 95% CI 0.396-0.857). On the other hand, -169TT genotypes were significantly more numerous in RA patients with non-destructive disease as compared with patients with destructive disease (CC+CT vs TT: p = 0.007, OR 1.672, 95% CI 1.149-2.432). The -169T allele frequency was also significantly increased in non-destructive RA compared with patients with destructive disease (C vs T: p = 0.010, OR 1.423, 95% CI 1.089-1.859). FCRL3 SNP -169TT homozygous donors were significantly more numerous among female cyclic citrullinated peptide (CCP)-negative RA patients versus female CCP-positive RA patients (CC+CT vs TT: p = 0.019, OR 1.64, 95% CI 1.085-2.479). CONCLUSION: The functional FCRL3 SNP -169T/C appears to play important roles in the development of certain phenotypes such as SLE leukopenia and RA disease severity in Taiwanese patients with SLE and RA.
20498218 Catecholamine-producing cells in the synovial tissue during arthritis: modulation of sympa 2010 Oct BACKGROUND: The proinflammatory and anti-inflammatory role of the sympathetic nervous system in early and late inflammation is an unresolved paradox. A drastic loss of sympathetic nerve fibres in the synovial tissue of patients with rheumatoid arthritis (RA) has previously been demonstrated. The presence of tyrosine hydroxylase (TH)-positive cells in RA and osteoarthritis (OA) has been determined, but the role of these cells in inflammation is still unclear. OBJECTIVE: To characterise TH-positive cells in inflamed RA and OA synovial tissue and to study their role in inflammation. METHODS: Synovial samples were obtained from 32 patients with OA and 19 patients with RA and from 10 control patients. Synovial tissue samples were used for immunofluorescence staining. Synovial cells were isolated by tissue digestion and immediately used for cell culture. For in vivo experiments, collagen type-II arthritis in DBA/1J mice was induced. RESULTS: TH+ cells were present only in inflamed tissue and not in controls. Catecholamine-storing vesicles and vesicular monoamine transporter 2 (VMAT2) were identified in the synovial tissue. Experimental increase of cytoplasmic catecholamines by VMAT2 blockade strongly reduced tumour necrosis factor (TNF) independently of canonical extracellular β-adrenergic signalling. In addition, VMAT2 blockade increased cyclic AMP (cAMP) and cAMP responsive element binding protein, responsible for TNF inhibition. In vivo, appearance of VMAT2 positive cells was confirmed. VMAT2 blockade ameliorated inflammation also in vivo. CONCLUSIONS: This study demonstrates that local catecholamine-producing cells start to replace sympathetic nerve fibres around the onset of disease, and modulation of locally produced catecholamines has strong anti-inflammatory effects in vivo and in vitro.
19109936 Citrullinated fibrinogen shows defects in FPA and FPB release and fibrin polymerization ca 2009 Mar BACKGROUND: Antibody-antigen complexes formed by IgG autoantibodies against citrullinated proteins and citrullinated forms of the alpha- and beta-chains of fibrin in rheumatoid synovial tissue play a key role in the pathophysiology of rheumatoid arthritis. METHODS: Recombinant fibrinogen was citrullinated by rabbit skeletal muscle peptidylarginine deiminase so that we could analyze the function of citrullinated fibrinogen. Namely, thrombin-catalyzed fibrin polymerization and fibrinopeptide release, protection against plasmin digestion, and factor XIIIa-catalyzed cross-linking of fibrin or fibrinogen were performed. RESULTS: Strong citrullination of the Aalpha- and Bbeta-chains and weak citrullination of the gamma-chain were detected by an anti-modified citrulline detection kit. Citrullinated fibrinogen did not release FPA or FPB by thrombin catalyzation and no thrombin-stimulated conversion of fibrinogen into fibrin occurred. The citrullination of fibrinogen did not affect the 3 functions of the C-terminal gamma-chain, "a-hole," low affinity Ca binding, and gamma-gamma cross-linking. CONCLUSION: Our functional analyses demonstrated that no thrombin-stimulated conversion of fibrinogen into fibrin occurred, because citrullinated fibrinogen did not release FPA or FPB after thrombin catalyzation. Our results and those of other reports suggest that citrullinated fibrin and fibrinogen are present in the synovium and might both be associated with the pathophysiology of RA.
19899255 [Caplan's syndrome in marble workers as occupational disease]. 2009 Aug Rheumatoid pneumoconiosis is an uncommon combination of occupational lung disease caused by exposure to harmful silica dust with rheumatoid inflammation of the joints, rheumatoid arthritis, with an autoimmune background. Until now, the disease was observed mostly among coal and gold miners and granite workers. Written documents on the theme are summarized. This case study outlines the syndrome pathology with typical features presented by the worker, employed for many years in the marble industry. Although in general marble is free of silica, the collection of occupational anamnesis and familiarity with the patient's work conditions and demands gave the authors an opportunity to uncover the exposure source and to determine the most probable diagnosis.
19077716 Vasculitis in rheumatoid arthritis. 2009 Jan PURPOSE OF REVIEW: To examine the occurrence and pathophysiology of vasculitis in rheumatoid arthritis (RA), describe the epidemiology and clinical features, and provide a therapeutic perspective. RECENT FINDINGS: With improved control of RA over the past two decades, the risk of severe outcomes such as vasculitis may be decreasing. Rheumatoid vasculitis continues to be associated with longstanding, erosive, seropositive disease, and it has recently been shown to be more frequent among patients with antibodies to cyclic citrullinated peptides. Apart from circulating immune complexes, expansion of cytotoxic CD28null T cells and circulating proinflammatory cytokines also play a role in the pathogenesis. The role of agents directed against the tumor necrosis factor (TNF) in the occurrence and management of rheumatoid vasculitis remains unclear, as rheumatoid vasculitis may be both associated with and treated with anti-TNF agents, once it has appeared. SUMMARY: Vasculitis in RA is generally associated with longstanding disease, has an important impact on a patient's well being, and markedly influences patient life expectancy. Advances in therapies for RA will likely continue to reduce the incidence of vasculitis, and improved management of cardiovascular comorbidity in patients with RA will be of particular benefit to those who suffer from vasculitis and other extraarticular manifestations.
19205736 Medical history and risk of lymphoma: results of a European case-control study (EPILYMPH). 2009 Aug INTRODUCTION: Lymphomas are a heterogeneous group of immune-cell malignancies. Immunology-related conditions are among the few factors for which consistent evidence exists relating them to lymphoma risk. MATERIALS AND METHODS: We used the data from the European case-control study Epilymph on 2,362 lymphoma cases and 2,458 controls to investigate associations between a medical history of infectious and non-infectious diseases with overall and subentity-specific lymphoma risk. RESULTS: As key results, we observed an increased odds ratio (OR) for self-reported infections with hepatitis B virus (HBV, OR = 1.91, 95% CL = 1.24-2.94) and a null result for rheumatoid arthritis. Additionally, we found an increased OR for infectious mononucleosis (OR = 1.68, 95% CL = 1.14-2.48), an inverse association to frequency of sickness in childhood (OR = 0.68, 95% CL = 0.55-0.84), and-as casual finding-an increased OR with acetaminophen intake (OR = 2.29, 95% CL = 1.49-3.51). CONCLUSION: Our results are consistent with the current knowledge about the association with mononucleosis as indicator of Epstein-Barr-virus infection, suggest serological study of the association to HBV infection and do not support the view of a positive association between rheumatoid arthritis and lymphoma risk.
20456595 Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. 2010 Oct OBJECTIVES: To examine the prevalence of preterm birth, infants with low Apgar score, small for gestational age (SGA) birth, stillbirth and congenital abnormalities in women with rheumatoid arthritis (RA) compared with women without RA. DESIGN: Prevalence study. SETTING: Combined Sweden and Denmark nationwide from 1994 to 2006. SUBJECTS: We included 871,579 women with a first-time singleton birth identified through population-based healthcare databases. MAIN OUTCOME MEASURES: We compared the prevalence of preterm birth, low Apgar score (<7 at 5 min), SGA birth, stillbirth and congenital abnormalities amongst women with RA compared with women without RA using prevalence odds ratio (OR) with 95% confidence interval (95% CI), whilst controlling for maternal age, smoking, parental cohabitation and year. We stratified analyses by period of birth (1994-1997, 1998-2001 and 2002-2006). RESULTS: Amongst 1199 women with RA, 7.8% gave birth between 32 and 36 gestational weeks (adjusted OR, 1.44; 95% CI, 1.14-1.82), 1.4% gave birth before gestational week 32 (adjusted OR, 1.55; 95% CI, 0.97-2.47), 1.6% had an infant with a low Apgar score (OR, 0.99; 95% CI, 0.95-1.65), 5.9% had an SGA birth (adjusted OR, 1.56; 95% CI, 1.2-2.01), 0.9% experienced stillbirth (adjusted OR, 2.07; 95% CI, 0.98-4.35) and 4.3% gave birth to an infant with congenital abnormalities (adjusted OR,1.32; 95% CI, 0.98-1.79). The OR for congenital abnormalities decreased from 2.57 (95% CI, 1.59-4.16) in 1994-1997 to 1.00 (95% CI, 0.64-1.56) in 2002-2006. CONCLUSIONS: Women with RA had a high prevalence of most adverse birth outcomes. This could be due to inflammatory activity, medical treatment or other factors not controlled for.